Bates Assessment Final Exam Questions With 100% Correct Answers.

4 cardinal features of inflammation - swelling, warmth, redness, pain Anterior and posterior drawer test - Anterior drawer = + ACL (less sensitive/specific compared with Lachmans) + posterior drawer test = Posterior cruciate ligament, Medial collateral ligament, or Posterior oblique ligament damage Approach to MSK disorders: - 1. Articular or extra-articular? 2. Acute (<6wk) or chronic (>12wk)? 3. Inflammatory or non-inflammatory? 4. Localized (monoarticular) or diffuse (polyarticular)? Articular cartilage is composed of? - a collagen matrix containing charged ions and water, allowing the cartilage to change shape in response to pressure or load, acting as a cushion for underlying bone Articular structures include? - Joint capsule and articular cartilage, the synovium and synovial fluid, intra-articular ligaments, and juxta-articular bone Bones of the hand - -Carpals -Metacarpals -Phalanges -Pollexcartilaginous joints - allow only slight movement and consist of bones connected entirely by cartilage such as vertebral bodies of the spine caude equina - collection of spinal nerves below the end of the spinal cord Symptoms: Severe low back pain. Motor weakness, sensory loss, or pain in one, or more commonly both legs. Saddle anesthesia (unable to feel anything in the body areas that sit on a saddle) Recent onset of bladder dysfunction (such as urinary retention or incontinence) Recent onset of bowel incontinence. De Quervain's Tenosynovitis - affects APL(Abductor pollicis longus) affects EPB (Extensor pollicis brevis) most common diagnosed wrist in athletes a painful condition affecting the tendons on the thumb side of your wrist; it will probably hurt when you turn your wrist, grasp anything or make a fist any activity that relies on repetitive hand or wrist movement — such as working in the garden, playing golf or racket sports, or lifting your baby — can make it worse. De Quervain's Tenosynovitis involves the extensor and abductor tendons of the - thumbs, as they cross the radial styloid Decreased grip strength is a positive test for weakness of the finger flexors and/or intrinsic muscles of the hand. It can be seen in what disorders? - -inflammatory or degenerative arthritis -carpal tunnel -epicondylitis -cervical radiculopathyDecreased sensation in the median nerve distribution characterizes? - carpal tunnel syndrome (sensitivity to pinprick and two-point discrimination) Decreased spinal mobility is common in? - OA and ankylosing spondylitis Degenerative changes at the first carpometacarpal joint of the thumb are more common in? - Women Diffuse swelling is common in? - Arthritis or infection DIP - distal interphalangeal joint Drop arm test - Ask patient to lower arm from 90 degrees of abduction; failure to lower arm in smooth, controlled fashion or with pain suggests tear of supraspinatus tendon Weakness during this maneuver is a positive test for a supraspinatus rotator cuff tear or bicipital tendinitis Dupuytren flexion contractures - 3rd, ring, and 5ht fingers arise from thickening of the palmar fascia empty can test procedure - 1. pt elevates arms to 90• and internally rotate arms w/ thumb down 2. push down on arms while patient resists Inability of the patient to hold the arm fully abducted at shoulder level or control lowering the arm is a positive test for supraspinatus rotator cuff tearExternal rotation lag test - With the patient's arm flexed to 90' with palm up, rotate the arm into full external rotation. Inability of the patient to maintain external rotation is a positive test for supraspinatus and infraspinatus disorders External rotation resistance test - Ask the patient to adduct and flex the arm to 90' with the thumbs turned up. Stabilize the elbow with one hand and apply pressure proximal to the patient's wrist as the patient presses the wrist outward in external rotation. Pain or weakness during this maneuver is a positive test for an infraspinatus disorder Limited external rotation points to glenohumeral disease or adhesive capsulitis Extra-articular structures include? - Periarticular ligaments, tendons, bursae, muscle, facia, bone, nerve, and overlying skin fibrous joints - consists of inflexible layers of dense connective tissue, holds the bones tightly together, such as the skull Finkelstein's test - stretching or lengthening of the thumb tendon to assess the possibility of de Quervain's disease, or tenosynovitis of the thumb tendon Flexor tendon damage causes? - abnormal finger alignment Full elbow extension also makes ___________ or ___________ unlikely - effusion or hemarthrosis Full elbow extension has a sensitivity of 84% to >98% and specificity of 48% to >97% for absence of? - elbow fracture Grip weakness plus wrist pain - De Quervain tenosynovitisHard dorsolateral nodules on the DIP joints or Heberden nodes are common in? - OA Hawkins Impingement sign - Flex the patient's shoulder and elbow to 90 degrees with the palm facing down; then with one hand on the forearm and one on the arm, rotate the arm internally to compress the greater tuberosity against the coracoacromial ligament. Pain during this maneuver is a positive test for supraspinatus impingement/rotator cuff tendinitis Heberden (DIP) and Bouchard (PIP) nodes are - soft and nontender, and are associated with osteoarthritis (OA) Hip exam - Inspection - Gait Muscle atrophy Bruising Symmetry Hip muscle groups - Psoas flexor group gluteus adductor abductor How many maneuvers are there that have the best LRs and the narrowest confidence intervals and are currently recommended? What are the classes? - Five 1. Pain provocation test (1) 2. Strength tests (3) 3. Composite test (1)How to test pure glenohumeral motion? How about scapulothoracic motion? Both? - Have the patient raise the arms to shoulder level at 90' with palms facing down. For scapulothoracic motion have the patient turn the palms up and raise the arms an additional 60' The final 30' tests the combined glenohumeral and scapulothoracic motion Hypothenar atrophy - ulnar nerve compression Hypothener eminence - mound located at the base of the fifth digit (little finger) If the NEXUS criteria is met? - The patient can be cleared of cervical spine injury In RA inspect for? - Symmetric deformity in the PIP, MCP, and wrist joints later there is MCP subluxation and ulnar deviation In RA there is what - Persistent bilateral swelling and/or tenderness Inflammatory factors - interleukins and tumor necrosis Internal rotation lag test - Ask the patient to place the dorsum of the hand on the low back with the elbow flexed to 90'. Then you lift the hand off the back, which further internally rotates the shoulder. Ask the patient to keep the hand in this position. Inability of the patient to hold the hand in this position is a positive test for a subscapularis disorderJoint pain and <60 yo consider? - Repetitive strain or overuse syndromes like tendinitis or bursitis, crystalline arthritis (gout; crystalline pyrophosphate deposition disease (CPPD) (males), RA, psoriatic arthritis, and reactive (Reiter) arthritis (in IBD), and infectious arthritis from gonorrhea, Lyme dx, or viral/bacterial infections Joint pain and >60 yo consider? - OA, gout/pseudogout, polymyalgia rheumatica (PMR), osteoporotic fx, and septic bacterial arthritis Knee Exam Inspection - gait alignment swelling erythema muscle atrophy symmetry Kyphosis (hunchback) - An excessive outward curvature in the thoracic portion of the vertebral column Lachman's Test - pivot shift test causes pain (ACL tear/instability) Lifetime incidence of back pain in adults? - 60-90% List NEXUS criteria - -normal alertness -no post midline cervical spine tenderness -no focal neuro deficits -no evidence of intoxication -no painful distracting injury