Posted: November 1st, 2023

A 3-year-old child with Down’s syndrome is in the cardiac ICU of Shadow General Hospital

Assess The Musculoskeletal System Of Tina Jones, A Digital Standardized Patient. Interview And Examine The Patient, And Document Your Findings
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Concept Notebook

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Client (virtual or living) background: Please tell us a little about the client you cared for today, either virtual or living. For living clients, no personal identifying information needed.

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Lifespan Activity Time: 2 min
A 3-year-old child with Down’s syndrome is in the cardiac ICU of
Shadow General Hospital following open heart surgery. Which of the
following musculoskeletal physical exam findings would you expect
to find on this child?
Correct:Children with Down’s syndrome often have palmar simian crease, hyperextensible joints,
and short, broad extremities.
 Fixed joints
 Lordosis
 Hyperextensible joints (Correct Response)
 Scoliosis
An 86-year-old woman has been admitted to the Shadow General
surgical floor after a knee replacement. She has a history of
degenerative joint disease (DJD). What physical exam findings would
you expect to find?
Correct:Persons with DJD have limitations in strength and range of motion, joint crepitus, and pain
with activity that is relieved with rest. Humpback, or kyphosis, is commonly due to osteoporosis,
while shuffling gait and postural instability are commonly seen in those with Parkinson’s disease.
 Joint deformity (Correct Response)
 Shuffling gait
 Postural instability
 Humpback
Review Questions Activity Time: 2 min
If Tina had displayed limited abduction of the left shoulder, it would
mean that:
Correct:Abduction is defined as a motion in which a body part is moved away from the body’s
midline.
 She has limited movement forward
 She has limited movement in a circular motion
 She has limited movement toward her body
 She has limited movement away from her body (Correct Response)
Suppose you noted that Tina’s left knee was swollen. Which of the
following tests should be done?
Correct:The bulge sign is a test for excess fluid accumulation in the knee. It is performed by rubbing
the knee capsule in upward strokes to displace fluid and observing for the creation of a bulge when
the fluid returns to its original position.
 Balloon test
 Fluid wave
 Bulge sign (Correct Response)
 Tinel’s sign
Imagine that Tina was unable to move her right ankle. You notice
that her muscles contract as she attempts to dorsiflex her ankle, but
no movement occurs. How would you grade her ankle strength?
Correct:According to the Oxford Scale, a muscle group that has no mobility but displays visible
muscle contraction is graded as a 1/5 strength.
 1/5 (Correct Response)
 2/5
 4/5
 3/5
When assessing Tina’s uninjured ankle, what range of motion would
you expect of this joint?
Student Response:I would expect 5/5 range of motion in her uninjured ankle.
Model Note:Normal range of motion of the ankle joint includes dorsiflexion and plantarflexion,
inversion and eversion, and abduction and adduction.
When assessing Tina’s wrist, what range of motion would you
expect?
Student Response:I would expect 5/5 range of motion in her wrist.
Model Note:Normal range of motion of the wrist joint includes flexion and extension, and abduction
and adduction (also known as radial and ulnar movements).
Because of her injury, Tina’s right ankle is inflamed. What are the
characteristics of inflammation?
Student Response:Redness, heat, swelling and pain. THese are the four basic characteristics of
inflammation.
Model Note:The classic local signs of inflammation are heat, redness, edema, pain, and loss of
function. Systemic signs of inflammation can include fever, leukocytosis, and increased plasma
protein synthesis such as increased C­reactive protein and erythrocyte sedimentation rate.
Self-Reflection Activity Time: 1 min
After completing this assessment, what goals can you set for
yourself for the next time you complete a similar assessment? Think
about efficiency, organization, time management, and holistic care
of the patient.
Student Response: I think I would try to ask the questions as i am doing the physical assessment
that way the time is cut in half and i can coordinate my questions for each system.
###
Assess The Musculoskeletal System Of Tina Jones, A Digital Standardized Patient. Interview And Examine The Patient, And Document Your Findings
Chief Complaint:
Tina is a 25-year-old female who presents for evaluation of right knee and ankle pain following a fall down stairs one week ago.
History of Present Illness:
Tina reports she was going downstairs carrying a box of books when she missed a step and fell, landing hard on her right knee and ankle. She heard a “popping” sound in her ankle and immediate swelling and pain developed in both her knee and ankle. She has difficulty bearing weight on her right leg since the injury.
Past Medical History:
Tina reports being generally healthy with no other medical issues. She was a competitive soccer player in high school and college but has not played in 2 years since graduating.
Physical Exam:
General: Tina is in no acute distress. She ambulates with an antalgic gait favoring her right leg.
Right knee: +1 swelling and effusion. Range of motion is 0-90 degrees with pain at endpoints. Negative McMurray’s and Lachman’s tests. No joint laxity.
Right ankle: Significant swelling and ecchymosis present laterally. Range of motion is 0-10 degrees dorsiflexion and 0-20 degrees plantar flexion with pain. Positive anterior drawer test.
Neurovascular: Neurovascular exam within normal limits bilaterally in lower extremities.
Assessment:
Right knee sprain
Right ankle anterior talofibular ligament sprain
The physical exam findings are consistent with an acute knee sprain and ankle ligament injury from her fall. The positive anterior drawer test suggests an ankle ligament tear. Further imaging may be warranted to fully evaluate the extent of any injuries present.

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