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DSE > Ortho part 2 > Flashcards

Ortho part 2 Flashcards

1
Q

Ankylosing spondylitis

A

Inflammatory d/o involving the spine and sacroiliac joint
Onset 15-35 yoa male > female 3:1
Inflammation of the outer fibers of the annulus fibrosis may lead to ossification and complete fusion of vertebrae
Severe cases cause appearance of brittle “bamboo spine”
Strong genetic component HLA-B27 gene contributes approximately 37%

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2
Q

Presentation of ankylosing spondylitis

A

LBP with sacroiliitis
-LBP > 3 mos
-Worse with rest, better with bending forward
Flattening of lumbar lordosis and increasing kyphosis
May be associated with extraspinal inflammatory sx
-Uveitis (most common)
-Aortic and mitral regurgitation murmurs
-Progressive restrictive lung dz d/t fibrosis causing limited expansion
-Possible inflammatory enteritis, prostatitis, or tendonopathy

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3
Q

Dx of ankylosing spondylitis

A

Pelvic radiographs are essential for the dx of sacroiliitis showing subchondral bony erosions of SI joints
L-spine, T-spine and C-spine radiographs to exclude fxs and may reveal bamboo spine
ESR and CRP may be elevated
Basic labs may show leukocytosis, renal impairment, and elevated CPK

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4
Q

Tx of ankylosing spondylitis

A

NSAIDs

PT

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5
Q

Lumbar strain/sprain

A

Common complaint in ED and PCP office
D/t injury of paravertebral muscles (erector spinae multifidus or quadratus lumborum), ligamentous injury of facet joints, or anulus fibrosis
Often d/t lifting, twisting, or straining
Need to take careful hx and perform complete PE to r/o serious etiology of back pain, i.e., cauda equina, AAA, GI causes, fxs, etc.

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6
Q

Presentation of lumbar strain/sprain

A

Sx after injury
Pain may radiate into buttock or legs
Trouble with extension of low back

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7
Q

PE of lumbar strain/sprain

A

TTP over paravertebral muscles and SI joints
ROM is decreased, esp flexion
Senosry and DTR exam are nl
Straight leg raise elicits pain usually unilateral

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8
Q

Dx of lumbar strain/sprain

A

X-rays often unnecessary unless atypical sx or significant trauma

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9
Q

Tx of lumbar strain/sprain

A

Short period of bed rest
Cold therapy followed by heat therapy after 48 hrs
NSAIDs or other non-narcotic pain meds
Muscle relaxers may be helpful

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10
Q

Sciatica

A

LBP in the distribution of lower lumbar spinal roots

May cause neurosensory and motor defecits

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11
Q

Presentation of sciatica

A

Complaints of sharp, shooting, well-localized pain
Pain radiates down buttock into back of leg
Leg complaints often greater than back pain
Objective weakness

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12
Q

PE of sciatica

A

Straight leg raise- elevating leg while supine reproduces pain
Decrease ROM
R/o fever, saddle anesthesia, decreased rectal tone, GU findings, and abd pain

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13
Q

Dx of sciatica

A

Lumbosacral radiographs unnecessary unless:

  • Significant trauma
  • Fever
  • Pain at rest
  • IVDA
  • Suspicion of tumor or hematoma
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14
Q

Tx of sciatica

A

APAP 1st line
NSAIDs
Muscle relaxers
Corticosteroids show no benefit in radicular or non-radicular back pain

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15
Q

Spinal stenosis

A

LBP caused by spinal canal narrowing or narrowing of neural foramina that compresses the thecal sac or nerve roots respectively
Can be caused by degenerative changes, congenital or Paget’s dz

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16
Q

Presentation of spinal stenosis

A

LBP, stiffness, and sx may develop after accident or minor trauma
Compression on nerve roots cause radicular sx in lower extremities
Pain is generally worse with walking but temporarily relieved with leaning forward

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17
Q

PE of spinal stenosis

A

Muscle weakness of the lower extremities
Decreased reflexes
May have decreased anal sphincter tone
Impaired proprioception

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18
Q

Dx of spinal stenosis

A

CT or MRI to evaluate for spinal stenosis when pt is neurovascularly impaired

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19
Q

Tx of spinal stenosis

A

NSAIDs, PT, and activity modification

Surgery for refractory cases

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20
Q

Herniated disc

A

LBP d/t herniation of nucleus pulposus into the spinal canal

Commonly occurs at L4-L5 or L5-S1

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21
Q

Presentation of herniated disc

A

Abrupt onset of pain that worsened by sitting, walking, or standing
Pain radiates down the back of the leg through buttock

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22
Q

PE of herniated disc

A

Pos straight leg raise
Limited ROM
Neurologic sc may be evident (weakness, numbness, tingling)

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23
Q

Dx of herniated disc

A

MRI

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24
Q

Tx of herniated disc

A

NSAIDs are used in acute phase
Bed rest for 1-3 days
Muscle relaxants and possible narcotics may be helpful
Corticosteroids may be useful in reducing pain and inflammation
Surgery may be needed if no improvement (laminectomy or disc excision)

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25
Q

Spondylolysis/spondylolisthesis

A

Spondylolysis- defect of the pars interarticularis between superior and inferior facets
Spondylolisthesis- slipping forward of one vertebrae upon another
Spondylolysis predisposes for spondylolisthesis
2-4 times more likely in males than women
Spondylolisthesis can cause nerve root impingement and radiculopathy

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26
Q

Presentation of spondylolysis/spondylolisthesis

A

Often gradual onset LBP
May be seen in children and athletic teens
Pain after exercise or hyperextension activities (diving, gymnastics, etc.)
Sitting or bending forward relieves pain

27
Q

PE of spondylolysis/spondylolisthesis

A

Palpation may reveal step-off
Hamstring tightness
Hyperlordotic posture
Neurologic exam nl except with severe spondylolisthesis

28
Q

Dx of spondylolysis/spondylolisthesis

A

Lateral and oblique X-rays may show radiolucent defect in pars (broken neck of Scottie dog)
X-rays may show grade I-grade IV spondylolisthesis (mild-severe degree of slippage)

29
Q

Tx of spondylolysis/spondylolisthesis

A 
Pain control with NSAIDs and muscle relaxants
Restrict activities (sports) for 3-6 wks
30
Q

Hip dislocation

A

Femoral head displacement from acetabulum
D/t high energy trauma
Posterior > anterior
AVN may occur d/t vascular compromise

31
Q

Presentation of hip dislocation

A 
Hx of trauma (MVC or falls)
Posterior-internally rotated and short
Anterior-externally rotated
May have femoral artery, sciatic nerve or obturator nerve injury
Check if pt is neurovascularly intact
32
Q

Dx of hip dislocation

A

Plain film X-rays of affected side hip and pelvis

33
Q

Tx of hip dislocation

A

After fracture ruled out, closed reduction ASAP

Limited weight bearing with crutches

34
Q

Hip fx

A

Incidence of hip fxs doubles with each decade of life >50 yrs of age
Women > men
Increased mortality d/t DVT and PE
Often d/t osteoporosis and falls

35
Q

PE of hip fx

A

Leg is shortened with external rotation

Pain over hip and inability to weight bear

36
Q

Dx of hip fx

A

Plain film X-rays of hip and pelvis

37
Q

Tx of hip fx

A

ORIF or hip arthroplasty

38
Q

Knee bursitis

A

Pad-like fluid filled sac that reduces friction and cushions knee
Chronic injury or pressure leads to excess fluid formation, swelling, pain
Most commonly prepatellar (knee cap) or pes anserine (patellar tendon)

39
Q

PE of knee bursitis

A

Swelling noted over knee depending on which bursa is involved
Pain with direct palpation

40
Q

Dx of knee bursitis

A

Plain film X-rays generally not helpful

Aspiration of bursa fluid can assist in determining inflammatory, hemorrhagic, or septic etiology

41
Q

Tx of knee bursitis

A

NSAIDs
RICE
Aspiration may be therapeutic
Corticosteroid injections

42
Q

Meniscus injuries

A

Fibrocartilage pads that act as shock absorber between tibia and femur
MOI is usually twisting injury
Usually pt is able to ambulate with some swelling and stiffness
Pt complains of pain over lateral or medial aspect of knee
Pt describes pain as “locking” or catching of the knee

43
Q

PE of meniscus injuries

A

Tenderness on palpation over the medial or lateral joint line
McMurray and Apley’s test positive
Effusion or hemarthrosis may be present on exam

44
Q

Dx of meniscus injuries

A

MRI is needed to diagnose injury

45
Q

Tx of meniscus injuries

A

RICE

Surgical debridement of microtears or surgical repair may be indicated

46
Q

MCL injury

A

MOI direct blow to lateral knee

47
Q

LCL injury

A

MOI direct blow to medial knee

48
Q

ACL injury

A

MOI direct blow to knee or sudden change in direction of weight bearing knee

49
Q

PCL injury

A

MOI direct blow to anterior proximal tibia or hyperextension

50
Q

Presentation of MCL injury

A

Pain and swelling over medial knee and pt often report feeling a pop

51
Q

Presentation of LCL injury

A

Pain and swelling over lateral knee

52
Q

Presentation of ACL injury

A

Immediate pain and swelling after injury and weight bearing is difficult as knee is unstable

53
Q

Presentation of PCL injury

A

May report dull ache in posterior knee, swelling not typical

54
Q

PE of MCL injury

A

Valgus stress shows laxity

55
Q

PE of LCL injury

A

Varus stress shows laxity

56
Q

PE of ACL injury

A

Anterior drawer test or Lachman test positive

57
Q

PE of PCL injury

A

Posterior drawer test positive

58
Q

Dx of ligamentous injuries

A

Based on hx and physical or MRI

59
Q

Tx of ligamentous injuries

A

Ranges from conservative tx for mild sprains to surgical repair for full tears

60
Q

Knee fx

A

D/t direct trauma
Patellar fx occurs d/t direct blow to patella
Tibial plateau fxs d/t axial load or shearing type injuries

61
Q

PE of knee fx

A

Pt has difficulty weight bearing and pain with movements and direct palpation
Significant swelling and ecchymosis
Straight leg raise show pt unable to lift leg with full extension

62
Q

Dx of knee fx

A

4 view (including “sunrise” view) plain films likely show fx
MRI to evaluate soft tissue damage
CTA to evaluate popliteal vessel damage
Large lipohemarthrosis often evident on MRI

63
Q

Tx of knee fx

A

Knee immobilizer
Pain control
Non-weight bearing
Surgical fixation

DSE (14 decks)

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