CMN 574 Unit 2 Musculoskeletal UPDATED
ACTUAL Exam Questions and CORRECT
Answers
Trendelenburg test - CORRECT ANSWER - The patient stands and rises one foot and
then the other while the doctor observes the buttocks.
Positive sign is when the buttock drops on the side that the foot is elevated indicating hip
abductor weakness on the stance leg side.
Torticollis Findings - CORRECT ANSWER - Chin rotates to the OPPOSITE side of the
spasm
Head tilts toward spasm
Torticollis Cause - CORRECT ANSWER - Sternocleidomastoid muscle has been damaged
OR
Underlying disease process
-congenital deformity of cervical spine
-Tumors of spinal cord or cerebellum; syringomyelia, or RA
Torticollis Tx - CORRECT ANSWER - PASSIVE stretching effective in up to 97% of all
cases
Congenital Deformities - CORRECT ANSWER - RARE limb deficiencies (esp lower
limbs is rare) but associated with other congenital probs in femur, tibia, and fibula
,Also may have extra digits (polydactyly) or absence of brain matter (anencephaly)
*COMPLETE loss of limb is RARE
PARTIAL ABSENCE more common than loss of limb
Example of congenital limb defect/deformities - CORRECT ANSWER - Congenital
longitudinal deficiency of the fibula
Polydactyly (extra digits)
Congenital deformities TX - CORRECT ANSWER - Limb lengthening or contralateral
limb shortening
Removal of part of deformed limb
Prosthetics *early fitting is key
Lower Extremities--> 12 months of age, well tolerated, necessary for balance and walking
Upper Extremities--> 6 months of age, Mitten type, able to "develop" as child grows
Deformities of the Extremities - CORRECT ANSWER - Metatarsus Adductus
Talipes Equinovarus
Developmental
Dysplasia of the Hip
Torticollis
,Metatarsus Adductus - CORRECT ANSWER - Congenital foot deformity causing
INWARD deviation of the forefoot
May be associated with hip dysplasia
Most FLEXIBLE deformities resolve spontaneously (Caused by positioning in utero)
RIGID deformity has crease in medial aspect of arch
-Serial casting to correct if cannot reposition past midline
-may try corrective shoes
Talipes Equinovarus - CORRECT ANSWER - (AKA Clubfoot)
Idiopathic, neurogenic, or rt arthrogryposis or Larsen Syndrome
Check for SPINE anomalies, among others
Idiopathic clubfoot may be hereditary
-Plantar Flexion of the foot at ankle joint (equinus)
-Inversion deformity of the heel (varus)
-Medial deviation of the forefoot (adductus)
Talipes Equinovarus TX - CORRECT ANSWER - Preferred
-Ponsetti technique (manipulative technique w/ out invasive surgery)
-Manipulation and stretching of foo
-Serial Casting
-1/wk for 6-8wks
-Night brace req for long-term management
, Rigid and/or resistant to casting
-Surgical release and correction (15-50%)
Femur Anatomy - CORRECT ANSWER -
Developmental Hip Dysplasia - CORRECT ANSWER - (Abnormal growth or
development)
Hip dysplasia= abnormality between the FEMUR and ACETABULUM
Dislocated hip: femoral head is NOT IN CONTACT with acetabulum
Subluxatable hip: femoral head may be DISPLACED
(more common in L hip)
Femur and acetabulum are under developed
Continues w/ growth pattern, does not correct itself unless dislocation is corrected w/in few
weeks of birth
Diagnosis of Hip Dysplasia - CORRECT ANSWER - Ortolani and Barlow sign
Ortolani - CORRECT ANSWER - Place long finger over greater trochanter and thumb
over inner thigh. Flex hips at 90 degress-slowly ABDUCT from midline, 1 hip at a time. Use
gentle pressure to lift greater trochanter forward
(aBduct to have a baby -named ortolani)
Barlow sign - CORRECT ANSWER - ADDUCT medial side of thigh, listen for a 'clunk'
as femoral head "pops" out of joint
(Barlow girls aDDuct to prevent babies and add to the relationship)
ACTUAL Exam Questions and CORRECT
Answers
Trendelenburg test - CORRECT ANSWER - The patient stands and rises one foot and
then the other while the doctor observes the buttocks.
Positive sign is when the buttock drops on the side that the foot is elevated indicating hip
abductor weakness on the stance leg side.
Torticollis Findings - CORRECT ANSWER - Chin rotates to the OPPOSITE side of the
spasm
Head tilts toward spasm
Torticollis Cause - CORRECT ANSWER - Sternocleidomastoid muscle has been damaged
OR
Underlying disease process
-congenital deformity of cervical spine
-Tumors of spinal cord or cerebellum; syringomyelia, or RA
Torticollis Tx - CORRECT ANSWER - PASSIVE stretching effective in up to 97% of all
cases
Congenital Deformities - CORRECT ANSWER - RARE limb deficiencies (esp lower
limbs is rare) but associated with other congenital probs in femur, tibia, and fibula
,Also may have extra digits (polydactyly) or absence of brain matter (anencephaly)
*COMPLETE loss of limb is RARE
PARTIAL ABSENCE more common than loss of limb
Example of congenital limb defect/deformities - CORRECT ANSWER - Congenital
longitudinal deficiency of the fibula
Polydactyly (extra digits)
Congenital deformities TX - CORRECT ANSWER - Limb lengthening or contralateral
limb shortening
Removal of part of deformed limb
Prosthetics *early fitting is key
Lower Extremities--> 12 months of age, well tolerated, necessary for balance and walking
Upper Extremities--> 6 months of age, Mitten type, able to "develop" as child grows
Deformities of the Extremities - CORRECT ANSWER - Metatarsus Adductus
Talipes Equinovarus
Developmental
Dysplasia of the Hip
Torticollis
,Metatarsus Adductus - CORRECT ANSWER - Congenital foot deformity causing
INWARD deviation of the forefoot
May be associated with hip dysplasia
Most FLEXIBLE deformities resolve spontaneously (Caused by positioning in utero)
RIGID deformity has crease in medial aspect of arch
-Serial casting to correct if cannot reposition past midline
-may try corrective shoes
Talipes Equinovarus - CORRECT ANSWER - (AKA Clubfoot)
Idiopathic, neurogenic, or rt arthrogryposis or Larsen Syndrome
Check for SPINE anomalies, among others
Idiopathic clubfoot may be hereditary
-Plantar Flexion of the foot at ankle joint (equinus)
-Inversion deformity of the heel (varus)
-Medial deviation of the forefoot (adductus)
Talipes Equinovarus TX - CORRECT ANSWER - Preferred
-Ponsetti technique (manipulative technique w/ out invasive surgery)
-Manipulation and stretching of foo
-Serial Casting
-1/wk for 6-8wks
-Night brace req for long-term management
, Rigid and/or resistant to casting
-Surgical release and correction (15-50%)
Femur Anatomy - CORRECT ANSWER -
Developmental Hip Dysplasia - CORRECT ANSWER - (Abnormal growth or
development)
Hip dysplasia= abnormality between the FEMUR and ACETABULUM
Dislocated hip: femoral head is NOT IN CONTACT with acetabulum
Subluxatable hip: femoral head may be DISPLACED
(more common in L hip)
Femur and acetabulum are under developed
Continues w/ growth pattern, does not correct itself unless dislocation is corrected w/in few
weeks of birth
Diagnosis of Hip Dysplasia - CORRECT ANSWER - Ortolani and Barlow sign
Ortolani - CORRECT ANSWER - Place long finger over greater trochanter and thumb
over inner thigh. Flex hips at 90 degress-slowly ABDUCT from midline, 1 hip at a time. Use
gentle pressure to lift greater trochanter forward
(aBduct to have a baby -named ortolani)
Barlow sign - CORRECT ANSWER - ADDUCT medial side of thigh, listen for a 'clunk'
as femoral head "pops" out of joint
(Barlow girls aDDuct to prevent babies and add to the relationship)
