musculoskeletal

Question 1

MC fractured carpal bone

Answer 1

scaphoid

Question 2

scaphoid fractures - presentation

Answer 2

pain at the radial wrist proximal to the base of the thumb

examination: tenderness in the shallow depression
- risk of osteonecrosis

Question 3

scaphoid fractures - management

Answer 3

initial x-rays can be normal in nondisplaced fractures

if scaphoid fracture is suspected: CT or MRI to confirm or repeat x-ray in 7-10 d.

Question 4

scaphoid fractures - treatment

Answer 4

Displaced fractures –> surgical intervention

nondisplaced –> wrist immobilization (but monitor with serial x-ray to rule out osteonecrosis)

Question 5

ganglion cysts - age and area

Answer 5

age 15-40

arise in most cases due to repetitive stress or inflammation

Question 6

all patients with clavicular fracture should have

Answer 6

a careful neurovascular examination to rule out injury to the underlying brachial plexus and subclavian artery
- if bruise is heard –> angiogram to rule out injury of vessel

Question 7

MC clavicle fractures are at … (area) / how to treat every area

Answer 7

midline 3rd
fractures of the middle 3rd: nonoperatively with a brace, rest and ice
fractures of the lateral 3rd: open reduction and internal fixation

Question 8

clavicular fractrues - presentation

Answer 8

pain + immobility of the affected arm
the contralateral hand is classically used to support the weight of the affected arm
- the affected shoudler is displaced inf + posteriorly

Question 9

Meniscal tears - etiology

Answer 9

younger: rotational force on planted foot
older: degeneration of meniscal cartilage

Question 10

meniscal tears - symptoms

Answer 10

1. acute popping sensation
2. catching, locking, reduced range of motion
3. slow onset joint effusion

Question 11

meniscal tears - examination

Answer 11

1. joint line tenderness

2. pain or catching in provocative tests (Thessaly, McMurray

Question 12

medical tears - diagnosis

Answer 12

MRI

arthroscopy

Question 13

medical tears - management

Answer 13

mild symptoms, older: rest, activity modification

persistent symptoms, impaired activity: surgery

Question 14

meniscus injury - effusion

Answer 14

not immediately because is not perfused very well

in several hours

Question 15

Thessaly test

Answer 15

• patient stands on 1 leg with knee flexed 20 degrees

- then internally and externally rotates on flexed knee

Question 16

succinylcholine - mechanism of action and severe SA

Answer 16

depolarizing neuromuscular blocker that can cause life-threatening hyperkalemia in patients with a condition leading to upregulation of postynaptic ACE receptors (eg. skeletal muscle trauma, atrophy, burn injury, stroke) or prior hyperkalemia (muscle trauma)
Nondepolrizing neuromuscular blocking agents should be used with these patients

Question 17

situations that increase the risk for hyperkalemia in succinylochine use

Answer 17

upregulation of postsynaptic ACE receptors (skeletal muscle truama, atrophy, burn injury, stroke, denervation

Question 18

hip fracture - how can we wait for the surgery

Answer 18

72 hours (if needed to undress unstable medical cormobitity)

Question 19

supracondylar fracture of the humerus - mechanism

Answer 19

fall on an outstretched hand most common

Question 20

supracondylar fracture of the humerus - complications (MC)

Answer 20

1. Brachial artery injury (MC)
2. median nerve injury (MC)
3. cubitus varus deformity
4. compartment syndrome (rare: less than 1%)
5. volkman ischemic contracture (due to ischemia and infraction from compartment syndrome)

Question 21

acute collateral ligament tear - acute effusion/hematthrosis?

Answer 21

uncommon unless there is concurrent inury to the anterior crciate ligament

Question 22

medial collateral ligament - treatment

Answer 22

uncomplicated: nonoperatively with rest, ice, compression + elecation and analgesics

Question 23

fat embolism syndrome - etiology

Answer 23

1. fracture of marrow-contaning bone
2. orthopedic surgery
3. PANCREATITIS

Question 24

fat embolism syndrome - clinical presentation

Answer 24

24-72 h following inciting event:

triad: resp distress, neurologic, petechial rash

Question 25

Fat embolism syndrome - diagnosis

Answer 25

based on clinical presentation

Question 26

Fat embolism syndrome - prevention + treatment

Answer 26

ealy immobilization of fracture | 2. supportive care (eg. mechanical ventilation)

Question 27

trochanteric bursitis

Answer 27

middle age adult, unilateral hip pain that is exacerbated by external pressure to the upper lateral thigh (as when lying on the affected side in bed) superficial pain

Question 28

hip osteoarthritis - pain exacerbated by

Answer 28

internal rotation | deep pain

Question 29

athrocentesis in recommended to

Answer 29

evaluate unexplained joint effusion

Question 30

chronic exertional compartment syndrome

Answer 30

increased pressure within a muscle group during exercise --> young athletes (no point tenderness)

Question 31

Popliteal (Baker) cysts - etiology

Answer 31

extrusion of fluid from knee joint space into seminmembranous/gastrocnemius bursa

Question 32

popliteal (Baker) cyst - RF

Answer 32

1. trauma (e. meniscal tear) | 2. joint disease (RA or OA)

Question 33

popliteal (Baker) cysts - clinical presentation

Answer 33

asymptomatic | posterior knee pain, swelling, stiffness

Question 34

popliteal (Baker) cyst - complication

Answer 34

1. venous compression 2. dissection into calf (erythema, de,a, (+) Homan sign) 3. Cyst rupture (acute calf pain, warmth, erythema, ecchymosis

Question 35

causes of chronic low back pain

Answer 35

1. mechanical 2. radiculopathy 3. spinal stenosis 4. inflammatory 5. metastatic 6. infectious

Question 36

when to referral to orthopedic surgeon for a stress fracture

Answer 36

at high risk for malunion (anterior tibial corte, 5th metatarsal)

Question 37

meniscial tear - surgery or not

Answer 37

surgery in young

Question 38

Common causes of shoulder pain - DDX

Answer 38

1. rotator cuff impingement or tendinopathy 2. rotator cuff tear 3. Adhensive capsulitis (frozen shoulder) 4. Biceps tendinopathy/rupture 5. Glenohumeral osteoarthritis

Question 39

rotator cuff impingement or tendinopathy

Answer 39

- pain with abduction, external rotation - subacromial tenderness - normal range of motion with positive impingement tests (eg. Neer, Hawkins)

Question 40

rotator cuff tear

Answer 40

- similar to rotator cuff tendinopathy - weakness with external rotation - older than 40

Question 41

adhensive capsulitis (frozen shoulder)

Answer 41

- decreased passive + active range motion | - more stiffness than pain

Question 42

Biceps tendinopathy / rupture

Answer 42

- anterior shoulder pain - pain with lifting, carrying, or overhead reaching - weakness less common

Question 43

Glenohumeral osteoarthritis

Answer 43

- uncommon + usually caused by trauma - gradual onset of anterior or deep shoulder pain - decreased active + passive abduction + external rotation

Question 44

neer test

Answer 44

with the patient;s shoulder internally rotated and forearm pronated, the examiner stabilizes the scapula + flexes the humerus --> if pain is positive

Question 45

non heeled strees fracture (non in malunion position) - next step

Answer 45

podiatric shoe

Question 46

prepaterllar bursitis

Answer 46

anterior knee pain, tenderness, erythema, localized swelling, common in occupations requiring repetitive kneling - it is often due to S. aureus - active motion is often decreased and painful, passive is normal - culture (-) --> NSAID + rest - culutre (+) --> drainage + antibiotics