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Flashcards in Ortho Intro Deck (76):
1

Dermatomes: dorsal arm, 2nd and 3rd digits

C7

2

dermatomes: lateral arm, thumb

C6

3

dermatomes: medial arm, 4th and 5th digits

C8

4

dermatomes: nipple line

T4

5

dermatomes: clavicle, deltoid, lateral arm

C5

6

dermatomes: anterior/medial arm

T1

7

dermatomes: umbilical line

T10

8

dermatomes: groin

T12

9

dermatomes: upper medial thighs and FUPA area

L1

10

dermatomes: SI line, spiraling to lateral thigh, lateral knee, anterior shin, dorsal foot, and sole of foot

L5

11

dermatomes: SI line, spiraling to anterior thigh, anterior knee, medial ankle, great toe

L4

12

dermatomes (pick 2): anterior thigh and medial thigh

L2 and L3

13

dermatomes: posterior/lateral thigh/calf, lateral ankle

S1

14

dermatomes: posterior/medial thigh, genitalia, perineum

S2

15

dermatomes: genitalia and perineum

S3

16

dermatomes: perineum only

S4

17

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.

18

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.

19

MS pain is described as a burning stinging pressure. What's the most likely cause?

sympathetic nerve

20

MS pain described as sharp, severe, and intolerable

fx

21

MS pain is bright and lightning-like

nerve

22

MS pain is shooting

nerve root

23

MS pain is cramping, dull, and aching

muscle

24

MS pain is deep, nagging, and well localized

bone

25

MS pain is throbbing, diffuse, and cramping

vascular

26

What time of day would you expect the pain/stiffness from chronic inflammation and edema to be the worst?

AM

27

What type of MS pain typically gets worse throughout the day?

joint pain/swelling

28

What types of MS pain are typically worse in the evening?

peripheral nerve entrapments, thoracic outlet syndrome

29

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

30

What type of MS pain is most affected by activity levels and posture?

chronic pain

31

bow-legged

Genu Varum

32

knock-kneed

Genu Valgum

33

What PE findings are most often missed (typically b/c patient was not undressed fully)

muscle atrophy and asymmetry

34

What structures are included in the MS exam of the "shoulder"? (8)

1) sternoclavicular joint
2) clavicle
3) AC joint
4) coracoid process
5) biceps tendon
6) spine of scapula
7) infra/supraspinatus
8) inferior angle of scapula

35

When describing a normal "end feel", elbow flexion would be ___________

soft

36

When describing a normal "end feel", knee extension would be _________

hard

37

When describing a normal "end feel", head rotation would be ___________

firm

38

When describing a normal "end feel", forearm supination would be __________

firm

39

When describing a normal "end feel", knee flexion would be _______

soft

40

When describing a normal "end feel", elbow extension would be _________

hard

41

What a patient prevents you from reaching FROM on exam due to pain, how do you describe that "end feel"?

empty

42

If you were EXTENDING the knee, and it felt soft, what would you consider? (abnormal finding)

edema, synovitis

43

If you were extending the knee and it felt firm, what would you consider? (abnormal)

muscle spasm

44

If you were flexing the elbow, but you felt a hard endpoint, what would you consider? (abnormal)

a fracture or loose body

45

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

46

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

47

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)

48

_____ is a group of muscles supplied by a single nerve root

myotome

49

decreased biceps reflex

C5

50

decreased triceps reflex

C7

51

decreased patella reflex

L4

52

decreased Achilles reflex

S1

53

weak foot inversion

L4

54

weak dorsiflexion of great toe

L5

55

weak elbow flexion

C5

56

weak foot eversion

S1

57

No sensation over the knee

L4

58

No sensation lateral ankle

S1

59

No sensation lateral calf

L5

60

No sensation of deltoid

C5

61

No sensation of pinky finger

C8

62

No sensation of middle finger

C7

63

No sensation of thumb

C6

64

Absent deep tendon reflexes are graded at a _____, normal DTR is a _______, and clonus is a ______

1) Absent=0
2) Normal = 2+
3) Clonus = 4+

65

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

66

Rheum/Ortho review: ANA could indicate what?

SLE, sclera, sjogrens, RA

67

Rheum/Ortho review: RF could indicate what?

RA, SLE

68

Rheum/Ortho review: HLA-B27 could indicate what?

ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis

69

What imaging is typically the first step for ortho complaints?

plain film

70

What must you ALWAYS remember to do when ordering plain film to dx an ortho problem?

get orthagonal views

71

What type of imaging is best for soft tissue?

MRI

72

what are CT's best for?

bone and blood (trauma)

73

What type of imaging shows fat as bright and water as dark?

T1 imaging on MRI

74

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)

75

This type of imaging marks bone turnover

radionucleotide bone scan

76

When would you use contrast dye to help you diagnose an ortho problem?

1) intravascular (artery, vein)
2) arthrography (into joint)
3) myelography (into spinal cord, nerve root)