Bone Flashcards
(47 cards)
Testing abductor pollicis brevis tells us the state of what nerve?
median
[interossei=ulnar]
Mallet finger and jersey finger treatments?
6 wks splint
Fight bite 1st step in mgmt.?
X-ray to r/o fracture or foreign body (tooth)
[next irrigation & abx]
Skier’s/Gamekeeper’s thumb dx test? tx?
- Apply valgus force to thumb
- surgery or splint [this is the only hand injury we learned that warrants surgery!]
How to dx developmental hip dysplasia in baby? In child? Tx?
- Ortolani sign in newborn (flex hip, pops out)
- Abduction limited by adductor longus in child
- Pavlik Harness
Unilateral hip pain in a 7 year old child that is WORSE with abduction and internal rotation. First step in mgmt?
-Joint aspiration to rule out other causes. Transient/toxic synovitis is m.c.c. of hip pain in kids under 10, but is a dx of exclusion basically. [Tx is nothing/NSAID, goes away in a week]
Groin/medial thigh/knee pain in an obese 12-year old who can’t bear weight due to pain. On exam, you’re unable to internally rotate hip. 1st step in mgmt? Prognosis?
- X-ray for ice cream that doesn’t pass the line. (Klein line) -> orthopaedic surgery for slipped capital femoral epiphysis
- Prognosis depends not on the fact that it was an unstable slip (she couldn’t bear weight) but on how FAR it slipped in cm, so you can’t say prognosis w/o this info.
When taking orthopaedic history, what are bone red flags? 1st step in mgmt?
-up pain at night/with rest, enlarging mass, Frx with small force
-X-ray
(Think tumor)
Antalgic gait is?
Spending little time on a foot
Trendelenburg gait is?
weak glut. medius -> hip drops on opposite side OR person leans trunk to same side as lesion to balance on top of the bad hip.
Lurch gait is?
weak glut. maximus-> patient lurches backward to avoid falling forward with every step
What is the first thing patients lose when a joint goes bad?
ROTATION, so make sure to check this in your exam.
[then other motions like flex/extend, etc]
“Doc! I’ve got isthmic spondylolysthesis in my back!” What signs will I show?
- acute back pain w/ dermatome leg pain
- Straight leg raise (L2-4) OR femoral stretch test (L4-S2)evokes pain
[same signs for herniated nucleus pulposis]
“Doc! I’ve herniated my nucleus pulposis!” It hurts worse when I bend which way?
pain is WORSE w/ flexion (sit/bend/lift)
“Doc! I’m back again with spinal stenosis!” It hurts worse when I bend which way?
pain is WORSE w/ extension (standing/walking/moving) made better by sitting/lying
Doc, this time all I know is it’s low back pain. What will you treat me with? What’s the exception?
- “conservative” think NSAIDS etc
- Laminectomy if you have spinal stenosis causing SEVERE neurogenic claudication
Refer to an orthopaedic surgeon if you see which of the following frx on radiology? spiral, translational, foreshaortening, distraction, open, complex
-ALL of those refer! Simpler ones are ok.
You have orthopaedic trauma pt come in. What is first step in mgmt?
X-ray 2 perpendicular views! (then CT if spine issue, MRI if soft tissue suspected)
Which is the best (not the first) test for someone w/ bone pain after a recent upper respiratory infection? Tx?
- MRI (if I understand right, you’d do an x-ray first since it’s bone pain, but w/ osteomyelitis x-ray catches changes only after 2 wks, so you’d follow up w/ MRI)
- Aspiration/debridement THEN antibiotics
Joint infection: 1st step?
joint aspiration + abx
soft tissue infection: 1st step?
x-ray for gas (then MRI if needed)
I’m a kid and after x-rays AND physical exam, it’s unclear why my extremity hurts. What do you do?
-Aspirate it. (cancer? joint infection?)
Little Milo has leg pain near a joint after trauma, but you see nothing on x-ray. What do you do?
-PE: Jam your hand in and see if palpation of the physis hurts. Then totally immobilize Milo’s joint, and re-xray it 2 weeks later looking for “reactive processes”
[occult physeal injury]
Little Milo, age 12, fractured his femur. What’s tx?
Pound some nails into his leg
[Pavlik harness for infant, spica cast for 6 mo to 5 yr, flexible nails for 6-11 yr]
