Orthopedics Flashcards Preview

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Flashcards in Orthopedics Deck (90):
1

What is arthrodesis?

Fusion

Adjacent joint surfaces are excised to promote bone healing

2

What is myelopathy?

abnormal condition of spinal cord

3

What is varus? Valgus?

  • Varus
    • adduction of distal bone in relation to proximal partner
    • Bowleg deformity
  • Valgus
    • abduction of distal bone
    • Knock-knee deformity

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4

What is spondylolithesis?

Slippage of one vertebra on the one below it

5

What is Kienboch's Disease?

vascular necrosis of the lunate

6

Acute Compartment Syndrome

  • Cause
  • Result
  • Common locations

  • Cause
    • Trauma
      • fracture
    • Acute increase in exercise
  • Result:
    • Increased Intercompartmental pressure
      • obstructs blood flow
      • Can damage nerves and muscles
  • Common locations:
    • Volar aspect of forearm
    • Anterior compartment of leg

7

Acute Compartment Syndrome

  • Signs and Symptoms
  • Diagnosis

  • Signs and Symptoms
    • Three P's
      • Pain
      • Paresthesia
      • Paralysis
    • Tightness of compartment
    • Pain with passive stretching of mm
    • Inability to contract muscles of compartment
  • Diagnosis
    • PE
    • Pressure measurement of compartment
      • diastolic P - compartment P < 20 mmHg

8

What does pulselessness in a patient with suspected acute compartment syndrome indicate?

That it is NOT compartment syndrome!

It is an arterial injury

9

What is the most common bone tumor in patients over 40 y/o?

Metastatic!

  • Lung
  • Breast
  • Prostate
  • Thyroid
  • Renal

10

Cumulative Trauma Disorder

  • Cause
  • Symptoms

  • Cause
    • Etiology unknown
    • aggravated by repetitive motion or sustained exertion
  • Symptoms
    • Pain
    • Fatigue
    • Numbness
    • Tenosynovitis
    • Epicondylitis

11

Fibromyalgia

  • Cause
  • Symptoms
  • Diagnosis

  • 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

12

Torus fracture

  • Damage
  • Population

  • Damage
    • one side of cortex only
    • "buckle" or "wrinkle" frcture
  • Population
    • Young

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13

Greenstick fracture

  • Damage
  • Population

  • Damage
    • Break one side of cortex
    • Bend the other
  • Population
    • Young

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14

What does the Salter Harris Classification scale measure?

Severity of epithyseal fractures

15

What is a cominuted fracture?

Bone is in more than one piece

16

What is a segmental fracture?

Segment broken off of a bone

17

What bone abnormalities are common in Osteoporosis?

  • Fractures
    • Hip
    • Wrist
    • Compression
  • Kyphosis

18

What bone process is abnormal in Osteomalacia?  What is the result?

  • Abnormal Osteoblastic process
  • Soft bone

19

Reflex Sympathetic Dystrophy

  • Symptoms
  • Common location
  • Stage at which it is irreversible

  • Symptoms
    • Severe pain
    • Swelling
    • Discoloration
    • Excessive perspiration
  • Common location
    • Upper extremity
  • Stage at which it is irreversible
    • 8-9 mo (stage 3)

20

Falling on the tip of the shoulder results in what type of injury?

Acromioclavicular

21

What complication should be concidered when fracture of the scapula occurs?

Pulmonary Contusion

22

What are the characteristics of Adhesive Capsulitis (Frozen Shoulder)?  How long does it take to heal?

  • Characteristics
    • Insidious onset
    • Decreased range of motion
    • Pain
  • Time to heal
    • 2 years

23

What is the therapy for a shoulder dislocation?

  • Strengthening of subscapularis and infraspinatus
  • Immobilize for 2-3 weeks

24

What can present with subacromial pain that radiates into the brachium with weakness and catching with elevation?

  • Bursitis
  • Impingement
  • Rotator Cuff Tear
    • may need more aggressive therapy than the rest

25

What injury is pictured below?

Q image thumb

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?

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Rheumatoid arthritis

32

What disease process is pictured below?

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Degenerative Arthritis

33

Patient has a flexion deformity of PIP with hyperextension of DIP.  What is the condition?  What is the cause?

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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

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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

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39

What condition is pictured below?  What symptoms are present?  What causes this?

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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?

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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?

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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

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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?

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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

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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

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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?

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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?

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Slipped capital femoral epiphysis

77

Toward what bony structure should all fingers point when at rest?

Distal pole of the scaphoid

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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

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83

Which nerve allows thenar opposition?

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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