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MSK/Rheum Flashcards

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1
Q

What is the most likely causative organism for osteomyelitis in a healthy 7-year-old child with localized bone pain and fever?

A

Staphylococcus aureus

Osteomyelitis in healthy children

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2
Q

What organism is most commonly implicated in osteomyelitis for a child with sickle cell disease?

A

Salmonella species

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3
Q

What is the most common causative organism for osteomyelitis in a newborn under two months?

A

Group B Streptococcus

(Streptococcus agalactiae)

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4
Q

What pathogen is most associated with osteomyelitis in children aged 6 months to 4 years?

A

Kingella kingae

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5
Q

What organism is most likely responsible for osteomyelitis after stepping on a nail?

A

Pseudomonas aeruginosa

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6
Q

What organism should be considered for osteomyelitis following a cat scratch?

A

Bartonella henselae

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7
Q

Which organism is most likely responsible for osteomyelitis in a child recovering from chickenpox?

A

Group A Streptococcus

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8
Q

Which organism is increasingly implicated in community-acquired osteomyelitis cases?

A

Methicillin-resistant Staphylococcus aureus (MRSA)

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9
Q

What is the first-line diagnostic test for a child presenting with a swollen, painful knee, fever, and refusal to bear weight?

A

Arthrocentesis

(for septic arthritis)

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10
Q

What is the most appropriate next step for a patient presenting with back pain, fever, and neurological deficits?

A

Emergency surgical decompression for spinal epidural abscess

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11
Q

What imaging should be ordered to confirm the diagnosis in an obese adolescent with hip pain and limited internal rotation?

A

X-ray of the hip

(AP and frog-leg lateral views for Slipped Capital Femoral Epiphysis)

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12
Q

What is the treatment of choice for a patient with an inability to extend the distal phalanx after a finger injury?

A

Continuous extension splinting of the DIP joint for 6-8 weeks

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13
Q

What is the first-line pharmacologic treatment for juvenile rheumatoid arthritis?

A

Ibuprofen

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14
Q

What is the finding called when a patient presents with bony enlargement of the distal interphalangeal joints?

A

Heberden’s nodes

(indicative of osteoarthritis)

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15
Q

What is the most likely diagnosis for a patient presenting with bowel/bladder dysfunction, saddle anesthesia, and lower extremity weakness?

A

Cauda equina syndrome

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16
Q

What type of splint is best used to immobilize the elbow, wrist, and forearm after a fracture?

A

Sugar tong splint

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17
Q

What is the most likely diagnosis for a teenage athlete presenting with knee pain localized to the tibial tubercle?

A

Osgood-Schlatter disease

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18
Q

What lab test can be checked after an acute gout attack to assess long-term management?

A

Serum uric acid level

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19
Q

What is the most likely diagnosis for a child with a history of multiple fractures and blue sclerae on exam?

A

Osteogenesis imperfecta

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20
Q

What is the diagnosis for an elderly patient presenting with height loss and back pain, with normal labs but X-ray showing demineralization?

A

Osteoporosis

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21
Q

What cervical spine view is critical to visualize all seven cervical vertebrae and the upper margin of T1 in trauma evaluation?

A

Lateral cervical spine X-ray

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22
Q

What is the most likely diagnosis for synovial fluid analysis showing leukocytosis and low glucose?

A

Septic arthritis

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23
Q

What is the diagnosis for a child who develops migratory polyarthritis after a recent streptococcal infection?

A

Acute rheumatic fever

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24
Q

What is the diagnosis for a patient with wrist pain and a positive Finkelstein’s maneuver?

A

De Quervain’s tenosynovitis

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25
What is the diagnosis for a skier presenting after a fall with thumb pain and instability at the MCP joint?
Gamekeeper’s thumb ## Footnote (UCL injury)
26
What are the benefits of exercise in patients with osteoarthritis?
Maintains range of motion, strengthens muscles, improves fitness
27
At what age does the National Osteoporosis Foundation recommend women have a bone mass measurement?
Age 60–65 years
28
When should a patient with carpal tunnel syndrome wear a wrist splint?
During activities that worsen symptoms
29
What is the mainstay initial treatment for ankle sprains?
RICE: Rest, Ice, Compression, Elevation
30
How is a distal phalanx fracture with nailbed laceration classified and treated?
Open fracture; requires antibiotics and ortho follow-up
31
A patient with shoulder pain worsens with resisted forearm supination. What diagnosis is most likely?
Bicipital tendonitis
32
A patient complains of lower back pain after a twisting injury. Which mechanism of injury most likely caused a meniscal tear?
Axial loading and rotation
33
An adult patient presents after a minor fall with wrist tenderness. X-ray shows a torus fracture. What is the prognosis?
Stable fracture; heals uneventfully in 3-4 weeks
34
A patient with back pain shows a defect at the 'neck of the Scotty dog' on oblique lumbar spine X-ray. What is the diagnosis?
Spondylolysis (defect through pars interarticularis)
35
An IV drug user presents with fever and severe back pain. Imaging shows vertebral osteomyelitis. What is the likely origin of infection?
Hematogenous spread from the urinary tract or IV drug use
36
A young adult presents with severe knee pain and swelling. Synovial fluid analysis shows >50,000 WBCs and low glucose. What is the most likely diagnosis?
Septic arthritis
37
A child presents with increasing leg pain at night relieved by aspirin. X-ray shows a small, benign-appearing bone tumor. What is the diagnosis?
Osteoid osteoma
38
A patient with severe knee osteoarthritis failed conservative therapy. What intraarticular injection can provide longer relief than steroids?
Hyaluronic acid injection
39
A child falls and sustains a fracture of the proximal ulna with anterior dislocation of the radial head. What is this called?
Monteggia fracture
40
An overweight adult complains of medial knee pain. Exam reveals tenderness over the pes anserine bursa. What is the diagnosis?
Pes anserine bursitis
41
A middle-aged woman with dry eyes and dry mouth is diagnosed with Sjögren’s syndrome. Which class of medications should be avoided?
Anticholinergics
42
A toddler boy is diagnosed with Duchenne muscular dystrophy. What chromosome is affected?
Short arm of the X chromosome
43
A newborn’s lumbar spine X-ray shows a vertebral bony defect without external signs. What is the diagnosis?
Spina bifida occulta
44
A patient has impaired proprioception and vibration sense. Which spinal column is most likely affected?
Posterior column
45
A patient develops sudden severe calf pain during running, describing a 'pop' sensation. Exam shows a positive Thompson test. What is the diagnosis?
Achilles tendon rupture
46
During inflammation, which cells are responsible for producing collagen?
Fibroblasts
47
Which enzyme pathway do salicylates inhibit to reduce inflammation?
Cyclooxygenase (COX) pathway
48
An elderly woman presents after a minor fall with acute vertebral compression fracture pain. Which medication provides analgesic benefits?
Calcitonin
49
An elderly woman with osteoporosis fractures her hip. Labs show normal calcium, phosphate, and PTH levels. What imaging finding is expected?
Demineralization on X-ray
50
A trauma patient presents with a posterior knee dislocation. What structure must be assessed immediately?
Popliteal artery (via arteriogram)
51
After a wrist fracture, a patient cannot extend their wrist. Which nerve is likely injured?
Radial nerve
52
A middle-aged woman with joint pain, morning stiffness >1 hour, and anemia has C1-C2 instability. What is the underlying condition?
Advanced rheumatoid arthritis with atlantoaxial subluxation
53
A woman with PMR develops headache and jaw claudication. What treatment can prevent vision loss?
Glucocorticoids (prevent temporal arteritis)
54
A postmenopausal woman is prescribed raloxifene. What is one common side effect?
Increased hot flashes
55
A patient with wrist pain has anatomical snuffbox tenderness but normal initial X-rays. What is the next step?
Thumb spica casting (assume scaphoid fracture)
56
An elderly patient with chronic hepatitis is being evaluated for rheumatoid arthritis treatment. Which DMARD is contraindicated?
Methotrexate
57
An MRI shows L5-S1 disc herniation impinging a nerve root. Which reflex and muscle groups are affected?
S1 nerve root: Achilles reflex, gastrocnemius, soleus
58
A patient presents with thenar atrophy, weakness of thumb abduction, and positive Tinel's and Phalen's signs. What is the diagnosis?
Median nerve injury (Carpal tunnel syndrome)
59
Why is the supraspinatus tendon particularly prone to injury at the shoulder?
Reduced blood supply with arm abduction (critical zone)
60
Which antibiotic is first-line for treating young children under 12 years with infections?
Amoxicillin (Doxycycline contraindicated)
61
What is the cornerstone of early rheumatoid arthritis treatment to prevent disease progression?
Early initiation of DMARDs (e.g., methotrexate, hydroxychloroquine)
62
An adolescent with increased Q angle complains of anterior knee pain. What is the most likely diagnosis?
Patellofemoral pain syndrome
63
What management has been proven effective for fibromyalgia?
Carefully planned and individualized exercise program
64
An overweight adolescent male presents with a limp and knee pain. Hip X-rays reveal displacement. What is the diagnosis?
Slipped capital femoral epiphysis (SCFE)
65
Which antibody is associated with thrombotic events and pregnancy loss in SLE patients?
Anti-phospholipid antibody
66
A fracture of the femoral neck is most likely to compromise blood supply to which area?
Femoral head
67
A pediatric forearm X-ray shows a break on one side of the cortex but intact on the other. What is this fracture called?
Greenstick fracture
68
Anterior shoulder pain reproduced by resisted elbow flexion and palpation over the bicipital groove suggests what diagnosis?
Bicipital tendonitis
69
What is essential to determine the causative organism in suspected osteomyelitis?
Needle aspiration or bone biopsy for culture
70
When taking bisphosphonates, what important administration rule must patients follow?
Do not take with other medications or food
71
Symmetric joint swelling with warmth and tenderness suggests what diagnosis?
Rheumatoid arthritis
72
During acute back pain, what is the recommendation regarding activity?
Continue activities as tolerated; initiate strengthening after symptoms resolve
73
What ocular side effect is associated with hydroxychloroquine?
Macular damage (plus rash and diarrhea)
74
What is the treatment of choice for Morton's neuroma if conservative measures fail?
Steroid injection
75
An elderly sedentary patient has gradual loss of passive shoulder range of motion. What is the most likely diagnosis?
Adhesive capsulitis (frozen shoulder)
76
A patient steps on a nail through a tennis shoe and develops foot osteomyelitis. What is the likely organism?
Pseudomonas aeruginosa
77
Name five established risk factors for osteoporosis.
Low body weight, female sex, advanced age, Caucasian race, early oophorectomy without estrogen
78
A hip X-ray in an adolescent shows femoral head displacement and rotation of the femoral neck anteriorly. What is the diagnosis?
Slipped capital femoral epiphysis (SCFE)
79
Why is urgent decompression necessary in cauda equina syndrome?
Longer compression = lower chance of full neurologic recovery
80
Which clinical maneuver detects small effusions in the knee?
Bulge sign (milking fluid upward from knee)
81
Pain over the radial styloid with a positive Finkelstein's test suggests what diagnosis?
De Quervain's tenosynovitis
82
After a collision during football, a player develops burning arm pain. What is the likely injury?
Brachial plexus neurapraxia ('stinger')
83
An adolescent presents with bone pain and an X-ray showing an 'onion skin' periosteal reaction. What is the diagnosis?
Ewing sarcoma
84
At what degree of fracture angulation is open reduction indicated?
Greater than 40 degrees
85
What musculoskeletal symptoms are typical of polymyalgia rheumatica?
Proximal symmetric muscle pain and stiffness (shoulder, neck, pelvic girdle)
86
In a patient with suspected cervical radiculopathy, what is the appropriate first imaging study?
Plain film radiographs (for foraminal osteophytes)
87
What maneuver is used to reproduce carpal tunnel syndrome symptoms?
Phalen maneuver (wrist flexion)
88
A patient with ankylosing spondylitis presents with back stiffness and pain. What is the mainstay of therapy?
NSAIDs (e.g., indomethacin)
89
A patient experiences severe shoulder internal rotation contractions after a seizure. What injury should be suspected?
Posterior shoulder dislocation
90
A patient has full passive shoulder ROM but pain and weakness during active abduction. What injury is suspected?
Rotator cuff tear
91
What is the first-line treatment for an acute gouty attack?
NSAID medications
92
Which type of arthritis features Heberden's nodes?
Primary osteoarthritis
93
A patient presents with symmetrical joint swelling, insidious onset, and morning stiffness >30 minutes. What diagnosis is likely?
Rheumatoid arthritis
94
A patient has back and leg pain relieved by sitting and worsened by standing. What diagnosis is suspected?
Spinal stenosis
95
In a patient with suspected disc herniation, what imaging study is the diagnostic study of choice?
MRI
96
A patient presents with a metacarpal fracture. What is the best splint to apply initially?
Ulnar gutter splint
97
Low body weight, smoking, and early estrogen deficiency predispose patients to which bone disorder?
Osteoporosis
98
Which diagnostic test confirms the infectious agent in a case of septic arthritis?
Joint fluid culture
99
A teenage athlete presents with tibial tubercle pain exacerbated by activity. What diagnosis is likely?
Osgood-Schlatter disease
100
A patient complains of severe pain after a cast placement. What is the best immediate management?
Bivalve the cast to relieve pressure
101
Tenderness in the anatomical snuffbox after trauma suggests what injury?
Scaphoid fracture
102
What is the first-line medication for fibromyalgia, typically given at bedtime?
Amitriptyline
103
What is the most common spinal curvature pattern in idiopathic scoliosis among young females?
Right thoracic curve
104
What imaging is necessary to assess the degree of scoliosis?
Full spine X-rays (AP and lateral views)
105
At what degree of scoliosis curvature is bracing typically recommended?
20–40 degrees in an immature child
106
At what degree of scoliosis curvature is surgical fixation typically recommended?
Greater than 40 degrees
107
Penetrating trauma to an extremity with normal distal pulses still requires what test?
Doppler studies to assess vascular injury
108
an incentive spirometer is given to patients with rib fractures to prevent
pneumonia
109
What is this type of fracture?
intertrochanteric fracture
110
An athlete lands hard after a jump and now has ankle pain worsened by flexing the great toe. What fracture is likely?
Posterior lateral talar tubercle fracture
111
What is the typical mechanism for an anterior shoulder dislocation?
Abduction with external rotation
112
What is the preferred management for a flail chest with rib fractures?
Endotracheal intubation and mechanical ventilation
113
A patient with polymyalgia rheumatica improves dramatically after low-dose prednisone. What does this indicate?
Typical response confirming diagnosis
114
A scoliosis curvature greater than 40° indicates what treatment?
Surgical fixation
115
What is the most appropriate initial intervention for olecranon bursitis?
Rest and NSAIDs
116
Fever in a patient with back pain is a red flag indicating what?
Possible infection (e.g., epidural abscess, discitis)
117
A disc herniation at C6-C7 could affect which muscle group?
Wrist extensors
118
A stress fracture of the pars interarticularis results in what condition?
Spondylolysis
119
A patient reports leg claudication worsened by walking and relieved by sitting. What is the likely diagnosis?
Lumbar spinal stenosis
120
What is the most common bacterial cause of epidural abscess?
Staphylococcus aureus
121
Classic symptoms of spinal epidural abscess include what three findings?
Back pain, fever, neurological deficits
122
What is the treatment for large spinal epidural abscesses?
Surgical decompression
123
Discitis usually occurs secondary to what mechanism?
Hematogenous spread of infection
124
How long should antibiotics be administered for discitis?
2–6 weeks
125
Transverse myelitis is commonly associated with which autoimmune disorder?
Multiple sclerosis (MS)
126
What is the initial treatment for transverse myelitis?
High-dose corticosteroids
127
A patient with persistent low back pain after 6 weeks of conservative treatment needs what next diagnostic test?
MRI
128
What is the diagnostic study of choice for suspected sciatica?
MRI
129
What is the best imaging study to diagnose cauda equina syndrome?
MRI
130
How soon should cauda equina syndrome be treated to prevent permanent deficits?
Within 48 hours
131
An adolescent reports shoulder asymmetry during screening. What condition should be suspected?
Scoliosis
132
What is the recommended treatment for moderate scoliosis (25–45 degrees)?
Bracing
133
What is the most commonly torn rotator cuff tendon?
Supraspinatus tendon
134
What is the mechanism of injury for a posterior shoulder dislocation?
Adduction with internal rotation
135
What is the mechanism of injury for an inferior shoulder dislocation?
Hyperabduction
136
After a shoulder reduction, what is the immediate next step in management?
Shoulder immobilization
137
What is the recommended treatment for proximal biceps tendon rupture in older patients?
Conservative treatment
138
What types of AC separation typically require surgical intervention?
Type IV and V (ORIF)
139
What is the most common type of thoracic outlet syndrome?
Neurogenic thoracic outlet syndrome
140
Patients with venous thoracic outlet obstruction may require what treatment?
Anticoagulation
141
How are most scapula fractures managed?
Non-surgically (conservative treatment)
142
In proximal humerus fractures, which nerve is at greatest risk of injury?
Axillary nerve
143
What is the typical mechanism of injury for humerus fractures?
FOOSH (fall on outstretched hand)
144
How are most non-displaced proximal humerus fractures treated?
Sling immobilization
145
Which nerve is at risk with a humeral shaft fracture?
Radial nerve
146
A 5-7 year-old child falls on an outstretched hand and has elbow pain. What is the likely fracture?
Supracondylar fracture
147
If posterior fat pad is seen on elbow X-ray without visible fracture, what is the appropriate next step?
Splint the elbow (assume occult fracture)
148
What tendon is affected in lateral epicondylitis (tennis elbow)?
Common extensor tendon
149
What tendon is affected in medial epicondylitis (golfer's elbow)?
Common flexor tendon
150
What labs are important in the management of a septic bursa?
Aspirate and culture the fluid
151
What is the initial management for septic bursitis?
Antibiotics
152
A child refuses to use the arm after being pulled. Minimal swelling is noted. What is the diagnosis?
Nursemaid's elbow (radial head subluxation)
153
What is the treatment for nursemaid’s elbow?
Closed reduction (supination and flexion)
154
What antibodies are associated with dermatomyositis?
Anti-Mi-2 antibodies
155
What is the treatment for dermatomyositis?
Steroids
156
What X-ray finding suggests an occult radial head fracture?
Posterior fat pad sign
157
A fracture of the proximal ulna with dislocation of the radial head is called what?
Monteggia fracture
158
A fracture of the radius with distal radioulnar dislocation is called what?
Galeazzi fracture
159
Which repetitive posture can lead to cubital tunnel syndrome?
Resting elbows or holding a telephone for long periods
160
What test confirms carpal tunnel syndrome?
EMG (electromyography)
161
What is the initial treatment for De Quervain syndrome?
Thumb spica splint
162
Why must untreated scaphoid fractures be carefully monitored?
High risk of avascular necrosis
163
What is the treatment for a non-displaced scaphoid fracture?
Immobilization for 12 weeks
164
What distal radius fracture is dorsally angulated?
Colles fracture
165
What distal radius fracture is volarly angulated?
Smith fracture
166
A patient has a hip fracture after a fall. What is the standard management?
Surgical repair
167
A 4-year-old male develops avascular necrosis of the femoral head. What is the diagnosis?
Legg-Calvé-Perthes disease
168
A patient with a midshaft femur fracture awaiting delayed surgery should be managed with what?
Traction
169
Which imaging modality assists with operative planning for a distal femur fracture?
CT scan
170
After a forceful lateral blow to the knee, what ligament is most likely sprained?
Lateral collateral ligament (LCL)
171
A positive varus stress test during knee exam suggests injury to which ligament?
Lateral collateral ligament (LCL)
172
ACL reconstruction surgery should ideally occur how long after injury?
2–4 weeks
173
Isolated posterior cruciate ligament (PCL) injuries are common or uncommon?
Uncommon
174
A patient cannot actively extend the knee after a sports injury. What is the likely diagnosis?
Patellar tendon rupture
175
What is the required treatment for patellar tendon rupture?
Surgical repair
176
What is the most appropriate initial treatment for SCFE (slipped capital femoral epiphysis)?
Surgical pinning
177
Numbness on the dorsum of the foot suggests a herniation at which disc level?
L4-L5 disc herniation affecting the L5 nerve root
178
What is the typical management for a ganglion cyst in a child?
Observation
179
A growing boy has anterior knee pain exacerbated by resisted extension. What is the diagnosis?
Osgood-Schlatter disease
180
A patient describes a locking sensation in the knee after a twisting injury. What is the likely diagnosis?
Meniscal tear
181
Quadriceps tendon ruptures become more likely with what factor?
Increasing age
182
What is the most common direction for a patellar dislocation?
Lateral dislocation
183
What is the treatment for a first-time nonrecurrent patella dislocation?
Immobilization
184
Knee dislocations carry a high risk for what vascular injury?
Popliteal artery injury
185
What is the first-line treatment for Osgood-Schlatter disease?
RICE and physical therapy
186
Where will pain from pes anserine bursitis localize?
Medial side of the knee
187
Abnormal tracking of the patella over the femoral condyles leads to what condition?
Patellofemoral pain syndrome
188
An injury causing fracture of the proximal/mid fibula with medial ankle injury suggests what fracture?
Maisonneuve fracture
189
A fracture at the second metatarsal base or subluxation at the tarsometatarsal joint suggests what injury?
Lisfranc injury
190
What is the definitive treatment for a Maisonneuve fracture?
Surgery
191
What is the most common type and mechanism of ankle sprain?
Lateral ankle sprain due to inversion
192
The posterior malleolus is part of what bone?
Tibia
193
How is a lateral malleolus fracture typically managed?
Immobilization
194
How are bimalleolar and trimalleolar ankle fractures typically treated?
Surgical repair
195
If CT is inconclusive but stress fracture is suspected, what imaging is next best?
MRI
196
Calcaneal heel spurs on X-ray are associated with which condition?
Plantar fasciitis
197
Pain described as walking on a 'pebble' between the third and fourth toes suggests what diagnosis?
Morton's neuroma
198
Ecchymosis on the plantar aspect of the foot suggests what injury?
Lisfranc injury
199
What is the most common malignant bone tumor in children?
Osteosarcoma
200
Osteosarcoma is associated with which genetic condition?
Retinoblastoma
201
A patient has years of dull pain and a slow-growing bone mass resistant to chemotherapy. What diagnosis is likely?
Chondrosarcoma
202
What benign, pedunculated bone tumor is commonly seen in children?
Osteochondroma
203
How long should antibiotics be administered for osteomyelitis?
4–6 weeks
204
What is the imaging test of choice for diagnosing osteomyelitis?
MRI
205
How does menopause contribute to osteoporosis?
Decreased estrogen increases bone resorption
206
Tinel's sign is used to diagnose what condition?
Carpal tunnel syndrome
207
What genetic marker is associated with ankylosing spondylitis?
HLA-B27
208
What is the classic X-ray finding in ankylosing spondylitis?
Bamboo spine
209
What medication class can help relieve fibromyalgia symptoms?
Antidepressants
210
Which medication is used for gout prevention?
Allopurinol
211
What antibody test is most sensitive for diagnosing rheumatoid arthritis?
Anti-CCP
212
Rheumatoid arthritis typically affects joints in what pattern?
Polyarticular and symmetrical
213
What is the first-line class of medications to induce remission in rheumatoid arthritis?
DMARDs
214
Psoriatic arthritis typically shows what deformity on imaging?
Pencil-in-cup deformity
215
Patients with reactive arthritis are typically positive for which genetic marker?
HLA-B27
216
What two tests are used to assess for carpal tunnel syndrome?
Phalen sign and Tinel sign
217
What is the leading cause of death in systemic lupus erythematosus (SLE)?
Cardiovascular disease
218
a silver fork deformity
Colles fracture
219
A fracture of the 4th and often 5th metacarpal is named what?
a boxer's fracture
220
What does the crossover test assess?
AC joint
221
A fat pad sign would indicate what?
an occult fracture
222
What is the most common pathogen for IV drug users with epidural abscess?
Staph aureus
223
What are the classic symptoms of fat embolism syndrome occurring 48 hours after long bone fractures?
Neurologic deterioration, respiratory distress, and petechial rash
224
What is the first line option for patients with Raynaud phenomenon?
Calcium channel blockers like amlodipine
225
What are the characteristic symptoms of reactive arthritis?
Eye dryness, conjunctivitis, and muscle pain
226
What is the treatment for reactive arthritis?
Ibuprofen
227
What does an increased Q angle lead to?
Retropatellar pain
228
What is a risk factor for osteoporosis?
Low body weight
229
What would be a good treatment plan for a patient with fibromyalgia and no history of mental health issues?
Exercise
230
Is imaging recommended for generalized back pain?
No, imaging is not recommended for generalized back pain for at least 4-6 weeks.
231
What are the treatments for generalized low back pain?
Treatment includes acetaminophen, NSAIDs, maybe opioids, maybe muscle relaxers, and exercise.
232
Where do herniated discs typically occur?
Herniated discs tend to occur at L4-L5 or L5-S1.
233
How does herniated disc pain present?
Pain radiates from the back down to the leg.
234
What are other symptoms of a herniated disc?
Other symptoms may include weakness, sexual dysfunction, and incontinence.
235
What is the physical exam maneuver for herniated discs?
The straight leg test, where the straight leg is lifted until the hip is at 90 degrees to see if radiculopathy occurs.
236
How can we check for the L5 nerve root?
Look for decreased ankle strength, decreased strength of dorsiflexion of the great toe, and numbness of the medial foot and web space between the 1st and 2nd toes.
237
How can we check for the S1 nerve root?
Look for numbness of the posterior calf, numbness of the lateral foot, weakness of plantar flexion, and a decreased reflex of the Achilles.
238
What is the first line treatment for herniated discs?
First line treatment is NSAIDs, followed by consideration of epidural steroid injections; surgery is the last and most invasive option.
239
What is Cauda Equina?
Cauda Equina consists of the lumbar nerve roots of nerves 2-5, sacral nerve roots 1-5, and the coccygeal nerve, resembling a horsetail at the base of the spinal cord.
240
What causes Cauda Equina syndrome?
Cauda Equina syndrome occurs when the nerves in this area are compressed, potentially caused by anything that restricts the space.
241
What are the clinical presentations of Cauda Equina syndrome?
Typical presentations include saddle anesthesia and/or bowel or bladder incontinence.
242
What is the diagnostic test for Cauda Equina syndrome?
The best diagnostic test is an MRI, but a CT may also work.
243
Is Cauda Equina syndrome an emergency?
Yes, it is an emergency and requires surgical decompression.
244
What is the clinical presentation of spinal stenosis?
The clinical presentation includes low back issues/pain, gait issues, and claudication. Patients may have radiculopathy, pain, weakness, and paresthesias.
245
What is the shopping cart sign in relation to spinal stenosis?
The shopping cart sign is relief of symptoms while bending forward and pushing a shopping cart, indicating spinal stenosis as it alleviates pressure on the spine.
246
What is the primary diagnostic tool for spinal stenosis?
MRI is the primary diagnostic tool for spinal stenosis.
247
What are the treatment options for spinal stenosis?
1. Conservative: Oral analgesics, avoidance of triggers, PT 2. Epidural corticosteroid injections 3. Surgery if conservative treatment fails
248
What does decreased sensation to the posterior calf indicate?
It indicates an issue with the S1 nerve root.
249
What is the greatest risk factor for kyphosis?
age
250
What is the treatment for kyphosis?
1. Bracing 2. PT 3. Surgery
251
What is the characteristic/diagnostic finding for scoliosis?
spinal curvature more than 10 degrees
252
What is the COBB angle used to diagnose?
Scoliosis
253
What is osteosarcoma?
Osteosarcoma is new bone growth out of control.
254
What staging system is used for osteosarcoma?
The staging is done with the Enneking staging system.
255
What is the most common primary malignant bone tumor in children?
Osteosarcoma is the most common primary malignant bone tumor in children and adolescents aged 13-17.
256
What is the pathophysiology of osteosarcoma?
The pathophysiology involves overgrowth of bone during growth spurts and puberty, which is why it occurs in ages 13-17.
257
What other condition is often present with osteosarcoma?
Retinoblastoma is often present and is noted as a white shine when shown light and no red reflex.
258
What are the symptoms of osteosarcoma?
Symptoms include pain and swelling at the tumor site, with the most characteristic being night pain that often wakes them up and is not relieved by rest.
259
How is osteosarcoma diagnosed?
Diagnosis typically starts with an x-ray, which may show the 'Codman triangle' or a 'sunburst' appearance indicating new bone tumor formation.
260
What follow-up test may be useful for staging osteosarcoma?
A good follow-up test may be a Chest CT looking for lung metastases, as osteosarcoma most likely spreads to the lungs first.
261
What is the immediate treatment plan for osteosarcoma?
Immediate referral to an MSK oncologist for chemotherapy, amputation, or limb salvaging surgery (90% success rate).
262
What activity restrictions should be implemented for osteosarcoma patients?
Activity should be restricted to prevent fractures, specifically non-weight bearing.
263
Name two causes of kyphosis
vertebral fractures and degenerative disc disease
264
HLA-B27 positive conditions are
Ankylosing Spondylitis Psoriatic Arthritis Reactive Arthritis Juvenile Idiopathic Arthritis (specifically the enthesitis-related subtype)
265
What is Ewings Sarcoma?
A malignant bone tumor that tends to occur in long bones, usually seen in children. ## Footnote It is the second most common malignant bone tumor in children.
266
What age group is most affected by Ewings Sarcoma?
Males aged 3-25 years old.
267
What gene is linked to Ewings Sarcoma?
The EWSR1 gene on chromosome 22q12.
268
What are the symptoms of Ewings Sarcoma?
Symptoms include warm, inflamed, tender areas that almost mimic infection.
269
What are the diagnostic tests for Ewings Sarcoma?
1. Elevated ESR 2. X-ray shows large lytic lesion with characteristic 'onion skin' appearance 3. Biopsy/Bone marrow aspiration is the best test to diagnose.
270
What is the treatment for Ewings Sarcoma?
1. Refer to MSK oncologist for chemotherapy and radiation, possible surgical resection. 2. Surgical resection is difficult and extensive. 3. Protected weight-bearing during chemotherapy and follow-up appointments.
271
What is Chondrosarcoma?
A malignant bone tumor consisting of chondrocytes occurring in a cartilage matrix.
272
What are the symptoms of Chondrosarcoma?
Insidious onset of deep pain over years to decades, occurring at night and not relieved with rest.
273
What age group is most affected by Chondrosarcoma?
Usually occurs in older people.
274
What does the X-ray show in Chondrosarcoma?
'Popcorn' calcifications, intramedullary lesion with stippled and ring-like calcification, substantial erosion, thickening, and bone destruction.
275
What is the treatment for Chondrosarcoma?
1. Refer for surgery. 2. No chemotherapy is usually needed as they do not respond well. 3. Requires correlation of histologic findings with radiography for proper diagnosis and prognosis.
276
What is Osteochondroma?
A developmental abnormality of the peripheral growth plate resulting in lobulated outgrowth of cartilage and bone from the metaphysis. It is benign.
277
What age group is most affected by Osteochondroma?
Typically occurs in individuals aged 10-25 years old.
278
What is Hereditary Multiple Osteochondromas (HMO)?
Characterized by two or more exostoses in the appendicular and axial skeleton, with a prevalence of approximately one in 50,000.
279
What are the symptoms of Osteochondroma?
The tumor is palpable, hard, painless, and fixed. Pain comes from compression around it. The most common site is the knee/distal femur.
280
What are the diagnostic tests for Osteochondroma?
1. X-ray shows compact, pedunculated protuberance of bone. 2. CT for difficult areas like scapula and pelvis. 3. MRI if malignancy is expected.
281
What is the treatment for Osteochondroma?
Analgesics for minor aches and possible resection of lesions. For HMO, there is a 1-10% risk of malignant transformation.
282
What is Compartment Syndrome?
Increased pressure within a closed compartment compromises the circulation and function of the tissues within that space.
283
Is Compartment Syndrome an orthopedic emergency?
Yes, it is a true orthopedic emergency.
284
What are normal pressures within a compartment?
Normal pressures within the compartment are less than 10 mmHg.
285
What pressures are considered toxic in Compartment Syndrome?
Pressures exceeding 30-50 mmHg have traditionally been thought to be toxic.
286
What are the symptoms of Compartment Syndrome?
Symptoms include pain (out of proportion to the injury), paresthesia, pallor, pulselessness, poikilothermia, swelling, firmness, and tenderness to squeezing.
287
How do you calculate delta pressure?
Delta pressure is calculated as diastolic pressure minus measured tissue pressure.
288
What is the diagnosis threshold for delta pressure?
Diagnosis is made at a delta pressure of less than 30 mmHg.
289
What is the normal compartment pressure?
Normal compartment pressure is less than 10 mmHg.
290
What tests are used to assess muscle damage in Compartment Syndrome?
CPK and myoglobin can both be elevated.
291
What is the recommended action for Compartment Syndrome?
Referral/consult for immediate fasciotomy to relieve pressure; do not wait.
292
What is Osteomyelitis?
Osteomyelitis is inflammation or infection of the bone.
293
How is Osteomyelitis classified?
It is classified as either non-hematogenous or hematogenous.
294
What causes non-hematogenous Osteomyelitis?
It occurs in settings of trauma, usually in adults, and is most commonly caused by Staph aureus.
295
What are the risk factors for non-hematogenous Osteomyelitis?
Risk factors include diabetes and presence of orthopedic hardware.
296
What causes hematogenous Osteomyelitis?
It follows a bacterial infection, especially in kids, and is usually caused by Staph aureus.
297
What are the risk factors for hematogenous Osteomyelitis?
Risk factors include indwelling vascular devices, orthopedic hardware, IV drug use, hemodialysis, and sickle cell disease.
298
What is the pathophysiology of Osteomyelitis?
An infection begins in the sinusoids of the growth plate, causing thrombosis and inflammation of the bone cells, leading to pus movement through the cortex and abscess formation.
299
What are the symptoms of Osteomyelitis?
Symptoms include refusal to bear weight or use the limb, tenderness to palpation, warmth, and erythema.
300
What is the test of choice for Osteomyelitis?
MRI is the test of choice, showing bone marrow edema and abscesses.
301
What should be done for aspiration in Osteomyelitis?
Aspiration should include gram stain, aerobic and anaerobic cultures, acid-fast bacillus testing, and KOH for fungus.
302
What is required for a firm diagnosis of Osteomyelitis?
Two of the following criteria: pus aspirated from bone, positive bone or blood culture, symptoms of pain, swelling, warmth, and decreased ROM, or radiographic changes.
303
What is the antibiotic regimen for children with Osteomyelitis?
Children < 3 months: IV oxacillin + cefoxatime; Children > 3 months: IV oxacillin ± vancomycin.
304
What is the treatment for adults allergic to PCN with Osteomyelitis?
Adults: IV vancomycin + ceftriaxone.
305
How long is the treatment for Osteomyelitis?
Usually IV antibiotics for 5-10 days or until C&S is back, then continue for 4-6 weeks.
306
What are the indications for surgery in Osteomyelitis?
Indications include aspiration of frank pus, substantial bone resorption, or failure of symptom resolution after 36-48 hours of treatment.
307
What complication is most concerning with Osteomyelitis?
Growth plate arrest, especially in kids.
308
What is septic arthritis?
An orthopedic emergency characterized by joint inflammation, commonly affecting one joint (monarticular).
309
What is the most common joint affected by septic arthritis?
The knee is the most common joint affected.
310
What is the most common cause of septic arthritis?
Staphylococcus aureus is the most common cause.
311
What are the common gram-negative bacteria associated with septic arthritis?
Escherichia coli and Pseudomonas aeruginosa.
312
What are some risk factors for septic arthritis?
Invasive UTIs, IV drug use, older age, compromised immune system, and skin infections.
313
In which population is gonococcal septic arthritis most common?
In young, sexually active patients.
314
What are the symptoms of septic arthritis?
Symptoms occur over hours, with the patient reluctant to move the knee and a sensation of effusion when pressure is applied.
315
What does the aspirated fluid from the affected joint look like?
The fluid is yellow/green and cloudy.
316
What is the diagnostic test of choice for septic arthritis?
Aspirate the affected joint for cell count with differential **(WBCs over 50,000)**, gram stain, crystals, and culture and sensitivity.
317
What is the recommended treatment for septic arthritis?
Admit for IV vancomycin for 2-4 weeks, plus either ceftriaxone, cefotaxime, or ceftazidime.
318
What is the follow-up treatment after IV antibiotics for septic arthritis?
Oral antibiotics for an additional 2-3 weeks.
319
When should an orthopedic consultation be made in septic arthritis?
Consult ortho for surgical debridement and hardware removal.
320
What can cause osteoporosis?
Osteoporosis can occur as part of the aging process or due to nutritional deficiency, metabolic disorders, or medication side effects.
321
What are some risk factors for osteoporosis?
Inadequate physical activity, smoking, alcohol abuse, being female, and advanced age.
322
What medications can contribute to osteoporosis?
Steroids and PPIs decrease calcium reabsorption from the GI tract.
323
What is the balance in healthy bone?
Bone reabsorption by osteoclast cells is balanced by bone formation by osteoblast cells.
324
How does menopause affect bone health?
Decreased circulating levels of 17 beta-estradiol in menopause increase bone resorption without increasing bone formation.
325
What are potential consequences of osteoporosis?
Patients may experience kyphosis or vertebral compression fractures.
326
When should DEXA scan screening be considered?
All women ≥ 65 years old, all men ≥ 70 years old, postmenopausal women < 65 years old with risk factors, men aged 50-69 with risk factors, any adult with a fracture after age 50, and any adult with conditions or medications associated with low bone mass.
327
What is the T score correlation to the DEXA scan?
Normal: T-score ≥ -1, low bone mass (osteopenia): T-score -1 to -2.5, osteoporosis: T-score ≤ -2.5, severe osteoporosis: T-score ≤ -2.5 and ≥ 1 fracture.
328
What is the recommended calcium and vitamin D intake for osteoporosis patients?
Patients may want to add calcium (1000-1200 mg a day) and vitamin D intake.
329
What are the first-line treatments for osteoporosis?
Bisphosphonates such as Alendronate and Risedronate.
330
What are potential side effects of bisphosphonates?
They can cause pill-induced esophagitis, osteonecrosis of the jaw, and atypical femur fractures.
331
What is the FRAX tool?
FRAX (Fracture Risk Assessment Tool) predicts 10-year risk of fracture and helps guide decisions for patients with osteopenia.
332
What is ankylosing spondylitis?
A HLA-B27 positive chronic inflammatory rheumatic disease primarily involving the sacroiliac joints and spine, usually in men aged 20-30.
333
What triad is ankylosing spondylitis usually associated with?
IBD, anterior uveitis, and psoriasis.
334
How does activity affect ankylosing spondylitis?
Ankylosing spondylitis may improve with activity or exercise.
335
How is ankylosing spondylitis diagnosed?
Using ASAS Classification: 1) Sacroiliitis on imaging and 1 or more SpA features, or 2) HLA-B27 positive and 2 or more SpA features.
336
What sign on x-ray suggests ankylosing spondylitis?
Bamboo spine.
337
What is the treatment for ankylosing spondylitis?
1. Regular exercise and physical therapy, 2. NSAIDs, 3. TNF inhibitors, 4. Interleukin 17 inhibitors.
338
What characterizes fibromyalgia?
Widespread musculoskeletal pain in all four quadrants, cognitive dysfunction, and mood disorders.
339
What are risk factors for fibromyalgia?
Lyme disease and Hepatitis C.
340
What is the pathophysiology of fibromyalgia?
Impaired central pain processing, increased stimuli response, and larger distribution of pain.
341
What is the primary goal in treating fibromyalgia?
To increase quality of life through aerobic exercise and lifestyle modifications.
342
What medications may be advised for fibromyalgia?
Antidepressants like amitriptyline and duloxetine.
343
What is complex regional pain syndrome?
A condition that usually develops in an extremity after an injury or surgery, characterized by increased sensitivity and pain.
344
What are symptoms of complex regional pain syndrome?
Increased sensitivity to touch/vibration, burning pain, temperature asymmetry, skin color changes, and hair changes.
345
What is the treatment for complex regional pain syndrome?
1. Physical therapy/occupational therapy, 2. Medications like gabapentin and steroids, 3. Counseling.
346
What is gout?
Gout is characterized by monosodium urate crystals in joints, more common in men over 40, and associated with chronic kidney disease (CKD).
347
What are common causes of gout?
Common causes include purine-rich foods, red meat, seafood, alcohol (especially beer), and sugar-sweetened beverages (fructose increases serum urate levels).
348
What medications can cause gout?
Medications that can cause gout include pyrizinamide, loop diuretics, low-dose aspirin, thiazides, and ethambutol.
349
What is the pathophysiology of gout?
The pathophysiology of gout is usually due to hyperuricemia.
350
What are common symptoms of gout?
Common symptoms include pain in the first MTP joint (podagra) and tophi (crystals) poking through the skin.
351
What is the gold standard for diagnosing gout?
The gold standard for diagnosis is arthrocentesis or demonstration of monosodium urate crystals in synovial fluid analysis.
352
What do gout crystals look like under a microscope?
Gout crystals are negatively birefringent needle-shaped crystals.
353
What X-ray findings are associated with gout?
X-ray findings may show 'mouse bite' or punched-out erosions.
354
What is the best immediate therapy for acute gout?
The best immediate therapies are NSAIDs (like indomethacin), colchicine, and prednisone.
355
What is the best medication for prevention of gout?
The best medication for prevention is allopurinol, a xanthine oxidase inhibitor.
356
What is pseudogout?
Pseudogout, also known as calcium pyrophosphate dihydrate deposition disease, is typically caused by hypomagnesemia and usually occurs in larger joints.
357
What are the diagnostics for pseudogout?
Diagnostics include calcium pyrophosphate dihydrate crystals in synovial fluid or biopsied tissue, and detection of chondrocalcinosis on X-ray.
358
What is the first-line treatment for pseudogout?
The first-line treatment for pseudogout is steroids when 1-2 joints are involved.
359
What are other treatment options for pseudogout?
Other treatment options include NSAIDs and colchicine.
360
What is rheumatoid arthritis?
Rheumatoid arthritis is an autoimmune condition characterized by symmetrical joint pain and swelling, typically involving the hands, chronic destructive synovitis, and can cause panus in the joint space, especially in women.
361
What are the symptoms of rheumatoid arthritis?
Symptoms include Hammer Toe, RA nodules, subcutaneous nodules, symmetric swollen, tender, erythematous, 'boggy' joints, boutonniere and swan neck deformities in hands, and ulnar deviation at the MCP.
362
What is a common symptom related to morning stiffness in rheumatoid arthritis?
Morning stiffness lasting for greater than an hour, with symmetrical joint involvement, swelling, and tenderness.
363
What are the characteristics of the fingers in rheumatoid arthritis?
The middle knuckle is flexed and the last knuckle is hyperextended.
364
What are the diagnostic criteria for rheumatoid arthritis?
Diagnostics include Rheumatoid Factor (sensitive but not specific), Anti-Citrullinated Peptide Antibodies (very specific - MOST SPECIFIC TEST), arthritis in more than 3 joints, morning stiffness, and disease duration > 6 weeks.
365
What do X-rays show in rheumatoid arthritis?
X-rays may show narrowed joint space.
366
What is the first line treatment for rheumatoid arthritis?
Methotrexate is the first line treatment. Consider NSAIDs or steroids for acute flares.
367
What is Juvenile Idiopathic Arthritis?
Chronic inflammatory arthritis in children < 16 years old involving ≥ 5 joints during the first 6 months of illness, with other known conditions excluded.
368
What are the subtypes of Juvenile Idiopathic Arthritis?
1. Rheumatoid factor positive 2. Rheumatoid factor negative
369
What are the symptoms of systemic Juvenile Idiopathic Arthritis?
Persistent fever for 2 weeks, distinctive pink non-itchy rash, hepatitis, and hepatosplenomegaly.
370
What is the distinctive rash associated with systemic Juvenile Idiopathic Arthritis?
A pink non-itchy rash that is effervescent.
371
What are the symptoms of oligoarticular/pauciarticular Juvenile Idiopathic Arthritis?
Fewer than 5 joints involved with eye issues (uveitis-ANA +).
372
What are the symptoms of polyarticular Juvenile Idiopathic Arthritis?
Involves more than 5 joints, poor appetite, morning stiffness, and limb or walk refusal.
373
What are the diagnostics for Juvenile Idiopathic Arthritis?
Rheumatoid factor positive in about 15%.
374
What is the treatment for Juvenile Idiopathic Arthritis?
1. Methotrexate (DMARDS for chronic use) 2. NSAIDs for acute flares 3. Steroid joint injections for acute flares.
375
What is Psoriatic Arthritis?
Arthritis that can present with nail lesions and silvery scaly plaques on extensor surfaces.
376
What is dactylitis in Psoriatic Arthritis?
Inflammation of the entire digit causing a 'sausage-like' appearance.
377
What are the diagnostics for Psoriatic Arthritis?
Clinical symptoms of joint inflammation, absence of rheumatoid factor, and typical psoriatic skin and nail lesions.
378
What are the CASPAR criteria for Psoriatic Arthritis?
Inflammatory joint disease and ≥ 3 of the following: current psoriasis, personal or family history of psoriasis, typical psoriatic nail dystrophy, rheumatoid factor negative, current or history of dactylitis, radiologic evidence.
379
What is the radiologic evidence for Psoriatic Arthritis?
X-rays show 'pencil in cup' deformity.
380
What is the treatment for Psoriatic Arthritis?
1. Methotrexate (DMARDS for chronic use) 2. Biologic DMARDs if methotrexate is not effective 3. NSAIDs for acute flares 4. Steroid joint injections for acute flares.
381
What is Reactive Arthritis also known as?
Reactive Arthritis is also known as 'Reiter Syndrome'.
382
What is the TRIAD of Reactive Arthritis?
The TRIAD of Reactive Arthritis presents with arthritis, conjunctivitis/uveitis, and urethritis. ## Footnote This is summarized as 'can’t see, can’t pee, can’t climb a tree'.
383
Who is more commonly affected by Reactive Arthritis?
It is more common in patients who are HLA-B27 positive, particularly men aged 20-40 years.
384
What typically triggers Reactive Arthritis?
It is usually caused by a GU or GI infection, such as chlamydia.
385
When do symptoms of Reactive Arthritis typically occur after the trigger?
Symptoms typically occur 1-4 weeks after the trigger.
386
What are the common symptoms of Reactive Arthritis?
Symptoms include asymmetric oligoarthritis, dactylitis, scaly rash (typically on palms, soles, trunk, scalp, and/or scrotum), conjunctivitis/uveitis, mucosal lesions (oral, genital), and morning stiffness lasting about 1 hour.
387
What diagnostic test should be done if gonorrhea or chlamydia is suspected?
A urethral swab should be done if gonorrhea or chlamydia is suspected.
388
What are the treatment options for Reactive Arthritis?
Treatment options include NSAIDs, methotrexate, steroid joint injections for pain relief, and anti-TNF medications.
389
How long do symptoms of Reactive Arthritis typically last?
Symptoms will resolve in 4-6 months.
390
What is Systemic Lupus Erythematosus?
A multi-system autoimmune disorder where autoantibodies target nuclear material like DNA, RNA, T and B cells.
391
Who is more commonly affected by Systemic Lupus Erythematosus?
More common in noncaucasian women.
392
What does the acronym 'MD CHART' stand for in relation to lupus symptoms?
Malar rash, Discoid lesions, CV/constitutional symptoms, Hematologic manifestations, Arthritis, Renal issues, Thromboembolic events.
393
What are common symptoms of Systemic Lupus Erythematosus?
Malar rash (spares the nasolabial folds), joint pain, fever in women of childbearing age, photosensitivity, mouth sores, kidney issues.
394
What is livedo reticularis?
A mottled reticulated vascular pattern often seen in lupus.
395
What is Raynaud's phenomenon?
A condition that occurs when exposed to cold, often associated with lupus.
396
What is Discoid lupus?
A subtype of lupus that has annular, erythematous patches of face and scalp.
397
What are the diagnostic tests for lupus?
1. ANA (if positive, more likely lupus) 2. anti-dsDNA, anti-Sm, anticardiolipin 3. All 3 blood cell lines can be affected.
398
What is the first-line treatment for lupus?
Hydroxychloroquine.
399
What are other treatments for Systemic Lupus Erythematosus?
NSAIDs, Steroids, Methotrexate.
400
What is Systemic Sclerosis?
An autoimmune condition characterized by progressive fibrosis of the skin and internal organs.
401
What is the pathophysiology of Systemic Sclerosis?
It involves a graft-versus-host reaction where T cells overproduce cytokines, leading to excessive inflammation and collagen deposition by fibroblasts.
402
What are common symptoms of Systemic Sclerosis?
Symptoms include esophageal dysmotility, sclerodactyly, and thickening of the frenulum of the tongue, but it typically spares the trunk.
403
What are the diagnostic markers for Scleroderma?
+ ANA (non-specific) + Anti-centromere antibody (specific to CREST syndrome) + Scleroderma antibody (SCL-70, associated with diffuse disease)
404
What are the treatment options for Systemic Sclerosis?
1. DMARDS (methotrexate) 2. Steroids 3. CCB for Raynaud’s
405
What is Limited Cutaneous Systemic Sclerosis (CREST syndrome)?
A type of systemic sclerosis with fewer skin symptoms than cutaneous symptoms, characterized by calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia.
406
What is the most common type of Systemic Sclerosis?
CREST syndrome, which affects the face, neck, and areas distal to the elbows and knees.
407
What is Diffuse Cutaneous Systemic Sclerosis?
A form of systemic sclerosis where the trunk and proximal extremities are much more likely to have organ involvement.
408
What is Polyarteritis Nodosa?
A necrotizing arteritis primarily affecting medium-sized arteries such as the main visceral arteries and their branches. ## Footnote It spares the lungs.
409
What is the peak incidence age for Polyarteritis Nodosa?
50-70 years.
410
What are major risk factors for Polyarteritis Nodosa?
HEP B and Hep C.
411
What is a common complication of Polyarteritis Nodosa?
Formation of aneurysm in the medium-sized arteries.
412
What neurological condition is associated with Polyarteritis Nodosa?
Asymmetrical asynchronous peripheral neuropathy.
413
What are common systemic complications of Polyarteritis Nodosa?
Hypertension and renal disease.
414
What skin manifestations are associated with Polyarteritis Nodosa?
Livedo racemosa, subcutaneous nodules, and skin ulcers reflect involvement of deeper, medium-sized blood vessels.
415
What diagnostic tests are used for Polyarteritis Nodosa?
ANCA testing and angiogram will most likely show abnormalities and aneurysms. ## Footnote A biopsy at the symptomatic site (preferably skin or muscle) is needed to confirm.
416
What is the treatment for Polyarteritis Nodosa?
High dose steroids. ## Footnote Pulse methylprednisolone may be necessary for patients who are critically ill.
417
What is Polymyalgia Rheumatica (PMR)?
PMR is a condition where patients have giant cell arteritis, and 40%-60% of patients with giant cell arteritis exhibit PMR symptoms. ## Footnote Example: 'Paul-B-myalgia Rheumatica' refers to Paul Bunyan, the giant with Giant Cell Arteritis.
418
Who is most affected by PMR?
Women of Scandinavian or northern European descent, typically occurring after Parvovirus B-19 infection.
419
What are the symptoms of PMR?
Symptoms include symmetrical pain, morning stiffness typically lasting ≥ 30 minutes, stiffness worsening with rest, and pain radiating from proximal joints (shoulder to elbows or hip to knees).
420
Is imaging needed for PMR diagnosis?
No imaging is needed for diagnosis.
421
What is the treatment for PMR?
The treatment is low dose steroids.
422
What is Giant Cell Arteritis?
Giant Cell Arteritis is a chronic systemic vasculitis involving large- and medium-sized arteries.
423
What is temporal arteritis?
When the temporal artery is involved in Giant Cell Arteritis, it is referred to as temporal arteritis, which can cause blindness.
424
What is the diagnostic test for Giant Cell Arteritis?
The test of choice is MRI or CT angiography, which demonstrates long stretches of narrowing of the subclavian and axillary arteries.
425
What is the diagnostic test for temporal arteritis?
The test of choice is ultrasound, but the definitive diagnosis must be confirmed by temporal artery biopsy.
426
What is the treatment for Giant Cell Arteritis?
Treatment includes prednisone for 1-2 months and low dose aspirin to reduce the risk of visual loss or stroke.
427
What is Polymyositis?
Progressive muscle weakness of the proximal muscle groups and symptoms include distinctive butterfly facial rash, leg weakness, and dyspnea, especially when rising from a chair or climbing stairs.
428
What are the diagnostics for Polymyositis?
1. Elevated CK 2. Anti-JO-1 3. Muscle biopsy definitive
429
What is the treatment for Polymyositis?
1. Steroids 2. Methotrexate
430
What is Sjogren's syndrome?
Chronic autoimmune disorder characterized by exocrine gland dysfunction and dryness of mucosal surfaces (sicca symptoms), usually affecting the eyes and mouth.
431
What are the symptoms of Sjogren's syndrome?
Sicca symptoms, usually dry eyes (xerophthalmia) and dry mouth (xerostomia), parotid gland swelling, angular cheilitis (cracks in the corner of the mouth), cavities.
432
What are the diagnostics for Sjogren's syndrome?
1. Rheumatoid factor is found positive in 70% of patients 2. Anti-Ro and Anti-La antibodies 3. The Schirmer test measures the quantity of tears secreted 4. Salivary gland biopsy if other diagnostics unclear
433
What is the treatment for Sjogren's syndrome?
1. Symptom relief and prevention of complications 2. Pilocarpine can help reduce symptoms (cholinergic drug, promotes secretions) 3. Artificial tears to avoid corneal abrasions
434
What is osteoarthritis?
Degeneration of cartilage and underlying bone caused by wear and tear over time.
435
What factors contribute to osteoarthritis?
Age (older) and certain exercises like running.
436
What is the pathophysiology of osteoarthritis?
Chondrocytes start to break down more than they produce, causing cartilage to flake off into the synovium and leading to inflammation.
437
What are the stages of osteoarthritis?
Stage 1: Doubtful, minimum disruption, 10% cartilage loss. Stage II: Mild, joint-space narrowing, cartilage breakdown, occurrence of osteophytes. Stage III: Moderate, moderate joint-space reduction, gaps in cartilage expand to bone. Stage IV: Severe, joint space reduced by 60%, large osteophytes.
438
What are common symptoms of osteoarthritis?
Insidious onset, brief morning stiffness, weather predictors. Hip: pain with internal rotation. Knee: crepitus, varus/valgus deformity. Hands: osteophytes at PIP and DIP.
439
What are Bouchard’s nodes and Heberden’s nodes?
Bouchard’s nodes: osteophytes at the PIP. Heberden’s nodes: osteophytes at the DIP.
440
What diagnostics are used for osteoarthritis?
X-ray will show joint loss space, osteophytes, and narrowing of the joint space.
441
What are the treatment options for osteoarthritis?
1. Acetaminophen (Tylenol) 2. NSAIDs: Ibuprofen, Naproxen, Diclofenac (OTC topical NSAID gel) 3. Joint injections: Sodium hyaluronate 4. Glucosamine/chondroitin: supplement with placebo effect 5. Joint replacement 6. Avoid high impact exercises.
442
What is patellofemoral syndrome?
Anterior knee pain around or behind the patella, commonly seen in female runners.
443
What is IT Band syndrome?
Lateral knee pain due to overuse.
444
What is the most commonly injured ligament in ankle sprains?
The ATFL (anterior talofibular ligament).
445
What is myelopathy?
An injury to the spinal cord due to severe compression from trauma, congenital stenosis, degenerative disease, or disc herniation.
446
What can the use of Fluoroquinolones cause?
Achilles tendon rupture.
447
How is the Thompson test performed?
By squeezing the calf and seeing if there is appropriate plantar flexion.
448
What are the common causes of Mechanical Neck Pain?
History of injury or MVA, diffuse pain, repetitive motions.
449
What are the red flag symptoms of Mechanical Neck Pain?
Numbness, tingling, difficulty moving.
450
What is the test of choice for diagnosing Mechanical Neck Pain?
CT.
451
What should be used for acute injury assessment in Mechanical Neck Pain?
NEXUS or Canadian C-spine rule.
452
Is an x-ray usually needed for chronic pain in Mechanical Neck Pain?
Usually no x-ray needed.
453
What might an x-ray show in cases of Mechanical Neck Pain?
Straightening of the cervical spine due to muscle spasm.
454
What is the NEXUS criteria used for?
Ruling out cervical spine injury in patients under 65 years old.
455
What is the Canadian C-spine Rule used for?
Ruling out cervical spine injury in patients under 65 years old.
456
What is recommended for treatment of Mechanical Neck Pain?
Early gentle motion.
457
Are opiates recommended for Mechanical Neck Pain?
In general, they are not good.
458
Are cervical collars recommended for Mechanical Neck Pain?
They are not good.
459
What is Torticollis?
Fixed or dynamic posturing of the head and neck in tilt, rotation, and flexion, usually caused by muscle spasms.
460
What is a risk factor for congenital torticollis?
Difficult or breach birth.
461
How is Torticollis treated?
With muscle relaxers; it usually resolves in 1-2 weeks.
462
What are some specific cervical spine injuries?
Atlanto-occipital dissociation, C1 fracture, odontoid fracture, distraction injury.
463
What results from anterior subluxation of the cervical spine?
It results from posterior ligamentous complex injury.
464
How is cervical spine injury diagnosed?
By CT.
465
What is the treatment for cervical spine injuries?
Surgery (neurosurgery).
466
What are disc herniations?
Radicular symptoms and degenerative diseases.
467
What is spondylosis?
Age-related 'wear and tear' of intervertebral discs, which can cause similar symptoms to herniation.
468
What occurs during a tear in the annulus fibrosus?
Material of the nucleus pulposus can track through this tear and impinge on neural structures.
469
What are common symptoms of disc herniation?
Unilateral shooting electric pain, often exacerbated by extension and rotation of the neck.
470
What are the most common areas for disc herniation?
C6-C7 and L5-S1.
471
What is the Spurling test?
Neck extended with head rotated to affected shoulder while axially loaded; shoulder or arm pain suggests cervical spinal nerve root compression.
472
What is the straight leg raise test?
With the patient supine, elevate the affected leg slowly; positive if radiating pain is reproduced at 30-70 degrees of hip flexion.
473
What imaging technique has the best sensitivity for diagnosing disc herniations?
MRI.
474
What are conservative management options for cervical disc herniation?
Oral analgesics, short course of oral corticosteroids, avoidance of provocative activities, short-term neck immobilization, physical therapy, cervical traction.
475
What are indications for surgery in cervical disc herniation?
Symptoms of cervical radiculopathy not relieved by conservative treatment, evidence of nerve root compression by MRI, progressive motor weakness.
476
What are conservative management options for lumbar disc herniation?
Oral analgesics, short course of oral corticosteroids, avoidance of provocative activities, physical therapy.
477
What is an indication for surgery in lumbar disc herniation?
Cauda equina syndrome.
478
What is spondylolysis?
Spondylolysis is a stress fracture in the pars interarticularis.
479
What is spondylolisthesis?
Spondylolisthesis is when the adjacent vertebrae have a larger crack in the bone, often due to degeneration or sports injuries.
480
What are the common symptoms of spondylolysis and spondylolisthesis?
Both conditions present with diffuse and dull back pain that rarely radiates.
481
How are spondylolysis and spondylolisthesis diagnosed?
They are diagnosed by x-ray and MRI if needed.
482
What is the treatment for spondylolysis and spondylolisthesis?
The treatment for both is conservative.
483
What is spinal stenosis?
Spinal stenosis involves ossification and hypertrophy of the posterior longitudinal ligament and ligamentum flavum.
484
What are the symptoms of spinal stenosis?
Symptoms include claudication with walking, which is relieved with sitting.
485
What is the test of choice for spinal stenosis?
MRI is the test of choice.
486
What are the treatment options for spinal stenosis?
1. Conservative: Oral analgesics, avoidance of triggers, PT 2. Epidural corticosteroid injections 3. Surgery if conservative treatment fails
487
What is an epidural abscess?
An epidural abscess is pus that accumulates in the epidural space between the dura and vertebral periosteum.
488
What is the most common cause of an epidural abscess?
Staph aureus is the most common cause.
489
What is the classic triad of symptoms for an epidural abscess?
The classic triad includes back pain, fever, and neurologic symptoms.
490
What is the test of choice for an epidural abscess?
MRI with gadolinium is the test of choice.
491
What is the initial treatment for an epidural abscess?
Start broad-spectrum antibiotics immediately and consult neurosurgery.
492
What are the treatment options for an epidural abscess?
Conservative treatment: antibiotic only or antibiotics and CT-guided drainage. Surgical treatment: laminectomy with evacuation of abscess.
493
What is discitis?
Discitis is inflammation of the vertebral disk space, often related to infection.
494
How does discitis commonly occur?
It almost always occurs with osteomyelitis, typically via hematogenous spread from a distant site or focus of infection.
495
What is the most sensitive test for discitis?
MRI with gadolinium is the most sensitive.
496
What is the treatment for discitis?
IV antibiotics, typically for 2-6 weeks.
497
When may surgery be required for discitis?
Surgery may be required if not responding to IV antibiotics (track with ESR/CRP) or if associated with hardware.
498
What does surgical treatment for discitis include?
Surgery includes debridement of any infected soft tissue and bone.
499
What is Transverse Myelitis?
Inflammation of the spinal cord, leading to progressive loss of the fatty myelin sheath surrounding the nerves. Causes are unclear, often following infections or due to multiple sclerosis. Symptoms are bilateral and symmetric.
500
What are the diagnostics for Transverse Myelitis?
MRI of the entire spine with and without IV gadolinium, labs to assess underlying autoimmune or infectious diseases, and CSF analysis.
501
What is the treatment for Transverse Myelitis?
High-dose corticosteroids, immunosuppressive drugs, and treating the underlying condition.
502
What defines low back pain/sprain/strain?
It can only be called 'low back pain' if all other conditions are ruled out. If there are no red flags, conservative treatment for 4-6 weeks without imaging is reasonable.
503
What imaging is preferred for low back pain if conservative treatment fails?
MRI is the imaging of choice after X-ray.
504
What are the conservative treatment options for low back pain?
Heat, massage, acupuncture, spinal manipulation, exercise, and physical therapy.
505
What pharmacotherapy options are available for low back pain?
NSAIDs, APAP (limited utility), muscle relaxers, and opiates (limited utility). ## Footnote 'If therapy is chosen by the patient, it has a better chance of working.'
506
What are the characteristics of Sciatica?
Positive straight leg raise, with leg pain usually greater than back pain and pain radiating unilaterally. Further diagnostic testing is recommended if radicular pain.
507
What is the test of choice for Sciatica?
MRI.
508
What are the treatment options for Sciatica?
1. Conservative management: heat, exercise as tolerated, NSAIDs, muscle relaxers, PT. 2. Epidural injections. 3. Surgical referral.
509
What are Thoracic/Lumbar Compression Fractures?
Fractures more likely to occur in Asian and Caucasian women than in African American women, often due to trauma. Wedge fractures are the most common.
510
What should be considered with Thoracic/Lumbar Compression Fractures?
Consider osteoporosis or malignancy. Types include biconcave or concave fractures and burst/crush fractures associated with high-energy trauma.
511
What diagnostics are used for Thoracic/Lumbar Compression Fractures?
X-rays of the thoracic and lumbar spine; a burst fracture may require a CT to fully assess the fracture.
512
What are the treatment options for Thoracic/Lumbar Compression Fractures?
1. Conservative treatment of underlying disease, referral to spine surgeon. 2. Observation if neurologically intact (in wedge fractures). 3. Bracing. 4. May require kyphoplasty or percutaneous vertebroplasty.
513
What is a Coccyx Fracture?
A Coccyx Fracture is commonly referred to as a 'broken tailbone'. ## Footnote Non-operative treatment includes cushioning and analgesia.
514
What is Cauda Equina?
Cauda Equina refers to the 'horses tail' of the lumbar, sacral, and coccygeal nerves. It is considered an EMERGENCY. ## Footnote Usually caused by lumbar disc herniation.
515
What are the stages of Cauda Equina syndrome?
1st Stage: Bilateral radicular pain (more concerning). 2nd Stage (incomplete): Urinary difficulties. 3rd Stage (retention): Painless urinary retention and overflow incontinence. 4th Stage (complete): Bowel and bladder incontinence, saddle anesthesia, loss of rectal tone.
516
What is the gold standard for diagnosing Cauda Equina syndrome?
MRI is the gold standard for diagnosis.
517
What is the treatment for Cauda Equina syndrome?
1. Urgent neurosurgical consult. 2. Surgical lumbar decompression must be done within 48 hours.
518
What is Conus Medullaris Syndrome?
Conus Medullaris Syndrome is similar to Cauda Equina but occurs at L1-L2. ## Footnote MRI is used to diagnose and requires urgent surgical decompression.
519
What is the light bulb sign?
The light bulb sign on x-ray indicates posterior shoulder dislocations.
520
What is scoliosis?
A common spinal deformity characterized by a lateral curvature of the spine > 10 degrees on a posterior-anterior radiograph while standing.
521
What is adolescent idiopathic scoliosis associated with?
Elastic fiber disorganization in the ligamentum flavum and symmetry.
522
How is scoliosis diagnosed?
X-ray from C7 to iliac crest with the patient in a standing position. Lateral curvature (Cobb Angle) > 10 degrees is diagnostic.
523
What is the treatment for scoliosis with curves < 25 degrees?
Observe.
524
What is the treatment for scoliosis with curves between 25-45 degrees?
Bracing.
525
What is the treatment for scoliosis with curves > 45 degrees?
Surgery.
526
What factors contribute to Rotator Cuff Syndrome/Tear?
Age, smoking, participation in overhead activities (occupations or sports).
527
Which rotator cuff tendon is most commonly torn?
Supraspinatus.
528
What are common symptoms of a rotator cuff tear?
Difficulty sleeping on the affected side.
529
What provocative tests are used for rotator cuff assessment?
Hawkins impingement, Neer impingement, empty can, drop arm test.
530
What are the initial diagnostics for rotator cuff injuries?
X-rays for initial imaging and MRI for definitive diagnosis.
531
What is the treatment for partial thickness rotator cuff tears?
Activity modification for 1-2 weeks, NSAIDs, and physical therapy.
532
What is the operative management for partial thickness rotator cuff tears?
For those with no improvement for 3-6 months, typically only for younger patients.
533
What age groups are most affected by shoulder dislocations?
Mostly adolescents and individuals aged 50-60.
534
What causes anterior shoulder dislocations?
Usually due to indirect force on the arm while in an abducted and externally rotated position.
535
What causes posterior shoulder dislocations?
Associated with epileptic seizure, electric shock, or involuntary muscle contraction.
536
What is the treatment for shoulder dislocations?
Reduction using several techniques, followed by shoulder immobilization for 1-3 weeks.
537
What should be done after shoulder reduction?
Assess for soft tissue injury and provide physical therapy for shoulder instability.
538
What medications can be given for shoulder dislocations?
Drugs like ketamine or etomidate.
539
What is the risk after one shoulder dislocation?
The risk for another dislocation increases due to stretched soft tissue around the joint.
540
What imaging should be done before and after shoulder reduction?
Always get an x-ray.
541
What is adhesive capsulitis?
Limited passive and active range of motion in the shoulder, typically in individuals aged 40-70, especially females.
542
What is the treatment of choice for adhesive capsulitis?
Physical therapy and range of motion exercises.
543
What may be performed if physical therapy fails for adhesive capsulitis?
Manipulation under anesthesia.
544
Who is most likely to experience a biceps tendon rupture?
Usually athletes or patients over 50.
545
What is a characteristic sign of a proximal biceps tendon rupture?
Popeye deformity.
546
What is the treatment for proximal tendon rupture?
Usually conservative management: immobilization for a short period, NSAIDs, and physical therapy.
547
What is required for distal tendon rupture?
Surgical referral.
548
What is the most common location for a clavicle fracture?
Most are in the middle third.
549
What are the symptoms of a clavicle fracture?
Pain, swelling, deformity over the clavicle.
550
What should be performed in a clavicle fracture assessment?
A careful neuromuscular and lung exam.
551
What imaging is used for clavicle fractures?
X-ray.
552
What is the treatment for clavicle fractures?
Sling for 3-4 weeks, then gentle ROM exercises. Comminuted mid and proximal clavicle fractures may require open reduction internal fixation (ORIF).
553
What ligaments hold the AC joint in place?
Acromioclavicular ligament, Coracoclavicular ligament, Coracoacromial ligament.
554
Who commonly experiences AC separations?
Athletes and active individuals.
555
What imaging is used for AC separations?
X-ray imaging while holding a weight.
556
What is the treatment for Type I and II AC separations?
Brief sling immobilization, rest, ice, PT.
557
What is the treatment for Type III AC separations?
Surgery if athlete or if required for occupation, or if failed conservative treatment.
558
What is the treatment for Type IV and V AC separations?
Surgery (ORIF).
559
What is Thoracic Outlet Syndrome (TOS)?
Occurs when nerves or blood vessels are compressed by the rib, collarbone or neck muscles at the top of the outlet.
560
What are the symptoms of Thoracic Outlet Syndrome?
Dermatomal pain (usually in the ulnar region), occipital headaches, coolness/pallor, weakness/loss of dexterity, pain increases along the axillary vein, heaviness in the affected extremity, arm swelling and cyanosis.
561
What imaging studies are used for Thoracic Outlet Syndrome?
Chest radiography identifies cervical rib, MRI with arms held in different positions for impaired blood flow, angiography confirms obstruction.
562
What is the treatment for Thoracic Outlet Syndrome?
Analgesics, PT, anticoagulation/thrombolysis, surgery.
563
How do scapula fractures usually occur?
With high energy trauma and rarely occur alone.
564
What imaging is required for scapula fractures?
Dedicated 'scapula view'.
565
What is the typical treatment for scapula fractures?
Usually treated non-surgically (sling, ice, analgesia) or CT.
566
What are the common types of proximal humerus fractures?
Surgical neck and greater tuberosity.
567
What is the most commonly injured nerve in proximal humerus fractures?
The axillary nerve.
568
What should be documented in proximal humerus fractures?
Neuro and vascular status.
569
What imaging is used for proximal humerus fractures?
X-ray, may need CT.
570
What is the treatment for proximal humerus fractures?
Most are handled conservatively (sling, ice, analgesia), need EARLY ROM to prevent adhesive capsulitis, some require surgery (ORIF).
571
Who is most likely to experience humeral shaft fractures?
Males 20-30 with high energy trauma, females > 60 with FOOSH.
572
What should be noted in humeral shaft fractures?
The radial nerve.
573
What imaging should be included for humeral shaft fractures?
X-ray including the joint above and below the injury.
574
What is the treatment for humeral shaft fractures?
Coaptation splint followed by brace, surgery (ORIF) if severe angulation, open fracture, or nerve or vascular injury.
575
What are supracondylar fractures and their common causes?
Supracondylar fractures occur in kids aged 5-7, often due to a fall on an outstretched hand (FOOSH). ## Footnote Perform a distal neurovascular exam of the nerves.
576
What diagnostic sign indicates a supracondylar fracture?
The posterior fat pad sign and swelling of the back of the distal humerus indicate a fracture, even if not visible on X-ray.
577
What is the treatment for displaced or non-displaced supracondylar fractures with neurovascular compromise?
Urgent closed reduction and percutaneous pinning under fluoroscopy.
578
What is lateral epicondylitis commonly known as?
Tennis elbow.
579
What are the symptoms of lateral epicondylitis?
Pain during active wrist extension or forearm supination, with point tenderness and insidious onset.
580
What activities can exacerbate lateral epicondylitis?
Manual labor with heavy and/or vibratory tools, and playing tennis.
581
What is the treatment for lateral epicondylitis?
Rest, ice, NSAIDs, tennis elbow brace, physical therapy, corticosteroid injections, and surgery if pain persists after 6-12 months.
582
What is medial epicondylitis commonly known as?
Golfer’s elbow.
583
What causes medial epicondylitis?
Overuse injury of the wrist flexor tendons, exacerbated by repeated wrist flexion, forearm pronation, and valgus stress at the elbow.
584
What is the treatment for medial epicondylitis?
Rest, ice, NSAIDs, physical therapy, corticosteroid injections, and surgery if pain does not resolve after 6-12 months.
585
What is olecranon bursitis and its common causes?
Olecranon bursitis is most common in men aged 30-60 years, caused by acute direct trauma, repetitive microtrauma, or prolonged pressure on the bursa.
586
What are the signs of septic bursitis?
Warmth, cellulitis, erythema, and fever.
587
How to diagnose septic bursitis?
Aspirate bursa and send fluid for analysis.
588
What is the treatment for aseptic olecranon bursitis?
Rest, ice, compression, activity modification, NSAIDs, needle aspiration, and steroid injection if conservative treatment fails.
589
What is the treatment for septic olecranon bursitis?
Drainage of bursa fluid plus systemic antibiotics is the mainstay of therapy.
590
What is the most common type of elbow dislocation?
Posterior elbow dislocation.
591
What are the common symptoms of elbow dislocation?
Obvious deformity and involvement of the ulnar nerve.
592
What is the treatment for elbow dislocation?
Closed reduction and a posterior long arm splint for 3 days, followed by gentle range of motion and physical therapy.
593
What is nursemaid's elbow?
Radial head subluxation usually due to the arm being pulled, common in children aged 6 months to 7 years.
594
What is the treatment for nursemaid's elbow?
Closed reduction; X-ray is not needed.
595
What is a radial head fracture and its common cause?
A fracture of the proximal radius due to FOOSH.
596
What are the X-ray signs of a radial head fracture?
Large anterior fat pad ('sail sign') and posterior fat pad.
597
What is the treatment for a radial head fracture?
Posterior long arm splint; surgery may be indicated if displacement.
598
What is a Monteggia fracture?
Fracture of the proximal third of the ulna with dislocation of the radial head.
599
What is the treatment for a Monteggia fracture?
Immediate reduction of the radial head with splinting and subsequent surgery.
600
What is a Galeazzi fracture?
Fracture of the middle portion of the radius with dislocation of the distal radioulnar joint.
601
What is the treatment for a Galeazzi fracture?
Open reduction and internal fixation (ORIF) of the radius and reduction of the distal radioulnar joint.
602
What is cubital tunnel syndrome?
Entrapment of the ulnar nerve at the elbow.
603
What activities can lead to cubital tunnel syndrome?
Prolonged periods of elbow flexion and resting elbows on hard surfaces.
604
What is the diagnostic test for cubital tunnel syndrome?
Electromyography (EMG) is the diagnostic test.
605
What is the treatment for cubital tunnel syndrome?
NSAIDs, elbow pad, and surgery if conservative treatment fails.
606
What is carpal tunnel syndrome?
Condition caused by high hand or wrist repetition rate.
607
What are the symptoms of carpal tunnel syndrome?
Symptoms may wake the patient at night.
608
What diagnostic tests are used for carpal tunnel syndrome?
Tinel test and Phalen test; EMG can confirm the diagnosis.
609
What is the treatment for carpal tunnel syndrome?
Conservative treatment first: NSAIDs, wrist splint, decrease provocative activity, steroid injection, and surgery if needed.
610
What is DeQuervian Syndrome?
Wrist tendon entrapment syndrome where gliding of the abductor pollicis longus and extensor pollicis brevis tendons is restricted within the first dorsal compartment. ## Footnote Treatment includes a Thumb Spica splint, avoiding provocative movements/lifting, steroid injection, and rarely surgery.
611
What is a Schaphoid Fracture?
Most commonly fractured carpal bone with a high risk of avascular necrosis. ## Footnote Pain is located at the anatomical snuffbox (87-100% sensitivity) and with axial load applied to the thumb. Treatment for non-displaced fractures is immobilization for 6 weeks.
612
What is the treatment for a displaced Schaphoid Fracture?
Surgery is required for displaced fractures.
613
What is a Scapholunate dislocation?
An injury involving the rupture of ligaments stabilizing the scaphoid with the lunate. ## Footnote Symptoms include swelling and tenderness over the dorsal wrist, and X-ray will show scapholunate joint space widening.
614
What is a Colles Fracture?
A distal radial metaphysis fracture that is dorsally angulated, causing pressure on the median nerve. ## Footnote It presents with a 'Dinner fork' deformity. Stable fractures can be treated with immobilization, while unstable fractures require immediate reduction/immobilization and possibly surgery.
615
What is a Smith Fracture?
A volar angulated fracture of the distal radius. ## Footnote Stable fractures can be treated with immobilization, while unstable fractures require immediate reduction/immobilization and possibly surgery.
616
What is Mallet Finger?
A tear of the extensor mechanism at the distal phalanx, often after a sudden axial blow to an extended fingertip. ## Footnote The patient is unable to extend the fingertip. Treatment involves a finger splint in full extension for 6-8 weeks.
617
What is Bountonneire Deformity?
An extensor tendon injury or slip at the PIP. ## Footnote Must splint in full extension for 6-8 weeks; surgery is indicated if displaced.
618
What is Gamekeepers Thumb?
Injury to the ulnar collateral ligament of the thumb metacarpal-phalangeal joint. ## Footnote Symptoms include pain and laxity at the thumb MCP joint. Treatment may involve immobilization in a cast or splint, and surgery if the joint is very unstable.
619
What is a Boxer's Fracture?
A fifth digit metacarpal neck fracture. ## Footnote Look for evidence of 'fight bite'. Treatment varies based on angulation: minimal angulation requires immobilization, moderate angulation requires closed reduction and splinting, and severe angulation requires ORIF.
620
What causes Thumb Fractures?
Caused by axial force with the thumb in flexion. ## Footnote Treatment includes a Thumb spica splint/cast or surgery.
621
What are Phalangeal Fractures?
Fractures can occur at the tuft (very distal end, usually a crush injury), shaft, or intraarticular (at the DIP). ## Footnote Treatment depends on angulation and articular involvement, including splinting, surgery, closed reduction/pinning, or ORIF.
622
What is Phalangeal Dislocation?
Dislocations can occur at the PIP or DIP in volar, dorsal, or lateral directions. ## Footnote Treatment involves X-ray, injection to numb the area, reduction, and splinting.
623
What is the treatment for Metacarpal Fractures?
Treatment involves splinting, closed reduction, and possibly surgery (ORIF, pinning).
624
What are flexor tendon injuries?
Laceration/injury on the palmar side of the palm or fingers. May occur with a fracture or have a foreign body (FB), so get x-rays.
625
How are flexor tendon injuries diagnosed?
X-ray to assess for associated fracture/FB. Actual tendon injury is diagnosed based on exam.
626
What is the treatment for flexor tendon injuries?
These ALWAYS require referral to hand surgery. DO NOT MISS, patient can lose function of hand.
627
What is Trigger Finger?
Impingement at the level of the A1 pulley. Tendon fibrosis associated with previous injury, diabetes, and autoimmune disorders.
628
What is the treatment for Trigger Finger?
Splint first, then steroid injection, then surgical release of A1 pulley.
629
What is Flexor Tenosynovitis?
Infection of the synovial sheath that surrounds the flexor tendon.
630
What are the most common bacteria causing Flexor Tenosynovitis?
Staph most common, MRSA, Eikenella (human bites), Pasteurella multocida (animal bites).
631
What are the symptoms of Flexor Tenosynovitis?
Delayed fashion (over last 24-48 hours). Kanavel signs: held in flexion, fusiform swelling (sausage finger), tenderness, pain on passive extension.
632
How is Flexor Tenosynovitis diagnosed?
Clinical.
633
What is the treatment for Flexor Tenosynovitis?
Surgery: I and D, IV antibiotics, hand immobilization.
634
What is Dupuytren's contracture?
A benign proliferative disorder characterized by fascial nodules and contractures of the hand.
635
What is the treatment for Dupuytren's contracture?
ROM exercises but will often require surgery.
636
What is a Felon?
A subcutaneous abscess of the fingertip pulp. It can occur due to fingerstick glucose infection or spread from paronychia, usually caused by staph.
637
What is the treatment for a Felon?
Bedside I and D, antibiotics.
638
What is Costochondritis?
Palpation of costochondral and/or chondrosternal joints reproduces pain.
639
How is Costochondritis diagnosed?
Clinical diagnosis. Be sure to rule out other causes of chest pain: EKG, CXR.
640
What is the treatment for Costochondritis?
Self-limited course that may require weeks to months for resolution. Analgesics, local heat or ice compresses, limiting or avoiding aggravating activities.
641
What are the causes of Rib fractures?
Trauma, MVA, forceful cough, chest compressions.
642
How are Rib fractures diagnosed?
CXR, be sure to look for pneumothorax.
643
What is the treatment for Rib fractures?
Pain management (NSAIDs, opiates, lidocaine patches, ice), incentive spirometer - breathing exercise that decreases pneumonia risk.
644
What are Hip fractures classified by?
Hip fractures are classified anatomically.
645
What are the symptoms of Hip fractures?
Shortened affected extremity and externally rotated. Distal pulses and sensation of affected extremity compared to unaffected extremity.
646
How are Hip fractures diagnosed?
X-ray.
647
What is the treatment for Hip fractures?
Surgery within 48 hours associated with decreased mortality. Severely debilitated, at end of life, medical illness that cannot be corrected for surgery.
648
What is a hip dislocation?
An orthopedic emergency that must be reduced within 6 hours to prevent avascular necrosis.
649
What happens if a hip dislocation cannot be reduced under sedation?
The patient is taken to the OR.
650
What are the types of pelvic fractures?
Inferior pubic ramus fracture and acetabular fractures.
651
What is a common cause of pelvic fractures?
Motor vehicle accidents (MVA), particularly knee vs dashboard.
652
How can pelvic fractures be diagnosed?
They can be subtle and may require a CT scan.
653
What is the typical treatment for pelvic fractures?
Typically require open reduction and internal fixation (ORIF).
654
What is Legg-Calve-Perthes Disease?
An idiopathic hip disorder characterized by ischemic necrosis of the growing femoral head, leading to permanent deformity in children aged 4-8 years, primarily in white males.
655
What are the pathophysiological factors of Legg-Calve-Perthes Disease?
Factors disrupting bone formation or blood supply of the femoral head, and coagulation abnormalities resulting in stasis in blood vessels.
656
What are the symptoms of Legg-Calve-Perthes Disease?
Limping, high and calf muscle atrophy, and limb-length discrepancy of 1-2.5 cm.
657
What are the diagnostics for Legg-Calve-Perthes Disease?
Start with an X-ray; MRI is more sensitive.
658
What is the treatment for Legg-Calve-Perthes Disease?
NSAIDs, physical therapy (PT), and possibly surgery.
659
What is Slipped Capital Femoral Epiphysis?
A condition occurring in adolescent kids characterized by slippage of the proximal femoral epiphysis on the femoral neck.
660
What are the common causes of Slipped Capital Femoral Epiphysis?
Obesity, growth spurts in adolescence, hypothyroidism, and growth hormone deficiency.
661
What are the symptoms of Slipped Capital Femoral Epiphysis?
Limp (which can be painless).
662
What are the diagnostics for Slipped Capital Femoral Epiphysis?
X-ray.
663
What is the treatment for Slipped Capital Femoral Epiphysis?
Screw fixation.
664
What is a femoral shaft fracture?
A fracture typically occurring in young men (20-25 years old) and in individuals over 75.
665
What are the symptoms of a femoral shaft fracture?
Shortening of the leg along the mid-femur and potential concurrent injuries due to high-energy mechanisms.
666
What are the diagnostics for a femoral shaft fracture?
X-ray.
667
What is the treatment for a femoral shaft fracture?
In-line traction (EMS or ER) and intramedullary nailing.
668
What is a distal femur fracture?
A fracture that may present with varus or valgus deformity and knee effusion, potentially with intra-articular involvement.
669
What are the diagnostics for a distal femur fracture?
Initial imaging is an X-ray; CT can be used for further description and operative planning.
670
What is the treatment for a distal femur fracture?
ORIF and intramedullary nailing.
671
What is the most commonly injured ligament in the knee?
The medial collateral ligament (MCL) is the most commonly injured ligament in the knee.
672
What are the inspection findings for MCL injuries?
Inspect for swelling, effusion, and alignment.
673
What are the palpation findings for MCL injuries?
Palpate for tenderness along the medial knee.
674
What test is used for MCL injuries?
Valgus stress test.
675
What are the inspection findings for LCL injuries?
Inspect for swelling, effusion, and alignment.
676
What are the palpation findings for LCL injuries?
Palpate for tenderness along the lateral joint line.
677
What test is used for LCL injuries?
Varus stress test.
678
What is the definitive diagnostic test for MCL and LCL injuries?
MRI is the definitive diagnosis.
679
What is the treatment for an isolated MCL tear?
1. NSAIDs 2. RICE 3. Early ROM 4. Hinged knee brace for 3-4 weeks 5. WBAT, crutches if needed for 3-4 weeks ## Footnote Consider surgery after 4 weeks.
680
What is the primary stabilizing structure for the knee?
The anterior cruciate ligament (ACL) is the primary stabilizing structure.
681
What is the most sensitive physical exam finding for ACL injuries?
Lachman test.
682
What is the definitive diagnostic test for ACL injuries?
MRI is the definitive diagnostic.
683
What is the treatment for ACL injuries?
Reduce pain, edema, and hemarthrosis with NSAIDs and knee joint aspiration. ## Footnote Delay of 2-4 weeks before surgical correction is common.
684
Who may not need surgery for an ACL tear?
Older, sedentary individuals or those willing to change their exercise habits.
685
What is the diagnostic test of choice for PCL injuries?
MRI is the diagnostic test of choice.
686
What is the treatment for isolated PCL injuries?
RICE, NSAIDs, hinged knee brace, PT. Surgery rarely needed.
687
What are the symptoms of meniscal tears?
Locking, popping, and difficulty bending and straightening the knee.
688
What are the provocative tests for meniscal tears?
McMurray and Apley Grind tests.
689
What is the test of choice for diagnosing meniscal tears?
MRI is the test of choice.
690
What is the treatment for meniscal tears?
RICE, knee sleeve or brace, crutches as needed, PT. Surgery indicated for failure of conservative management. ## Footnote Surgery is knee arthroscopy with meniscal repair or meniscectomy.
691
What is the diagnostic method for patella fractures?
X-ray; CT if X-ray is negative and high clinical suspicion.
692
What is the treatment for non-displaced patella fractures?
Immobilization of the entire leg.
693
What are the symptoms of a patella tendon rupture?
High-riding patella, popping or tearing sensation, inability to extend the knee.
694
What is the treatment for patella tendon rupture?
Place in knee immobilizer and immediate operative repair within 3 days.
695
What are the symptoms of quadriceps tendon rupture?
Sudden knee pain and inability to extend the knee, low-riding patella.
696
What is the treatment for quadriceps tendon rupture?
Place in knee immobilizer and immediate operative repair within 3 days.
697
What are the risk factors for patella dislocation?
Female gender and being in the 20s.
698
What is the treatment for patella dislocation?
1. Closed reduction 2. Knee immobilizer 3. Crutches 4. PT 5. Surgery if patella is still loose.
699
What is a knee dislocation?
Disruption of the tibiofemoral articulation, often due to high-energy trauma.
700
What is the most common type of knee dislocation?
Anterior dislocation.
701
What is the diagnostic method for knee dislocation?
X-ray and ankle-brachial index.
702
What is the treatment for knee dislocation?
Closed reduction. ## Footnote Emergent vascular surgery consult if diminished pulses or ABI <0.9.
703
What is Osgood Schlatter Disease?
Inflammation and pain of the tibial tuberosity, usually in adolescents.
704
What is the diagnostic method for Osgood Schlatter Disease?
Clinical diagnosis; X-ray to confirm.
705
What are the treatments for Osgood Schlatter Disease?
Activity modification, NSAIDs, PT. Surgery if conservative treatment fails, but must wait for growth plate closure.
706
What is a Baker's Cyst?
A distension of a bursa within the popliteal fossa, usually the gastrocnemius-semimembranosus bursa on the medial side of the knee.
707
What are the symptoms of a Baker's Cyst?
Painful lump/bump in the popliteal fossa. Tender flutuant cyst. Check for aneurysm of the popliteal artery (is it pulsatile?).
708
What is the treatment for a Baker's Cyst?
Conservative treatment (RICE, NSAID), correction of underlying knee pathology.
709
What is Pes Anserine Bursitis?
Pain and tenderness near pes anserinus bursa on proximal medial tibia where sartorius, gracilis, and semitendinosus muscles insert.
710
What is Prepatellar Bursitis?
Also known as 'housemaid’s knee', it affects those who kneel a lot and has a tendency to get infected.
711
What is a key diagnostic feature of Prepatellar Bursitis?
NO EFFUSION OF THE KNEE JOINT.
712
What is the treatment for Nonseptic Prepatellar Bursitis?
Supportive care and avoidance of recurrent injury. Occasionally, steroid injection can be considered.
713
What is the treatment for Septic Prepatellar Bursitis?
Treat with antibiotics. May require repeat aspiration if bursal effusion persists. In severe cases, surgical incision and drainage or bursectomy may be needed.
714
What is the treatment for Pes Anserine Bursitis?
RICE, PT, Steroid Injection (band aid solution). Rarely, surgery is required.
715
What is Chondromalacia?
Fraying and damage to the patellar cartilage due to patellofemoral syndrome.
716
What are the symptoms of Chondromalacia?
Pain and/or stiffness during prolonged sitting with knees flexed, known as 'theater sign'. Patella may be hypermobile. Pain with patella grind test.
717
What is the treatment for Chondromalacia?
RICE, refrain from high impact activities, NSAIDs, PT, knee taping/foot orthotics. Surgery ONLY IF 6-12 months of conservative treatment fails.
718
What is IT Band Syndrome?
Lateral knee pain resulting from overuse and biomechanical factors, usually associated with running/cycling.
719
What is the treatment for IT Band Syndrome?
Conservative: Ice, NSAIDs, stretching, activity modification (bicycle modification, foot orthotics).
720
What is a Tibial Plateau Fracture?
> 50 YO, osteoporosis is a risk factor. Varus/valgus stress with axial load can lead to these fractures.
721
What are the symptoms of a Tibial Plateau Fracture?
Unable to bear weight. Relation of open wounds to fracture site. Distal pulses and peroneal nerve function.
722
What is the diagnostic approach for a Tibial Plateau Fracture?
X-ray and if a fracture is seen, a CT is needed for surgical planning. An MRI may be required later.
723
What is the treatment for stable, minimally displaced Tibial Plateau fractures?
Conservatively with splint, long leg cast, or cast brace for 8-12 weeks.
724
What are the indications for surgery in Tibial Plateau fractures?
> 2 mm joint depression or separation, open injuries, fractures with vascular injury, fractures with associated ligamentous injuries requiring stabilization.
725
What is a Fibular Head Fracture?
Associated with ligamentous injury and neurovascular injury. Be cautious and look for other injuries.
726
How are isolated Fibular Head fractures treated?
With a hinged knee brace and weight-bearing as tolerated (WBAT).
727
What is a Maisonneuve Fracture?
A fracture of the proximal/mid fibula plus a fracture or ligamentous injury of the medial ankle. ## Footnote This injury disrupts the tibiofibular syndesmosis and creates an unstable ankle joint.
728
What is the tibiofibular syndesmosis?
A fibrous interosseous membrane attaching the tibia and fibula along the entire length of both bones.
729
What are the symptoms of a Maisonneuve Fracture?
Severe pain along the medial ankle. Tenderness elicited by squeezing the tibia and fibula together at the midshaft suggests a tear to the interosseous membrane.
730
What diagnostics are used for a Maisonneuve Fracture?
Ankle x-rays typically reveal an avulsion fracture of the medial malleolus or widening of the ankle joint mortise space. Tibia-fibula x-rays will demonstrate a proximal fibula fracture.
731
What are the treatments for a Maisonneuve Fracture?
Immediate reduction of ankle with long leg splint, NWB, and referral to ortho, but definitive treatment is surgery.
732
What are ankle sprains?
Sprains may involve lateral ankle ligaments, medial (deltoid) ankle ligaments, or ankle syndesmosis (ligament that connects the tibia and fibula).
733
What is the most common type of ankle sprain?
Most ankle sprains are lateral ankle sprains caused by an inversion injury.
734
What is the pathophysiology of a lateral ligament sprain?
Caused by inversion injury of ankle, with varying degrees of plantar flexion.
735
What can cause a medial ligament sprain?
Eversion injury of ankle, abduction, and external rotation of ankle on pronated foot.
736
What are the symptoms of an ankle sprain?
Difficulty weight bearing. Anterior drawer test is used to determine integrity of anterior talofibular ligament. Talar tilt test is used to determine integrity of calcaneofibular ligament.
737
What diagnostics are used for ankle sprains?
X-ray to rule out fracture. MRI may also be used in patients with persistent symptoms or if suspected after a few weeks of conservative treatment.
738
How are ankle sprains classified?
Classified as grade 1-3: 1. Minimal tenderness and swelling, can weight bear, just do PT. 2. Moderate tenderness and swelling with decreased ROM and possible instability, treated with air splint. 3. Significant swelling and tenderness and instability, treated with immobilization, PT, and surgery.
739
What is Achilles Tendonitis?
More common in males 30-50 YO due to overuse.
740
What are the symptoms of Achilles Tendonitis?
Intermittent pain related to exercises or activity, occurring at tendon insertion site on calcaneus.
741
What is the pathophysiology of Achilles Tendonitis?
An intrinsic factor (like hypercholesterolemia) plus an extrinsic issue that occurred leads to Achilles tendonitis.
742
What diagnostics are used for Achilles Tendonitis?
Testing is usually unnecessary.
743
What are the treatments for Achilles Tendonitis?
1. Conservative management: RICE, NSAIDs, activity modification. 2. PT. 3. Surgery as a last resort (removal if inflamed tendon).
744
What is an Achilles tendon rupture?
A traumatic or spontaneous tear associated with frequent fluoroquinolone (FQ) use.
745
What is the Thompson Test?
A test indicating a likely Achilles tear; failure of foot to plantarflex with calf squeeze is a positive result.
746
What diagnostics are used for Achilles tendon rupture?
X-ray helps rule out additional fractures.
747
What are the treatments for an Achilles tendon rupture?
1. Splint in slight plantar flexion, non-weight bearing (NWB). 2. Surgical repair is always needed.
748
What types of ankle dislocations are most common?
Posterior and lateral dislocations.
749
What are common associations with ankle dislocations?
Commonly associated with malleolar fractures.
750
What diagnostics are used for ankle dislocations?
X-ray.
751
What are the treatments for ankle dislocations?
1. Need to be reduced quickly to avoid neurovascular compromise (within hours). 2. Splint. 3. Post-reduction X-rays are essential. 4. Likely require surgery due to instability and concomitant injuries.
752
What is an ankle fracture?
A fracture of the distal fibula or tibia at the ankle joint.
753
What are the types of ankle fractures?
Bimalleolar ankle fracture involves the lateral and medial malleoli; Trimalleolar ankle fracture involves the lateral, medial, and posterior malleoli.
754
What are the symptoms of ankle fractures?
Edema and ecchymosis.
755
What diagnostics are used for ankle fractures?
X-ray; CT if complex fractures are involved.
756
What are the treatments for ankle fractures?
Isolated lateral malleolus fracture: Boot or cast, NWB. All others likely require surgery.
757
What are stress fractures?
Fractures that develop due to repetitive strain on healthy or unhealthy bones, usually occurring in the lower extremities.
758
Where do stress fractures most commonly occur?
In the metatarsals, calcaneus, and navicular bones.
759
Who is at risk for stress fractures?
Typically occur in athletes or military recruits, especially women with the female athlete triad.
760
What are the symptoms of stress fractures?
Pain gradually worsens and starts earlier during activity.
761
What diagnostics are used for stress fractures?
X-ray ≥ 3 months from symptom onset; MRI if stress fracture is not visible on plain X-ray.
762
What is the treatment for stress fractures?
6-8 weeks of non-weightbearing with immobilization for incomplete or nondisplaced complete fractures; displaced fractures require surgery.
763
What is plantar fasciitis?
A condition involving the plantar fascia, a thick ligament running from the calcaneus to the metatarsal heads.
764
What are the peak incidence ages for plantar fasciitis?
40-60 years.
765
What are the symptoms of plantar fasciitis?
Plantar medial heel pain, often severe in the morning, exacerbated by prolonged weight-bearing.
766
What diagnostics are used for plantar fasciitis?
Clinical evaluation; bone spurs may be seen on X-ray.
767
What are the treatments for plantar fasciitis?
NSAIDs, ice, stretching, steroid injection. If no relief after 6-12 months, consider plantar fascia release.
768
What are bunions?
Inflamed metatarsal head, most common in elderly females.
769
What are the symptoms of bunions?
Pain and swelling over the first metatarsophalangeal (MTP) joint.
770
What diagnostics are used for bunions?
X-ray may help determine severity.
771
What are the treatments for bunions?
Accommodative shoes, orthoses, surgery if needed.
772
What is hammer foot?
A fixed flexion deformity of the proximal interphalangeal joint.
773
What are the symptoms of hammer foot?
Localized pain/swelling, deformity over the PIP joint.
774
What diagnostics are used for hammer foot?
Clinical evaluation.
775
What are the treatments for hammer foot?
Relieve pressure on deformity with shoe modification, padding, splinting, or orthotics; surgery as a last resort.
776
What is Charcot foot?
Neurogenic arthropathy due to underlying neuropathy, often in diabetics.
777
What are the symptoms of Charcot foot?
Lack of pain, erythematous, swollen, and warm foot or ankle with preserved pulses.
778
What diagnostics are used for Charcot foot?
1. Foot X-ray with weight-bearing views. 2. MRI if X-ray inconclusive. 3. Bone biopsy if diagnosis is unclear.
779
What are the treatments for Charcot foot?
1. Offloading with total contact cast for 6-8 weeks. 2. Orthosis or Charcot specific shoes. 3. Surgery if non-healing ulcers, un-braceable deformity, or osteomyelitis. 4. Amputation may be unavoidable.
780
What is Morton Neuroma?
Fibrous change of the common digital nerve as it passes between the metatarsal heads. Most common between the third and fourth metatarsal heads.
781
What are the symptoms of Morton Neuroma?
Numbness and/or tingling in third and fourth digits. Feeling of walking on a pebble. The mass may be big enough to splay the toes. Moving the adjacent toes up and down may recreate pain.
782
What is the diagnostic method for Morton Neuroma?
Imaging is not needed. MRI can show inflammation.
783
What is the treatment for Morton Neuroma?
Avoid compressive shoes (like heels). Steroid injection. Last resort is surgical removal.
784
What is a Jones Fracture?
Base of the 5th metatarsal fracture, often from stepping off a curb.
785
What are the symptoms of a Jones Fracture?
Pain to the lateral side of the foot with difficulty bearing weight after adduction/inversion.
786
What is the diagnostic method for a Jones Fracture?
X-ray.
787
What is the non-operative treatment for a Jones Fracture?
Short leg cast (non weight bearing) for 6-8 weeks.
788
What is the operative treatment for a Jones Fracture in active individuals?
Screw fixation.
789
What is a Lisfranc Injury?
Fracture at the second metatarsal base or second cuneiform, metatarsal subluxation/dislocation, and widening of this area.
790
What are the symptoms of a Lisfranc Injury?
Pain and swelling in the midfoot. Unable to bear weight or stand on toes. Bruising of the midfoot is pathognomonic for this injury.
791
What is the diagnostic method for a Lisfranc Injury?
X-rays. Widening of the space between the first and second metatarsal base > 2mm suggests a Lisfranc injury.
792
What is the acute treatment for a Lisfranc Injury?
Immobilization (short leg splint), non weight bearing, and urgent orthopedics consult.
793
What surgical intervention is required for a Lisfranc Injury?
Require surgery (ORIF).
794
What is a Phalanx Fracture?
Lesser toe fracture, 4x more common than first toe.
795
What is the diagnostic method for a Phalanx Fracture?
X-ray.
796
What is the treatment for a stable and non-displaced Phalanx Fracture?
Can be splinted (buddy taped) and placed in a hard sole shoe.
797
What is the treatment for a displaced Phalanx Fracture?
Closed reduction and splinting; if unable to reduce, will require operative fixation.
798
What is a Calcaneus Fracture?
Can lead to long term disability, more common in men, and warrants a diligent search for associated injuries.
799
What are the symptoms of a Calcaneus Fracture?
Unable to bear weight. Tenderness, swelling, ecchymosis, unable to tolerate any ROM testing.
800
What is the best initial diagnostic test for a Calcaneus Fracture?
X-ray is the best initial test. CT may be used to further characterize fractures and for operative planning.
801
What is the treatment for a Calcaneus Fracture?
Most require operative treatment, as they are intraarticular and/or displaced. Non-displaced, non-intraarticular fractures can be immobilized for 6-8 weeks.
802
What is the initial splinting recommendation for a Calcaneus Fracture?
Initial splinting should be very bulky to allow for swelling.

Clin Med II (9 decks)

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