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Clin Med II - Exam 2 > Ross - General Ortho > Flashcards

Ross - General Ortho Flashcards

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1
Q

name 7 components of ortho ER hx

A
  1. numbness/weakness
  2. MOI
  3. snap/crackle/pop?
  4. r or l handed
  5. previous injury
  6. tetanus
  7. last meal (if acute)
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2
Q

what 3 components should you base “neurovascular intact (NVI)” on

A
  1. pulses
  2. color of extremity
  3. sensory and motor peripheral nerve fxn
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3
Q

in acute ortho injury, what is the 2nd step after ABCs

A

assess neurovascular status

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4
Q

when should you document neurovascular status

A

before AND after any manipulation → ex even just a sling

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5
Q

what are 4 pe signs of bone fx

A
  1. crepitus
  2. false motion
  3. exposed fragments
  4. pain
  5. locked joints
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6
Q

what does blood on clothing suggest

A

open fx

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7
Q

what does pain out of proportion suggest

A

compartment syndrome

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8
Q

what does an elderly pt w. hip pain and a neg film suggest

A

occult hip fx

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9
Q

what imaging should you order for previous pt

A

MRI

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10
Q

what injury does a jump from a height suggest

A

calcaneous fx w. vertebral body compression

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11
Q

what does an elderly pt w. hx malignancy and mechanism that doesn’t fit suggest

A

pathologic fx

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12
Q

what does a grossly deformed extremity in field, now normal suggest

A

dislocation reduced in field

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13
Q

what is a do not miss in the previous pt

A

vascular injury!

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14
Q

what is a major concern in this fx

A

femoral fx → concern for severing of popliteal artery

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15
Q

bones heal by

A

callus formation

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16
Q

what are the 3 stages of callus formation

A
  1. inflammatory
  2. ossification
  3. remodeling
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17
Q

in acute ortho injury __ first

then order __

A

examine

xray

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18
Q

what is the second most common reason for medical law suit

A

missed fracture

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19
Q

tx for open fractures is always

A

operating room

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20
Q

what type of fx is this and what pt population does it affect

A

greenstick

peds

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21
Q

what type of fx

A

spiral

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22
Q

what type of fx

A

comminuted

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23
Q

what type of fx

A

transverse

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24
Q

what type of fx

A

compound

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25
how many hours until a limb is dead in vascular injury
6 hours
26
where should you check the pulse for an acute fx
distal to fx
27
what are the peripheral nerves of upper extremity
MARMU → median, axillary, radial, musculocutaneous, ulnar
28
what are the peripheral nerves of the lower extremity
I2GOLF
29
what is the only nerve that goes to the distal end of the phalanges
flexor digitorum profundus
30
what type of fx
supracondylar
31
what nerve is damaged
median
32
what nerve is injured
ulnar n
33
signs of a median n injury (3)
1. weak pronation of forearm 2. weak flexion and radial deviation of wrist 3. thenar atrophy and inability to oppose or flex thumb
34
is it ok to give narcotics to a fx pt?
yes
35
what do you need to do before ordering xray in female
pregnancy test
36
what does tdt stand for
tetanus diptheria
37
does this need immediate ortho consult
yes! still an open fx
38
what is abx of choice for open fx
1. cefazolin 1-2 g IV q8 → wt based dosing 2. pen allergy: clindamycin 600 mg IV
39
where do splint in hand fx
one joint above fx
40
closed and angulated fx needs
reduction
41
you should splint a pt in what position
anatomical
42
what are 4 post fx complications
1. non-healing 2. neurological dysfxn → sympathetic dysreflexia 3. loss of fxn 4. avascular necrosis
43
what 2 bones are highest risk for avascular necrosis
scaphoid femur
44
what are 3 causes for compartment syndrome
1. overuse w. edema 2. crush 3. fracture
45
what is mc location for compartment syndrome
ant leg
46
what part of leg is often missed in compartment syndrome
deep posterior
47
where is flexor compartment syndrome
volar forearm volkmann's contracture
48
what pediatric fx is prone to compartment syndrome
supracondylar
49
for compartment syndrome raise extremity, but not
above the heart
50
tx for compartment syndrome w. pressure btw 10-20
admit → watch
51
tx for compartment syndrome btw 10-20
emergent fasciotomy
52
painful joint, swelling + fever makes you think
septic joint until proven otherwise!
53
what should you do if you see blood in joint aspirate
advanced imaging
54
reactive arthritis RA SLE are
monoarticular
55
lyme dz and gonococcal dz are
migratory
56
septic arthritis and crystal induced arthritis are
monoarticular
57
usually w. septic joint there is a hx of
penetrating trauma (may be minor)
58
what should you do BEFORE you tap a joint
xray! → then aspirate
59
what is gold standard to r.o septic joint
arthrocentesis
60
is a peripheral cbc helpful in a painful joint
no!
61
what labs may helpful in painful joint
CRP sed rate → but limitied → no parameters for values for septic joint -
62
what will arthrocentesis look like for OA
yellow clear WCC: 700 PMN: 15% crystals: none bacteria: none
63
what does arthrocentesis report look like for traumatic arthritis
color: straw clarity: cloudy WCC: 100 PMN: 25% crystals: none bacteria: none
64
septic joint clues (5)
pain out of proportion pain w. passive/active ROM limited ROM pain at rest elevated WBC in aspirate
65
at risk for septic joint (4)
1. elderly 2. DM 3. IVDU 4. prosthetic joint
66
mc locations for septic joint (3)
knee wrist ankles
67
mc organisms in septic joint
s. aureus streptococci
68
early abx for septic joint
vancomycin OR cefazolin
69
mc cause of septic arthritis in young sexually active adults
gonococcal arthritis
70
mc locations for gonococcal arthritis
large joints: knee wrist ankle
71
what are these called what condition what tx
gun metal gray lesions disseminated gonorrhea ceftriaxone 250 mg im + single dose arythromycin 1 gm po
72
when would you xray a pt w. bursitis
if trauma is involved
73
no pain w. radiation means this is unlikely
septic joint
74
are serum uric aid levels useful for ACUTE attacks of gout
no! just for chronic
75
how do you confirm dx of acute gout attack
joint aspiration
76
what is podagra
mc location for acute gout attack → great toe
77
what med is preventive and abortive for gout
colchicine
78
does allopurinol help w. acute gout attack
no! prophylactic only
79
mc pathogen in osteomyelitis in pt w. scc
salmonella
80
mc cause of osteomyelitis in ivdu pt
pseudomonas
81
mc cause of osteomyelitis overall
s. aureus
82
what is gs to diagnose osteomyelitis
MRI → said in lecture bone bx → on slide
83
initial abx tx for osteomyelitis
3rd gen cephalosporin
84
the lower the number in a likelihood ratio,
the more helpful

Clin Med II - Exam 2 (14 decks)

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