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Stanford PCAP 2010
Msk/Neuro/Joint/Bones
| Question | Answer |
|---|---|
| Which bone of the list below has the poorest blood flow (when considering healing times)? a. fibula b. scaphoid c. pisiform d. 2nd DIP | b. scaphoid (also called navicular) |
| You observe the physician withdrawing fluid from a patient's extremely swollen/puffy knee. You happen to note blood (heme). What structures are MOST likely injured? a. meniscus b. articular cartilage c. anterior cruciate ligament | c. anterior cruciate LIGAMENT (although it's still possible the other structures listed are also damaged they probably would (by themselves)NOT result in heme in the fluid removal) |
| You are asked to view an xray image of an 8 year old girls forearm/wrist when you note a possible fracture that is through one cortex but not both and it's somewhat angulated. Fx type? | Greenstick fracture |
| A fat pad sign or sail sign noted on the xray image of a lateral of the elbow could possibly indicate a fx of? | Radial head although the bone itself may not show a fracture |
| A fracture of the fifth metacarpal is also called? | Boxer's fracture |
| A main difference between the adult and child bone xray image is the lack of ________ on the adult image. | growth plate |
| You enter the Emergency Room trauma bay and observe a bone protruding from the arm of a motorcycle rider injured in a crash. Is this CLOSED? OPEN? | Open (open to the air/germs) |
| A Baker's cyst, when associated with the knee region, is generally located? 1. ANTERIOR 2. LATERAL 3. POSTERIOR 4. MEDIAL | Posterior |
| A 'boutonniere' deformity involves the avulsion of the ________of the extensor digitorum tendon from its insertion. | central slip (a firm piece of cartilage that helps connect the tendon to the bone) |
| True or False? Heberden's nodes form a mallet finger. | False; Heberden's nodes are found on the dorsal and lateral surfaces of the DIP joints...assoc with osteoarthritis |
| The ____ test makes it possible to determine whether or not the radial and ulnar arteries are supplying the hand fully. | Allen Test |
| When palpating the posterior cervical region you should be able to easily locate the ____ spinous process because of its size. | C7 (it's the largest spinous process of the cervical region) |
| All of the following are major peripheral nerves EXCEPT: a. median nerve b. C7 c. ulnar nerve d. axillary nerve e. musculocutaneous nerve | b. C7 is a cervical ROOT nerve |
| What percentage of the gait is spent in the Stance Phase? | 60% (when foot is on the ground) |
| If I say Yergason test you say (pick a joint) | Shoulder! Specifically the biceps tendon stability. |
| If I say McMurray test you say (pick a joint) | Knee! Specifically the integrity of the meniscus. |
| If you come across the term Anterior Drawer test you should think of two joints immediately and they are? | The anterior drawer test is most likely associated with KNEE joint injury/testing and also with ANKLE joint injury/testing. |
| The Valsalva Maneuver can be used to recreate intrathecal pressure (to rule out intrathecal pathology). What is the name of another similar test? | Milgram Test: patient supine, raises both legs with a goal of 30 seconds and pain free entire time. If not...think herniated disk. |
| The Hoover test will help you determine if... | the patient is trying to HOOVER (ha ha) the system...aka...is a big faker or not! |
| If I say Anatomical Snuff box you think about what bone? | Scaphoid or navicular (wrist) |
| What are the FOUR main fracture mechanisms? | • Direct blow • Axial loading • Bending • Twisting (torque) |
| A pathologic fracture can occur... T or F ...after MINIMAL or INSIGNIFICANT force? | TRUE |
| T or F A common pathologic fracture rarely occurs at site of metastatic lesion or bone cyst | FALSE: actually is does often occur at the site of metastatic lesion or bone cyst |
| Which of the following are HALLMARKS of a fracture? a. Lack of point tenderness at site of fracture b. more bruising & swelling than overlying soft tissue injury would explain c. Changes in alignment d. Often significant pain if not stressed | b. and c. are correct and are hallmarks of a fracture |
| MAIN circulation of cerebrospinal fluid? | subarachnoid |
| Hydrocephalous is MOST LIKELY due to a NARROWING of? | cerebral aquaduct |
| Most afferent fibers of the spinal cord? | Posterior Columns |
| Damage to the VENTRAL HORN (of spinal cord) result in? | Decrease/Loss of deep tendon reflex |
| Pain due to a HERNIATED DISK? Most likely structure causing this? | nucleus pulposus |
| Rheumatoid Arthritis TYPICALLY affects which joint(s)? | MP joints of hands |
| Pannus would most likely be palpated where? | MP joints of hands |
| Non-inflamed bony swellings of PIP joints suggests? | osteoarthritis |
| Mostly likely to halt progression of RA? | TNF inhibitor (Enebrel) |
| Risser staging for pelvic bone calcification best for measuring prognosis of? | Osteogenesis Imperfecta (see scoliosis) |
| High viscosity of joint fluid specimen in a acutely inflamed joint? | suggests bacterial infection |
| typical feature of osteoarthritis? | osteophyte |
| Haversian canals and their blood vessels supply | nutrients |
| ends of bones are called? | epiphyses |
| osteoblasts produce? | bone matrix |
| osteocytes do what? | maintain bone tissue |
| bursae are sacs of synovial fluid found | between ligament/tendon/bone |
| cloudy appearing septic joint aspiration sent for lab evaluation reveals wbc over 50,000/cu ml, glucose less than 50% of serum level and elevated protein level mostly likely indicates | septic joint, Gram positive |
| knowledge of dermatomes will assist in the evaluation of lesions of the: | sensory nerve root/spinal nerves |
| triceps reflex involves what nerve/s? | C7, radial nerve |
| achilles reflex/ankle flexion involves what nerve/s? | S1 |
| biceps reflex involves what nerve/s? | C5, C6 |
| patellar reflex involves what nerve/s? | L2, L3, L4 |
| what diagnostic imaging technique takes advantage of the fact that bone is a living tissue? | radionucleide bone scan |
| cerebrospinal fluid is produced? | choroid plexus |
| Waddell signs are to help distinguish the difference between? | physical and non-physical low back pain |
| 30 y.o. male with 2 mo hx of fatigue,morning stiffness improves with Ibuprofen, symmetrical hand & wrist pain; what labs would be MOST HELPFUL to help diagnose the problem? | rheumatoid factor |
| what change on xray MOST STRONGLY indicates osteoarthritis? | osteophyte formation |
| which is more indiciative of lumbar disk herniation? a.increased patellar tendon reflex b.spastic thigh muscle c.weak dorsiflexion of big toe | c. weak dorsiflexion of big toe |
| Bouchard's nodes are indiciative of? | osteoarthritis |
| Older DMARD (used to treat RA) that requires regular retinal exam? | hydroxychlorquine |
| Most reliable sign of meningitis? | Nuchal rigity |
| Primarily afferent (ascending) in function? a. corticospinal tract b. motor horn c. ventral spinal nerve root d. posterior columns e. central canal | d. posterior columns |
| Site of reabsorption of cerebrospinal fluid? | arachnoid villi |
| Part of spinal column most likely affected by polio virus infection? | anterior horn cells |
| Positive Babinski | Damage to Upper Motor Neuron |
| Back pain reproduced on same leg raised in SLR test correlates with? | osteomyelitis |
| Osteophytes | osteoarthritis |
| Common cervical sprain cause? | whiplash |
| C1 burst fracture? | Jefferson fx |
| C2 fracture/dislocation from HYPEREXTENSION and DISTRATION | hangman's fracture |
| C7 spinous process fracture | Clay shoveler's fracture |
| An injury to the glenoid labrum that can be described as Superior Labrum Anterior to Posterior? | SLAP lesion |
| 95% of all shoulder dislocations (direction)? | anterior |
| Golfer's elbow is more officially known as? | medial epicondylitis |
| Tennis elbow is more officially known as? | lateral epicondylitis |
| Dislocation caused by an anterior force, seizure, or electric shock and is fairly UNCOMMON? | posterior shldr dislocation |
| Ulnar shaft fracture with proximal radius dislocation? | Monteggia fracture |
| 90% of distal radial fractures? | Colles' fracture |
| Distal radial fracture from a fall on the back of the hand. Causes a volar angulation of the distal fragment. | Smith fracture |
| This injury can damage the radial nerve: | Humeral shaft fracture |
| An avulsion of the anteroinferior glenoid labrum at its attachment to IGHL complex? | Bankhart lesion |
| Most common carpal fracture (at an icreased risk for avascular necrosis) | scaphoid fracture |
| Fracture of teh distal 5th metaCARPAL? | Boxer's or Brawler's fracture |
| Thickened palmar fascia forms nodules over the flexor tendons causing a flexion contracture. Most common at ring and pinky finger? | Dupuytren's contracture |
| Colapse of anteirior vertebral body with intact posterior wall from hyperflexion or osteoporosis? | wedge fracture |
| Classification system used for grading hip fractures? | Garden type |
| MVA injury where the lap belt immobilizes pelvis & thorax is forcefully flexed forward, seen on AP as a crack through the owl's eyes (pedicles), or an open beak (cracked spinous process): | Chance fracture |
| Vertebral slippage? | spondylolisthesis |
| Seen on blique view, a defect in the pars interarticularis puts a collar on the scotty dog? | spondylolysis |
| Childhood fracture in which the physis is widened. Growth disturbances are uncommon. | Salter Harris I |
| Childhood fraccture that involves the metaphysis as well as the physis. Rarely results in functional deficits. The MOST common type. | Salter Harris II |
| Childhood fracture that involves both the epiphysis as well as the physis. There is damage to the growth plate but prognosis is relatively favorable. | Salter Harris III |
| Childhood fracture that involves the epiphysis, physis, and metaphysis. Can result in chronic disability. | Salter Harris IV |
| Childhood fracture that is a compression of the physis caused by an axial load. Poor functional prognosis. | Salter Harris V |
| Can occur from a blow to the top of the head and affects C1. | Jefferson fracture |
| Flat foot is called? | Pes Planus |
| also known as shin splints | medial tibial stress syndrome |
| Fracture of the proximal 5th metatarsal, from an inversion injury | Jones fracture |
| To test radial and ulnar artery patency? | Allen's test |
| With patient supine & arm at side with elbow flexed to 90, place your finger on biceps tendon. Externally rotate. Pos for biceps tendonitis if pain or feel tendon slip out of groove. | Yergason's test |
| Patient's shoulder is ABducted to 90, elbow flexed to 90. Apply pressure behind humeral head & externally rotate shoulder. Positive for anterior instability if pain. | Apprehension test |
| Urate crystals in 1st MTP joint? | Gout |
| Place dorsum of hands together for 1 minutes; Positive for carpal tunnel syndrome if pain/paresthesia in median nerve distribution. | Phalen's |
| Knee flexed to 90 degrees, stabilize foot on table. Move tibia posterior. Laxity can indicate PCL injury. | Posterior drawer |
| Test for MCL injury, apply stress to lateral knee while stabilizing lower leg. | Valgus stress |
| Test for meniscus injury. One hand on joint line and other on the sole of foot. Flex knee 90 degrees and internally and externally rotate and extend the knee. Palpable or audible click? | McMurray |
| Test for meniscus tear. Pt in prone position, flex the knee to 90 degrees, apply load through foot and IR/ER lower leg. Pain is positive test. | Apley grind test |
| Patient's knee flexed 90 degrees. Stabilize foot on table, pull tibia forward. Laxity can indicate ACL injury. | Anterior drawer |
| Cup hand around superior patella. Have pt contract quads while applying pressure. Pain is positive sign for patellar injury. | Patella grind |
| Fusiform swelling of fingers, significant tenderness along course of the tendon, marked pain on passive extension, flexed figner at rest. ositive for septic tenosynovitis. | Kanavel sign |
| Patient in prone position. Squeez calf. Lack of plantar flexion is indicative of achilles tendon rupture. | Thompson's test |
| Patient lying on side. Hold hips in neutral & cradle affected leg. Bring patient into hip flexion then adduction and extension. Let leg drop, if leg stays elevated positive for IT band tightness. | Ober test. |
| Put patient's foot into 10 degrees plantar flexion; stabilize tibia, other hand on heel & move ankle mortis forward on tibia. Pain & laxity postiive for lateral ankle sprain (tests calcaneofibular lig). | Talar tilt |
| Evert patient's talus/calcaneous on tibia while suporting tibia with other hand. Pain and laxity positive for medial ankle sprain (deltoid ligament). | Valgus stress (ankle) |
| With both hands, press tibia and fibula together. Pain indicates injury to syndesmosis. | Squeeze test |
Created by:
rcdanks
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