Orthopedics/Rheumatology Flashcards
(144 cards)
1
Q
Forced arm abducted externally rotated with “squared off shoulder” indicates
A
Anterior glenohumeral shoulder dislocation
2
Q
What x-ray is needed in a glenohumeral dislocation
A
AP plus Y view
3
Q
What is most common glenohumeral joint dislocation?
A
Anterior
4
Q
Tx for glenohumeral joint dislocation
A
Immediate reduction, sling imobilize for 2-4wks
5
Q
Describe
Diagnose
A
Hill Sach Lesion : Humeral head groove
Occurs with Anterior glenohumeral dislocation
6
Q
Describe
Diagnose
A
Bankart Fx of inferior glenoid rim
Occurs with Anterior glenohumeral dislocation
7
Q
MOI AC joint separation
A
Direct blow to tip of shoulder
8
Q
Describe
Diagnose
TX
A
Type 1 AC dislocation
AC joint intact
Point tenderness at AC joint
Brief Sling imobilization Ice, analgesia
9
Q
Describe
Diagnose
Tx
A
Grade 2 AC separation
Slight widening AC ligament Ruptured, caraclavicular ligament sprain
Point tenderness, less ROM , instability w/ stress test
Sur. intervention may be needed but less likely
10
Q
Describe
Diagnose
Tx
A
Grade 3 AC separation
Significant widening, both ligaments ruptured
Severe pain, deformity Loss of ROM
Surgical intervention most likely necessary
11
Q
What structures make up the rotator cuff
A
SITS
Supraspinatus
Infraspinatus
Teres MINOR
Subscapulars
12
Q
Pt’s with rotator cuff abnormalities <40yo usually tend to have what etiology?
A
Impingement, tendonitis
13
Q
Pt’s with rotator cuff abnormalities <40yo usually tend to have what etiology
A
Cuff tears
14
Q
What structure in the rotator cuff is most commonly injured?
A
Supraspinatus
15
Q
The “empty can” test is testing the strength of which muscle?
A
Supraspinatous
16
Q
MC complication of Humeral shaft fx
A
Radial nerve injury
17
Q
Where do most clavicular fx occur?
A
Middle one third of the clavicle
18
Q
MOI in Humeral shaft fx
A
FOOSH
19
Q
Management for Mid 1/3rd clavicular fx
A
Arm sling 4-6wks in adults
20
Q
Management for proximal 1/3rd clavicular fx
A
Ortho consult
21
Q
What is the most common fx in children?
A
Clavicle
22
Q
+ adson on physical exam indicates what?
A
Thoracic outlet syndrome
23
Q
Adson test
A
Loss of radial pulse w/ head rotated to affected side
24
Q
Pt presents w/ FOOSH w/ hyperexteded elbow, swelling and tenderness at the elbow. Diagnose?
A
Elbow (supracondular fx)
25
Describe
Dx
posterior fat pad indicative of fx. (anterior fat pad also present but these are sometimes a normal variant).
Supracondylar (elbow) FX
26
Managment of displaced supracondylar fx
Immediate ortho consult, possible ORIF
27
MOI of Radial head fx
FOOSH
28
Sx indicative of radial head fx.
Hx consistent w/ FOOSH
Decreased pronation/supination
29
Describe
Diagnose
Radial head fx.
This photo does not have it - but a posterior fat pad would help to dx this - These are notoriously hard to see
30
MOI olecranon fx
Direct blow (fall on flexed elbow)
31
complication of olecranon fx.
Ulnar nerve dysfunction
32
Describe
Diagnose
Tx
Olecranon fx
All olecranon fx are considered intraarticular and need reduction
Non-displaced split (90deg); when displaced ORIF
33
Describe a "nightstick" fx
Isolated unlar shaft fx
34
Describe
Dx
Tx
Proximal ulnar shaft fx w/ radial head dislocation
Monteggia fx
ORIF
35
What nerve can be injured in monteggia fx
Radial nerve
36
Describe
Dx
Tx
Distal radioulnar disloation with distal radial shaft fx
Galeazzi Fx
VERY UNSTABLE - Immediate ORIF
37
Child presents w/ arm slightly flexed, refusing to use it. No swelling, and tenderness to palpation of radial head. TX?
Reduction-Pressure on the radial head w/ supination and flexion. If the child cannot almost immediately use the arm after get x-ray to r/o fx.
Nursemaids elbow
38
What action increases the sx/pain of lateral epidondylitis?
Gripping, forearm pronation and wrist extension against resistance (radiates down the forearm).
39
What action increases pain of Medial epicondylitis?
Pulling activities, forceful extension of elbow against resistance w/ forearm supinated and wrist flexion against resistance
40
Describe
Dx.
Tx
posterior Elbow dislocation - MC type
Emergent reduction
Posterior splint at 90deg. x 7-10d
41
What nerve is compressed in carpal dunnes syndrome?
Median nerve
42
Describe Tinel sign
percussion of median nerve produces symptoms
43
Phalen's sign
Flex both wrists for 30-60 seconds reproduces sings
44
Tx of Carpal Tunnel
No tx if pregnant
Volar Splint
NSAIDS
Corticosteroids
45
What part of the hand is effected by Carpal Tunnel Syndrome
1st 3 and 1/2 of 4th digit esp at night
Thenar muscle wasting if advanced
46
Pain along radial aspect of wrist radiating to forearm indicatie of?
Dequervain's tenosynovitis
47
Describe Finkelstein's test, and what does it indicate?
Pain w/ ulnar deviation or thumb extension
Dequervain's tenosynovitis
48
Tx for Dequervain's
Thumb spica splint
49
Gamekeeper's thumb is also known as?
Skier's thumb
50
MOI of Scaphoid (Navicular Fx)
FOOSH
51
What is the most common carpal fx?
Scaphoid (navicular) fx.
52
Describe
Diagnose
Posterior angulation d/t FOOSH
Colles Fx
"Hand is Oustretched = cOlles"
53
Describe
Diagnose
Ventral angulation on lateral view
FOOSH w/ wrist in flexion
Hand is "Inside" when they fell = smIth
54
Dinner fork deformity describes
Colle's Fx
55
Garden spade deformity describes
Smith fx
56
What is considered the most serious carpal fx
Lunate fx
57
Describe
Dx
Tx
Fx at neck of 5th metacarpal
Boxer's Fx
Ulnar gutter splint
58
If pt has snuffbox pain and no fx evident what do you do?
Tx as a scaphoid fx and imobilize
repeat xray in 2 weeks
Maintain high suspicion for fx
59
hallmark pain in anatomic snuffbox?
Scaphoid fx
60
5p's of compartment syndrome
Pain
Pallor
Parasthesias
Pulselessness
Paralysis
61
Xray show's "bamboo spine" What does this make you think of?
Ankylosing spondylitis
62
T for Ankylosing Spondylitis
NSAIDS
63
If NSAIDS and PT aren't successful what is the next step in pharm. tx for Ankylosing spondylitis?
TNF a inhibitor (Infliximib)
64
Management of lumbosacral sprain/strain?
Brief bed rest \<2d NSAIDS/Anagesics +/- muscle relaxers
65
MC site of herniated Nuecleus pulposis
L5-S1
66
What are the physical exam findings of pt with herniated disk?
+ slr
+crossover test
Strength, reflex and sensibility defects
67
Pt presents w/ new onset of urinary/bowel retention/incontinence w/ saddle anesthesia, uni/bilateral leg radiation. Decreased anal sphincter tone on rectal exam. What is our dx/Tx
Cauda equina syndrome
Emergent Neurosurgery consult
68
Back pain in spinal steonsis is relieved with _____ and worsened with \_\_\_\_\_.
Relieved wtih flexion (sitting/walking uphill) and worsened with extension (walking/standing)
69
Lateral curvature of the spine greater than ___ deg is indicative of scoliosis
10deg.
70
Pt's with 20-40deg of scoliosis require what tx?
bracing observation
71
Pt's with scoliosis \>40deg require what tx?
Surgery
72
Most common upper C-spine fx?
Odontoid fx
73
What are NEXUS criteria
No midline tendernss
No focal neuro defect
Normal alertness
No intoxication
No painful, distracting injury
74
Legg-Calve'-Perthes disease is also known as
Avascular oseteonecrosis of the femoral head in children
75
Clinical description of pt/ with LCP
Painless liming x weeks. Worse w/ activity. Hip pain radiating to thigh, knee or groin. Loss of abduction and internal rotation
76
Tx for pt with Legg-Calve'-Perthes
Observation, NSAIDS, Rest, bracing in children \>5yo or signficicant loss of abduction
77
Define SCFE
Femoral head (epiphysis) sleeps posterior and inferior at the growth plate.
78
Clinical picture of SCFE
Obsese, male pt during groth spurt c/o hip, thigh, or knee pain w/ limp.
79
Tx of SCFE
ORIF (inc risk of AVN)
80
Pain with limp in a kid. Think
SCFE
81
Painless limp in a kid think
Legg-Calve'-Perthes
82
Tx of Hip dislocation
TRUE ortho emergency!!
Risk of avascular necrosis
83
MC hip dislocation
posterior
84
Pt presents w/ leg shortening and internal rotaiton with adduction and hip/knee slightly flexed. Think \_\_\_\_.
Hip dislocation
85
Hip pain with leg shortened and externally rotated, abducted think \_\_\_\_\_.
Hip Fracture
86
MOI MCL
vaLgus stress
So injury comes from outside of the knee
87
MOI LC tear
vaRus stress
So the injury comes from the inside of the leg
88
ACL injury MOI
Noncontact pivoting injury
89
MC injured knee ligament
ACL
90
PCL injury MOI
"Dashboard injury"
91
Lachman's test when positive indicates what?
ACL laxity
92
Anterior drawer test indicates what?
ACL laxity
93
Most common meniscal tear
Medial
94
PE sign indicatve of Meniscal tear
McMurray's sign
95
MOI Patellar dislocation
Valgus stress
96
MOI knee (tib fem) dislocation
High velocity trauma
97
With tib-fem dislocations what is concerning?
Popliteal artery injury! These pt's need arteriography immediately ortho consult
98
MC cause of chronic knee pain in young active adolesents?
Osgood-Schlatter dz
99
Tx for osgood-schlatter
RICE, Nsaids, stretching
100
Ottawa ankle rules
Ankle films if :
pain along lateral malleolus
Paul along medial malleolus
Foot Films if:
Midfoot pain
5th metatarsal or navicular pain
If unable to walk \>4steps at time of injury and in ER
101
Pt describe sudden heel pain w/ pushoff movement, a pop, and sudden sharp calf pain. You think \_\_\_\_
Achilles rupture
102
Pt has a spiral prox fib fx and distal medial malleolar fx w/ deltoid ligament rupture. What is this called?
Maisonneuve fx.
103
Salter harris type I fx
Through the physis - best outcome
104
Salter harris type 2 fx/
Metaphysis and physis
105
Salter harris type 3
physis and epiphysis
106
Salter harris type 4
fx of metaphysis, physis, and epiphysis
107
Salter harris type 5
Complete erasure of physeal plate
108
Osteomyelitis
inflammation/infection of bone by pyogenic organism
109
MC pathogen of osteomyelitis
S aureus
110
Labs for osteomyelitis
Inc. WBC
Inc ESR
111
Most sensitive test in early dz for Osteomyelitis
MRI
112
Gold standard for Osteo testing
Bone aspiration
113
Management of chronic osteomyelitis
1. debride
2. culutre and tx
114
Acute osteo tx. in Newborn
MC patho is GBS: - Nafcillin or oxacillin + 3rd gen cephalo
115
Acute osteo tx in \>4mo
Staph aureus most likely - MRSA/MSSA: Tx w/ nafcillin or oxacillin or cefazolin
116
Septic arthritis
infection in joint cavity
117
MC pathogen of septic arthritis
S. areus
118
Tx for septic arthritis w/ gram pos coccli
Nafcillin, Vanco if MRSA
119
Tx for septic arthritis w/ Gram neg cocci, unknown, or gonoccocal suspect
Ceftriaxone
120
MC bone malignancy
Osteosarcoma
121
MC mets of Osteosarcoma
Lungs
122
Onion peel appearance on Xray
Ewing's sarcoma
123
Primary joint affected in RA
Wrist, MCP, PIP
124
Primary joint affected in OA
DIP, Thumb
125
Morning stiffness indicates?
RA
126
Evening stiffness indicates
OA
127
Joints in RA are
Boggy and tender
128
Joints in OA are
hard and bony
129
When is DEXA scan indicated in Female?
65
130
When is first DEXA scan indicated for males?
70
131
DEXA scan for osteopenia
1-2.4
132
DEXA score for osteoporosis
2.5
133
What fx is the primary cause of Compartment syndrome?
Tibial shaft fx
134
Tx for RA
DMARDS Methotrexate
135
TX for OA
Acetaminophen
NSAIDS
136
Test for SLE
ANA
Antismith antibodies
137
Management of SLE
Hydroxychloroquin for skin lesions, NSAID, Acetaminophen for arthritis
138
Fibromyalgia diagnosis requirements
diffuse pain in 11 out of 18 trigger points\>3mo
139
Crystals seen in synovial fluid in GOUT
Negatively birefringent; needle shaped
140
Synovial fluid crystals in Pseudogout
WEakly positive; rhomboid shaped
141
Inflammatory causes of polyarthritis include what?
SLE and RA
142
Scheuermann kyphosis
Kyphotic curve w/ anterior wedge of more than 5 degrees in three successive vertebrae
143
Ankylosing spondylitis results in what?
straightening and fusion of involved spinal segment
144
