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AANP Class - Leik, Sarah Michell, MedMastery, & Other > Musculoskeletal and Assessments > Flashcards

Musculoskeletal and Assessments Flashcards

1
Q

Tendons

A

Connect muscles to bones

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2
Q

Tibial Torsion

A

Inward twisting of the tibia causing a child’s foot to turn inward

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3
Q

Gower’s Sign

A

Seen when a child rises from sitting to standing position with use of hands to push the trunk up indicating generalized muscle weakness.

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4
Q

Meniscal Injury

A
  • athletes still able to compete despite injury likely caused by a twisting maneuver
  • feel a “pop” during injury
  • tends to “lock up” after the injury leading to reduced ROM
  • delayed swelling
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5
Q

Apley Grind Test

A

Meniscal injury

  • Patient lies prone and flexes the affected knee 90 degrees
  • Examiner places their hand on the thigh for stabilization of the joint, then with the other hand, hold the heel and rotate internally and externally
  • Click, pop, or pain is a positive test.
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6
Q

Anterior Cruciate Ligament (ACL)

A
  • connects femur (thigh bone) to tibia (shinbone)

-stabilizes knee during rotational movements

  • pain & swelling almost immediately
  • “sudden popping” and knee gave way
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7
Q

Lachman Test

A
  • ACL injury
  • Knee joint laxity suggestive of anterior cruciate ligament (ACL) damage of the knee
  • while supine, put one hand on lower thigh and one on lower leg, bed knee 20 degrees, pull lower leg forward while keeping thigh stable, assess for too much range of motion (laxity)

It is more sensitive than the anterior drawer test for ACL damage but not as specific

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8
Q

ACL Management

A
  • refer to ortho
  • Rest, Ice, Compression, Elevate (RICE)
  • Physical Therapy (PT)
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9
Q

What is a meniscus?

A

Meniscus is a c-shaped piece of cartilage that acts as a cushion between the shinbone (tibia) and thighbone (femur), each knee has two menisci

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10
Q

McMurray Test

A

Meniscal Injury

Patient supine, grab patient’s heel with one hand and grab the knee with other hand, internally and externally rotate the knee

Knee pain, click upon manipulation of the knee suggests injury to medial meniscus

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11
Q

Meniscal Injury
Tx

A
  • Rest, Ice, Compression, Elevate (RICE)
  • refer to ortho
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12
Q

O’Brien Test

A

Assesses the labrum of the shoulder

Weakness during this maneuver may indicate labral (ball and socket joint) tear.

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13
Q

Trendelenburg Test (sign)

A

Assesses weak hip abductor muscles.

Done with having patient stand on one leg. If the pelvis drops on the opposite side, the hip abductor is weak on the leg the patient is standing on.

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14
Q

Varus/Valgus Stress Test

A

Varus = medal collateral ligament (MCL) injury

Valgus = lateral collateral ligament (LCL) injury

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15
Q

Osteoarthritis (Isolated)
Define
s/s

A

Degenerative joint disease

cartilage covering the articular surface of joints becomes damaged

  • spine, hip, hand, foot, knee
  • Joint Pain (weight bearing & hands)
  • Stiffness in the morning, but pain usually resolves in an hour
  • gradual onset, over the years
  • asymmetrical, no warmth, no redness
  • Heberden’s nodes (only here)
  • Bouchard’s nodes

risk: older age overuse of joints, family history

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16
Q

Osteoarthritis Labs & xray

A
  • ESR negative
  • Rheumatoid Factor negative
  • Xray shows joint space narrowing
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17
Q

Collateral Ligaments (Valgus and Varus)

A

Positive find is an increase in laxity of the damaged knee (ligament tear)

Varus stress test of the knee: a test for the medial collateral ligament (MCL)

Valgus stress test of the knee is a lateral collateral ligament

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18
Q

Finkelstein’s Test

A

De Quervain’s tenosynovitis

Pt grabs thumb and performs ulnar deviation, if this causes pain, test is positive

  • inflammation of the tendon and its sheath at the base of the thumb
  • abductor pollicis longus
  • extensore pollicis brevis tendons
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19
Q

Genu Valgum

A

Knock knee where knees tilt inward toward each other while the ankles remain spaced apart

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20
Q

Carpal Compression Test

A

Durkan Test

Pressure with the examiner’s thumb over the patient’s carpal tunnel for 30 seconds elicits symptoms. A positive test will result in pain or numbness distal to the compression.

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21
Q

Carpel Tunnel
Tests (2)
Initial Tx

A

Phalen’s: think backward prayer hand, flexion wrist test where positive test will cause numbness/tingling in the affected extremity

Tinel’s: percussion / tap technique where tapping on inner wrist causes tingling sensation of median nerve

Tx: Splint or brace

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22
Q

Volar

A

Relating to the palm of the hand or the sole of the feet

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23
Q

Ligaments

A

Connect bone to bone

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24
Q

Carpel Tunnel Syndrome

A

Median nerve compression of the wrist beneath the transverse carpal ligament

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25
Q

Lordosis

A

Inward curvature of the spine, common in pregnancy and obesity

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26
Q

Phalanges

A

fingers and toes

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27
Q

Morton’s neuroma
- What is it?
- s/s
- risk factors

A
  • feels like “pebble in their shoe”
  • inflammation of the distal nerve of the foot between the third and fourth metatarsals
  • factors causing a greater risk: high-heeled shoes, tight shoes obesity dancers runners
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28
Q

Mulder Test

A

Test for morton’s neuroma

  • Grasp first and fifth metatarsals and squeeze the forefoot
  • Positive test: hear a click along with a patient report of pain during compression
  • Pain is relieved when compression is stopped
29
Q

Genu Varum

A

Bowleggedness

30
Q

Pes cavus

A

High arch of foot

31
Q

Plantar fasciitis

A

Acute of recurrent pain on the bottom of the feet that is aggravated by walking, caused by microtears in the plantar fascia due to tightness of the achilles tendon.

Factors causing a greater risk: obesity, diabetes, flat feet prolonged standing aerobic exercise.

32
Q

Tarsal (Tarso)

A

Refers to the bones of the feet or the ankle

33
Q

Hawkins Test

A

Practitioner raises the patient’s arm to 90 degrees and internally rotates. Positive sign indicates subacromial impingement or rotator cuff tendinitis.

34
Q

Carpal (Carpo)

A

refers to bones of hands and wrists

35
Q

Pes Planus

A

flat foot

36
Q

Neer Test

A

Assessment of subacromial impingement by flexing the shoulder, internally rotating, and applying pressure over the shoulder blade.

37
Q

Straight leg test tests for?

A

Sciatica / Sciatica Neuritis where pain runs down one or both legs

  • Passive evaluation of the leg in a supine position with the hip and knee extended
  • Neurological pain between 30-70 degrees of hip flexion is a positive sign and suggestive of disc herniation
38
Q

Drawer Sign (2 tests)

A

Tests for knee stability looking for a torn or ruptured ligament

  1. Anterior drawer sign shows anterior cruciate ligament (ACL) injury
  2. Posterior drawer signs shows posterior cruciate ligament (PCL) injuyr
39
Q

Osteoporosis Diagnosis

A

Gold Standard: DEXA scan
Dual X-Ray Absorptiometry
Score: < - 2.5

40
Q

Osteopenia Diagnosis

A

Gold Standard: DEXA scan
Dual X-Ray Absorptiometry
DEXA Score: -1.0 to -2.5

41
Q

Drugs cause osteopenia/osteoporsis

A

Depro-Vera
Long-term steroids
Proton Pump Inhibitors

42
Q

Osteoporosis Prevention

A

Vitamin D 800-1000 IU
Calcium 1200 mg
Weight bearing exercise
- swimming, bicycling

43
Q

Osteoporosis Risk Factors

A

Smoking

44
Q

Osteoporosis
- Tx
- Education

A

Bisphosphonate
- dronate
alendronate / Fosamax
ibandronate / Boniva

  • upright for 30 min after consuming (minimize acid reflux that can erode esophagus)
  • take alone before all other meds and foods
45
Q

Drugs cause osteopenia/osteoporsis

A

Depro-Provera
Long-term steroids
Proton Pump Inhibitors

46
Q

Patient has both osteoporosis and hypertension

A

Prescribe Thiazide Diuretics
- stimulate osteoblasts and decrease excretion of calcium

47
Q

Rheumatoid Arthritis (systemic)

A

Systemic autoimmune
Affects women (8:1)
Systemic infection of joints, skin, heart, blood vessels, kidney, GI, brain, nerves, eyes

48
Q

Rheumatoid Arthritis (systemic) Tx

A

Disease-modifying anti-rheumatic drugs (DMARDs)
DMARDs
methotrexate / Rheumatrex

49
Q

Bouchard’s Nodes

A

Located in Proximal Inter-phalangeal Joint
PIP
- Bony enlargements of the middle joints associated with rheumatoid and osteoarthritis

50
Q

Heberden’s Nodes

A

Located in Distal Inter-phalangeal Joint
DIP

51
Q

Ankylosing Spondylitis diagnosis
stiff/rigid - ankylosing

A
  • commonly known as bamboo spine
  • Autoimmune arthritis and chronic inflammatory disease that primarily affects the spine
  • xray first, possibly MRI
52
Q

Snuff Box Tenderness
Diagnosis
Tx

A

Scaphoid fracture test

Diagnosis: takes 2 weeks to show up on xray

Tx: presumptively treat with thumb spica cast to immobilize wrist to prevent osteonecrosis in wrist

53
Q

Lateral Epicondylitis
define
s/s

A
  • tennis elbow (outside)
  • elbow pain worsens with activity and assessment reveals painful tendon on outer part
54
Q

Medial Epicondylitis
define
Tx

A
  • golfer’s elbow (inner)
  • tendon on inner part of elbow is inflammed

Tx: RICE, NSAIDs, PT

55
Q

Rotator Cuff Tear Test

A

Drop Arm Test

suprapinatus tear and infraspinatus tear

abduct the arm and have patient lower arm slowly but if positive the arm just drops to the side

56
Q

Empty Can Test

A

Supraspinatus Tear

patient shoulder is 90 degrees abduction fully internally rotated, 30 degrees of forward flexion is added and provider imposes downward pressure of elbow or wrist, if pain or weakness is reported then test is positive

57
Q

Gout
s/s
diagnostics

A

Caused by increased uric acid / uric crystals, tophi (stone-like deposits in the joints)

s/s: commonly inflammation with big toe, shoulder, elbow, knee

Diagnostic
- uric acid (may be high, not during acute attack)
- ESR elevated
- C-reactive protein elevated
- WBC elevated

58
Q

Gout
- Acute
- Prevention

A

Acute Attack
- NSAIDs such as
1) Indocin or Indomethacin
2) naproxen or Aleve
- corticosteroids
- colchicine

Prevention:
- low purine diet (red meats)
- no alcohol
- adequate hydration
- weight loss
- avoid diuretics, no thiazides

Side Effect: cause bone marrow suppression

59
Q

Gout
-maintenance therapy

A

allopurinol / Zyloric (do not start or change during acute attack)

monitor CBC on allopurinol b/c it can cause true bone marrow suppression

More expensive options:
- colchicine (Colcrys)
- probenecid (Probalan)
- febuxostat (Uloric)

60
Q

Fibromyalgia

A
  • widespread pain
  • diagnosis: pain, fatigue, waking up not feeling refreshed, cognitive problems for three months +
  • Tx: duloxetine, Cymbalta, amitriptyline / Elavil (off market only generic is offered), pregabalin, Lyrica, cyclobenzaprine, Flexeril

Treat your-CELF

61
Q

Hallux Valgus

A

bunion

  • affects 1st metatarsal phalange joint

Diagnosis: xray

62
Q

Plantar Fasciitis
s/s
Tx

A
  • Sharp pain in heels, symptoms get better as day goes on
  • common in runners
  • rest, ice, stretching arches, wearing supportive shoes, changing shoes, changing sports, anti-inflammatories, and referral for surgery
63
Q

Cauda Equina Syndrome

A
  • severe low back pain
  • numbness and tingling in perineum or saddle area
  • new incontinence
  • refer immediately to ED
64
Q

Bursa

A

Sacs that cushion the joints

65
Q

Bursitis

A

sacs that cushion joints become inflamed

66
Q

Olecranon Bursitis

What is it?
Tx

A

sacs that cushion joints are inflamed in elbow (superficial) causes generalized pain on elbow

  • rest, ice, NSAIDs (celecoxib / Celebrex)
  • if rest, ice, NSAIDs provides no relief, aspirate the joint to check for pathogenic causes, then treat with antibiotics
67
Q

Test for Sciatica
S1

A

walk on toes where diminished or absent ankle jerk

68
Q

Test for sciatica
L4

A

Squat and rise exam where knee jerk is diminished

69
Q

Test for Sciatica
L5

A

heel walking with numbness at big toe

AANP Class - Leik, Sarah Michell, MedMastery, & Other (20 decks)

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