Muscleoskeletal

Question 1

Define the 4-point grading scale for deep tendon reflexes.

Answer 1

4+ Very brisk, hyperactive with clonus, indicative of disease
3+ Brisker than average, may indicate disease, probably normal
2+ Average, normal
1+ Diminished, low normal, or occurs only with reinforcement
0 No response

Question 2

Which vertebral level is assessed when eliciting each of these reflexes:
Biceps reflex
Triceps reflex
Brachioradialis reflex
Quadriceps reflex   
Achilles reflex

Answer 2

Biceps reflex: C5-C6
Triceps reflex: C7-C8
Brachioradialis reflex: C5-C6
Quadriceps reflex: L2-L4     
Achilles reflex: L5-S2

Question 3

Denver II

Answer 3

method of screening for evidences of slow development in infants and preschool children. The test covers four functions: gross motor, language, fine motor-adaptive, and personal-social.

Question 4

physiologically why is “crampy” associated with muscle pain?

Answer 4

clotication arteriole insufficiency causing pain with movemoent dur to muscle ichemia

Question 5

Claudication

Answer 5

Pain, commonly in the legs, caused by too little blood flow, usually during exercise. Often indicates peripheral artery disease.

Question 6

What can morining vs night pain indicate?

Answer 6

Morning (pain from not using)

Night (pain from prolonged use): OA

Question 7

Dislocation:

Answer 7

loss of contact between 2 bones in a joint

Question 8

Subluxation:

Answer 8

misalignment of two bones in a joint (partial dislocation)

Question 9

Contracture:

Answer 9

shortening of muscle leading to decreased ROM (usually results from prolonged immonbility)

Question 10

Crepitation:

Answer 10

audible and palpable crunching or grating that accompanies movement

Question 11

Myaliga
Ostealgia
Arthralgia

Answer 11

“-aliga” = pain

muscle, bone, joint

Question 12

Cephalocaudal

Answer 12

means head to toe

Question 13

During inspection and palpation of the musculoskeletal system, what are you appreciating?

Answer 13

color, swelling, deformities, masses, alignment, thenderness, pain, crepitus, heat, spasms (muscles)

This is the same for all joints!!

Question 14

How is muscle strength appreciated?

Answer 14

though passive ROM

Grading scale out of 5 (5=normal, 0= no movement)

Question 15

How is CN XI tested?

Answer 15

turning head against resistance, shoulder shrug

Question 16

Spinal column:
inspection
assess
ROM

Answer 16

• inspect- normal S shape standing, curved when bent at waist
• assess- spinal movement with measuring tape (+2”)
• ROM- flex/ extend (forward/ back); rotational; lateral bend

Question 17

Shoulders:
ROM
muscle strength

Answer 17

• ROM: add/ abd (rotator cuff injury); internal (hands behind head)/ external rotation (hands at small of back); flex (bring arms straight up)/ extend (bring back down/ hyperflexion (behind)
• muscle strength (performed against resistance!): shoulder shrug (CN XI); add/ abd

Question 18

Elbows:
ROM
muscle strength

Answer 18

-ROM: flex/ extrend; supinate/ pronate

-muscle strength (performed against resistance!)
while supporting pt. elbow with one hand: flex (biceps)/ extrend (triceps)

Question 19

Wrists and Hands:
ROM
muscle strength
2 tests for carpal tunnel

Answer 19

• ROM: spread fingers and make a fist; touch thumb to each finger and base of pinky
• muscle strength: Finger grips, wrist flexion/ extension/ hyperflexion (performed against resistance!)

-Phalen: hold hands dorsal surface of hands together for 60s
-Tinel Sign: tap on medial nerve
Paresthesia= positive for carpal tunel

Question 20

Hips:
ROM
muscle strength

Answer 20

• Pt. should be supine
• ROM: flex/ extension (bring knee up, then back straight); internal/ external rotation (knee bent rotate away, then toward the midline); abd/ adducction (straight leg to side and back to midline)
• Muscle Strength: straingth led raise

Question 21

Leg and Knees:
Palpation/ inspection
ROM
Muscle strength
Length

Answer 21

• Palpation/ inspection: signs of fluid accumulation- Bulge Sign or Ballottement of Patella
• ROM: flex/ extension (bring heel back, then back to ground); Hyperextension
• Muscle strength: hamstring and quads

-Length: True- anterior iliac spine to medial malleolus;
Apparent- umbilicus to medial malleolus (abnormalities caused by pelvic)

Question 22

Ankels and Feet:
ROM
Muscle strength

Answer 22

• ROM: dorsi/ plantar flexion; eversion/ inversion; equal and bilateral flexion/ extension of toes
• Muscle strength: walk on toes/ heels; foot pushes/ pulls

Question 23

Developmental Competence: INFANTS
shape of spine
congenital dislocation (3 tests)
ROM
motor development

Answer 23

-C shaped spine

• Ortolani’s Manueuver (most reliable): abduction, will hear and see dislocation
• Barlow: adduction
• Allis: knee height
• ROM: through spontaneouls movement and responces to reflexes (may signal fractures)
• Denver II: motor milestones

Question 24

Developmental Competence: Pregnancy
shape of spine
joints

Answer 24

-Lordosis

• Paresthesia; carpal tunnel
• Estrogen relaxes ligaments leading to joint instability

Question 25

Developmental Competence: Older Adults sape of spine ADLs Muscle strength

Answer 25

- Kyphosis - Decreased height due to loss of water content and thinning of intervertebral disks - slower at performing ADLs - muscle strength slightly lower than adult, shoulf not be <4/5 bilaterally

Question 26

When are CMS checks done for muscleoskeletal

Answer 26

- 6 P's - checks that arteries are oxygenating the lower extremities - checks are done distal to the site of injury - eg: after a femur break, check the toes

Question 27

Osteoporosis what is it what is this caused by primary vs secondary treatment

Answer 27

NOT a normal part of aging! But caused by factors associated with aging - Loss of bone density - caused by decline in estrogen related to Ca deficit, vit. D; lack of impact exercise - Primary: fast walking - Secondary: bone density screening (DEXA- examines density)

Question 28

``` RA: what is it what is this caused by common clinical findings advanced stage findings ```

Answer 28

Rheumatoid Arthritis - Inflammation of connective tissue, bilateral - Chronic autoimmune disease (gradual onset) - Findings: bilateral pain, edema, stiffness (espically in the morning) - Ulnar deviation, swan-neck, boutonniere

Question 29

``` OA: what is it what is this caused by common clinical findings Heberden's Nodes Bouchard's Nodes ```

Answer 29

OsteoArthritis - Noninflammatory degenerative change in articular cartilage, unilateral or bilateral - caused by repetitive movement; affects weight bearing joints - Findings: stiffness, swelling, hard/ bony nontender protuberances, limited ROM - Heberden's Nodes: in distal IP joints - Bouchard's Nodes: in proximal IP joints

Question 30

``` Gout: what is it what is this caused by common clinical findings: acute chronic ```

Answer 30

- A type of arthritis - caused by increased serum uric acid due to increased productin and/ or decreased excretion (diet, renal function) - Acute: severe throbbing joint pain; limited ROM - Chronic: >1 attack/ yr; Tophi (uric acid deposits on ear pinna, subcutaneous tissue, or joints); kindney stones may cause flank pain and CVA tenderness

Question 31

``` Herniated Nucleus Pulposus: what is it what is this caused by common clinical findings How to test ```

Answer 31

- Herniated/ slipped disk: - Caused by lifting, twisting etc -Clinical findings: L5/S1 most common: may cause lateral tilting and forward lean; numbness or radiating pain in leg. Cervical herniation: arm pain and paresthesia - Lasegue Test: Passive straight leg raise cause sciatic pain (the slipped disk puts pressure on spinal nerve); confirm by lifting the pt opposite leg, and notice pain in 1st leg - DTRs may be depressed

Question 32

Scoliosis: shape of spine clinical findings

Answer 32

-S shaped spine from posterior view -Depends on severity: uneven shoulder and hip levels; rib or flak asymmetry. Lungs, spine, pelvis may be compromised

Question 33

``` Carpal Tunnel Syndrome what it is cause clinical findings 2 tests ```

Answer 33

-Occures when medial nerve is compressed -caused by repetitive movements or hand/ arms, injury, systemic disorders (RA, gout, hypothyroidism). May also occure with fluid retention that occures with pregnancy and menopause. - clinical findings: Parethesia in hands (often at night) - Phalen's, Tinel's