Orthopedics Flashcards
(166 cards)
1
Q
What is the most commonly torn ligament in ankle sprain?
A
ANTERIOR talofibular
2
Q
which guidelines do you use to determine if an ankle fracture or sprain needs evaluation via xray?
A
Ottawa ankle rules
3
Q
What grade of ankle sprain would you classify a person with a partial tear of a ligament?
A
Grade 2
4
Q
T or F: mechanism of injury is not a reliable factor of whether an ankle is sprained or broken
A
T
5
Q
What view of XRay is the best and most reliable way to determine if an ankle FRACTURE is present?
A
AP-Lateral ankle XRAY
6
Q
Knowing that the lateral malleolus is the most commonly fractured ankle bone, what guidelines are used to determine the location?
A
Weber Classification; determines the fracture based on its proximity to the syndesmosis tib/fib joint
7
Q
what is the most common type of Weber fracture?
A
Type 2 (at the syndesmosis)
8
Q
what are the 2 injuries that look like an ankle fracture but YOU CANT MISS because they have poor outcomes when untreated?
A
Jones Fracture (5th metatarsal) Achilles tendon rupture
9
Q
patient presents with history of a twisting ankle injury. On physical exam, you notice pain on palpation of lateral forefoot. What is your next step ?
A
XRAY
you’re thinking Jones Fracture
Tenderness over laderal midfoot*
10
Q
Patient presents with posterior ankle pain; reports hearing a “pop” when he was jumping for a rebound. You perform the Thompson test and it’s positive. What is it and what do you do?
A
Achilles Rupture –> surgery within 1 week!
11
Q
What is the Thompson test?
A
knee flexed at 90 degrees;when squeeze the calf, it should jump. If not, it is a positive test for Achilles rupture
12
Q
patient reports with stabbing pain with the first steps in the morning. She hasn’t come in because it usually goes away as the day progresses. What are you thinking?
A
Plantar Fasciitis
13
Q
T or F: plantar fasciitis is worse during exercise, and better after
A
FALSE
worse AFTER exercise, better during
14
Q
T or F: after obtaining imaging for plantar fasciitis; you notice a heel spur; this is the cause of your patient’s plantar fasciitis!
A
FALSE: spur is result of fasciitis
15
Q
what is the 1st line treatment for plantar fasciitis
A
NSAIDs + stretching
16
Q
what should you never do with achilles tendonitis?
A
never inject steroids!!
17
Q
this condition is characterized by friction on digital nerves from metatarsal heads over a period of time; develops a thickening that “feels like a pebble in their foot”
A
Morton’s neuroma
18
Q
what is the most common location of a Morton’s neuroma?
A
between 3 and 4 metatarsals
in the third webspace
19
Q
In what condition would you perform the metatarsal shift test?
A
Morton’s neuroma
20
Q
what is the condition where the metatarsal bases dislocate from the tarsus?
A
Lisfranc injury
21
Q
treatment Lisfranc injury?
A
internal fixation (ORIF)
22
Q
your patient presents with pain and swelling during activities like running. On exam you note a dome-shaped swelling over the anterior aspect of the knee. What is your dx?
A
prepatellar bursitis
pes anserine would be medial anterior tibia BELOW joint line
23
Q
Why would you XRAY for suspected patellar or pes anserine bursitis?
A
rule out bony causes
24
Q
Your patient presents with pre-patellar bursitis; you think it may be infected because it is red and hot to touch. What do you do next?
A
Aspirate!
25
Your patient who is 40 years old presents with gradual onset of a mildly tender bulge at the posterior aspect of the knee joint. He notes that it feels full and swollen back there, but he never had any trauma to it. What is this and what underlying cause are you concerned about
Popliteal cyst (Baker's) cyst
underlying ligament damage or arthritis
26
A ruptured Popliteal cyst can mimic what?
DVT - always rule this out with popliteal cysts
| Do US to rule out DVT
27
would you see anything on imaging for popliteal cyst (baker's cyst)?
MRI not necessary but may identify pathologic cause of the cyst (arthritis/ligament/RA/OA)
US can rule out aneurysm (pulse) and DVT - do this!
28
T or F: a ruptured Baker's cyst needs admission to hospital
FALSE: analgesics + Rest + ice
29
T or F: if a patient reports hearing a "pop" with a knee injury, think Ligament (LCL, MCL, PCL, ACL)
True
30
what kind of force causes MCL tear?
Valgus
31
What imaging study do you do first for suspected LCL/MCL tear?
XRAY - rule out avulsion fracture
then do MRI
imaging not always necessary
32
what type of ligament tear can you suspect with history of hyperflexion of knee or fall on flexed knee?
PCL
33
What exam finding might be positive with torn PCL?
posterior drawer test
34
what is the treatment approach to PCL tear?
PT first.
if no regained function --> surgery
PCL + other injuries --> right to surgery
35
Which ligament is the PRIMARY stabilizer of the knee against anterior translation?
ACL
36
which other ligament is commonly torn with ACL tears?
meniscus (medial) and sometimes MCL
| less likely with LCL or PCL
37
patients presents with painful Left knee; she heard a painful popping sound when pivoting on her foot during basketball practice. It happened 1 hour ago and is already very swollen. What is your dx?
ACL tear (hyperextension injury)
38
What are the 3 physical exam tests for ACL tear?
Lachman Test (MOST SENSITIVE)
Anterior drawer
Pivot shift test
39
T or F: if Lachman test is positive for patient with suspected ACL tear; you only perform MRI to prep for surgery - imaging is not needed
True
| you can do XRAY to rule out avulsion
40
T or F: ACL tears require immediate surgical repair
False
| RICE + crutches - let swelling go down
41
what is the most common knee injury?
Meniscus tear (Medial)
42
what is the hallmark (3) symptoms of Meniscal tear?
Joint line pain
effusion
locking
43
Patient presents with knee pain that locks when she climbs stairs. She notes twisting her knee while carrying a new mirror into her house. You note swelling, and she said it's been gradually getting worse. What do you think?
Meniscus tear
| twisting while weight bearing, locking, climbing stairs
44
Which physical exam tests would you perform for meniscal tear?
- McMurrays test (positive if "click")
- Apley's Compression test
- Distraction test (pull tibia from femur)
- Knee Bounce test
- Joint line pain
- Deep flexion test
45
How do you manage torn meniscus regarding imaging?
may need MRI (but not if patient displays classic signs of tear)
46
treatment meniscus tear
6 weeks conservative: RICE, NSAIDs, crutches, PT
47
what is the most common running injury?
Patellofemoral syndrome
48
how would you explain patellofemoral syndrome?
patella not tracking in patellofemoral groove; due to overuse in athletes
49
What is "theater sign"?
pain from patellofemoral syndrome worse with prolonged sitting
50
What are the differences in symptoms with patellofemoral syndrome (vs meniscus?)
No locking or catching
| No swelling
51
Patient presents complaining of bilateral knee pain. It's excruciating when descending her stairs, and feels as if it is "giving away". She denies any swelling or locking up
Patellofemoral syndrome
52
What is Crepitation regarding patellofemoral syndrome (physical exam test)
palm on patella while patient flex/extends knee; crunching/grinding in joint = positive
53
what type of imaging to order for patellofemoral syndrome?
XRAY - Merchant/sunrise view
54
Treatment Patellofemoral syndrome
```
REST
NSAIDs
ICE
PT to strengthen quads
knee brace
```
55
What is the knee disorder characterized by loss of cartilage on articular surface of joint, due to "wear and tear"
OA of knee
56
symptoms of OA in knee
pain, stiffness, swelling, locking/catching
57
65 year old patient presents with pain and stiffness in both knees. On exam you note angular deformities of knees.What is the next step?
XRAY - weight-bearing
sunrise view and lateral view too.
58
what is the usual treatment of choice in OA of knee
Cortisone injection
also oral supplements, braces, weight loss, cane/walker, PT
surgery for knee replacement eventually
59
a 12 year old boy presents to your office complaining of pain at the front of his knee, especially painful when he's playing football. It's been going on for months. What do you have him do to test what you think it is
Knee hyperflexion to his buttock - PAIN = positive for Osgood Schlatter
60
Do you perform imaging in Osgood Schlatter?
yes - XR to rule out fracture/osteomyelitis/tumor
61
Treatment Osgood-schlatter
self-limited; resolves over months. Reduce activity, use infrapatellar strap. NSAIDs
62
Can you give steroid injections for Osgood-Schlatter?
NO!! can exacerbate the pain (and they're young!)
63
what is the most common type of patellar fracture?
stellate
64
Patellar fracture can be treated nonsurgically or surgically. What indications would lead you to surgical?
displaced
65
how do you treat a nondisplaced patellar fracture?
immobilize for 8-10 weeks with cylinder cast (weight-bearing ok)
-repeat XR at 2 weeks, 4 weeks
66
Pelvic fractures from trauma are associated with ____________
significant bleeding - do FAST US and CT to look for hemorrhage
67
What other injury/dysfunction should you think about with pelvic fractures?
Bladder/urethral injury
68
treatment pelvic fracture
pelvic binder
69
what are the 2 most common types of hip fracture?
```
femoral neck (intracapsular)
Intertrochanteric (extracapsular)
```
70
which hip fracture type has the higher risk of AVN?
femoral neck fracture (poor blood supply)
71
patient presents with hip pain; is unable to bear weight. You note a shortened limb, hip externally rotated and abducted
Hip fracture (femoral neck or intertrochanteric)
72
What kind of imaging is best to evaluate hip (proximal femur) fracture?
XRay
| DO NOT DO FROG LEG!
73
Treatment of hip fracture?
Surgery!
| ALWAYS give VTE prophylaxis
74
a 55 year old obese female present with aching hip pain; she says it gets worse as the day progresses and with prolonged rest. She specifically notices morning stiffness that lasts about 20 minutes. What is your dx?
Hip OA
75
morning hip stiffness lasting >30 minutes raises a red flag for ____
RA
| OA is <30 min
76
On physical exam of your 60 year old hip pain patient, you note loss of ROM, crepitus, and joint swelling. No hx trauma. What do you think?
hip OA
77
What would you see on hip OA weight-bearing XRAY
- joint space narrowing
- osteophyte formation
- subchodral cyst formation
- subchondral sclerosis
78
Treatment hip OA
At first: NSAIDs/Acetaminophen, PT, weight loss
then: surgery: total hip, hip resurfacting
79
what is the main contributor to hip OA?
Obesity
80
T or F: in hip dislocation, patient is unable to move the leg/hip, and are in excruciating pain
True
81
patient presents with excruciating hip pain, and you note that leg is flexed at the hip and shortened. What is your dx
hip dislocation (posterior)
82
After you determine that patient has a posterior hip dislocation; how do you confirm and treat?
XRAY followed by emergent reduction
83
which artery associated with the hip is at the highest risk of causing AVN
lateral circumflex
84
you should link alcoholics and what hip-associated issue?
AVN
| also sickle-cell, RA, steroids
85
55 year old alcoholic male presents with bilateral hip pain, described as a dull ache, worse with weight-bearing. No hx trauma. dx?
AVN
86
what might you see on imaging of AVN of hip?
"crescent sign" - sclerotic area just beneath articular surface
and collapse of femoral head
87
treatment AVN
protected weight-bearing early on
| TOTAL HIP ARTH.
88
which hip disorder to be cautious of if baby is born breech?
hip dysplasia
89
how would you explain hip dysplasia?
femoral head dislocates from acetabulum due to shallow acetabulum
90
which 2 exams to test for hip dysplasia?
Barlow - positive if femoral head dislocates
| Ortolani - positive if CLUNK (not click)
91
you perform the ortolani hip dysplasia maneuver and hear a "click" - what next?
we are looking for CLUNK - if "click", wait 1 month to see if persists before Ultrasound
92
what do you do next if the barlow OR ortolani tests are positive?
immediate bilateral hip US
| and refer to ortho for Pavlik
93
OBESE child age 8 presents with gradual onset pain in groin and anterior thigh, worse with activity. On exam, you note hip pain on INTERNAL ROTATION. Dx?
Slipped capital Femoral Epiphysis (SCFE)
-chronic is more common (not precipitated by trauma)
94
What type of imaging do you want to assess SCFE?
XRAY Frog leg - see the epiphysis
95
what findings may you see on XRAY frog leg for SCFE?
- displaced femoral epiphysis
- Klein's line: does not transect 25% of femoral head
- "melting ice cream cone"
96
Treatment SCFE
refer to ortho for SURGERY
97
You have a patient post-car accident with a clearly deformed mid-thigh, and he is in significant pain. What do you suspect, and what should you remember to do?
Femoral shaft fracture
-don't be distracted by leg pain, ASSESS FOR OTHER INJURIES
98
Treatment femoral shaft fracture
Immobilize hip
- handle arterial or nerve damage if applicable
- ORIF (surgery)
99
which artery should you be most concerned about in femoral shaft fracture?
peroneal artery (and nerve)
100
Malleolar pain + bone tenderness at medial/lateral malleolus + inability to bear weight
Ottawa ankle rules - get XRAY
101
where are stress fractures most commonly located?
Tibia (over-use injury)
102
a 21 year old dancer presents with a deep ache in her tibia. She says that it is worse with rapid training change. You compress the bone and she winces. Dx?
tibial stress fracture
103
Diagnosing stress fracture/imaging pattern
XRAY (won't show anything)
wait 2 weeks, XRAY again to look for calcification (won't see anything)
-MRI
104
T or F: since finger dislocations are clinical, no imaging is needed
FALSE - xray to rule out fracture
105
treatment finger dislocation
reduction w/ digital nerve block.
repeat imaging afterwards
-splint for 2 weeks
106
what 2 conditions can be associated with subungual hematoma?
Nail bed laceration
| distal tuft fracture
107
if subungual hematoma is taking up > _____% of the nail bed, do an XRAY to rule out tuft fracture
50%
108
what are the contraindications of draining a subungual hematoma?
- phalanx fracture
- nail bed laceration
- >50% nail bed
109
if LARGE subungual hematoma (>50% nail bed), what do you do?
remove nail --> repair laceration --> replace nail and splint
110
what is a tuft fracture?
blunt trauma or crush injury to fingertip
111
how to treat an open tuft fracture?
clean and debridement + Antibiotics and Tetanus
| -splint 4-6 weeks
112
how to treat closed tuft fracture
reduction of angulation/displacement and splint 2-4 weeks
113
ganglion cyst is also known as
"bible bump"
114
if patient present with suspected ganglion cyst in hand, do you do imaging?
yes - XRAY to rule out bone tumor
115
Treatment options for ganglion cyst
aspiration + compression 48-72 hours
- splint
- surgery if symptoms persist despite steroid injection
some resolve on own without treatment
116
this benign bone tumor is very common; presents as pain-free pass near joints. It is a result of developmental defect of growth plate
Osteochondroma
117
On XRAY of a bone mass, what is diagnostic of osteochondroma?
lesion in metaphyseal region; pedunculated or sessile
| CORTEX FLOWS INTO BASE OF TUMOR
118
treatment osteochondroma
none (unless interferes with function)
119
bone lesion whose hallmark is night pain relieved by NSAIDs. Patient has tenderness over the lesion
Osteoid Osteoma
120
XRAY of bone lesion has radiolucent nidus surrounded by dense osteosclerosis, but CT scans are confirmatory. What is the condition?
Osteoid Osteoma
121
treatment osteoid osteoma
surgical excision OR radiofrequency ablation
| must remove it all of it'll recur
122
bone lesion characterized by a nest of benign cartilage within the long bones of the hand
enchondroma
123
treatment endochondroma
surgical curettage + bone grafting
124
patient presents with pain around joint; specifically the knee. you get an xray: radiolucent lesion in the epiphysis. dx?
chondroblastoma
125
treatment chondroblastoma
curettage + bone grafting
126
bone lesion on distal femur and proximal tibia; incidental finding on imaging; has thin sclerotic border
nonossifying fibroma
127
do you have to remove chondroblastomas?
yes - they will destroy the joint surface
128
do you treat nonossifying fibroma?
no - stop growing once patient stops growing
can remove if risk of causing fracture
129
what are the differences between simple bone cysts and aneurysmal bone cysts
- aneurysmal is blood-filled, and expands the cortex of the bone without breaking it
- simple is fluid-filled and does not expand past the cortex
130
LAbs for metastatic bone tumor look like:
elevated alk phos
elevated calcium
anemia
131
treatment bone cancer
```
pain control (NSAIDs Opioids)
-Denosumab + bisphosphonates for bone health
```
132
common type of Bone cancer in children
osteosarcoma
133
you are seeing a rapidly growing 15 year old male who presents with pain in his humerus. XRAY shows a destructive, expanding lesion. What is you dx
osteosarcoma
134
what does lesion on XRAY of osteosarcoma show
Codman's triangle (elevated periosteum)
- moth-eaten appearance
- sunburst type reaction
135
treatment osteosarcoma
surgical removal (or amputation) + chemotherapy
136
15 year old male presents with bone pain in his humerus. He also reports fever, and CBC shoes leukocytosis. Histologyshows small, round blue cells. dx?
ewing sarcoma
137
what does lesion look like on XRAY of ewing sarcoma
moth-eaten
sunburst
onion skin layering
138
treatment ewing sarcoma
chemo AND radiation --> then surgical resection
139
culprit of osteomyelitis (organism)
staph aureus
140
most common cause of osteomyelitis in IV drug users
pseudomonas
141
cause of osteomyelitis in kids with sickle cell
salmonella
142
unlike bone mets, osteomyelitis labs/workup looks like:
ESR and CRP - elevated
| Alk phos and calcium NORMAL
143
how do the WBC counts differ in acute vs chronic
elevated in acute
| normal in chronic
144
what is diagnostic of osteomyelitis
bone biopsy
145
T or F: changes to the bone structure as a result of osteomyelitis can be seen right away
FALSE - may take 10 days for adults (5-7 days for kids)
146
you get an XRAY on someone with suspected osteomyelitis. It comes back negative for any abnormalities, so can you rule it out?
NO! negative XRAYs do not rule it out
147
explain treatment of osteomyelitis
Abx for 4-6 weeks; surgical debridement if no improvement or abscess on bone
if surgery contraindicated, may need Abx for 6-9 months to lifetime
148
how long do you put your osteomyelitis patient on Abx
4-6 weeks
149
septic arthritis secondary to prosthetic joints are due to what organism?
Coagulase negative staph aureus
150
most common cause of septic arthritis in sexually active?
Neisseria gonorrhea
151
triad of septic arthritis?
fever + pain + impaired ROM
152
patient presents with fever and pain in the knee. It is hot to touch and red. You suspect septic arthritis; what is your next step?
joint aspiration + fluid analysis: CULTURE IS DEFINITIVE
| will also see elevated WBC
153
Treatment septic arthritis
- Drain infection synovial fluid
- Abx (3-4 weeks)
- Immobilize joint
154
Exception to the 3-4 week Abx course for septic arthritis, how do you treat gonococcal septic arthritis?
Ceftriaxone + azithro for 2 WEEKS, then switch to PO meds; treating gonorrhea AND chlamydia
155
while treating septic arthritis during the 3-4 weeks Abx therapy, you need to monitor. How often?
after 5 days re-evaluate and consider NSAID
| -if no improvement, re-culture joint fluid
156
how to treat septic arthritis with MRSA/MSSA?
4 full weeks of Abx
157
what to add to treatment if organism is CoNS, MRSA, MSSA?
Rifampin
158
what disorder would you see codman's triangle?
Osteosarcoma
159
where might you see sinus tracts and nonhealing ulcers
chronic osteomyelitis
160
What/ are the Ottawa ankle rules
hx trauma + malleolar ankle pain + (one of these): age >55, inability to bear weight, tender over posterior 6 cm of medial/lateral malleolus
161
are the Ottawa ankle rules for sprains or fractures?
sprains
162
what is the metatarsal shift test?
moving the metatarsals against each other to try and reproduce the discomfort from MORTONS NEUROMA
163
"feels like pebble is in my shoe" pain at 3rd metatarsal
Morton's neuroma
164
what is the main physical exam finding in compartment syndrome?
extreme pain with passive motion
165
what are the bony nodules located at the PIP joints and what are they indicative of?
Bouchard nodes (OA)
166
what are the bony nodules palpated at the DIP joints?
Heberdeens nodes (OA)
