Flashcards in Money makers Deck (41):
When do posterior shoulder dislocations commonly happen?
Post seizures and electrical shock
A patient has a painful, tense leg and you are worried about compartment syndrome. So you check for a pulse and there is one. Is compartment syndrome ruled out?
A patient comes in with a painful leg that is pale and cold. On exam, there is decreased sensation, it cannot be actively moved, and pulses are absent. What maneuver would most significantly diagnose compartment syndrome?
Pain with passive stretch
What is the most common wrist fracture?
Colles fracture (fall on outstretched arm...distal radius is posteriorly displaced +/- ulnar involvement)
Particular common in osteoporotic bone
What is a distal radius fracture called when it happens by falling on a flexed wrist and the radius is anteriorly displaced?
A guy gets pretty rowdy out at a club and a bouncer tries to hit him with a nightstick, so he blocks it with his forearm. The next morning when he sobers up a little, his arm is killing him. What fracture does he have to be worried about?
Monteggia fracture...dislocation of radial head and ulnar diaphysral fracture
What kind of back pain that radiates down the legs is worse with exertion?
What kind of back that radiates down the legs is worse with walking, standing?
What kind of back pain that radiates down the legs is worse with rest and better with activity?
What kind of back pain that radiates down the legs happens at rest or during the night?
Rule out cancer
What kind of back pain also causes bowel or bladder dysfunction or saddle area anesthesia?
Patient has back pain that is worse with straight leg raise or with valsalva. What is going on?
Degenerative joint disease
Patient comes in because he's having pain that goes down his arm and having a hard time lifting that arm up. On exam, he has decreased sensation to his anterior shoulder and decreased biceps reflex. What is going on?
Compression of C5...weak deltoid and biceps
Guy comes in concerned about pain in his arm and he can't lift as much and he says "Doc, I can't even open a beer can anymore." On exam, he has decreased sensation along his lateral forearm, and decreased brachioradialis reflex. What is going on?
Compression of C6...weak biceps and wrist extensors
Guy comes in and says, "this is going to sound like I'm whiny, but I've got pain in my left arm and I can't reposition myself in my chair like I used to be able to with that arm." On exam, he has decreased sensation along the posterior forearm and decreased triceps reflex. What is going on?
Compression of C7...weak triceps, wrist flexors, and finger extensors
A guy comes in and says, "Doc, I don't know what is wrong with me, but I've had to play pool left handed lately because I can't bridge as well as I used to be able to with my left hand." On exam, he has decreased sensation of his 4th and 5th digits and along his medial forearm. What is going on?
Compression of C8...weak finger flexors
A guy comes in because he keeps tripping with his right foot. As you watch him walk, he is kind of dragging his toes and on exam, he has decreased patellar reflex on that side and medial leg paresthesia. What is going on?
Compression of L4...weak tibialis anterior (foot dorsiflexion)
Guy comes in saying that he can't really feel anything on the lateral side of his proximal lower leg then it wraps around to his big toe, and he cannot really pick his big toe up on that side. What is going on?
Compression of L5...weak extensor hallicus longus
Guy comes in concerned about not being able to push off of his left foot. On exam, the lateral side of his foot has paresthesia, his achilles reflex is diminished, and he has weak plantarflexion and eversion. What is going on?
compression of S1...weak peroneus longs and brevis and gastrocnemius
Patient had a really bad fall where she landed on an object in the middle of her lower back. Since then she has had urinary retention and fecal incontinence. What is going on? What should be done?
Cauda equina syndrome
Immediate surgical decompression...IV corticosteroids can be given; radiation for malignancy
Patient comes in with arm pain, and the arm is extended and adducted with pronated. What is going on? What likely happened?
Erb-Duchenne palsy (injury to superior trunk)...presents with waiter's tip
Caused by hyperadduction of arm causing widening of the humeral-glenoid gap (birth...shoulder dystocia; also falling onto side of head/shoulder)
What causes claw hand?
weak lumbricals secondary to ulnar nerve injury from epiphyseal separation of median epicondyle of humerus
What causes wrist drop? What else is going on?
Posterior cord or radial nerve injury caused by mid-humerus fracture
Loss of sensation of dorsal hand
What makes it so person cannot elevate or abduct her arm?
Deltoid paralysis caused by axillary nerve damage...often via anterior shoulder dislocation
Person has claw hand, horner syndrome, and poor wrist and hand function. What is going on?
Klumpke palsy...posterior or medial cord injury due to hyperabduction of arm places excess tension on lower cords and nearby sympathetic chain
Person has had multiple fractures, vision loss, hearing loss, and neurologic symptoms. Labs show decreased Hgb and Hct, increased acid phosphatase, and increased creatinine kinase. What is going on? How is it treated?
Osteopetrosis...increased bone density causes nerve compression and decreased marrow cavities
Transfusion of marrow components necessary for osteoclast production
Patient comes in because her hats won't fit anymore and she doesn't hear as well as she used to. What could be going on? What should be done? How should this be treated?
Consider Paget's disease of bone (increased clast and blast activity)
Get a bone scan
Bisphosphonates and calcitonin
Kid comes in and you think that he is being abused because he has multiple fractures at different levels of healing, but then you see that he has blue sclera and has hypermobile joints. What is going on?
Osteogenesis imperfecta (genetic collagen defect)
What are sodium urate crystals? What is seen on aspiration?
Gout...uric acid does NOT have to be high
needle shaped, negatively bifringent crystals
What is it called when there are calcium pyrophosphate dihydrate crystals? Which joints are often affected? Which joint is NOT affected? What is seen on aspiration?
Pseudogout...chondrocalcinosis can also happen
Primarily affects wrists and knees
Does NOT affect big toe (Podagra)
rhomboid, positively bifringent crystals
A young sexually active girl comes in with unilateral knee pain. What should be considered? What would be seen gram stain? Is an I&D necessary?
Consider N. gonorrhea
Inflammatory response is not that severe...don't need to I&D
What is the most common cause of osteomyelitis in sickle cell patients? Drug abusers?
Staph a...just higher risk for salmonella
Staph a...just higher risk for pseudomonas
What are Heberden nodes? Bouchard nodes?
Heberden...bony protuberance on DIP joint
Bouchard...bony protuberance on PIP joint
Somebody comes in with joint pain and it says something about anticitrulline-containing protein IgM antibodies and/or HLA-DR4. What should you consider?
RA...it'd be stupid for them to give us that instead of rheumatoid factor, ANA, or elevated ESR, but whatever
You see antihistone antibodies. What is it?
You see anti-Jo-1 antibodies. What is it?
Polymyositis or dermatomyositis
You see HLA-B27. What is it?
Ankylosing spondylitis (most likely)
Psoriatic arthritis (maybe)
You see anti-Scl-70 ANA. What is it?
You seen anticentromere antibodies. What is it?
You see anti-RNP ANA. What is it?
Mixed connective tissue disease