Ortho

Question 1

Partial or full patellar tendon tears F/U

Answer 1

Knee immobilizer and given urgent orthopedics follow-up

Question 2

Tendon pathology, including rupture, which antibiotic class?

Answer 2

Fluoroquinolones

Question 3

Rhabdo fluid replacement

Answer 3

Goal UOP of 3 cc/kg/hour or 200 to 300 cc/hr to prevent acute renal failure

Question 4

Normal ABI

Answer 4

> 0.9

Question 5

Humeral shaft fractures most common nerve affected

Answer 5

Radial nerve (wrist drop)

Question 6

Primate bite treatment and why?

Answer 6

• Monkeys carry Cercopithecine herpesvirus 1, also called Herpesvirus simiae or more simply, B virus
• Fatal to humans if not treated early.
• Treatment is with acyclovir

Question 7

• Pain with overhead movement.
• Pain with arm in 180 degrees forward flexion, followed by internal rotation
• Pain with arm in 90 degrees abduction, elbow flexed at 90 degrees, followed by internal rotation

Answer 7

Subacromial bursitis 2/2 overuse causing impingement

Question 8

Weakly positively birefringent and rhomboid shaped crystals

Answer 8

Calcium pyrophosphate crystals = pseudogout

Question 9

Needle like and negative birefringent crystals

Answer 9

Uric acid crystals = gout

Question 10

Most common cause of septic arthritis

Answer 10

Staph Aureus

Question 11

In a patient with sickle cell disease presenting with septic arthritis, what additional organism must be considered?

Answer 11

• Salmonella.

- Patients with sickle cell anemia require vancomycin and ciprofloxacin for better coverage for salmonella.

Question 12

What nerve is most commonly injured in a perilunate dislocation?

Answer 12

Median nerve.

Question 13

Fracture of the distal radius paired with a dislocation of the distal radioulnar joint.

Answer 13

Galeazzi fracture

Question 14

Fracture of the proximal ulna, paired with dislocation of the radial head

Answer 14

Monteggia fracture

Question 15

Flexor tenosynovitis treatment

Answer 15

IV ampicillin-sulbactam (Unasyn) and vancomycin

Question 16

• Symmetrical swelling of the involved finger
• Finger held in flexion at rest
• Tenderness along the flexor tendon sheath
• Pain with passive extension

Answer 16

Flexor tenosynovitis

Question 17

• Loss of motor, pain, and temperature below injury

- Proprioception and vibration intact

Answer 17

Anterior Cord Syndrome

Question 18

Fluoroquinolone S/E

Answer 18

• Prolongation of the QTc

- Spontaneous tendon rupture

Question 19

Clay-shoveler fracture

Answer 19

• Avulsion of the spinous process of C6 or C7

- Stable fracture

Question 20

Unstable cervical spine fractures

Answer 20

Jefferson bit off a hangman’s thumb

• Jefferson burst fracture
• Bilateral facet dislocation
• Odontoid type II and type III fractures, any fracture with a dislocation
• Hangman fracture
• Teardrop fracture

Question 21

Septic joint ESR and CRP

Answer 21

ESR is normal in up to 30% of patients and CRP is normal in up to 12% of patients.

Question 22

Finkelstein test

Answer 22

• Flexion of the thumb across the palm and then ulnar deviation of the wrist.
• Sharp pain at the dorsal compartment suggests a positive test and a diagnosis of de Quervain’s tenosynovitis.

Question 23

Hawkins-Kennedy test

Answer 23

• Shoulder flexed to 90° and their elbow flexed to 90°.
• Clinician grasps proximal to the wrist and elbow and then quickly rotates the arm internally.
• Positive test suggests subacromial impingement syndrome.

Question 24

Felon treatment

Answer 24

• S.aureus is the most common bacterial pathogen

- Most effective treatment is incision and drainage and trimethoprim-sulfamethoxazole

Question 25

Compartment pressure: normal?

Answer 25

0-10 normal, <30-40 associated with tissue necrosis

Question 26

Delta pressure to assess for compartment syndrome

Answer 26

DBP - direct compartment pressure, if <30 consistent with acute compartment syndrome

Question 27

Most common electrolyte abnormality in rhabdomyolysis

Answer 27

Hypocalcemia

Question 28

Plantar puncture wounds: most common organism and treatment

Answer 28

Pseudomonas aeruginosa, Levofloxacin

Question 29

Parkland formula for fluid resuscitation in burns

Answer 29

Total Body Surface Area Burned x Weight (kg) x 4mL. First half is administered in first 8 hours followed by the second half in the next 16.

Question 30

Upper motor neuron findings, such as hyperreflexia, clonus, spasticity, and a positive Babinski sign.

Answer 30

Conus medullaris syndrome

Question 31

If there is no history of trauma or previous infection as the cause of flexor tenosynovitis, what additional antibiotic coverage should be considered?

Answer 31

Ceftriaxone for disseminated gonorrhea.