ortho/sports medicine Flashcards Preview

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Flashcards in ortho/sports medicine Deck (89):
1

What is the appropriate immediate treatment for an ankle sprain ?

Ice for 20min at a time over the first 48 hours

2

What is the likely diagnosis in a pre-adolescent child with bone pain over the physis who has a normal X-ray?

Salter Harris 1 fracture

3

What is a grade 1 ankle sprain?

Minor stretching of ligament with minimal discomfort or loss of function

4

What is the difference between grade 2 and grade 3 sprain?

Grade 2 has partially torn ligaments whereas grade 3 has complete tear

5

What is the appropriate treatment for a child who sustained an ankle injury after being stepped on...exam shows bruise and swelling with strong pulses and diminished sensation to light touch

Obtain compartment pressures

6

What are the 5 symptoms of compartment syndrome ?

Pain
Paresthesias
Pallor
Paralysis
Pulselessness

7

What diagnosis should you consider in a patient who presents with fracture who is found to have blue sclera? What other condition is associated with this disease?

Osteogenesis imperfecta type 1 - conductive and sensorineural hearing loss

8

What disease presents with an infant born with multiple fractures with a large head who is born either stillborn or died shortly after birth?

Osteogenesis imperfecta type 2

9

What disease presents with an infant who is born with fractures and sustain progressive deformities and has gray sclera, macrocephaly and short stature?

Osteogenesis imperfecta type 3

10

What is the inheritance pattern of achondroplasia ?

Autosomal dominant 20%
Spontaneous mutation 80%

11

What is the most likely cause of sudden death in an infant with achondroplasia ?

Cervicomedullary junction compression

12

What syndrome presents with fusion of cervical vertebrae, short neck,scoliosis, spina bifida, deafness and renal problems?

Klippel Feil syndrome

13

What diagnosis may present with torticollis and upper motor neuron findings such as increased DTRs?

Posterior fossa tumor

14

What other abnormality is associated with congenital torticollis?

Hip dysplasia

15

What is the treatment for congenital torticollis?

Daily stretching and PT - if continued after one year, surgical intervention

16

What is the cause of muscular torticollis?

Positioning or trauma

17

What is the diagnosis in a patient with repeated attacks of torticollis that lasts a few minutes and is accompanied by vomiting, pallor and irritability ?

Paroxysmal torticollis

18

What is the sprengel deformity?

Affected side of the neck is broader and shorter and mimics torticollis

19

What is the cause of sprengel deformity?

Poor fetal development and failure of the scapula to descend to the normal position

20

What are the 4 risk factors for developmental dysplasia of the hip?

Breech
Female
First born
Family hx

21

You are presented with a patient who recently immigrated from a developing country, he presents with painful ankle that is swollen and red. He had similar symptoms in the knee yesterday and now has macular rash. What is the likely diagnosis?

Rheumatic fever

22

What is the treatment of choice for an adolescent with septic joint?

Ceftriaxone plus azithromycin (to cover GC)

23

What organisms are commonly the cause of septic joint in a neonate?

GBS, staph and gram negative bacillus

24

What is legg calve perthes disease?

Avascular necrosis of the femoral head

25

What is the most common etiology of osteomyelitis in the neonatal period and what is the most common complication?

E. coli and GBS
Septic joint

26

What is the likely diagnosis in an adolescent male with chronic knee pain that locks up and swells? How would you diagnose this?

Osteochondritis dissecans (necrosis of the articulate surface)
MRI

27

What is the appropriate treatment of osteochondritis dissecans?

Immobilization and surgical removal of fragments if no improvement

28

How might a pelvic osteomyelitis present, other than hip or thigh pain ?

Abdominal pain

29

What is the treatment for osgood schlatter disease?

Weeks of rest with gradual return to activity
NSAIDs

30

What is the mechanism behind the pain caused by osgood schlatter disease ?

Excessive activity at the insertion of the patellar tendon at the anterior tibial tubercle (apophysis)

31

At what curvature does scoliosis require surgery?

Curvature >40 degrees

32

At what curvature may you simply observe a child with scoliosis?

<25

33

What determines when to brace a child with scoliosis curvatures 25-40 degrees?

Bracing required if there is more than 2 more years of growth expected

34

What should you do if a child with scoliosis has >1 degree per month of increased curvature during the growth spurt ?

MRI to rule out a cause other than idiopathic scoliosis

35

What is the cause of congenital scoliosis? What can this be associated with?

Failed segmentation or formation of spinal elements - can be associated with fused ribs or spinal cord anomalies

36

What is idiopathic scoliosis and what is the normal progression?

Isolated scoliosis with no cause - worsens by 1 degree per month during the growth spurt

37

What diagnosis should you consider in a patient with rapidly progressive scoliosis and neurological deficits?

Neurofibromatosis

38

What type of screening is warranted in patients with congenital scoliosis? (3 answers)

Renal ultrasound and ECHO as well as spinal MRI

39

What is the normal range of thoracic kyphosis and at what degree is intervention indicated ? What is the first study to perform in these cases?

Normal range: 20-40
PFTs if >60 degrees

40

What is the likely diagnosis in a teenager who can't stand up straight and has chronic upper back pain? What is the treatment?

Scheuermann disease - NSAIDs and physical therapy

41

What is the diagnosis in an infant with swelling of the bones and progressive cortical thickening on X-ray?

Caffey disease (infantile cortical hyperostosis)

42

How can caffey disease be distinguished from non accidental trauma?

Abuse involves the periosteum but caffey disease involves only the cortex

43

What is the difference between unicameral and aneurysmal bone cysts? (Comment on location, symptoms and complications)

Unicameral - found on proximal humerus or femur. Asymptomatic and not precancerous.
Aneurysmal - found on tibia or femur. Present with pain and associated with bone tumors

44

What is the diagnosis for a patient with pain over the distal clavicle with area of prominence ?

Acromioclavicular Injury

45

What diagnosis presents as shoulder pain with elevation of the arm, but no deformity ?

Rotator cuff injury

46

When is intervention needed for genu varus (bow legged) ?

If unilateral, worsening after age 1 or unresolved by age 2

47

What are the two major concerns if genu varus is present after age 2?

Rickets or Blounts disease

48

What is the cause of adolescent Blount disease? What is the treatment ?

Overweight adolescent develops distortion of proximal tibial physis and epiphysis
Bracing or surgery is needed

49

What is the treatment for infantile Blounts disease?

No treatment indicated

50

What type of fracture presents as a separation of the epiphysis and metaphysis? What is the treatment?

Salter Harris type 1 - casting 2-3 weeks

51

What type of fracture goes through the growth plate and extends through the epiphysis? What is the treatment ?

Salter Harris type 3 - open reduction needed

52

What type of fracture involves a splitting of the metaphysis and physis? What is the treatment?

Salter Harris type 2 - closed reduction with casting 3-6 weeks

53

What is the cause of an anterior and posterior fat pad on X-ray of the elbow?

Anterior - normal
Posterior - fracture

54

What is the diagnosis in a patient with pain over the anatomical snuffbox (even with a negative X-ray)?

Scaphoid bone fracture

55

What type of fracture does through the metaphysis/physis/epiphysis? What is the treatment ?

Salter Harris type 4 - open reduction

56

What is the likely diagnosis in a patient who heard a pop after twisting of the knee and pain over the lateral patella ? What is the treatment?

Patella subluxation - maintain quadriceps and hamstring strength and flexibility

57

What diagnosis would you consider in an obese teenager with left knee pain?

SCFE (hip pain commonly presents as knee pain)

58

What is the appropriate treatment for tibial torsion and femoral anteversion?

Nothing!!! Resolves spontaneously

59

What are 3 situations where acute illness makes a child ineligible for participation in sports?

Fever
Carditis
Hepatosplenomegaly

60

What is the definition of heat exhaustion?

Mild dehydration with core temp <104

61

When is power lifting safe for pre-adolescents ?

Low resistance weight training is permitted but power lifting is not safe for preadolescents

62

What should be done for a patient participating in sporting events who presents with headache, nausea or confusion and is sweating on physical exam?

Stop exercising and drink fluids

63

What are the 4 criteria for heat stroke ?

Temp >105
Hot dry skin (not sweating)
CNS depression
Severe dehydration

64

What is the risk involved in heat stroke and why?

End organ damage due to release it endotoxins and cytokines

65

What should be done in a patient who presents with diagnosis of heat stroke?

Decrease core body temperature (down to 102, avoid hypothermia)
Rehydrate with IVF only
Vasopressors if needed

66

What is the diagnosis in a patient who sustains eye trauma and develops a collection of blood between the cornea and iris?

Hyphema

67

What is the appropriate treatment for hyphema?

Referral to ophthalmology
Bed rest and HOB at 30 degrees to decrease intraocular pressure (should not patch the eye)

68

What diagnosis should you consider in a patient with blunt eye trauma who presents with double vision when looking to one side and disconjugate gaze but intact pupillary reflexes ?

Blowout fracture of orbital wall

69

What diagnosis would you consider in a patient who sustains eye injury and presents with pain and tearing but no Diplopia or dysconjugate gaze? What would confirm this diagnosis ?

Corneal abrasion
Focal uptake of fluorescein

70

What diagnosis presents as a visual deficit in the peripheral fields but no dysconjugate gaze?

Detached retina

71

What diagnosis should you consider in a patient who wears contacts and presents with redness and irritation of the eye, normal pupil exam and diffuse uptake of fluorescein stain? What is the appropriate treatment?

Gram negative infection or ulcer of corneal epithelium - urgent management by ophthalmology

72

What diagnosis presents as anterior knee pain over the patella and visible swelling? What is the treatment ?

Prepatellar bursitis - NSAIDs and padding during sports

73

What is the most likely diagnosis in a patient who presents with large area of swelling on anterior thigh after blunt trauma ? How would you treat?

Hematoma of soft tissue - NSAIDs, Ice and rest

74

What is the most likely diagnosis in a patient with pain over the dorsum of the hand near the base of the thumb?

Scaphoid fracture

75

What is the most likely diagnosis in a 12y/o gymnast with left wrist pain x 3 months without any significant trauma and normal physical exam with tenderness only at distal radius? How would you treat?

Distal radial epiphyseal injury - rest and splint until wrist is healed to avoid growth plate disruption

76

Hep would you treat a non displaced mid shaft clavicle fracture ?

Sling (no reduction needed)

77

What is the appropriate treatment for a patient with medial clavicle fracture?

CT scan may be needed to rule out complications

78

What diagnosis should you consider In a patient with distal clavicle pain after trauma injury who has negative clavicle X-ray ?

AC separation

79

What is the next step in a patient with hemophilia who sustains hand injury and presents with numbness of the hand?

Measure compartment pressure

80

What should be done to secure an airway in a patient who sustains a neck injury while playing football?

Never remove helmet or should pads - may remove face guard only!

81

What are potential risks involved in anabolic steroid use in females?

Hirsutism and early closure of growth plates

82

What are 6 potential side effects of Anabolic steroid use in males?

Acne
Gynecomastia
High pitched voice
Hypogonadism
Aggression
HTN

83

Until what age are children required to wear a face guard when batting during baseball games?

Up to age 14

84

What are 4 common lab findings consistent with anabolic steroid use?

Elevated LFTs
Low HDL
High LDL
Oligospermia

85

How long are anabolic steroids detected after PO vs IM use?

PO steroids remain in urine up to a few weeks
iV steroids remain in the system >6 months

86

What would you do in an athlete who presents for sports clearance and is found to have LVH?

No sports restriction as this is normal in athletes

87

What is part of sports clearance in a patient with Down syndrome?

Plan neck X-ray to rule out AA instability

88

What should diabetic patients do in preparation for exercise?

Increased caloric intake or decreased insulin to avoid hypoglycemia

89

In defining varus vs valgus, which one refers to when the distal part of the deformity points away from midline ?

Valgus