Ortho/Rheum Flashcards

Question

Red Flags of Back Pain

Answer 1

* Fever * wt loss * morning stiffness * IVDU/steroid hx * trauma * cancer * saddle anesthesia * loss of anal sphincter tone * motor weakness

Answer 2

MCC prolapsed intervertebral disk and low back strain - occurs w/in 24 hrs of injury/overuse * pain in back & r-\> down leg * sciatic in buttocks, posterior thigh, posterolat asp of leg to lat malleolus and lat dorsum of foot * unilat LB and butt pain - worse with standing --\> SI Joint involvement * Pain in elderly incr with walking, better with rest and leaning forward - spinal stenosis (Hoffman's sign)

Answer 3

* Red Flags for LBP (fever, wt loss, IVDU/steroid use, hx of cancer etc) * Special Tests * Straight Leg Raise = + if numbess and tingling * 15-30 degrees = severe * 30-60 degrees = mild to moderate * XRay not needed if nl hx and PE * CT - bony stenosis & lateral nerve root compression * MRI - tumors, HND, stenosis, cord patho, infx tx: * Short term rest \< 2d, support under neck & knees - NSAIDs * PT, rehab * Imaging \> 6wks if no improvement

Answer 4

Infection and inflammation of bone and bone marrow d/t hematogenous spreading or inoculation from trauma/surgery * S aureus MC * Pasteurella - dog/cat bites * Human bites - mixed anaerobes * Staph epidermis - prosthesis * Mycobacterium TB - vertebral involvement Sxs: * fever * throbbing pain and mvmt restriction over sight * refusal to bear weight

Answer 5

dx * **Bone aspiration and bx - gold std** * Blood cultures and needle aspiration * XR (lags 7-10d after sxs) triad - demineralization, bone destruction, periosteal rx * ele CRP 4-6 wks, ESR, WBC tx * Empiric abx for targeted organism * Amox-Clauv (Augmentin) = Dog/cat and human bites * Targeted after cultures * **IV Abx 4-6 wks for acute OM**, \> 8 wks for chronic OM or MRSA

Answer 6

Direct bacterial invasion of joint space MC knees and hips MCC - S aureus, N gonorrhea in sexually active YA, streptococcus; Pseudomonas sxs: * Single, swollen, warm, painful joint * tender to palpation + * constitutional sxs (fever, sweats, myalgia, malaise, pain)

Answer 7

Dx: * Arthrocentesis - joint fluid aspirate - gold std * WBC \> 50k, primarily PMNs * WBC \> 1000 is + for prosthetic joints tx: * 2-4 wks of abx + arthrotomy w/ joint drainage * S aureu - vanco/Nafcillin (vanco or clindamycin if pcn allergic) * Gonorrrhea - ceftriaxone * IVDU - cipro/levaquin

Answer 8

MOI - direct blow MCC radial n. injury, posterior fat pad/sail sign - pain, swelling, deformity, shortened extremity - motion at fracture site Tx with sugar tong splint ortho f/u in 24-48 hrs

Answer 9

MC Peds elbow frx - FOOSH **Gartland Classification:** * I, II, III - Extension Type * IV - Flexion Type **\*Anterior Interosseous Nerve (AIN)** MC injured in Type I-III **Brachial Artery** MC Vascular Structure Damaged → **Volkmans Contracture** (Radial nerve contracture) 1. Type I - FOOSH, non-displaced, **posterior fat pad sign** 2. Type II - FOOSH, angulated fx w/ distal posterior segment 3. Type III - FOOSH, complete frx through cortext and posterior displacement of distal frx 4. Type IV - Flexed frx, fall on **flexed elbow**, anterohumeral line falls **posteriorly** to capitulum

Answer 10

Lateral X Ray Type I: * Without NV compromise * Cast in flexion \<90 degrees for 3wks * Re-evaluate & x-ray Type II: * Refer same day * Closed Reduction and +/- pinning/fixation * Casting Type III: * Refer same day * Reduction and Internal Fixation * Casting Type IV: * Refer same day

Answer 11

Pain and tenderness along lateral asp of elbow limited elbow/forearm ROM - pronation and supination MCC - FOOSH Sling or long arm splint at 90 degrees ORIF

Answer 12

MC young children \< 4yo MOI - pulling upwards motion Lateral elbow pain hold elbow in slight flexion and forearm pronated Pain and tenderness in lateral asp of elbow

Answer 13

MCC Direct blow to midshaft of ulna Pain and bruising at site eval for abuse victims Tx * functional brace w/ good interosseous mold for isolated/nondisplaced * ORIF for displaced

Answer 14

Proximal 1/3 ulnar shaft fracture w/ radial head dislocation d/t FOOSH sxs * elbow pain and swelling * tenderness to palp along elbow * decreased elbow ROM tx radial n injury ORIF

Answer 15

Distal radial shaft fracture, dislocation of ulna d/t FOOSH on pronated hand sxs: * wrist pain * swelling * pain with extension/flexion Radial n injury ORIF

Answer 16

FOOSH - **distal radius** fracture * Dorsal angulation extra-articular * **dinner fork deformity** Dx - lateral xray Tx * Conservative * close reduction * **sugar tong splin**t, immobilization with cast for 4-6 wks * Surgery * **ORIF** followed by cast/splint immobilization for 4-6 weeks

Answer 17

Fracture of **distal** **radius** w/ **volar angulation** and displacement **garden spade deformity -** fall w/ palm closed, hands flexed, blow to back of wrist Median n injury --\> develop carpal tunnel over time

Answer 18

FOOSH Sxs: * pain on radial surface of wrist at **anatomical snuffbox** * **leads to avascular necrosis - radial artery** Dx: * X-Ray = Fracture may not be evident for \>2wks, if no frx on Xray - tx as fracture and immobilize. Repeat Xray in 2 wks Tx: * Non-displaced = Long vs short **thumb spica 10-12wks** * Displaced = surgical fixation

Answer 19

Fracture of neck of 5th/4th metacarpal * Punch with clenched fist * **no knuckle sign** Tx: * Reduce to anatomic position * Abx if skin breakdown - with Augmentin * **Ulnar gutter split** w/ joints in 60 degree flexion * Immobilization 4-6 wks * Surgical repair =\> cast immobilization

Answer 20

MC in elderly for low velocity complications = adhesive capsulitis/RC Tear Sxs: * inability to hold wrist up = **radial n palsy aka wrist drop** Dx: * Xray Tx * immobilize 4-6 wks - sling and swathe * then begin gentle passive ROM and modalities * Progress to light strengthening after 6 wks * Surgery if displaced or rotated

Answer 21

MC anterior - arm is **abducted and externally rotated** Posterior - arm is adducted and interally rotated Sxs: * Pain, deformity, loss of function Dx: * XRay - AP, Axillary and Y-view * **Special Tests** * Apprehension test * Relocation test * Sulcus test * Obriens Test Tx: 1. Reduce 2. postreduction films 3. Sling and swath 4. PT

Answer 22

Bankart Lesion - fracture of anterior inferior glenoid frm impaction of humeral head against glenoid

Answer 23

Direct blow to tip of shoulder or upward force on long axis of radius Sxs: * Pain/point tenderness over tip of shoulder * +/- deformity Dx: * weight X ray Tx * Sling * analgesics * PT * +/- Surgery

Answer 24

Stabilizes the shoulder; Comprised of Four muscle groups 1. **Supraspinatus - MCC of tears** 2. Infraspinatus 3. Teres minor 4. Subscapularis - internal rotation Eti: * \<40 yo = Impingement, tendonitis * \>40 yo = cuff tears Sxs: * Can't abduct arm above horizontal plane * pain when elbow higher than shoulder Dx: * Special tests * **Drop Arm** * **Empty can** * **Neer Impingement Test** * Radiographs - shoulder series * **MRI - gold standard** Tx * Conservative - NSAID, PT, Rest, Steroid * Surgical - arthroscopic vs open

Answer 25

Painless inflammation of bursa; swelling dev's gradually or acutely Dx: * X ray if trauma * Aspirate and culture if septic Tx: * RICE * elbow pad

Answer 26

Compression of Median Nerve, dt overuse, repetitive motions SxS: * numbness thumb to mid of ring finger * tingling * thenar wasting Dx: * Tinnel's * Phalen's * Electrodiagnostic studies

Answer 27

W 30-50yo Sxs: * pain, swelling, point tenderness along dorsal aspect of wrists Dx: * +Finkelstein's Tx: * Rest * Thumb spica/splint immbolization * NSAIDs, PT, CS

Answer 28

breakdown, loss of articular cartilage btwn bones - age, injury Sxs: * pain in groin region * decrease ROM, abduction * pain with ambulation, climbing stairs Dx: * X-ray Tx * Activity mod * Shoewwear * NSAIDs * Wt loss * joint CS injection * Total joint replacement

Answer 29

High impact trauma - usu from MVA dashboard =\> **90% posterior** Sxs: * limbed shortened * **internally rotated** Dx: * XR and CT r/o frx Tx: * Reduction promptedly

Answer 30

Subcapital/Femoral Neck = wary of avascular necrosis of femoral neck intertrochanteric; Subtrochanteric Sxs: * Pain * inability to wb * shortened leg - external rotation Dx: * XR Tx - ORIF

Answer 31

Twisting motion - change in motion/speed Sxs: * **Pain with instability - knee giving out** * Hemarthrosis Dx: * Anterior drawer * Lachman's Tx: * RICE, PT, bracing, Progressive return to activity * Surgical reconstruction w/ **patellar tendon or hamstring** or cadaver's tendon

Answer 32

Traumatic vs degenerative Sxs: * Twisting injry * Triad * joint line pain * effusion - 6-24 hrs post injury * locking Dx: * **MRI- Gold \*\*\*\*** * McMurray's - knees flexed and * Tibial Externally rotated - **medial** **meniscus** * Tibia Internal rotated - **lateral meniscus** * **Apley's Compression** * ****axial loading = pain Tx: * Rest * Activity Mod * NSAIDs * PT * CS * Surgery

Answer 33

Medial and Lateral CL Knee forced into **VALGUS** - hit on outside of knee L * MCL tear Knee forced into **VARUS** - hit on inside of knee (inner thigh) * LCL tear Dx - **MRI gold \*\*\*** Tx * RICE * Brace * WBAT - crutches * PT/surgery

Answer 34

Inversion sprain - Lateral malleolus strain AFTL Ecchymosis and edema Xray to r/o fracture Tx: * RICE * Splinting and casting * PT * acute vs chronic

Answer 35

Plantar heel pain - worse in morning, better with moving stretching - overuse activity Dx - XRay Tx: * Stretching * PT * NSAID * CS injection * Patience

Answer 36

Fracture/dislocation of 1st/2nd TMT joint MOI - MVA, fall from height Low energy - stepping off curb or hole Swelling in mid foot, non WB Dx: * X ray * CT Tx: * Displacement \> 2mm not good = surgery ORIF * Non-displaced NWB cast immobilization x 4-6wks

Answer 37

heels and twisting ankle inversion **_Jones Fracture_** * base of 5th MT at metaphyseal diaphyseal junction * ORIF = high risk of avascular necrosis

Answer 38

Pain at tibial tuberosity d/t growth spurt ## Footnote Self limiting ice quad strengthening Knee patellar strap

Answer 39

Obese kid, adolescent Xray - slipped femoral cap Tx - ORIF

Ortho/Rheum Flashcards

(63 cards)