Ortho & Rheumatology

Question 1

Arthritis that “Spares the DIPs”

Answer 1

Rheumatoid

Worse in the mornings, eases after about a half hour.

Question 2

PIPs extended & DIPs flexed deformity

Answer 2

Swan Neck Deformity

Rheumatoid Arthritis Sign

Question 3

Best Rx for Osteoarthritis

Answer 3

Tylenol

choose it over Ibuprofin if that is an option, otherwise choose Ibuprofin or naproxim

Question 4

SALTER HARRIS FRACTURE

What is it?

Classification?

Answer 4

A Salter Harris Fracture involves the Ephyseal Plate (growth plate) thus they only occur in immature bones, mainly long bones, mainly around the ankle but it can be digits and the wrist.

Pneumonic is SALTR (Remove the E from Salter)

S- “Straight” fractured Straight thru the plate
Type I

A- “Above” fracture extends above the plate
proximal to the body
Type II

L- “Lower” fracture extends below the plate
Type III

T-“Transverse Thru” thru the plate vertically
Type IV

R- “Rammed” Compression of plate from
being rammed/jammed rare
Type V

Question 5

Septic Arthritis

Answer 5

Fluid contains huge # of WBCs with a preponderance being polymorphonuclear lymphocytes. Other clue to set it apart from Rheumatoid Arthritis is joint aspirate being lower in sugar than serum.

Question 6

Gout vs Pseudo-Gout

Answer 6

Gout has (-) Bifringement, Needle Shaped Uric Acid XLs

PseudoGout has (+) Bifringement, Prism-Shaped Calcium Pyrophosphate XLS.

“P” for Pseudo and Positive and Prism

Question 7

+ Faber

Answer 7

Iliopsoas tendonitis
Tensor Fascia Lata tight

Pain will be on anterior hip

this will also hurt, of course if there is a break in the hip or pelvis….

Kneeling warrior pose next to sofa, affected knee down on folded blanket. Shift backward and lean toward sofa to capture the IT band then fwd to stretch it in a way that it can’t escape

https://www.youtube.com/watch?v=sS7cYp4Z2kk

Question 8

Osteoporosis presents with

Labs

Answer 8

Backpain + loss of height most commonly, fracture out of proportion to injury not uncommon

Labs will be normal unless you do a dexascan, even though bones are demineralizing, serum calcium will not usually be elevated

Rx:

Question 9

Estrogen and Progesterone in Osteoporosis

Answer 9

Estrogen suppresses Rank Signaling and thereby prevents bone resorption

Progesterone stimulates new bone growth and is the standard of care in Europe for osteoporosis.

Personally, I think I’d continue a post menopausal woman on BiEst and Progesterone with no more than 60mg progesterone- not sure if It ought to be daily or if a pseudo cycle

Question 10

Odontoid View, Xray

Answer 10

Open Mouth

Will catch 10% of cervical fractures.

Question 11

Best view for identifying cervical fracture?

Answer 11

Lateral

Ensure you get all 7 Cervical Vertebra

Question 12

BEST and FIRST test for compartment syndrome

Answer 12

Compartmental Pressures (NOT doppler!!)

The lower leg has 4 compartments: anterior, lateral, deep posterior, and superficial posterior. Of these, the anterior is especially prone to compartment syndrome.

You’ll gauge pressure in each compartment with a long manometry needle. Pressure over 30mmHg in any compartment indicates fasciotomy

Question 13

(+) Tinels and/or Phalens Tests

Answer 13

Carpal Tunnel

Question 14

Carpal Tunnel Rx progression

Answer 14

+ tests but no thenar eminence atrophy gets a thumb spika splint for 2-6 weeks

If that doesn’t work, inject corticos

If that doesn’t work, surgical referral

Where does vitamin b come in here?

Question 15

Sprained ankle regardless of grade, Rx

Answer 15

RICE

Moist heat and casting aren’t helpful
Surgury only for chronically unstable joint, not acute relief

Question 16

Distal finger fracture that disrupts the nailed (likely a crush injury), plan?

Answer 16

Splint it

Give ABX as the disrupted nail bed makes this an open fracture

Refer to ortho within the week.

Question 17

Tear vs Tendonitis in the Rotator Cuff

Answer 17

Tears have full passive ROM but weakness

Tendonitis has diminished ROM but no weakness