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Block 2 > Clin Med > Flashcards

Clin Med Flashcards

1
Q

s/s of bursitis/subacromial impingement

A

pain in superior shoulder, posterior or radiating to lateral arm; worse after overhead activity, onset after repetitive activity; wake up at night in certain positions

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2
Q

why pain after overhead activity for bursitis?

A

subacromial bursa = pinch b/w greater tuberosity and acromion

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3
Q

how to test for bursitis?

A

Hawkins sign (pain w/ internal rotation of humerus); full/empty can for supraspinatus; + arc sign in 70°-120° and then moves easier there

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4
Q

plan for bursitis?

A

XR, antiinflamm, PT

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5
Q

what is RC tear/tendonitis? S/s? Dx?

A

bursitis can progress to RC tear over time –> longer lasting bursitis sxs. Wake up at night d/t pain in any position. Hawkins sign, supraspinatus atrophy

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6
Q

Grade I vs II vs III bursitis

A

edema and hemorrhage vs fibrosis, thickening, partial tuff tearing vs thickness tendon tear, bony changes, tendon rupture

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7
Q

s/s of osteoarthritis

A

pain, morning stiffness, reduced ROM, muscular atrophy

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8
Q

s/s vs dx vs tx of proximal humerus shoulder fx/little leaguer’s shoulder

A

overuse d/t repetitive throwing; pain at supero-lateral shoulder and lateral deltoid vs XR showing widening proximal humeral growth plate vs sling and rest, PT, pain ctrl

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9
Q

s/s of adhesive capsulitis/frozen shoulder

A

BOTH limited active & passive ROM, progressive pain; assoc w/ DM, thyroid, mastectomy, RA, lung ca/TB/COPD

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10
Q

how to tx adhesive capsulitis

A

pain ctrl (calcitonin nasal spray, steroids, NSAIDs, intraarticular injection), PT, Spencer’s technique

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11
Q

anterior dislocations = subclassifed into:

A

subcoronoid (85%), subglenoid, subclavicular, intrathoracic

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12
Q

imging for anterior dislocation/instability

A

Hill-Sachs lesion: posterolateral humeral head compresses/fx as it impact anterior inferior glenoid rim; Bankart fx: anterior inferior glenoid rim fx as humeral head dislocates –> labrum pulls bone away as part of tear

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13
Q

how to tx anterior dislocation

A

surgery if <25yo, rehab if >25yo; pain ctrl, immobilization. closed reduction w/ sedation or open reduction in OR

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14
Q

SLAP lesions

A

superior labral tear in ant-post plane. most common cause of dislocation; labrum = separated from glenoid

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15
Q

how to tx SLAP lesion?

A

antiinflam, PT, MR arthrogram, orthopedic surgeon

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16
Q

how to test vs tx AC joint separation

A

observe, palpate, Chuck Norris test vs ice, sling and rest, NSAIDs

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17
Q

how to dx vs tx clavicle fx?

A

observe, palpate, pain w/ any ROM above 90 degrees, XR vs surgery if bones overlap

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18
Q

3 types of clavicle fx: I/middle 1/3 fx vs II/lateral fx vs III/medial fx

A

72-80% of all clavicle fx vs 25-30% of all clavicle fx vs 2% of all clavicle fx

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19
Q

bicep tendon rupture

A

“Popeye” muscle; anterior pain but painless “pop”, pain at bicipital groove, weak supination = complication

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20
Q

Major risk factors of osteoporosis

A

Menopause, thin frame, steroids/meds, inactivity/smoking, fhx, DM/hypogonad, fx w/ bone loss

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21
Q

Bone remodeling: bone formation vs resorption

A

Blasts and stromal cells release OPG —> binds and sequesters RANKL —> inhibits clasts vs PTH binds to blasts —> blasts secrete RANKL and M-CSF —> clast precursor to mature clasts; 1,25 vit D stimulates RANKL; PGE2 activates adenylyl cyclase —> resorption; IL6 and MIP1A activated for myeloma

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22
Q

Molec for osteoclast inhibition

A

Blasts and stromal cells release OPG —> OPG binds and sequesters RANKL —> inhibit clast activation and differentiation; calcitonin interacts w/ clasts via cell-surface receptors —> dec RANKL; estrogen inc bone formation and inhibits activation of adenylyl cyclase —> dec resorption; TGFB and IL10 suppress clasts

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23
Q

Primary vs secondary osteoporosis

A

D/t age or loss of gonad fxn; not assoc w/ other dz vs microarchitectural alterations d/t other dz or med

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24
Q

How does vit D let Ca2+ defic and secondary hyper parathyroidism contribute to osteoporosis?

A

Aging skin + dec sun exposure —> dec 7-dehydrocholesterol to cholecalciferol —> vit D defic —> dec Ca2+ absorption —> inc PTH to main serum Ca2+ —> bone resorption

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25
Q

Meds causing/ osteoporosis

A

Steroids, excess thyroid hormones, GnRH agonists (br and prostate ca), cyclosporine, methotrexate, pheno-, heparin

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26
Q

Recs to prevent osteoporosis

A

Calcium (1200mg) and vit D (400-800IU/d regardless of sun), wt bearing exer/axial loading (start light and inc), stop tobacco and alc

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27
Q

DEXA vs FRAX

A

Measures femoral neck, hip, spine vs fx risk assessment tool to predict 10yr probabilities of osteoporotic and hip fxs; takes nicotine, alc, and glucocorticoids into account; rec for 40-90yo

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28
Q

How to tx osteoporosis?

A

Use preventive measures, bisphosphonates, SERMS, calcitonin

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29
Q

Bisphosphonates: alendronate vs residronate vs etidronate

A

Inc bone density of spine and hip, dec vertebral fx rate; GI side effects: esophagitis, dyspepsia, N/V/D, MSK pain vs inc bone density of spine and hip, dec vertebral fx rate; GI side effects vs not approved tx for osteoporosis —> use for idiopathic osteoporosis if other meds don’t work

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30
Q

Instructions for taking bisphosphonates

A

1st thing in morning before eating/drinking, take w/ at least 8oz of water upright sitting or standing and stay upright for 30min after ingestion; don’t eat/drink after 30min ingestion

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31
Q

How do bisphosphonates work? What’s one contraindication?

A

Stop bone resorption. Osteonecrosis of jaw —> don’t give to pts w/ oral dz, make sure pts have dental exam before rx

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32
Q

Teriparatide

A

Recombinant PTH1-34 inc bone density of spine after 3mo and hip after 6-12mo; trabecular bone inc first then cortical bone after a year

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33
Q

Selective estrogen receptor modulators (SERM)

A

Estrogen agonist in bone and heart —> inc blast activity; estrogen antagonist in br and ut —> dec br and ut ca

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34
Q

SERM: raloxifene

A

For post menopausal women; dec bone turnover, dec vertebral fx, dec br ca, dec total chol and LDL; side effects: flu like sxs, hot flashes, leg cramps, peripheral edema

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35
Q

Prolia/Denosumab

A

Monoclonal ab that protects healthy cells from dmg —> for postemenopausal women and men who have high fx risk, for pts w/ prostate or br ca to tx bone loss

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36
Q

Calcitonin

A

Inc BMD, dec vertebral fx, no stats on hip fx; possible analgesic effect in women w/ compression fx

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37
Q

Asx vs sx of vertebral fx

A

Dx by radiographs, inc kyphosis, dec height, chronic back pain d/t vertebral compression vs pain lasts 2-4wks, debilitating

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38
Q

How to tx vertebral fx?

A

NSAIDs, calcitonin; narcotics for pain ctrl; OMT or PT for acute and chronic pain; postural exer; education, support groups

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39
Q

What’s percutaneous vertebroplasty?

A

If pts don’t respond to conservative tx or cont to have pain —> inject acrylic cement into collapsed vertebra to stabilize and strengthen fx and vertebral body (DOES NOT restore shape or height of compressed vertebra)

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40
Q

What’s kyphoplasty?

A

Cement = injected into cavity by high pressure balloon; being eval and could restore height to collapsed vertebra

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41
Q

Paget’s dz

A

Localized bone d/o when you have high clast activity then high blast activity to compensate —> unorganized bone pattern; larger, weaker, more vascular, less compact bone —> more fx

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42
Q

How to dx Paget’s?

A

XR, blood test (high serum ALP), bone scan

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43
Q

3 phases of Paget’s: lytic vs mixed vs sclerotic

A

High clast activity —> inc bone turnover vs high blast activity to compensate —> unorganized bone formation —> resorption + formation —> inc bone turnover vs inc blast activity —> unorganized bone formation, infiltrated by fibrous connective tissue —> hyper vascular

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44
Q

Sxs of Paget’s

A

Bone pain, secondary arthritis, bone deformity, excess warmth (d/t hyper vascular), neurological complications (d/t nerve compression)

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45
Q

If pt comes in with acute monoarthritis case w/ fever 101, what would you do?

A

If infxn —> labs (CBC —> high WBC, ESR and CRP = inflamm; joint aspiration to look at fluid —> gram stain vs crystals). If bone at risk —> XR (usually first test ordered)

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46
Q

Noninflamm vs inflammatory s/s for RA

A

No morning stiffness, pain worsens w/ activity (nml CRP) vs morning stiffness, “gel” phenomenon (high CRP), warmth or erythema

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47
Q

Labs for rheumatic dzs: ESR vs C reactive protein

A

Blood drawn into long thin tube and set for 1hr; Rate = dependent on conc of igG and fibrinogen vs IL1, IL6, TNF alpha activate acute phase response —> inc liver proteins —> inflamm

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48
Q

Criteria for RA dx

A

6wks of: Morning stiffness 1hr+, swelling of 3+ joints, swelling of hand joints (PIP, MCP, wrist), symmetric swelling; subq nodules; labs: serum RF, ANA

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49
Q

Rheumatoid Factor (RF) vs Anti-nuclear ab (ANA) vs Anti-Citrullinated Protein Antibodies (ACPA)

A

Mult proteins bind to Fc portion of IgG, nonspecific vs Targets nml nuclear proteins; if pos —> autoab = present, nonspecific (found in 95% of lupus, scleroderma, polymyositis) vs tested by ELISA, antiCCP dx RA

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50
Q

6 diffuse connective tissue dzs

A

RA, systemic lupus erythematosus, systemic sclerosis/scleroderma, polymyositis, dermatomyositis, Sjogren’s

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51
Q

Anti-ribonucleoprotein (anti-RNP)

A

Assoc w/ mixed connective tissue dz > SLE > scleroderma > RA

52
Q

Scleroderma markers

A

Anti-SCL70 —> diffuse scleroderma, anti-topoisomerase1; anti-centromere (ACA) —> correlates w/ CREST syndrome

53
Q

Inflammatory myopathy aka myositis

A

Dzs involving chronic muscle inflam w/ muscle weakness; high ESR and CK, anti-Jo1 ab targets histidine-tRNA ligase (assoc w/ cracked hands, Raynaud’s phenomenon, arthritis)

54
Q

Anti-neutrophil cytoplasmic ab

A

C-ANCA; p-ANCA —> autoimmune liver dz, RA, inflamm bowel dz. If pos —> do titer (higher titer —> more ab in blood)

55
Q

When to do XR vs CT vs MRI vs MR arthrogram vs myelogram vs electromyogram vs nerve conduction test for MSK pain?

A

Good for trauma not stress fx; picks up mass/tumor; usually first study done vs good for fx vs for muscle/soft tissue problems like RC or labra tears vs MRI w/ contrast w/in joint, for instability and can find fluid leaks vs MRI CT w/ contrast in spinal canal for spinal problems vs measures electrical activity of muscles at rest and ctx vs measures how fast and well nerves send electrical signals

56
Q

OA/DJD

A

Slow progressive joint dz where articular cartilage breaks down d/t high loads on joint surfaces —> loss of proteoglycans and chondrocytes in the cartilage; most common form of arthritis

57
Q

Cartilage vs joint capsule vs synovium vs synovial fluid

A

Lubricating surface at end of bone, “shock absorber” vs tough membrane sac holding bones and joints together vs thin membrane inside joint capsule vs fluid lubricating joint and keeping cartilage smooth and healthy

58
Q

Primary vs secondary vs erosive osteoarthritis

A

D/t age (55-60yo) b/c the longer you use joints the more likely to develop OA vs d/t previous joint injuries or fx (45-50yo), inactivity (weaker muscles/tendons surrounding joint), genetics, other dz vs more severe; combo of cartilage degeneration w/ inflamm synovial changes; more in women post menopause

59
Q

Why does articular cartilage degenerate?

A

Poor access to nutrients for chondrocytes deep in cartilage —> dec water and more small cavities in matrix —> calcification of cartilage —> chondrocytes die; adult chondrocytes can’t keep up pace of regen

60
Q

Components of cartilage: water vs collagen vs proteoglycans vs chondrocytes

A

65-80% vs fibrous protein in connective tissue vs combo of proteins and sugars that weave w/ collagen to make mesh —> shock absorber fxn of cartilage vs cells that maintain cartilage’s health

61
Q

OA of knee may involve?

A

Medial or lateral femorotibial compartment —> genu varus/bowleg or genu valgus/knock knee, patellofemoral compartment, small effusions, crepitus

62
Q

OA of hands may involve?

A

Bouchard’s nodes at PIP, Heberden’s nodes at DIP (most common of idiopathic OA); pain, redness, swelling of joints

63
Q

What do radiographs show for OA?

A

Joint space narrowing in medial compartment, osteophytes, subchondral sclerosis

64
Q

How to tx for OA?

A

Reduction of joint loading, exer/PT, drug therapy, intraarticular therapy (corticosteroids, hyaluronic acid), surgery (if meds fail)

65
Q

Types of exer to tx OA

A

Strength: add resistance; aerobics: lungs and circ in shape; ROM activities: limber joints; agility: maintain daily living skills; neck and back strength: stronger and limber spine

66
Q

Types of meds for OA

A

Analgesics, NSAIDs, opioids, CAM, gemmotherapy

67
Q

Risk factors of OA

A

Age, women, race, genetics, joint trauma, repetitive stress, obesity

68
Q

Pathology of OA

A

Thicker cartilage —> joint surface thins, cartilage softens, integrity = breached —> vertical clefts develop => fibrillation —> deep cartilage ulcers, becomes hypocellular

69
Q

Spine OA: apophyseal joint vs spondylosis vs spondylolysis vs spondylolisthesis vs spondylitis

A

Joint around bone that has no independent ossification; 2+ bones join w/ spine vs ankylosis/stiffening of vertebrae vs degen of articulating part of vertebrae vs forward movement of body of one lower vertebrae on vertebrae below it vs inflam of 1+ vertebral bodies

70
Q

Spinal stenosis

A

Narrowing of spinal canal —> compresses spinal cord in neck, cauda equina nerve roots in low back —> back pain, radiating pain, numb, muscle weakness in limbs (better when sitting, worse when walking), bladder/bowel disturbances

71
Q

How to tx spinal stenosis?

A

OMT/PT, wt loss, posture change, pain meds, laminectomy

72
Q

Risks vs complications of laminectomy

A

depends on # of lvls compressed, other medical conditions, difficult anatomy, marked stenotic canal vs wound infxn, hematoma, dural tears, risk of meningitis, nerve root dmg, postoperative spinal instability

73
Q

Scoliosis. What are the 4 types?

A

Spine curvature in coronal plane >10degrees; dextroscoliosis (thoracic) levoscoliosis (lumbar, thoracic —> likely tumor). Congenital, neuromuscular, compensatory, idiopathic

74
Q

Congenital scoliosis

A

Spinal curvature from asymmetric spinal growth, implies failure of segmentation or formation of vertebral elements assoc w/ fused ribs and spinal cord anomalies; partial or complete failure of segmentation —> unsegmented bar —> spine = fused, partial or complete failure of vertebral formation —> hemivertebra/wedging —> growth centers

75
Q

Congenital scoliosis: VACTERL vs Klippel-Feil syndrome

A

Vertebral anomalies, anal atresia, cardiac defects, tracheoesophageal fistula, renal defects, limb defects vs variable fusion of C2-6 —> AA instability; triad: limited neck motion, low hair line, short neck; deaf, GU abnlities, CV abnlities, Sprengel’s deformity = congenital elevation of scapula

76
Q

Neuromuscular scoliosis

A

In children w/ cerebral palsy, muscular dystrophy, SMA, congenital myopathies or neuromuscular conditions, spina bifida, spinal cord injuries; nonambulatory pts at risk; rapid progression of curvature than idiopathic

77
Q

Compensatory scoliosis

A

D/t body’s compensatory mechanisms (ex: leg length discrepancy); tx = shoe lifts

78
Q

Idiopathic scoliosis. Complications?

A

Curvature w/o identifiable cause; most common type; females > males; early onset = infant (<3yo) or juvenile (4-10yo), late onset = 12yo multifactorial. Thoracic insufficiency syndrome - deformed thoracic rib cage —> impaired and restricted lung growth and fxn —> restrictive lung dz (thoracic curve > 70degrees —> compromised resp fxn, thoracic curve = 75-80degrees —> cardiopulmonary comproomise

79
Q

How to screen scoliosis?

A

US Preventative Services Task Force and American Academy of Family Physicians rec AGAINST screening asx adolescents; American Academy of Orthopedic Surgeons & Peds and Scoliosis Research Society rec screening girls 10-12yo & boys 13-14yo; Bright Futures rec screening >8yo

80
Q

How to dx scoliosis?

A

Shoulder and waist asymmetry, unilateral scapular prominence; PA spine radiograph to assess coronal curvature, lateral spine radiograph to assess sagittal alignment, pelvic radiograph to chk iliac crests (all radiographs should be done standing)

81
Q

Cobb angle

A

Determine end vertebra of curve (based on ends of con cavity of curve) —> draw 2 perpendicular lines, one from top and bottom —> meet the 2 lines so you have right angles from each —> measure angle in b/w

82
Q

risser sign for scoliosis

A

Grade 0-2: substantial growth remaining
Grade 3: little growth remaining; monitor q6-12mo till 1 yr after skel maturity
Grade 4 in girls and Grade 5 in boys: skel maturity

83
Q

How to tx scoliosis?

A

Cobb angle </= 10 degrees: rpt imaging if curve progresses
Cobb angle 11-19 degrees: observation w/ f/u q 6-8mo
Cobb angle 20-29 degrees: refer to ortho and f/u q 6mo
Cobb angle >30 degrees or progressing >5 degrees in 3-6mo period: bracing
Cobb angle >50 degrees: surgery

84
Q

Scoliosis indications for referral

A

Cobb angle = 20-29 degrees in premenarchal girls and boys 12-14yo, Cobb angle >30 degrees for any pt, progression of >5 degrees for any pt; scoliometer >/= 7 degrees in pts w/ BMI <85th percentile, scoliometer >/=5 degrees in pts w/ BMI >85th percentile; sig back pain w/ presentation; L sided curve = high incidence of intraspinal pathology (syrinx or tumor)

85
Q

How can OMT help scoliosis?

A

Optimize mobility, improve musculature strength (psoas, abd muscles), stretch tight tissues, correct somatic dysfxns (ME, MR, HVLA = good for fxnal but not for structural)

86
Q

Kyphosis. Causes vs tx

A

Spine curvature in sagittal plane (nml thoracic curve = 25-50 degrees). Congenital vertebral anomalies, spinal growth disturbance (Scheuermann dz), neuromuscular afflictions, metabolic dz, skel dysplasia, posture vs none if mild curve and skel mature; exer and education to dec complications; bracing, surgery if >70 degrees w/ back pain

87
Q

Scheurmann dz

A

Most common cause of FIXED kyphosis deformity; 13-16yo, boys > girls; presents w/ h/o poor posture, thoracic curve, hyperlordosis of lower spine, +/- hamstring tightness; can be assoc w/ spondylosis

88
Q

OI/brittle bone dz

A

Auto doom mutation in COL1A1/2 in type I collagen

89
Q

4 types of OI: I vs II vs III vs IV

A

Blue sclerae for all (in dec severity). most common and mildest; nml stature, no bone deformity, recurrent childhood fx vs most severe —> lethal; short; intraut fx vs most severe if survive neonatal; short, mod to severe bone/pectoral deformity, hearing loss, in utero fx vs moderate; short, bone deformity/bowing, hearing loss, in utero fx

90
Q

What labs to do for OI?

A

Collagen seq, XR, CBC w/ diff, coag panel (PT, PTT/INR), CMP, electrolytes, child abuse team consults (ortho, ophtho, hem/onc, genetics)

91
Q

Complications vs tx of OI

A

Recurrent PNA, cor pulmonale for adults, brain stem compression from basilar skull defects, hydrocephalus vs no cure; reduce freq of fx, prevent long bone deformity and scoliosis, minimize pain; PT, calcium and fluoride supplements, bisphosphonates —> inhibit resorption, GH (experimental at this time)

92
Q

Non accidental trauma

A

Inconsistent hx, retinal or subdural hemorrhage, fx in mult healing stages, spiral or long bone fx, delay in care

93
Q

achondroplasia/short limb dwarfism

A

Auto dom mutation in FGFR3 gene —> Short limbs, nml trunk, large head w/ prominent forehead and mid face hypoplasia

94
Q

How to dx ACH?

A

Skel surgery, fhx, PE: short stature and limbs, large head w/ frontal bossing and mid face hypoplasia, brachydactyly/short digits, limited elbow extension, lumbar lordosis, genu varum/bow legs; gross motor delay

95
Q

Complications vs tx for ACH

A

Failure to thrive, recurrent otitis media, quadriparesis, spinal cord compression, urinary and bowel incontinence, obstructive sleep apnea, SIDS d/t cervical medullary compression vs multidisciplinary supportive care (PCP, endo, ortho, PT/OT, neuro, plum), GH, surgical limb extensions

96
Q

rickets

A

Dec bone mineralization of growth plate d/t vit D defic b/c of vit d receptor d/o, malabsorption, renal d/o, inadeq intake

97
Q

S/s of rickets

A

Craniotabes/ping pong skull, Harrison sulcus - groove at lower thorax caused by pulling diaphragm on ribs, rachitic rosary - enlargement of costochondral jxn, metaphysical cupping on XR: widening of growth plates at wrists & ankles, delayed fontanelle closure

98
Q

How to dx vs lab findings for rickets

A

Diet, pmhx, PE, imging, labs like CMP/UA/PTH/vit ADEK/coat. Inc ALP, PTH and dec Ca2+, PO43-

99
Q

How to tx rickets?

A

Vit D rich foods (milk, cheese, soy, egg yolk, fatty fish), vit D supplementation (2000-5000IU)

100
Q

Scurvy/Barlow dz

A

Vit C defic —> can’t hydroxylate pro/lys —> no collagen synthesis —> bruising/Pete hair, gingivitis w/ bleeding, impaired wound healing, anemia, subperiosteal hemorrhage, muscle weakness/tenderness

101
Q

How to dx vs tx scurvy?

A

Horizontal lines of calcification (white line of Frankel), osteopenia, wimburger’s sign (rimmed circle) vs vit C supplement (100-200mg daily)

102
Q

S/s of scapular winging

A

FOOSH, posterior shoulder dislocation, long thoracic nerve palsy, thoracic/rib dysfxn

103
Q

indications for nonoperative care vs operative care for fx

A
  • Nondisplaced fractures
  • Acceptable angulation
  • Closed reduction with manipulation
    vs
    closed reduction fails, articular surfaces are displaced (“step-off”), fracture is secondary to tumor metastasis, multiple injuries present; Emergency –> open fractures and unstable fractures and dislocations
104
Q

translation vs angulation vs shortening

A

sideways motion of the fracture; % of movement when compared to the diameter of the bone vs amount of bend at the fracture described in degrees; Described with reference to position of distal part vs amount a fracture has collapsed; Fractures can only shorten with 100% displacement

105
Q

Salter Harris: I vs II vs III vs IV vs V

A

only in children w/ growth plates. thru physis –> won’t show on XR –> clinical dx vs thru physis and metaphysis; MOST COMMON vs thru physis and epiphysis vs thru epi/meta/physis –> surgery vs crush injury to physis –> premature growth plate closure (distal ulnar plate dmged –> 50-60% chance closure, distal radial plate dmged –> 8-10% chance closure); CLASSIC GYMNAST WRIST

106
Q

when do growth plates stop growing in children?

A

girls 14yo, boys 16yo

107
Q

types of hip fxs

A

intertrochanteric –> tx w/ cephalomedullary nail; subtrochanteric, fx of greater trochanter, fx of lesser trochanter, femoral neck

108
Q

how can you get anterior vs posterior vs inferior shoulder dislocation?

A

abduction, external rotation vs adduction, internal rotation, sz; light bulb sign vs hyperabduction, levering on acromion, ELECTROCUTION

109
Q

complications for shoulder dislocation?

A

o Recurrent dislocation: age at first dislocation
o Rotator cuff tear: elderly
o Axillary nerve injury
o Axillary artery injury
o Shoulder stiffness – prolonged immobilization
o Unreduced (undiagnosed) dislocation

110
Q

what’s a stable fx?

A

fracture that does not have a tendency to displace after it has been reduced and immobilized

111
Q

Allen’s test

A
  • Used for volar ganglion cyst, checks volar radial artery
  • The hand is elevated and the patient/person is asked to make a fist for about 30 seconds
  • Pressure is applied over the ulnar and the radial arteries to occlude both of them
  • The hand is then opened → it should appear blanched
  • Radial or ulnar pressure is released → the color should return within 5 seconds
112
Q

common forearm fx: Colle’s vs Smith’s vs Barton’s vs Chauffeur’s

A

d/t FOOSH. extra-articular, oblique, dorsally displaced, fracture of the distal radius vs extra-articular, oblique, volarly displaced, fracture of the distal radius  requires surgery vs intraarticular fracture of the distal radius with dislocation of the radio-carpal joint – dorsal or volar, carpal bones displace with the fracture fragment → always needs surgery vs nondisplaced radial styloid fracture

113
Q

Essex-Leprosti lesion

A
  • Comminuted radial head fracture, longitudinal radio-ulnar dissociation with disruption of the forearm interosseous ligament
114
Q

s/s vs tx of hook of hamate fx

A

: pain at hamate hook, ulnar neuropathy, weakness, often negative x-ray findings → must get a CT scan vs cast – high nonunion, ORIF – risk of ulnar nerve injury, excision of hook of hamate – fastest recovery

115
Q

s/s vs dx vs tx of scaphoid fx

A

from FOOSH, MOST COMMON WRIST FX; swelling of anatomical snuffbox vs XR vs splint 7-10d then rpt XR, get CT if neg XR, cast if nondisplaced but otherwise ORIF

116
Q

scaphoid fx: Presier’s disease vs Keinbock’s disease

A

avascular necrosis of scaphoid vs avascular necrosis of lunate

117
Q

Scapholunate ligament tear gives what sign?

A

Terry Thomas sign (think gap teeth example); if left untxed –> slack wrist due to scaphoid lunate advanced collapse

118
Q

perilunate dislocation of wrist

A
  • Lunate is not articulating with capitate → disruption of Gilula lines
  • Double density
  • If lunate is in carpal tunnel → surgical emergency, urgent ORIF
119
Q

Bennet’s fx vs Rolando’s fx

A

intraarticular, oblique, displaced fx of ulnar base at 1st metacarpal vs intraarticular, comminuted, displaced fx of ulnar base at 1st metacarpal

120
Q

Stener lesion (“Gamekeeper’s Thumb, Skier’s Thumb”)

A

Adduct aponeurosis prevents reduction of the ulnar collateral ligament

121
Q

distal phalangeal fx

A

open fx but not txed like any other open fx –> Irrigate in ER, gentle approximate skin, and cover with antibiotics, and splint. do surgery if ligaments = severely displaced

122
Q

how to tx Mallet fx?

A

Stax splinting 24/7 for 6 wks; do surgery if:
o Joint surface > 50% involved
o Incongruent DIP joint
o Irreducible piece
o Drooping finger malunion

123
Q

fingernail infxns: felon vs Paronychial infection

A
  • Infection of fingernail pulp
  • Aka “finger compartment syndrome”
  • Needs urgent I&D, usually done in the ER or urgent care
  • oral antibiotics
    vs
  • I&D and nail removal
  • Oral antibiotics and soaks
124
Q

how to tx Dorsal fracture/dislocation of the PIP joint

A

splint dorsal side;
o Nonoperative
o Volar plate arthroplasty
o Pin fixation
o External fixation
o Fusion

125
Q

Indications for surgery for fxs

A

open fx, unstable fx, irreducible fx, mult fx, fx w/ bone loss, fx w/ tendon involvement

126
Q

nml double density examples

A

pisiform on triquetrum, hook of hamate, trapezium on trapezoid

Block 2 (16 decks)

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