MSK Assessment Overview
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Questions and Answers

Which of the following conditions is associated with a sudden worsening of intermittent claudication?

  • Thromboembolism (correct)
  • Congestive heart failure
  • Aortic aneurysm
  • Appendicitis
  • What is typically indicated by the presence of McBurney's point or rebound tenderness?

  • Appendicitis or Peritonitis (correct)
  • Systemic Disease
  • Thromboembolism
  • Aortic Aneurysm
  • A patient with diabetes presents as confused and lethargic. Which of the following is a potential cause?

  • Diabetic coma (correct)
  • Psychological overlay
  • Aortic aneurysm
  • Hypothyroidism
  • Which of the following conditions is NOT directly indicated by unexplained weight loss?

    <p>Thromboembolism (D)</p> Signup and view all the answers

    What should be assessed first with a patient presenting with signs of abuse?

    <p>Safety at home and in their relationship (D)</p> Signup and view all the answers

    Which of the following is NOT considered a 'red flag' requiring immediate medical referral?

    <p>Muscle spasm following exertion. (D)</p> Signup and view all the answers

    A patient experiencing which of these signs should be suspected of a diabetic coma?

    <p>Confusion, lethargy, or sudden change in mental function. (B)</p> Signup and view all the answers

    Which of these findings is most suggestive of cauda equina syndrome?

    <p>Bowel/bladder incontinence with saddle anesthesia. (D)</p> Signup and view all the answers

    What is the primary concern when a physical therapy patient presents with McBurney's point tenderness?

    <p>Appendicitis or peritonitis. (B)</p> Signup and view all the answers

    Which symptom, if present, should raise concern for a possible thromboembolism?

    <p>Sudden worsening of pain that had been intermittent. (D)</p> Signup and view all the answers

    What is the primary reason for physical therapists to identify 'red flag' symptoms?

    <p>To identify conditions needing immediate medical attention. (B)</p> Signup and view all the answers

    A patient reports a significant, unexplained weight loss. Which of the following conditions is NOT a likely cause?

    <p>Acute muscle strain. (A)</p> Signup and view all the answers

    What is the main purpose of recognizing 'yellow flag' symptoms during a physical therapy assessment?

    <p>To signal a need for deeper examination and assessment. (A)</p> Signup and view all the answers

    Which of these questions would be most appropriate for a therapist to ask given potential 'other flag' signs?

    <p>Do you feel safe at home? (C)</p> Signup and view all the answers

    What immediate action should a physical therapist take if a patient shows symptoms of anaphylactic shock?

    <p>Call 911 immediately. (C)</p> Signup and view all the answers

    Which of these is the MOST appropriate first step when taking a patient's history?

    <p>Establishing the patient's presenting complaints and functional limitations. (A)</p> Signup and view all the answers

    What is the primary purpose of taking a patient's history, according to this content?

    <p>To gather information for differential diagnosis and to guide subsequent tests and measures. (B)</p> Signup and view all the answers

    Which of these is considered a 'don't' during a patient interview?

    <p>Interrupting the patient. (A)</p> Signup and view all the answers

    What is the recommended approach to questioning a patient during a musculoskeletal (MSK) examination history?

    <p>Use a funnel sequence, progressing from open to closed to follow-up questions. (C)</p> Signup and view all the answers

    A physical therapist notes a patient answers all questions with a 'yes' or 'no.' What should be the next best step?

    <p>Make a note of this pattern and review the findings with the patient. (D)</p> Signup and view all the answers

    Which of the following is MOST likely to contribute to a diagnosis of shoulder impingement in an individual over 40?

    <p>Degenerative changes in the shoulder joint. (D)</p> Signup and view all the answers

    A patient presents with pain. What information should a therapist obtain about the pain during the patient history?

    <p>Types, sources, patterns, and whether it’s acute or chronic should be assessed. (C)</p> Signup and view all the answers

    During a patient interview, what aspects of communication should a clinician be conscious of?

    <p>Both verbal and nonverbal behaviors, including tone of voice, body language, and facial expressions. (D)</p> Signup and view all the answers

    Why is it important to inquire about a patient's living environment during a history taking?

    <p>To understand potential influences on their health from their home and living situation. (A)</p> Signup and view all the answers

    Which of the following is the BEST reason to ask a patient about their last physical, eye, hearing and dental exams during their history?

    <p>To assess their general health and potential contributing factors to their conditions. (B)</p> Signup and view all the answers

    Which of the following is considered a 'red flag' symptom that warrants further investigation?

    <p>Increased symptom intensity with exertion, accompanied by a palpable pulsating abdominal mass. (D)</p> Signup and view all the answers

    Bilateral root signs and symptoms are most indicative of which of the following conditions?

    <p>Neoplasm or cord compression. (A)</p> Signup and view all the answers

    Which of the following findings would be considered a 'yellow flag' during a patient examination?

    <p>Sensation of a 'heartbeat' when lying down and noticeable increase with exertion (D)</p> Signup and view all the answers

    A patient reports arm pain lasting over 3 months. What serious condition should be considered?

    <p>Neoplasm, or other neurologic dysfunction. (A)</p> Signup and view all the answers

    What does 'saddle anesthesia' generally indicate during a physical examination?

    <p>A problem in the caudal spinal cord or cauda equina. (D)</p> Signup and view all the answers

    Which testing category would include assessing a patient via active motion?

    <p>Active movements. (B)</p> Signup and view all the answers

    In musculoskeletal examinations, why are resisted isometric tests performed?

    <p>To assess muscle strength and pain at that point in the motion. (D)</p> Signup and view all the answers

    What is the primary intention of 'Provocation tests' in musculoskeletal examinations?

    <p>To reproduce or worsen symptoms. (B)</p> Signup and view all the answers

    What does the 'Joint Play' category of musculoskeletal testing focus on?

    <p>Accessory movements and joint end feel. (A)</p> Signup and view all the answers

    Which of the following would fall under the 'Functional Assessment' category during a musculoskeletal exam?

    <p>Observation of daily tasks (e.g. walking or lifting) that the person might do at home. (D)</p> Signup and view all the answers

    Progressive gait disturbances, especially rapid onset, are a red flag for what condition?

    <p>A potentially serious neurologic issue. (B)</p> Signup and view all the answers

    Visual disturbances are found to be a yellow flag and can potentially indicate?

    <p>Multiple sclerosis or neoplasm. (C)</p> Signup and view all the answers

    What is the primary focus of 'Selective Tension' in musculoskeletal testing?

    <p>Differentiating which structures are involved in a patient's specific symptoms. (A)</p> Signup and view all the answers

    Which is most likely to cause frequent nausea and vomiting as a common symptom?

    <p>Gastrointestinal and many other common types of diseases. (B)</p> Signup and view all the answers

    If a patient presents with SOB, what systems/conditions should you be considering?

    <p>Cardiovascular, pulmonary, and issues such as asthma. (D)</p> Signup and view all the answers

    Flashcards

    MSK Assessment

    A systematic approach to evaluating a patient's musculoskeletal system by considering their medical history, physical examination, and functional limitations.

    Cyriax Method

    A method of evaluating musculoskeletal pain and dysfunction by identifying and addressing the specific tissues that are causing the problem.

    Selective Tension

    The amount of tension or force that can be applied to a muscle or joint without causing pain or worsening the symptoms.

    Red Flag

    Pain that arises from a medical condition that is not directly related to the musculoskeletal system.

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    Yellow Flag

    Factors that may contribute to the patient's pain and disability, but are not directly related to the musculoskeletal system.

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    Pain Assessment

    The onset, duration, location, intensity, and quality of pain.

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    Boissonnault Examination Scheme

    A structured approach to taking a patient's history by asking specific questions and reviewing relevant documents.

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    Review of Systems

    Gathering information on the patient's past medical experiences, injuries, and treatments.

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    Predisposing Factors

    Factors that contribute to an individual's susceptibility to developing musculoskeletal disorders.

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    Patient Profile

    A collection of information about the patient's personal and family medical history, occupation, lifestyle, and other relevant factors.

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    Sudden worsening of intermittent claudication

    A sudden worsening of intermittent claudication could indicate a serious issue like a blood clot in the leg.

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    Unexplained weight loss

    Unexplained weight loss can be a symptom of various health conditions like cancer, thyroid problems, or diabetes.

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    Changes in mental function

    Changes in mental function like confusion or lethargy might indicate a serious medical condition like diabetic coma.

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    Patient Assessment Factors

    Personal characteristics, current fitness level, knowledge of a patient's lifestyle and exercise habits, functional status, and activity level. These factors are considered by physical therapists to understand their patient's overall condition and needs.

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    Angina Pain Not Relieved in 20 Minutes

    A type of chest pain that resolves within 20 minutes and is not relieved by rest or medication. It is a common symptom of myocardial infarction (heart attack), which requires immediate emergency medical intervention. The longer it takes to resolve the pain, the higher the risk of serious harm.

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    Angina Pain with Nausea and Sweating, Especially at Night

    A type of chest pain accompanied by nausea and sweating, often occurring at night. This is a serious sign of a heart attack (MI) and requires immediate emergency medical attention, as the patient's life is at risk.

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    Bowel/Bladder Incontinence and/or Saddle Pain Unaffected by Anesthesia, Medication, or Position

    A combination of symptoms that can indicate a serious nerve injury affecting the spinal cord, specifically the cauda equina. This requires urgent medical attention for immediate surgical intervention to prevent permanent damage.

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    Anaphylactic Shock

    A life-threatening allergic reaction requiring immediate emergency medical attention. It can quickly progress to severe airway obstruction, circulatory collapse, and even death. The key is to recognize the symptoms early and address them immediately.

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    Signs and Symptoms of Inadequate Ventilation

    This presents as signs and symptoms of inadequate ventilation. It could indicate a life-threatening condition with an inability to breathe properly. It requires emergency medical intervention to address the underlying cause and ensure proper oxygenation.

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    Sudden Worsening of Intermittent Pain

    Sudden worsening of intermittent pain, often suggestive of a blood clot in the veins (thromboembolism). This requires immediate medical assessment and treatment to prevent a potentially life-threatening situation.

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    Diabetic Coma

    A medical emergency occurring in a patient with diabetes, characterized by confusion, lethargy, altered mental function, and potentially loss of consciousness. Immediate medical attention is crucial to stabilize blood sugar levels and prevent long-term complications.

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    Observation

    Observing the patient's posture, gait, and overall appearance for any signs of distress or dysfunction.

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    Inspection

    Closely examining the affected areas for signs of swelling, redness, bruising, or other abnormalities.

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    Active Movements

    Assessing the patient's ability to move through a full range of motion in each joint.

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    Passive Movements

    Assessing the range of motion in each joint by passively moving it, checking for limitations or pain.

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    Resisted Isometrics

    Testing the strength of each muscle group by asking the patient to resist the therapist's force.

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    Neuromuscular Testing

    Assesses the patient's nervous system function through tests like reflexes, sensation, and coordination.

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    Special Tests

    Specific maneuvers designed to test for a particular injury or condition.

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    Provocation Tests

    Performing movements or actions to provoke pain or symptoms, helping identify the source of the problem.

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    Joint Play

    Examining the integrity of the joint surfaces, ligaments, and other structures through specific movements and pressures.

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    Palpation

    Using touch to evaluate the tissues for tenderness, warmth, or other abnormalities.

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    Functional Assessment

    Assessing the patient's ability to perform daily activities such as walking, reaching, or lifting.

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    Testing Related Areas

    Testing areas that may be related to the patient's symptoms, such as the neck, spine, or other joints.

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    Imaging/Diagnostic Tests

    Utilizing imaging techniques like X-rays, MRIs, or CT scans for further diagnosis.

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    Study Notes

    MSK Assessment

    • Overview of Cyriax: Concept of selective tension and interpretation of findings important.

    • MSK Examination Components: History taking and physical examination are crucial.

    • History: Includes yellow flags, red flags, immediate medical referral, pain types (acute, chronic), sources, patterns, and assessment. Boissonnault Examination scheme is a method for reviewing medical history, patient profile, and functional limitations.

    • Pain Assessment: Consider the presenting complaints, functional limitations, and relevant medical history.

    • History Interview: Begins with family and personal history, noting any consistent "yes" or "no" answers needing further exploration. Determine the chief complaint (C/C), mechanism of injury (MOI), if the issue is acute, subacute, or chronic, and general irritability. Assess contraindications for physical therapy, including red flags, yellow flags, or immediate referral. Establish a baseline, determine past medical history and discuss, and agree upon patient goals. Identify potential diagnoses (DDx) and necessary tests/measures.

    • Do's and Don'ts of Interviewing: Create a comfortable atmosphere using eye contact, appropriate distance, open-ended questions rather than close-ended ones, paraphrasing, active listening, patience, and avoiding interruptions.

    • Communication: Pay attention to tone, eye contact, body language, personal space, and facial expressions both verbal and non-verbal. Practice cultural competency and compassion.

    • General Principles: Age, gender, and race can affect disease prevalence (e.g., osteoarthritis in older individuals, shoulder impingement in 15-35-year-olds). Important to consider past medical history (PMHx) for general health, major illnesses, surgeries, accidents, injuries, allergies, and medications (present, past). Family history (FHx) includes heredity, familial illnesses, such as achondroplasia and mental health issues. Assess growth development, dominance, development and congenital problems. Ask about occupation, school, recreational activities, and last physical, eye, hearing, and dental exams. Lifestyle factors such as smoking, drug use, nutrition and sexual history must be investigated. Explore the immediate living environment (home, who they live with) and social history (personal characteristics, current fitness level, knowledge of exercise, functional status/activity level).

    • Immediate Medical Referral: 911 is required in emergencies.

    • Red Flag Symptoms: Indicate possible urgent medical conditions requiring attention from a medical provider before physical therapy.

    • Examples of Red Flags: Chest, back, or abdominal pain worsening with exertion; sudden worsening of intermittent claudication. Angina lasting longer than 20 minutes; angina with nausea, sweating; bowel/bladder incontinence/saddle anesthesia; anaphylactic shock; signs of inadequate ventilation, patient with DM who is confused, lethargic, or has a change in mental function; McBurney's point or rebound tenderness; severe, unrelenting pain, especially at night; pain unaffected by medication; severe pain with no MOI; pain unaffected by position; severe spasm; psychological overlay; loss of appetite; unexplained weight loss; weight gain; dizziness; frequent nausea or vomiting; soB or congestive heart failure.

    • Yellow Flag Symptoms: These symptoms suggest a need for a more comprehensive examination.

    • Examples of Yellow Flags: Abnormal symptoms, bilateral symptoms, peripheralizing symptoms, neurological symptoms, abnormal sensations, saddle anesthesia, upper motor neuron (UMN) signs, fainting, progressive weakness, progressive gait disturbances, multiple inflamed joints, psychosocial stresses, circulatory or skin changes.

    • Additional Flags: Signs of abuse, safety questions.

    MSK Examination-Test and Measures

    • Observation: Assess the patient's posture, gait and overall appearance.
    • Inspection: Visually assess the affected area for any deformities or abnormalities.
    • Active Movements: Evaluate the patient's ability to move the joint through a full range of motion.
    • Passive Movement: The therapist actively moves the joint to assess range of motion.
    • Resisted Isometrics: Test muscle strength by applying resistance during isometric contractions.
    • Neuromuscular Testing: Assess neurological function including reflexes and sensation.
    • Special Tests: Specific tests to identify specific conditions (e.g., impingement tests).
    • Provocation Tests: Further assess the injury by eliciting symptoms through specific provoking actions.
    • Joint Play: Assess the joint's mobility.
    • Palpation: Examine the affected area for tenderness, swelling, and other abnormalities.
    • Functional Assessment: Evaluate how the patient functions in daily activities.
    • Testing Related Areas: Assess other areas of the body that might be related to the issue.
    • Imaging/Diagnostic Tests: Imaging and diagnostics such as X-rays, MRI etc. are included for cases where further medical investigation is necessary.

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    MSK Assessment PDF

    Description

    This quiz covers the essential components of MSK assessment, focusing on Cyriax's selective tension concept and the importance of taking thorough medical history. It highlights the key aspects of physical examination, pain assessment, and the identification of red and yellow flags in patient history. Test your understanding of these critical skills for effective MSK evaluations.

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