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30 Cards in this Set

  • Front
  • Back
What are the ACR classification criteria for fibromyalgia?
Widespread pain (must have axial, r side, l side, above waist and below waist)for at least 3 months
Pain in 11 of 18 trigger pts
What are the trigger points in fibromyalgia? (9 paired points)
Occiput: Bilateral, at the suboccipital muscle insertions.
Low cervical: bilateral, at the anterior aspects of the intertransverse spaces at C5-C7.
Trapezius: bilateral, at the midpoint of the upper border.
Supraspinatus: bilateral, at origins, above the scapula spine near the medial border.
Second rib: bilateral, at he second costochondral junctions, just lateral to the junctions on upper surfaces.
Lateral epicondyle: bilateral, 2 cm distal to the epicondyles.
Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle.
Greater trochanter: bilateral, posterior to the trochanteric prominence.
Knee: bilateral, at the medial fat pad proximal to the joint line.
Fibromyalgia: population and associated symptoms (4)
Females 20-50

Sx: sleep disturbance (stage IV), anxiety or depression, irritable bowel syndrome, obsessive-compulsive behavior
ACR classification of SLE -- need 4 of these 11 either sequentially or concurrently
1) Malar rash
2) Discoid rash
3) Photosensitivity
4) Oral ulcers
5) Arthritis
6) Serositis (pleurisy or pericarditis)
7) Renal disorder (3+ protein or casts)
8) Neuro disorder (seizures or psychosis)
9) Hematologic abnormalities
10) Immunologic disorder (anti-DNA antibody, anti-5m antibody, antiphospholipid antibody)
11) positive ANA in absence of drugs causing it
Osteoarthritis -- history
Older adults
asymmetrical joint pain & stiffness
Improves throughout the day
Hx repetitive trauma
Osteoarthritis -- PE
DIP & PIP joint enlargement
Heberden's nodes
Limited C-spine ROM
Osteoarthritis -- dx'tic studies
Increased ESR
Radiographs show osteophytes, loss of joint space
Rheumatoid arthritis -- hx
Morning stiffness of small joints
Symmetrical involvement
Weight loss
Rheumatoid arthritis -- PE
Rheumatoid nodules (soft, spongy, on elbows, forearms, and hands)
Ulnar deviation of wrists
Rheumatoid arthritis -- assoc conditions (3)
Pleuritis, pericarditis, vasculitis
What is Yergason's test and how do you do it?
Tests for bicipital tendonitis.

Pt supinates the forearm against resistance
Explain one test for rotator cuff tear.
Pt externally rotates and abducts the shoulder.

Partial tear - abducts but cannont maintain against resistance
Full tear -- attempt to abduct = shoulder shrug
How do you test for tennis elbow?
Pt resists forearm supination with the elbow flexed 90 degrees

Pain suggests lateral humeral epicondylitis
What is Finkelstein's test and how do you do it?
Pt flexes fingers over a clenched thumb then passively deviate the wrist ulnarly

+ pain in de Quervain's syndrome (1st dorsal compartment tenosynovitis)
What is Tinel's sign?
Provider taps over median nerve to assess for compression neuropathy

+ test is prickling or tingling along the 1st 3 digits, wrist pain
What is Phalen's test?
Pt palmar flexes hands with dorsal surfaces together and holds for one minute

Tests for compression neuropathy (carpal tunnel)

+ test is numbness and parasthesia in the fingers
How do you perform the iliopsoas muscle test & when do you use it?
Checks for iliopsoas tendinitis

Seated pt places heel of the affected leg on the knee of the other leg
What is Foucher's sign and what does a + and a - test mean?
Change in the consistency of a mass in the popliteal fossa that hardens with extension and softens with flexion

+ = popliteal tumor or aneurysm
- = Baker's cyst
What is a Bulge sign?
If there is fluid in the knee joint, applying lateral pressure to the area adjacent to the patella will produce a medial bulge
How do you check for Drawer sign?
Pt supine, flex knee 90 degrees and hip 45 degrees with the foot on the table.

Apply slow, steady, anterior pull and then gently push tibia back
What is a Drawer sign?
Tests for cruciate ligament stability

Abnormal anterior or posterior movement of the tibia on the femur is a + sign indicating ligamentous instability
How do you do a collateral ligament test?
Apply medial or lateral pressure when the knee is flexed at 30 degrees and when it is extended.

Medial or lateral collateral ligament sprain will show laxity in movement and no solid end point depending on degree of sprain
What is Lachman's test and how do you do it?
Tests for ACL damage

With knee flexed 30 degrees, pull the tibia forward with one hand while the other hand stabilizes the femur.

+ sign is mushy or soft end feel
What does McMurray's manuever test for?
Meniscus injury
How do you perform McMurray's manuevers? (3 steps)
1) Pt supine. Maximally flex knee and hip. With one hand on distal end of tibia and other on the knee joint, rotate tibia internally and externally rotate tibia - Pain and palpable/audible click = meniscal injury

2) Extend knee with slight lateral pressure with tibia internally rotated - pain/click in this position indicates lateral meniscus injury

3) Repeat, but with medial pressure and tibia rotated - + findings indicate medial meniscus injury
Chondromalacia patellae -- history, PE, studies
Hx - adolescent females
hx knee trauma or misalignment
anterior knee pain worse when biking or climbing stairs

PE - tenderness to palp over knee

4 view xrays to r/o arthritis, show irregularities of the joint
What is patellar tendinitis?
Jumper's knee

Overuse syndrome characterized by inflammation in the distal extensors of the knee joint
Describe hx and PE in patellar tendinitis
Hx --
overuse, esp running or jumping
Dull, achy knee pain
Clicking or popping w/movement

Q angle > 10 deg in males and 15 deg in females
What is the Q angle?
Quadriceps angle. Assessed in ? patellar tendinitis

Measure from center of patella to anterior superior iliac spine and from center of patella to the tibial tubercle
Describe typical hx & PE in ACL tear
Hx of twisting or extension knee injury with audible pop

PE - swelling, + Lachman's test