Flashcards in Ortho Intro Deck (76):
Dermatomes: dorsal arm, 2nd and 3rd digits
dermatomes: lateral arm, thumb
dermatomes: medial arm, 4th and 5th digits
dermatomes: nipple line
dermatomes: clavicle, deltoid, lateral arm
dermatomes: anterior/medial arm
dermatomes: umbilical line
dermatomes: upper medial thighs and FUPA area
dermatomes: SI line, spiraling to lateral thigh, lateral knee, anterior shin, dorsal foot, and sole of foot
dermatomes: SI line, spiraling to anterior thigh, anterior knee, medial ankle, great toe
dermatomes (pick 2): anterior thigh and medial thigh
L2 and L3
dermatomes: posterior/lateral thigh/calf, lateral ankle
dermatomes: posterior/medial thigh, genitalia, perineum
dermatomes: genitalia and perineum
dermatomes: perineum only
Your patient complains of right ankle pain after a fall. You establish that it occurred as a result of twisting it stepping off a curb. You've noticed that the ankle looks bruised and swollen. Describe your physical exam. (basics)
1) Palpate the LEFT ankle first to establish baseline. Then the right ankle.
2) Request active ROM in left and then right ankles to compare
3) PROM in left, then right if there is a discrepancy in range on #2.
4) continue with neuro, special tests, and imaging.
Besides the typical PQRST questions, what additional questions will you specifically be asking for an MS history?
handedness and typical daily activity/work/athlete, etc.
MS pain is described as a burning stinging pressure. What's the most likely cause?
MS pain described as sharp, severe, and intolerable
MS pain is bright and lightning-like
MS pain is shooting
MS pain is cramping, dull, and aching
MS pain is deep, nagging, and well localized
MS pain is throbbing, diffuse, and cramping
What time of day would you expect the pain/stiffness from chronic inflammation and edema to be the worst?
What type of MS pain typically gets worse throughout the day?
What types of MS pain are typically worse in the evening?
peripheral nerve entrapments, thoracic outlet syndrome
For a "tumor" diagnosis, how would you expect your patient to describe their MS pain?
deep, nagging pain at night that is unrelenting regardless of position
What type of MS pain is most affected by activity levels and posture?
What PE findings are most often missed (typically b/c patient was not undressed fully)
muscle atrophy and asymmetry
What structures are included in the MS exam of the "shoulder"? (8)
1) sternoclavicular joint
3) AC joint
4) coracoid process
5) biceps tendon
6) spine of scapula
8) inferior angle of scapula
When describing a normal "end feel", elbow flexion would be ___________
When describing a normal "end feel", knee extension would be _________
When describing a normal "end feel", head rotation would be ___________
When describing a normal "end feel", forearm supination would be __________
When describing a normal "end feel", knee flexion would be _______
When describing a normal "end feel", elbow extension would be _________
What a patient prevents you from reaching FROM on exam due to pain, how do you describe that "end feel"?
If you were EXTENDING the knee, and it felt soft, what would you consider? (abnormal finding)
If you were extending the knee and it felt firm, what would you consider? (abnormal)
If you were flexing the elbow, but you felt a hard endpoint, what would you consider? (abnormal)
a fracture or loose body
You test elbow flexion and find the strength to be 5/5, but the patient complains of pain. What is the likely anatomy that is affected?
muscle or tendon
You test elbow flexion and find the strength to be 3/5, and the patient complains of pain. What is the likely anatomy that is affected?
Fx or bone lesion
You test elbow flexion and find strength is 2/5, but there is no pain. What is the likely anatomy that is affected?
Nerve problem, muscle rupture (or poor pt effort)
_____ is a group of muscles supplied by a single nerve root
decreased biceps reflex
decreased triceps reflex
decreased patella reflex
decreased Achilles reflex
weak foot inversion
weak dorsiflexion of great toe
weak elbow flexion
weak foot eversion
No sensation over the knee
No sensation lateral ankle
No sensation lateral calf
No sensation of deltoid
No sensation of pinky finger
No sensation of middle finger
No sensation of thumb
Absent deep tendon reflexes are graded at a _____, normal DTR is a _______, and clonus is a ______
2) Normal = 2+
3) Clonus = 4+
No contraction on strength exam is graded a ________, movement against gravity only is _________ and normal is __________
1) None = 0
2) Gravity = 3
3) Normal = 5
Rheum/Ortho review: ANA could indicate what?
SLE, sclera, sjogrens, RA
Rheum/Ortho review: RF could indicate what?
Rheum/Ortho review: HLA-B27 could indicate what?
ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis
What imaging is typically the first step for ortho complaints?
What must you ALWAYS remember to do when ordering plain film to dx an ortho problem?
get orthagonal views
What type of imaging is best for soft tissue?
what are CT's best for?
bone and blood (trauma)
What type of imaging shows fat as bright and water as dark?
T1 imaging on MRI
You want to see the ligaments and tendons on MRI, would you order T1 or T2?
TRICKSTER: doesn't matter, they are dark on both. (if any area appears bright, that means pathology)
This type of imaging marks bone turnover
radionucleotide bone scan