Contains the scapula, humerus, clavicle, glenohumeral joint, acromioclavicular joint glenohumeral is the actual shoulder joint scapulothoracic joint is in the back → important for impingement injuries

Most are not problematic except the great toe can often be reduced & taped use postop shoe or split great toe will often require surgery

Proximal [5'th metatarsal](https://smartypance.com/wp-content/uploads/2018/01/Jones-Fracture.jpg) diaphysis fracture Pain over the lateral border of the forefoot, especially with weight-bearing The fracture is believed to occur as a result of significant adduction force to the forefoot with the ankle in plantar flexion The area has a poor blood supply Treatment: Walking boot/cast, RICE, surgery for displaced fractures. Requires 6 weeks of non-weight bearing

410C Quiz 2: Neuro Imaging/Hx, MSK Imaging, Rheum, Acid-Base, Simulation Flashcards by Gillian Collom

Shoulder Joints

Contains the scapula, humerus, clavicle, glenohumeral joint, acromioclavicular joint
- glenohumeral is the actual shoulder joint
- scapulothoracic joint is in the back → important for impingement injuries

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Rotator Cuff General info

consists of SITS: supra spinatus, infra spinatus, teres minor, sub scapularis
- impingement syndrome → most important muscle = supra spinatus muscle b/c it passes beneath the acromion

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Y view of the shoulder

aka transcapular view b/c it shoots down the body of the scapula
used to look for impingement
gets a good look at the acromion
used to assess the acromion

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What is the grashey view?

Shoulder film

no overlap of the humerus and glenoid

Used to see the glenohumeral joint

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Xray of (lateral & AP) Elbow vs radial-capitellar view

Xray Elbow:
- cannot see the radial head that well
XR Elbow Radiocapitellar View:
- if suspect elbow fracture (usually a radial head fracture) → need to order a radiocapitellar view
- better view of the radial head

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Posterior vs Anterior Fat Pads in the Elbow

Anterior can be normal
Posterior is always Pathological
- indicative of a fracture

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Galeazzi Fracture vs Monteggia Fracture

“Gruesome Murder”

Galeazzi: Radial fracture, ulnar dislocation (distal)
Monteggia: Ulnar fracture, radial dislocation (proximal)

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Torus/Buckle Fracture

AP of the wrist
kids bones are covered with a very thick, fibrous periosteum
torus, buckle, and greenstick are all the same thing
**Only found in children → check for open growth plate

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Salter Harris Classification

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Pelvis Fractures

Super serious, major trauma!!

look for associated injuries

anticipate large blood loss
- up to 9-15 units of blood in unstable fractures
- external and internal iliac arteries are present anterior
- femoral artery, profunda and circumflex artery are present posterior
tx:
- admission
- look for associated injuries → vessel/bladder/nerve/head trauma/ cervical spine injuries
- Manage blood loss
- often surgical
  - **side note: pelvis & ankle are a ring so if there is one fracture it is still stable, but two make it unstable!!!

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Garden Classification of Hip Fractures

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Names of Different Fractures

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What do you do if you see a tibial plateau fracture?

if both side → need CT

could be due to MVA

need neurovascular exam ASAP

check hgb & HCT asap

give blood prn

check for compartment syndrome!

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Mortise Joint

the medial malleolus of the tibia forms the top of the mortise joint
can order a mortise view -→ can see both sides
- spaces in the mortise joint should be equal ~1mm
- if there is a difference in the spaces = displaced ankle

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Lisfranc Injury

VERY BAD, takes significant trauma
Can’t miss
usually requires surgery to repair
- and often has residual issues after surgery

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Phalangeal Fractures

Most are not problematic except the great toe

can often be reduced & taped
use postop shoe or split
great toe will often require surgery

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Jones Fracture

Proximal 5’th metatarsal diaphysis fracture
Pain over the lateral border of the forefoot, especially with weight-bearing
The fracture is believed to occur as a result of significant adduction force to the forefoot with the ankle in plantar flexion
The area has a poor blood supply
Treatment: Walking boot/cast, RICE, surgery for displaced fractures. Requires 6 weeks of non-weight bearing

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What should you never do with a fresh fracture?

put the pt in the cast → you need to splint then refer

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What films do you need to order for a shoulder dislocation?

Axillary View and AP view before AND after reduction

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If pt fell on their arm in full extension what film do you need to order?

Grashey view

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What is the most important muscle for impingement?

Supraspinatus

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If pt has impingement syndrome what film do you always order & why?

Y film → b/c if you don’t order Y view you might not know that the acromion is a type III which requires surgery and that is why the injury isn’t resolving → not enough anatomical space for the supraspinatus tendon

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If pt comes in for a fall on their hand with positive snuffbox tenderness what film should you order and why?

Scaphoid view b/c this is a scaphoid fracture until proven otherwise

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Admit Orders Mnemonic

ADC Vandalism

Admit to
Diagnosis
Condition
Vitals
Allergies
Nursing Orders
Diet
Activity
Labs
IV Fluids
Special Studies
Medications

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Inflammatory Vs Non-Inflammatory Disease

Important Hx Elements in Rheumatology

Synovial Fluid Analysis

Crystals in Gout vs Pseudogout vs Septic Joint

ESR vs CRP

Normal CRP Levels

≤ 0.9 mg/dL = normal to minor elevation (can be elevated due to obesity, pregnancy, DM, common cold, gingivitis, cigarette smoking, sedentary,etc.) ≤ 0.3 = normal healthy adult

ANA Testing

Rheumatoid Factor

Anti-CCP

Anemia of Chronic Disease

Causes of Anemia in Rheumatoid Arthritis

Axial vs Sagittal vs Coronal View of the Brain

How and What type of Brain CT do I order for a pt?

T or F: MRI is better for nerves & spinal Cord

True

Epidural vs Subdural Hematoma

What does this image show?

Hydrocephalus

What is Bright on a T1 vs T2 MRI

T1: blood & fat T2: water, inflammation, fat

T1 vs T2 weighted image anatomy of the spine

Clot vs Plasma on a CT vs MRI

Images Demonstrating which Vessels Supply Blood to Which Parts of the Brain

Lewy Body Dementia

Multiple Sclerosis

HSV Encephalitis

What can PET scans measure & what can they diagnose?

blood flow, oxygen use, sugar use Alzheimer's Disease, Depression, Epilepsy, Parkinson's Disease, **Cancer**

Why is EEG used?

diagnose and manage epilepsy investigate encephalitis, dementia, head trauma, brain tumors, hemorrhage

What is EMG?

Electromyography tests the muscle and the nerves to that muscle

Henderson-Hasselbach Equation

pH = pk + [base]/[acid]

Henderson-Hasselbach Equation and the bicarbonate buffer system

pk = 6.1 have to convert P_CO2 into its soluble acid H₂CO₃with its solubility coefficient = 0.03 P_CO2 \*0.03 =H₂CO₃

Bicarbonate Buffer System Equation

CO₂ +H₂O H₂CO₃ H⁺ + HCO₃^-

Common causes of respiratory acidosis

1. airway obstruction 2. disorders of lung tissues 3. respiratory depression due to oversedation, brain stem trauma 4. disorder of chest wall 5. paralysis of respiratory muscles 6. advanced COPD 7. asthma 8. sleep apnea \*\*pH \<7.35 and hypercapnia (high CO₂)

Respiratory Acidosis

* low pH, high CO₂ * causes potassium shift to the ECF due to the H/K shift; increases the free Ca²⁺ * lack of ventilation in relation to metabolic production of carbon dioxide

Metabolic Acidosis

* acids in the blood (excluding H₂CO₃ ) are increased * when acid is high in the blood, it soaks up HCO₃^- due to the buffer role bicarbonate plays and lowers the levels of bicarbonate * or bicarbonate is lost * pH \< 7.35, HCO₃^- \<24 * \*\*potassium shift to the ECF due to the H/K shift; increases free Ca²⁺ * \*\*\*\*\****_ANION GAP_***\*\*\*\* used to determine cause of metabolic acidosis

Causes of Metabolic Acidosis

1. certain types of diarrhea 2. lactic acidosis due to poor perfusion or hypoxia 3. Renal failure 4. diabetic ketoacidosis 5. ingestion (methanol, ethylene glycol [antifreeze])

Anion Gap

* used to determine the cause of Metabolic Acidosis * normal range 8-16 * equation: * ANION GAP = ([Na⁺] + [K⁺]) - ([HCO₃^-] + [Cl^-]) * if anion gap is HIGH, suggests that an acid is "soaking" up HCO₃^-

Respiratory Alkalosis

* levels of CO₂in the blood are low due to excess ventialtion relative to carbon dioxide production * pH \>7.45 abd hypocapnia * \*\*potassium shift to the ICF due to H/K shift, hypokalemia, and low serum free Ca²⁺

Common Causes of Respiratory Alkalosis

1. anxiety, panic disorders 2. excess mechanical ventilation 3. hypermetabolic states: 1. fever 2. anemia 3. thyrotoxicosis 4. pregnancy--\> increased progesterone increases RR

Metabolic Alkalosis

* Retention of HCO₃^- or excessive loss of metabolic acids * pH\>7.45, high HCO₃^- * \*\*\*potassium shift to the ICF , hypokalemia, less free serum Ca²⁺\*\*\*

Common Causes of Metabolic Alkalosis

1. vomiting 2. too much gastric suction 3. antacids/ excessive bicarbonate intake 4. hyperaldosteronism with hypokalemia 5. diuretics

Arrow trick for metabolic vs. respiratory alkalosis vs acidosis