Ortho Block 1 Cram Flashcards by brandon lovin

Define Crystal Deposition Dz

What causes the main Sx

Arthritis characterized by episodes of pain and swelling of a single joint

Pain/swelling from lysis of PMN cells due to engulfing of crystals

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Most PTs with radiographic evidence of CPDD are ???

What are the 5 manifestations of Crystal Deposition Dz

ASx

ASx Dz, Pseudogout, Pseudorheumatoid, Pseudoosteoarthritis, Pseudoneuropathic Joint Dz

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What are the 3 phases of Gout?

What diagnostic lab tests are run on a serum analysis for gout?

Acute gouty arthritis, Interval Gout, Chronic Tophaceous gout

PCM FATISH
Phosph, Ca, Mg, Ferritin, Alkaline Phosph., Transferring, Fe, TSH

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What are the 3 common findings seen in Pseudo/Gout?

When serum uric acid is checked, what result is found?

Fever, Leukocytosis, Elevated ESR

Normal during acute episodes

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What lab test is critical for distinguishing gout from septic arthritis

Define Chondrocalcinosis and when is it seen?

Gram stain and culture

CPDD
Radiographic findings of punctate/linear calcification of articular cartilage and internal joint structures

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What 4 metabolic d/os are associated with CPDD

How is gout treated?

Hyperparathyroid, Hypothyroid, Hypophosphaasia, Hemochromatosis

1st- Indomethacin, Naproxen,
2nd- Colchicine, PO glucocorticoids, injections
Long term- Allopurinol, Probenecid

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How do long term gout control meds work?

Probenecid- inc urine excretion of uric acid, not for PTs w/ renal insufficiency

Allopurinol- XOI, decreases production of uric acid from purine synthesis; not used in acute settings

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How is CPDD treated

What are the 3 red flags of Gout/Pseudo gout

Aspirate, Injection (1-2 joints), PO NSAIDs/Colchicine for multiple joints, immobilization
3+ attacks/year= prophylaxis colchicine

Joint deformity/destruction
Large tophi masses or drainage

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DVTs are caused by ? and PEs are caused by?

What imagines modalities are used?

DVT- morbidity and mortality
PE- venous thrombosis (most preventable cause on in hospital deaths and 3rd cause of death to polytrauma PTs)

US to r/o
Venogram for PTs w/ suspected DVT (endomatous limb)

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What is the most common form of LMWH used during hip and knee arthroplasty

What are used for polytraumas/long bone Fxs

What is better for PTs w/ renal issues?

Enoxaparin

Enoxaparin and heparin

Heparin is used for PTs w/ renal insufficiency

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What agent is most commonly used for anti-coagulation?

What is this drug best for?

Warfarin w/ target INR 2-2/5

Prevents proximal clots in PTs undergoing hip arthroplasty

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? and mechanical prophylaxis are effective when combined for DVT prevention

How does mechanical prophylaxis reduce VTE Dz?

ASA

Secondary to increased fibrinolysis and decreased stasis w/ accelerated venous emptying

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Define DISH

What path does this issue follow?

Lateral x-rays prove osteophyte formation on 3 spaces or 4 bodies in thoracic/lumbar region

Anterior longitudinal ligament and peripheral disc margins

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What are the principles Sxs of DISH

What non-CN Sxs can present

Morning and evening stiffness w/ mild localized back pain

Dysphagia if anterior osteophyte presses on esophagus

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PE of DISH shows ?

What are the two most common causes of cervical myelopathy

Stiffness w/ flexion and extension

Cervical spondylosis
Ossification of PLL in DISH

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How is DISH treated?

What is an adverse outcome of DISH treatment?

Exercise and NSAIDs

Heterotrophic ossification post-hip replacement 5x more often in DISH PTs

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In order for Dx of Fibromyaliga to be given, pain must be present where?

What odd place is considered a quantifiable pain location?

Widespread= L, R, Superior/Inferior to waist
Axial skeleton pain- neck, anterior chest, thoracic, lower back

Low back pain= below the waist pain

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What tool is used to measure for fibromyalgia pain?

What are the 5 posterior locations to test?

What are the 4 anterior locations tested?

Dolorimeter- causes 4kg of pressure

Occiput, Supraspinatus, Traps, Glueal, Greater trochanter

Low cervical, Second rib, Lateral epicondyle, knee

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Other than the 3 FDA approved drugs, what drugs are used for fibromyalgia?

What non-pharm treatment methods are used?

DBC DNR
Anti-depressant/convulsant, Non-Benzos, Relaxants, Dopamine agonists, NSAIDs

Needling and infiltration w/ lidocaine (NS if allergic) is MOST effective

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How andwWhere does osteomyelitis grow in Peds?

How does it get access inside of adults?

Hematogenous spread to metaphysis

Open Fx, Surgical fixation of Fxs

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How does osteomyelitis present in older children and adults?

How does it present in post-op PTs?

Fever, pain and swelling at site

Drainage or substantial delayed healing

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What imaging modality is used to Dx osteomyeltits?

What will lab results show?

MRI to assess marrow changes

Inc WBC, may be normal in chronic/immunosuppressed PTs
Inc ESR and CRP

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What is the most common organism causing osteomyelitis in Peds?

What is the most common microbe in adults?

Staph A, GAS, Hem Influenza

Staph A, Pseudomonas Aeurginosa

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How is osteomyelitis treated?

What microbe causes Lyme Dz and what bug carries the microbe?

Surgical excision and implanted methyl methacrylate beads

Spirochete Borrelia Burgdorferi
Deer tick Ixodes Dammini

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What are the 3 phases of Lyme Dz Sxs What is the characteristic skin lesion?

Localized- Viral syndrome Sxs Disseminated- Cardiac/Neurological Sxs- meningitis, cranial neuropathy, radicuploapthy (Bells Palsy most common) Late- arthritis and neurological manifestations, Lyme encephalopathy, distal paresthesia Erythema Migrans

PTs with erythema migrans and Sxs need to be examined for ? How quickly should a tick be removed and have little/no risk of Lyme Dz?

Synovitis and Dec joint ROM 24-36hrs

What ABX are used for Lyme Dz

Doxy 100mg BID x 28 days Amoxicillin 500mg TID x 28 days Under 8yrs= Amoxicillin 20mg/kg

What are the different forms of osteoporosis

Primary Type 1- post menopause, 6x w>m Primary Type 2- senile, 2x w>m and older than 70yrs due to altered Ca metabolism and intrinsic problems Secondary- m>f, Dz process causing bone loss, commonly seen in long term steroid therapy, hyper thyroid, hypo parathyroid (neoplastic, metabolic, CT Dz)

How does a DEXA scan provide info on bone mass? Bone density is characterized by the lower value in what locations?

Real density and compared to peers (Z score) and young/healthy (T score) Spine, femoral neck, trochanter or total femur

What values are indicative of osteoporosis? What is the best test for assessing/monitoring treatment?

0 -- -1= norm - 1 - -2.5= osteopenia - 2.5 and lower= osteoporosis DEXA

What class of drug needs to be avoided to reduce risk of osteoporosis complications? What is the ideal exercise program for these PTs?

Long acting benzos Walking, strength and balance training

Overuse syndrome is secondary to ? and can produce what two reactions? What causes reactive/acute inflammatory overuse syndrome?

Repetitive microtrauma Acute inflammation, chronic degeneration Microtrauma causing fatigue and inflammation

What part of the tendon has to be involved for the Dx tendonitis to be given? In acute settings, overuse syndrome injury typically isn't associated with ? and what event reverses this absence

Epitenon Degeneration to musculotendinous unit which is reversed by persistent inflammation

Chronic tendon injuries are ? process rather than a ? process Define Apophysitis Define Epiphysiolysis

Degeneration, not an inflammatory Inflammation of growth plate Traumatic widening of growth plate

When conducting PE of overuse syndrome in an extremity, it's inspected for ? 4 things? How is this syndrome treated?

Swelling, Erythema, Pallor, Atrophy PRICE PT w/ eccentric strengthening NSAIDs/analgesics

What is the recommended treatment protocol for a muscle strain in the LE?

Acute: 1-5 days, control pain/swelling w/ RICE Subacute: 3-21 days, control pain and AROM Remodeling: 1-6wks, exercise and stretch Functional: 3wk-6mon, avoid re-injury

What is the single most valuable imaging modality when assessing bone lesions? When is CT or MRI superior? When are bone scans useful

X-ray MRI- superior to visualize soft tissues and marrow issues CT- better for bone detail Infection, trauma, tumors

In PTs over 40y/o w/ a bone tumor what is the most likely Dx? Growing pains are through to be a result of ?

Metastases or myeloma Over activity- muscle strain or fatigue

What is the x-ray series called that's ordered for kids under 2yrs w/ suspected abuse? What form of x-ray doesn't provide enough info for dx?

Skeletal survey Baby gram

What Fxs are moderately suspicious for abuse? What Fxs are strongly suspicious for abuse?

Bilateral, Different ages, Epiphyseal separation, Vertebral body, fingers and complex skull Fxs Multiple Fxs at various stages of healing w/out explanation

How can you tell how old a Fx is? How are Fxs older than 6wks distinguished?

7-14 days: new periostal bone and callous are visible 14-21: loss of Fx line, mature callous w/ trabecular formation 21-42 days: dense callous Fusiform sclerotic thickening best seen compared to normal contra lateral bone

# Define Toddler Fx What are the typical Sxs of CRPS

Spiral Fx of tibia in kids 1-3yrs old from fall ``` Ecessive pain Hypersensitivity to light touch Cold intolerance Transient swelling Skin discoloration- most commonly foot and ankle ```

How is CRPS Type 1 Dx? What type of PE results will be seen?

Dx of exclusion Limited AROM, PROM cause severe pain Brushing skin causes burning pain

What is the mainstay of Tx for CRPS What types of SALTAR Fxs need surgery?

Rehab, Amitriptyline, Gabapentin 3 and 4, involve growth plate and articular surface

What is a s/e risk to SATAR 3, 4 and open Fxs What Sx is common to all seven types of JIA

Physeal bars Chronic arthritis lasting longer than 6wks in PTs under 16

# Define the 6 types of JIA Which ones have uveitis

``` Systemic- arthritis, fever, rahs Oligoarticular- liver, heart, nopathy, arthritis in 4 or less joints, ASx uveitis RF-neg Poly- 5 or more joints w/ no RF Psoriatic- skin, nail and FamHx Enthesitis- HLA-B27 pos, sacroiliitis ``` Oligoarticular, Psoriatic, Enthesits

What PE exam is done for JIA? What labs are drawn for these PTs? What caution is taken with these results

Observe, Palpate, Assess A/PROM, Assess for pain at end of PROM CBC w/ Diff, ESR/CRP, Metabolic and UA Normal results don't r/o and positive results are not Dx

How is JIA treated? What two drugs are used for refractory uveitis?

NSAIDs, Methotrexate, a-TNFs Infliximab and Adalimumab

Where does Osteochondritis Dissecans occur What causes it?

Medial condyle of knee, elbow, talus and distal humerus, rarely in patella Repetitive small stress that disrupts blood

How is PE exam done to assess osteochondritis dissecans? How is it best viewed w/ imaging? When are MRIs ordered?

W/ knee flexed at 90* Tunnel- AP view w/ knee flexed Lateral Assess integrity of cartilage and lesion staging

How is osteochondritis dissicans treated? When is it referred for surgery?

Lesions smaller than 1cm wide: Activity mod, no impact, Immobilize refractory Sxs 1-2cm- treat Sxs and images Lesions larger than 2cm: Skeletal maturity and lesion has caused cartilage to separate

# Define Sequestrate Define Involucrum

infection in medullary canal penetrates metaphyseal cortex causing abscess causing necrosis leading to fragments Periosteum remains viable and new bone forms to stabilize area

What finding is typical on exam for ped osteomyelitis? What images are used to assess?

Fever +100.4/38*C and tenderness over site MRI w/ contrast

What labs are ordered for peds osteomyeltis? How is it treated?

CBC w/ diff, CRP (will be abnormal first, within first 8hrs) and blood culture IV ABX after gathering samples Surgery for debrisment

How does septic arthritis occur in kids? How do they present in clinic?

Hematogenous seeding after poneumonia, impetigo/skin infection Guarding of joint and systemic Sxs Painful ROM

How is pediatric septic arthritis Dx Seronegative Spond have what 4 characteristics in common?

Aspiration w/ +15K WBC count and +50K in synovium Inflammation, Pauciarticular arthritis in LE, extra articular inflammation, HLA-B27

How does ankylosing spondylitis present in kids under 9? What can cause Reiters in adolescents?

Asymmetric pauciarticular arthritis in LE YCSS Non-gonoccocal- Chlamydia or Trachoma

What two spots in adolescents w/ Retiers is extremely painful? What joint issue is seen in kids w/ IBDz Arthritis?

Achilles tendonitis, Plantar fasciitis Arthralgia w/out effusion is 2x more common in kids under 21

What is a key visual PE finding indicative of juvenile seronegative spondyloropathy What lab result supports a Dx of Reiters in Peds?

Purple discoloration around joint Sterile pyuria

How are juvenile seronegative ailments treated? Conus medularis stops at ? Cauna equina starts at ?

NSAIDs, PT, orthoses and counseling L1-2 L2-S4

PT w/ loss of cervical curvature, decreased range of motion and spasms has ? Define Lhermitte sign and where is it seen What other special tests/neuro findings will be seen with this issue?

Cervical Radiculopathy Shock of electricity produced by neck flexion in cervical spondylosis Hoffmann reflex, Clonus, Hyperflexia and Babinksi

What are the findings on PE for cervical strains? Where is pain associated with cervical strains most commonly located?

Pain w/ movement, paraspinal spasm, occipital HAs x 6mon post accident Cervicothroacic junction

PTs w/ persistent neck pain from cervical strains get x-rays to look for ? What is the most important x-ray image to get in multiple trauma PTs?

Instability greater than 3.5mm and/or angulation greater than 11* Cross table view of C1-C7

PTs w/ cleared C-spine but have persistent pain need to have ? precaution?

Soft collar worn x 7-10 days