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First Aid Step 2 > MS/ Orthopedic Surgery > Flashcards

MS/ Orthopedic Surgery Flashcards

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1
Q

Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips

A

Spinal stensis

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2
Q

Joints in the hand affected in RA

A

MCP and PIP joints, DIP spared

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3
Q

Joint pain and stiffness that worsen over the course of the day and are relieved by rest

A

OA

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4
Q

Genetic disorder that is associated with multiple fractures and blue sclerae and is commonly mistaken for child abuse

A

Osteogenesis imperfecta

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5
Q

Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Dx test?

A

Suspect ankylosing spondylitis

Check HLA-b27

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6
Q

Arthritis, conjunctivitis, urethritis in young men. Associated organisms?

A

Reactive (Reiter’s) arthritis
Bugs: Chlyamydia, also think Camplylobacter, Shigella, Salmonella, Ureaplasma
HLA B27
Can follow enteric infection

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7
Q

55 yo man has sudden excruciating MTP joint pain after a night of drinking red wine. Dx, workup, and chronic Tx?

A

Gout
Needle shaped negatively birefringent crystals
Chronic Tx: allopurinol or probenecid

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8
Q

Rhomboid shaped positively birefringent crystal on joint fluid aspirate

A

Pseudogout

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9
Q

Elderly woman with pain and stiffness in shoulders and hips, cannot lift arms above head. Labs show inc ESR and anemia

A

Polymyalgia rheumatic

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10
Q

Active 13 yo boy has anterior knee pain, Dx?

A

Osgood Schlatter disease

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11
Q

Bone fx in fall on outstretched hand

Describe position of Fx

A

Distal radius = Colles fracture - dinner fork

Dorsally displaced, dorsally angulated

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12
Q

Complication of scaphoid fracture

A

vasular necrosis

may not see on x-ray for 1-2 wks

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13
Q

Signs suggesting radial nerve damage with humeral fracture

A

Wrist drop, loss of thumb abduction

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14
Q

Young child presents with proximal mm weakness, waddling gait, pronounced calf mm

A

Duchenne muscular dystrophy

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15
Q

First born female born in breech position found to have asymmetric skin folds on newborn exam. Dx? Tx?

A

Developmental dysplasia of hip

If severe, consider Pavlik harness to maintain abduction

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16
Q

11 yo African Am boy presents with sudden onset of limp. Dx? Workup?

A

SCFE

AP and frog leg lateral X-rays

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17
Q

Most common primary malignant tumor of bone

A

Multiple myeloma

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18
Q

Anterior dislocation of shoulder hits what nerve

A

Axillary n

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19
Q

Anterior dislocation of shoulder- position pt holds arm in?

A

Abduction and ER

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20
Q

What would cause posterior dislocation of shoulder?

A

seizure, electrocution

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21
Q

Posterior dislocation of shoulder- hold in what position?

A

ADDuction and IR

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22
Q

Anterior dislocation of hip can damage what nerve

A

Obturator n

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23
Q

Most common hip dislocation

A

Posterior

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24
Q

Cause of posterior hip dislocation

A

Anteriorly directed force on IR, F, ADD hip = Dashboard injury

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25
Risks of posterior hip dislocation
Sciatic n injury | Avascular necrosis
26
Tenderness in anatomical snuffbox | Fall on radially deviated outstretch hand
Assume scaphoid Fx
27
Tx scaphoid Fx
Thumb spica cast
28
Fx 5th metatarsal neck | Due to forward trauma of closed fist - punching a wall
Boxer's Fx
29
Tx Boxer's FX
closed reduction and ulnar gutter splint | If open: assume infection by human oral pathogens - irrigate, debridement, abx (cover Eikenella)
30
Humerus Fx caused by
Direct trauma
31
Neuro complication humerus Fx
Radial n palsy = wrist drop, loss of thumb extension
32
Tx humerus Fx
Hanging arm cast vs coaption splint and sling, bracing
33
Ulnar shaft Fx resulting from self defense with arm against blunt object Tx
Nightstick Fx ORIF if significantly displaced
34
Diaphyseal Fx of proximal ulna with subluxation radial head | Tx
Monteggia's Fx | ORIF of shaft and closed reduction radial head
35
Diaphyseal fracture of radius with dislocation of distal radioulnar joint, 2/2 direct blow to radius Tx?
Galeazzi's fx | ORIF of radius and casting forearm in supination to reduce distal radioulnar joint
36
``` Hip Fx: What puts at increased risk? Presentation Major complications (2), esp if femoral neck Fx Radiology problems ```
Osteoporosis Shorted leg and ER DVT, AVN w/ femoral Fx Can be radiographically occult, CT or MRI
37
Tx hip Fx
ORIF, may need hip hemiarthroplasty | Anticoagulate
38
Cause femoral Fx | Major complication
Direct trauma | Fat emboli
39
S/S fat emobli
``` Fever Changes mental status Dyspnea Hypoxia Petechiae Dec platelets ```
40
Cause tibial Fx | Major complication
Direct trauma | Compartment syndrome
41
Open fractures
Orthopedic emergency
42
Sudden pop like rifle shot, 2/2 decreased physical conditioning Limited plantar flexion + Thompson
Achilles tendon rupture | Tx: long leg cast 6 wks
43
Unhappy triad
ACL MCL Medical meniscus
44
Causes ACL injury
Twisting mechanism Forced hyperextension Impact to extended knee
45
Cause PCL injury
Posteriorly directed force on flexed knee
46
Cause meniscal tears | Exam shows
Acute twisting or degenerative tear in elderly pts Joint line tenderness, + McMurrays
47
Test of knee injuries
MRI
48
Cause Volkmann's contracture of wrist and fingers
Compartment syndrome which can be 2/2 humeral Fx
49
Compartment pressure = compartment syndrome
>30 mmHg
50
Tx compartment syndrome
Immediate fasciotomy
51
CTS nerve affected
Median
52
Association of CTS
Overuse wrist flexors, DM, thyroid, pregnant
53
Positive tests CTS
Phalen's | Tinel's
54
``` Raidal nerve Motor fcn Sensory Cause injury Clinical finding ```
Wrist extension Dorsal forearm and first 3 fingers Humeral Fx Wrist drop
55
``` Median n Motor fcn Sensory Cause injury Clinical finding ```
Pronation, thumb opposition Palmar surface first 3 fingers Carp tunnel Weak wrist flexion and flat thenar eminence
56
``` Ulnar Motor fcn Sensory Cause injury Clinical finding ```
Finger adduction, 4 and 5 finger flexion, lumbricals Palmar and dorsal surface last 2 fingers Elbow dislocation- medial epicondyle Claw hand- clawed 4 and 5 digits
57
Axillary Motor fcn Sensory Cause injury
Abduction Lateral shoulder Anterior humeral dislocation
58
``` Peroneal Motor fcn Sensory Cause injury Clinical finding ```
Dorsiflexion, eversion Dorsal foot and lat leg Knee dislocation Foot drop
59
Wrist drop - n
Radial
60
Claw hand - n
ulnar
61
Foot drop- n
Peroneal
62
Causes bursitis - 4
``` Repetitive use Trauma Infection Systemic inflammatory disease TX: RICE ```
63
Rx with increased risk tendon rupture and tendonitis
Fluoroquinolones
64
Red flags LBP
``` age > 50 >6 wks pain Previous cancer Hx Constitutional Sx Severe pain Neuro deficits Loss of anal sphincter tone ```
65
Bowel or bladder dysfunction, impotence, saddle anesthesia
Cauda equina
66
Most common location herniated disc
L5-S1
67
L4 Motor Sensory Reflex
Foot dorsiflexion- tibialis anterior Medial aspect lower leg Patellar
68
L5 Motor Sensory Reflex
Big toe dorsiflexion - extensor hallucis longus; foot eversion (peroneus) Dorsum foot and lat lower leg None
69
S1 Motor Sensory Reflex
Foot eversion- peroneus longus and brevis; plantarflexion-gastrocnemius Plantar and lat foot Achilles
70
Most common benign bone tumor
Osteochondroma
71
Child 10-20 yrs of age with multilayered onion skinning on X-ray in diaphysis
Ewing sarcoma
72
Female 20-40 yrs w/ knee pain and mass; X-ray shows soap bubble appearance, epiphyseal/metaphyseal region long bones
Giant cell tumor
73
Male, 20-30, metaphyseal bone tumor in distal femur or proximal tibia, mets to lungs common, pain worsens at night
Osteosarcoma
74
Codman's triangle
Triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone Osteosarcoma Ewing sarcoma
75
Onion skinning
Ewing | successive layers of periosteal development;
76
Soap bubble
Giant cell``
77
Most common organisms in septic arthritis
STAPH Streo Gram - rods
78
Tx septic arthritis
Ceftriaxone and vacomycin
79
Child w/ gout and inexplicable injuries
Lesch Nyhan syndrome
80
Type of crystal in gout
Monosodium urate crystals
81
Mechanism colchicine
inhibits neutrophil chemotaxis good for acute flare cause diarrhea, BM suppression - neutropenia
82
Fx of distal radius with fall on flexed wrist | Displaced ant or post
Smith | Ant
83
Major risk of pelvic fracture
Major blood loss
84
Deltoid malfunction- cannot extend or abduct arm or shoulder numbness after dislocation
axillary n injury | ANTERIOR DISLOCATION
85
Exertional compartment syndrome
Young athlete Resolves when stop activity Minimal risk tissue ischemia
86
6 P Compartment syndrom
``` Pain Paresthesias Paralysis Poikilothermia Pallor Pulselessness ```
87
C5 Motor Sensory Reflex
Deltoid and biceps Ant shoulder Biceps
88
C6 Motor Sensory Reflex
Biceps, wrist extensors Lat forearm Brachioradialis
89
C7 Motor Sensory Reflex
Triceps, wrist flexors, finger extensors Post forearm Triceps
90
C8 Motor Sensory Reflex
Finger flexors 4 and 5 fingers, medial forearm NOne
91
T1 Motor Sensory Reflex
Finger interossei Axilla None
92
Erb Duchenne Palsy Where is injury Cause Clinical
Super trunk: c5-c6 Hyperadduction of arm- birth = shoulder dystocia Waiter's tip: arm extended and adducted in pronation
93
Klumpke palsy Where Cause Clinical
Posterior or medial cords:c8-t1 Hyperabduction of arm Clas hand- poor wrist and hand fcn, assoc Horner syndrome
94
Etiology osteopetrosis vs Paget
Osteo: increased bone density due to impaired osteoclast Paget: disorganized bone due to overactive osteoblast and osteoclast
95
Labs osteopetrosis vs Paget
Paget: Inc ALP, urine hydroxyprolone, normal Ca and Phos Osteo: Dec H and H, inc acid phosphatase and CK
96
Tx osteopetrosis vs Paget
Osteo: transfuse marrow components to stimulate osteoclast Paget: bisphosphonates, calcitonin
97
Leukocytes: | OA, trauma vs Inflammatory arthropathies (RA, pseudogout) vs septic joint
50000
98
Bouchard nodes
OA | DIP
99
Heberdon nodes
OA | PIP
100
Swan neck deformities
RA | flexed DIP plus hyperextended PIP
101
Boutenierre deformity
RA | Flexed PIP
102
Red heliotropic rash
Dermatomyositis/polymyositis
103
Bamboo spine
Ankylosing spondyltitis
104
Seronegative arthopathies
``` PEAR Psoriatic Enteropathic (IBD) Ankylosing Reactive ```
105
Tumors that met to bones
``` Permanently Relocated Tumors Like Long Bones Prostate Renal Thyroid Lung Lymphonma Breast ```
106
Sunburst on X-ray
Osteosarcoma | mixed lytic sclerotic pattern
107
Most effective Dx testing for developmental dysplasia of the hip
US, X ray no good until 4 months
108
2 types rickets
Hypocalcemic | Hypophosphatemic
109
Rickets with Inc ALP, Dec P, Dec Ca, Dec 25 Vit and 1, 25 Vit D, inc PTH
Hypocalcemic
110
Rickets with Inc ALP, Dec P, Increased 25 and 1,25 Vit D
Hypophosphatemic
111
Joints involved JRA: pauci, poly, systemic and ages of each
Pacui: less than 4 joints, 2-3 yrs Poly: 5+ joints, 2-5 and 10-14 yrs Poly: any number, < 17
112
Problem with Osgood schlatter
inflammation of bone-cartilage interface of tibial tubercle
113
Reduction of nursemaids elbow
Supinate, flex from 0-90
114
Club foot position
Inverted, planter flexion, adduction
115
Gower maneuver
push on hips to stand | Duchenne MD
116
Noninfectious vegetations seen on MV in SLE and antiphospholipid syndrome
Libman Sachs Endocarditis
117
SLE Criteria
``` DOPAMINE RASH Discoid rash Oral ulcers Photosensitivity Arthritis Malar rash Immunologic Neuro sx Elevated ESR ANA Serositis- pleural or pericardial Heme abnormal ```
118
CREST
``` Calcinosis Raynaud Esophageal dysmotility Sclerodactyly Telangiectasia ```
119
DIP: spared in, involved in = OA and RA
DIP spare RA | DIP affected OA
120
Felty's syndrome
RA Splenomegaly Neutropenia
121
Charcot joint
DM
122
Mosaic lamellar bone pattern
Pagets
123
Caplan syndrome
RA + pneuoconiosis
124
20s man, painful oral and genital ulcers, uveitis, arthritis, erythema nodosum
Behcet | Tx: steroids
125
Dermatomyositis S/S Dx Complication
Polymyositis plus skin (heliotrope rash around eyes with periorbital edema) Trouble rising from chair/climbing stair b/c proximal mm affected Dx: mm biopsy Increased incidence of malignancy

First Aid Step 2 (22 decks)

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