Orthopedics Flashcards
(90 cards)
1
Q
What is arthrodesis?
A
Fusion
Adjacent joint surfaces are excised to promote bone healing
2
Q
What is myelopathy?
A
abnormal condition of spinal cord
3
Q
What is varus? Valgus?
A
- Varus
- adduction of distal bone in relation to proximal partner
- Bowleg deformity
- Valgus
- abduction of distal bone
- Knock-knee deformity
4
Q
What is spondylolithesis?
A
Slippage of one vertebra on the one below it
5
Q
What is Kienboch’s Disease?
A
vascular necrosis of the lunate
6
Q
Acute Compartment Syndrome
- Cause
- Result
- Common locations
A
- Cause
- Trauma
- fracture
- Acute increase in exercise
- Trauma
- Result:
- Increased Intercompartmental pressure
- obstructs blood flow
- Can damage nerves and muscles
- Increased Intercompartmental pressure
- Common locations:
- Volar aspect of forearm
- Anterior compartment of leg
7
Q
Acute Compartment Syndrome
- Signs and Symptoms
- Diagnosis
A
- Signs and Symptoms
- Three P’s
- Pain
- Paresthesia
- Paralysis
- Tightness of compartment
- Pain with passive stretching of mm
- Inability to contract muscles of compartment
- Three P’s
- Diagnosis
- PE
- Pressure measurement of compartment
- diastolic P - compartment P < 20 mmHg
8
Q
What does pulselessness in a patient with suspected acute compartment syndrome indicate?
A
That it is NOT compartment syndrome!
It is an arterial injury
9
Q
What is the most common bone tumor in patients over 40 y/o?
A
Metastatic!
- Lung
- Breast
- Prostate
- Thyroid
- Renal
10
Q
Cumulative Trauma Disorder
- Cause
- Symptoms
A
- Cause
- Etiology unknown
- aggravated by repetitive motion or sustained exertion
- Symptoms
- Pain
- Fatigue
- Numbness
- Tenosynovitis
- Epicondylitis
11
Q
Fibromyalgia
- Cause
- Symptoms
- Diagnosis
A
- Cause
- etiology unknown
- Symptoms
- Muscular pain
- Fatigue
- Stiffness
- Multiple tender points
- Diagnosis
- Widespread pain
- longer than 3 mo
- Multiple trigger points
- Normal joints and x-ray
- Widespread pain
12
Q
Torus fracture
- Damage
- Population
A
- Damage
- one side of cortex only
- “buckle” or “wrinkle” frcture
- Population
- Young
13
Q
Greenstick fracture
- Damage
- Population
A
- Damage
- Break one side of cortex
- Bend the other
- Population
- Young
14
Q
What does the Salter Harris Classification scale measure?
A
Severity of epithyseal fractures
15
Q
What is a cominuted fracture?
A
Bone is in more than one piece
16
Q
What is a segmental fracture?
A
Segment broken off of a bone
17
Q
What bone abnormalities are common in Osteoporosis?
A
- Fractures
- Hip
- Wrist
- Compression
- Kyphosis
18
Q
What bone process is abnormal in Osteomalacia? What is the result?
A
- Abnormal Osteoblastic process
- Soft bone
19
Q
Reflex Sympathetic Dystrophy
- Symptoms
- Common location
- Stage at which it is irreversible
A
- Symptoms
- Severe pain
- Swelling
- Discoloration
- Excessive perspiration
- Common location
- Upper extremity
- Stage at which it is irreversible
- 8-9 mo (stage 3)
20
Q
Falling on the tip of the shoulder results in what type of injury?
A
Acromioclavicular
21
Q
What complication should be concidered when fracture of the scapula occurs?
A
Pulmonary Contusion
22
Q
What are the characteristics of Adhesive Capsulitis (Frozen Shoulder)? How long does it take to heal?
A
- Characteristics
- Insidious onset
- Decreased range of motion
- Pain
- Time to heal
- 2 years
23
Q
What is the therapy for a shoulder dislocation?
A
- Strengthening of subscapularis and infraspinatus
- Immobilize for 2-3 weeks
24
Q
What can present with subacromial pain that radiates into the brachium with weakness and catching with elevation?
A
- Bursitis
- Impingement
- Rotator Cuff Tear
- may need more aggressive therapy than the rest
25
What injury is pictured below?
Rupture of the long head of the Biceps
aka "Popeye muscle"
May occur spontaneously after 40 years
26
What is the anatomy of cubital tunnel syndrome? What symptoms are present?
* Anatomy
* entrapment of ulnar nerve
* Symptoms
* Pain
* Numbness
* pinky and half of ring finger
* Muscle weakness
* intrinsic mm of the hand
27
What causes acute olecranon bursitis?
Trauma
Infection
28
What causes chronic olecranon bursitis?
Gout
Rheumatoid
29
What is tennis elbow?
Lateral epicondylitis
| (elbow)
30
What is golfer's elbow?
Medial epicondylitis
| (elbow)
31
What disease process is pictured below?
Rheumatoid arthritis
32
What disease process is pictured below?
Degenerative Arthritis
33
Patient has a flexion deformity of PIP with hyperextension of DIP. What is the condition? What is the cause?
Boutonniere Deformity
Cause: disruption of central slip of PIP
34
Patient has flexion of the DIP joint on full extention of the finger. What is the condition? What is the cause?
Mallet / Baseball finger
Cause: disruption of terminal extensor tendon
35
What is the anatomy of Carpal Tunnel Syndrome? What are the symptoms? Diagnosis?
* Anatomy:
* Compression of the median nerve
* Symptoms
* Pain
* Numbness
* Nocturnal Paresthesia
* Thenar weakness
* Diagnosis
* Loss of 2 point discrimination
* Phalen's test
36
What is Dupuytren's contracture?
Idiopathic thickening of Palmar Fascia
37
Patient fell on his outstretched hand and now has tenderness over the snuff box. What injury does he have? What severe complication can result?
Fracture of the Scaphoid
Complication: avascular necrosis of the proximal pole
38
What is deQuervain's? How can you test for it?
* Tenosynovitis of the Wrist
* first dorsal extensor compartment
* APL and EPB tendons
* THUMB
* Test
* Finkelstein's Test
39
What condition is pictured below? What symptoms are present? What causes this?
Trigger finger
* Symptoms
* Locking
* Pain at A1 Pulley
* Cause
* Repetitive actions
* Rheumatoid arthritis
40
Where does ulnar nerve entrapment of the wrist occur?
Guyon's canal
41
Patient presents with one leg flexed, adducted, and internally rotated. In which direction was his hip dislocation? Function of what structure needs to be assessed?
Posterior dyslocation
Assess Sciatic Nerve function
42
Patient presents with one leg flexed, abducted, and externally rotated. In which direction was his hip dislocation? Function of what structure needs to be assessed?
Anterior hip dislocation
Assess Femoral Nerve function
43
The patient fell on their hip. The leg is now shortened and externally rotated. Where is the fracture?
Intertrochanteric
or
Femoral Neck Fracture
44
Patient presents with pain in the buttock and lateral thigh. They limp and have a positive trendelenburg sign. There is loss of internal rotation. What is the diagnosis?
Osteoarthritis of the hip
45
Patient has pain over the trochanter and lateral thigh with point tenderness over the trochanter. What is the diagnosis?
Trochanteric Bursitis
46
Patient had a twisting injury of the knee, causing it to "pop." There is now pain and an effusion around the knee. What is the next step in testing? What is the injury?
Test: Anterior Drawer sign
ACL tear
47
What is a fluid filled sac from the medial hamstring tendons?
Baker's cyst
aka Popliteal cyst
48
Pes Anserine Bursitis
* Anatomy
* Symptoms
* Anatomy
* Inflammation of the bursa beneath the tendons of
* Sartorius
* Gracilis
* Semitendonosis
* Symptoms
* Pain
* Point tenderness \*\*\*
49
Where is the pain located in a meniscal tear?
Along the joint line
50
Patient presents with sudden severe calf pain, described as feeling like a "gunshot." The calf is swollen. When squeezing the calf muscle, no plantar flexion is present. What is the injury? What is the test of squeezing the calf called?
Achilles Tendon Rupture
Test: Thompson test (negative here)
51
Patient presents with lateral deviation of the great toe at the MTP joint and pain secondary to wearing shoes. What is the diagnosis?
Bunion
52
What three major clinical problems of the foot can result from diabetes?
1. Diabetic Ulceration
2. Deep Infections
3. Charcot Joints
53
Patient presents with pain centralized between the 3rd and 4th MTP joint of the foot. He says says he feels like he is walking on a marble. What is the diagnosis?
Morton's Neuroma
54
Patient presents with heel pain that is more severe on waking up and the morning and with the first few steps. The pain becomes less severe with some movement. What is the diagnosis?
Plantar fasciitis
Inflammation of bone and fascia
55
What injury is usually associated with increased activity?
Stress Fracture
56
Spondylolithesis
* Anatomy
* Defect
* Anatomy
* Foreward slippage of vertebra on another
* Most common: L5-S1
* Defect
* in Pars Interarticularis
57
Does surgery reverse the damage that has already occured in lumbar disc herniation?
No! This is a degenerative process
58
What symptoms are associated with spinal stenosis? In which age group is it most common?
* Symptoms
* Back and leg pain
* Weakness
* Pseudoclaudication
* nerve pain w/ walking that causes them to need to stop and rest
* Pop
* 60s
59
What is the ddx if a child presents with acute, severe bone pain?
Fracture
Dislocation
60
What is the ddx if a child presents with bone pain that has progressed over several days?
Osteomyelitis
Septic Arthritis
61
What is the ddx if a child presents with bone pain with a slow (indolent) onset?
Inflammatory arthritis
Rheumatoid arthritis
62
What is the ddx if a child presents with bone pain at night?
* Bone tumors
* Osteosarcoma
* Osteoid Osteoma
* Marrow problems
* Leukemia
63
What is the most common site of disease is peds orthopedics?
Metaphyseal Region
64
What is the diagnosis for the condition pictured below?
Club foot
* Plantar flexion of ankle
* Inversion of heel
* High arch of foot
* Adduction of forefoot
65
What can result from untreated Congenital Dysplasia of the Hip in an older child?
Leg shortening
Limp
66
What are the Barlow and Ortolani tests used to diagnose?
Diagnosis: Congenital Hip Dysplasia
Barlow: Dislocation test
Ortolani: Relocation test
67
What is the treatment for Congenital Dysplasia of the Hip?
Contain head of femur in acetabulum
Stimulated growth / deepening of acetabulum
68
What is the ddx for a child whose limp is worse in the morning?
Transient synovitis
Rheumatoid Arthritis
69
What is the ddx for a child whose limp is worse in the afternoon, after activity?
Musculoskeletal conditions
70
What is the ddx for a child whose limp is worse at night?
Neoplasm
| (ex: leukemia)
71
Legg-Calve-Perthes Disease
* Pathology
* Age group
* Symptoms
* Complications
* Pathology
* Osteonecrosis of the femoral head
* Age group
* 4-8 y/o
* Symptoms
* limping
* Restriction of **_abduction_** of hip
* Complications
* Degenerative arthritis
* Head may collapse
72
Student athlete presents with pain and an enlargement of the anterior tibial tubercle. The radiology is shown below. What is the diagnosis? What is the pathology?
Osgood Schlatter Disease
* Path
* Apophysitis
* Normal developmental outgrowth of a bone which arises from a separate ossification centre, and fuses to the bone later in development.
* Forms an insertion for a tendon
* Involved tendon
* Infrapatellar
73
Scoliosis
* Definition
* Most common location
* Testing
* Definition
* Lateral curvature of the spine
* \> 10 degrees
* Most common location
* Thoracic and Lumbar
* Testing
* Forward bend test
* Look for elevation of ribs on one side and depression on the other
74
When is surgery necessary to treat scoliosis?
over 40 degree curvature
75
Child presents with fever and pain and swelling of the knee. Joint Aspirate shows WBC \> 50,000, Low sugar, Increased protein, and a culture is performed What is the diagnosis? What are the most common pathogenic causes?
Septic arthritis
* Pathogens
* Staph aureus (most common)
* Group B Strep (\< 1)
* H. influenzae (6 mo - 4 yrs)
* N. gonorrhea (12-18 yrs)
76
Patient presents with pain of the groin and anterolateral thigh with a limp. Radiography is shown below. What is the diagnosis?
Slipped capital femoral epiphysis
77
Toward what bony structure should all fingers point when at rest?
Distal pole of the scaphoid
78
Where does the tendon flexor profundus insert?
Distal Phalanx
79
Where does the tendon flexor sublimis insert?
Middle phalanx
80
While supporting the middle phalanx, the patient is unable to bend the distal phalanx. What structure has most likely been damage?
Tendon flexor Profundus
81
Patient is only able to flex the finger at the PIP joint. The other IP joints remain extended. What structure is probably damaged?
Flexor tendon Sublimis
82
Sensation is provided to which parts of the hand by these nerves?
* Median
* Ulnar
* Radial
* Median (green)
* Palm: part of thumb, fingers 2, 3, half of 4
* Dorsum: Tips of fingers 2, 3, half of 4
* Ulnar (blue)
* Both sides: pinky and half of finger 4
* Radial (red)
* Palm: half of thumb
* Dorsum: thumb, fingers 2, 3, half of 4 to the IPJ
83
Which nerve allows thenar opposition?
Median
84
What nerve provides motor function to the intrinsic mm of the hand?
Ulnar
85
Which nerve allows wrist and thumb extension?
Radial
86
What should be used to dress an injured hand?
* First layer
* Fine Mesh Gauze
* Second layer
* Bulky absorbent material
* Third layer
* Splint
87
What are Ultrasounds most useful in detecting?
1. Ganglia & abscesses
2. Foreign body
3. Ligament tear
4. Tendonitis
5. Ultrasound guided aspiration
88
CT is useful in evaluation of what type of injury?
Fracture
89
Which imaging tool provides the most information?
MRI
90
Bone scan
* Measures what factors?
* Indications
* Measures
* blood flow
* metabolic activity
* Bone turnover
* Indications
* Osteomyelitis
* Kienboch's disease
