Ross - General Ortho Flashcards
(153 cards)
1
Q
what are h&p and pe red flags for acute ortho injury (6)
A
blood on clothing
pain out of proportion
elderly pt w. hip pain
jumping from height
elderly, hx of malignancy,
grossly deformed extremity
2
Q
what might blood on clothing suggest
A
open fx
3
Q
what might pain out of proportion suggest
A
compartment syndrome
4
Q
what might an elderly pt w. hip pain and a negative film suggest
A
occult hip fx → needs CT, MRI, or DEXA
5
Q
what might hx of jumping from a height suggest
A
calcaneous fx w. vertebral body compression
6
Q
what might an elderly pt w. hx of malignancy/mechanism doesn’t fit suggest
A
pathologic fx
7
Q
what might a grossly deformed extremity in the field that is now normal suggest
A
dislocation reduced in field → think vascular injury
8
Q
you must always check and document vascular and neuro assessment for all injuries __
A
before AND after splint is placed
9
Q
what does SLIPPS stand for
A
nerves of sacral plexus
10
Q
what are the nerve roots of the sacral plexus
A
S1 - S4
11
Q
what are the nerves of the sacral plexus
A
superior gluteal n
lumbosarcral trunk
inferior gluteal n
posterior femoral cutaneous n
pudendal n
sciatic n
12
Q
how do you manage open fx (5)
A
- first gen cephalo
- splint
- ortho consult
- remove any gross contamination
- xrays
13
Q
what should you avoid in open fx
A
probing open wound
14
Q
why don’t we place casts in ER
A
swelling in first 24 hr of injury
15
Q
how do you describe a fx (7)
A
closed vs open
location
orientation fx line
displacement
angulation
shortening
dislocation/subluxation
16
Q
example of fx description
A
closed fx of the distal tibia
that is __
with __ displacement
with no angulation or shortening
17
Q
how do you manage angulated and/or dislocations
A
reduction
spint
18
Q
any vascular or neuro compromise and you must
A
consult ortho ASAP
19
Q
name 4 complications of fx’s
A
non-healing bones
necrosis
loss of fxn
pain
20
Q
what are the 3 stages of bone healing
A
inflammation
reparative
remodeling
21
Q
what is sympathetic dysreflexia
A
rare complication of fx → chronic intense pain, pallor, dysfxn of extremity
22
Q
what bones are high risk for sympathetic dysreflexia
A
scaphoid
femoral head
23
Q
what is the cardinal symptom of compartment syndrome
A
pain
pain
pain
pain
24
Q
pain is worse w. __ in compartment syndrome
A
passive movement
25
what injuries are prone to compartment syndrome
fx
crush
burns
26
2 mc locations for compartment syndrome
anterior compartment
forear,
27
what peds fx is at risk for compartment syndrome
supracondylar fx
28
how do you dx compartment syndrome
stryker device
29
what is nl for stryker test
\< 20 mmHg
30
if stryker shows \> 20 mmHg, you need to consider
fasciotomy
31
when evaluating joint pain, consider
infectious cause
32
what might be on your differential for joint pain
other inflammatory → ex gout
fx
33
what are rf for septic joint
DM
age \> 80
recent joint surgery
prosthetics
prior joint infxn
34
pe of septic joints will show pain with \_\_
and \_\_
and \_\_
passive movement
AND
active motion
AND
pain at rest
35
mc pathogens in septic joints
staph aureus
streptococci
36
what pt population is a concern for septic arthritis dt neisseria gonococcus
young, sexually active
37
what is a sign of a gonococcal septic joint
gunmetal gray lesions on hands
38
work up for first presentation of joint pain
1. xray
2. joint fluid aspiration
39
what labs do you order for joint aspiration
cbc
gram stain
lactate
40
total wbc count in septic joint
60,000
41
will wbc be high in infectious AND inflammatory joint conditions
yes
42
if wbc is around 60k in joint aspiration what must you do
order same day ortho consult
43
gout is often \_\_
and \_\_\_,
gonorrhea is \_\_
gout: monoarticular, recurrent
gonorrhea: ologoartigular (migratory)
44
lyme dz involves a __ arthritis
migratory
45
what are the 2 types of compounds that form in synovial fluid of joint or bursae
uric acid
calcium pyrophosphate
46
uric acid gout is also called
MSU (monosodium urate)
47
MSU gout has a __ appearance on aspiration
negatively birefringent needle shaped uric acid crystals
48
what lab value is unhelpful in acute gout attacks
serum uric acid levels
49
algorithm for gout - not using joint fluid
male
previous attack
onset w.in one day
joint redness
first metatarsal involvement
htn or cvd
serum urate \> 5.88
50
what is low risk for the gout algorithm
\< 4
51
what is intermediate risk for the gout algorithm
4-8
52
what is high risk for the gout algorithm
\>8
53
tx for acute gout attack
1. anti-inflammatories
2. allopurinol, probenecid
54
how does allopurinol work
inhibits formation of uric acid
55
how does probenecid work
eliminates uric acid in urine
56
when is allopurinol used
when uric acid levels are high
57
when is probenecid used
when uric acid levels are normal
58
bursitis is an __ cause of joint pain
inflammatory
59
what are pe findings of bursitis
distinct area of erythema
minimal pain
60
when does a clavicle fx need an asap ortho consult
depressed fx
skin tenting
proximal
61
in a clavicle fx, make sure to test
terminal branches of brachial plexus → **esp axillary motor and sensory**
62
for shoulder dislocations, evaluate the position of
humeral head in glenoid fossa
63
pt w. clavicle fx may have hand held in
adduction and internal rotation
64
what xray view shows you location of the humeral head
y view
65
what is a hill-sachs fx
compression fx or “dent” of posterosuperolateral humeal head after anterior dislocation
66
what tests evaluate rotator cuff tear
neer
empty can
67
what injury do you think when a pt c.o pain that wakes them up at night and pain w. abduction
supraspinatus tear
68
tx for supraspinatus tear
1. PT
2. +/- surgery
69
what injury causes anterior shoulder pain similar to rotator cuff tear
bicipital tendonitis
70
what might a positive yeargason test suggest
bicipital tendonitis
71
what test involves arm at the side, then flexion of elbow to 90 degrees, then flexion of forearm against resistant
yeargason
72
what injury involves radial head subluxation
nursemaid's elbow
73
tx for nursemaid's elbow
no xray
arm held in slight flexion and pronation → reduce
74
humeral shaft fx is concerning for what n damage
radial
75
supracondylar fx is concern for what n injury
ulnar
76
what is a monteggia fx
midshaft ulna fx and radial head dislocation
77
what fx is this
monteggia → midshaft ulna fx and radial head dislocation
78
what is a galeazzi fx
radius fx w. ulnar dislocation at wrist
79
what fx is this
galeazzi
80
supracondylar/medial condyle fx are concerning for injury to what nerves
ulnar
median
81
what is tenodesis
surgical procedure to tx injuries to biceps tendon in the shoulder
82
what is the allen test used for
vascular/motor and sensory testing of median, ulnar, radial nerves
83
what is fds testing
flexor digitorum profundus testing
84
fds testing needs to be used in
any potential flexor tendon injury
85
tx for flexor tendon injury
urgent repair
possible hand surgeon
86
which are more vital to hand fxn, flexor or extensor
flexor
87
in any trauma to the wrist, you need to evaluate the
anatomic snuff box
88
tender anatomic snuff box should make you consider
scaphoid fx
89
tx for wrist injury
spica splint
90
flexor tenosynovitis is a __ injury
do not miss
91
when would you use kanaval's signs
to evaluate flexor tenosynovitis
92
what injury is jersey finger
hyperextension → rupture of fdp
93
what is skier's thumb
ulnar collateral ligament tear → radial deviation of thumb
94
what is a boxer's fx
fx of 4th and 5th metacarpals
95
what is a “fight bite”
human bite wound
96
what must be considered in bite wounds
hidden tendon tears
97
abx tx for bite wounds
augmentin if no pcn allergy
98
abx tx for bite wounds
augmentin if no pcn allergy
99
aseptic necrosis most commonly affects __ aged populations,
they often complain of __ pain
middle aged
dull, throbbing
100
rf for aseptic necrosis include (3)
chronic steroids
etoh
SSA
101
tx for aseptic necrosis
1. ct or xray
2. non weight bearing
3. ortho
102
tx for pelvic fx
1. exsanguinate (drain) for small vessel bleeding
2. traction splint to compress pelvis
103
hip fractures may present w. __ pain
groin
104
pe for hip fx will show
short, abducted and externally rotated leg
105
what should you do for an elderly pt who c.o of hip pain but has negative xray
keep imaging till you find something
106
what is shenton's line and when should it be evaluated
obturator foramen to underneath femoral head
hip fx
107
hip dislocations are high risk for \_\_
and should be __ early
avascular necrosis
reduced
108
mc hip dislocation
posterior
109
ottowa criteria is used to decide
who does NOT need imaging
110
if a pt meets none of the ottawa criteria,
fx risk is low → you do NOT need to xray
111
if pt does not meet ottawa criteria you should
evaluate pt
then make final decision
112
acl injury is caused by
direct blow to the knee → person changing direction
113
what test is used to evaluate acl
anterior drawer
114
in acl injury, a pt might say they heard a \_\_
and pe will show \_\_
pop
immediate pain/swelling
115
pcl injuries are caused by
hyperextension
116
test to evaluate pcl
posterior drawer
117
in a pcl injury, a pt might say they heard a \_\_
and pe will show \_\_
pop
immediate pain/swelling
118
mcl injury is caused by
direct blow to the lateral knee
119
what test evaluates mcl
valgus → laxity
120
lcl injuries are concerning for damage to what n
peroneal
121
peroneal n damage will manifest as
foot weakness w. dorsiflexion and eversion
122
pt w. an mcl injury can probably __ after injury
because it takes __ days for swelling to occur
ambulate
2-3
123
pe of mcl injury will show \_\_
and __ of the joint
clicking and locking
124
what tests are used to evaluate mcl injury
mcmurry's
apley's
125
what are the ottawa criteria for ankle pain
1. pain at medial malleolus radiating 6cm → xray
2. pain at lateral malleolus radiating 6cm → xray
3. inability to walk → xray
126
what is the ottawa foot criteria
pain at navicular → xray
pain at base of 5th metatarsal → xray
127
how many xray views do you need to evaluate ankle/foot fx
3
128
what are the 3 views for foot/ankle fx
AP
lateral
mortisse
129
what view is this
mortisse
130
what is the mnemonic for SALTR fx
slipped →
above
lower
131
the rest of SALTR mnemonic
through
ruined
132
ankle sprains are graded \_\_
through \_\_
1-4
133
grade 1 ankle fx
no ligament tear
no limitation
134
grade 2 ankle fx
some torn ligaments
some functional limits
135
grade 3 ankle fx
significant swelling/pain
laxity of joint
136
which grade fx should be non wt bearing
3 and 4
137
unstable ankle fx's have wide __ involvement and
need __ emergently
mortisse
ortho consult
138
for tx of amputations, you should clean amputated part w.
normal saline!
139
after ns rinse, place amputated part in sterile container and
float on ice
140
4 indications for re-implantation
multiple fingers
thumb
single finger in kids
clean amputation at wrist, distal forearm, hand
141
contraindications for re-implantation
crushed, avulsed, dirty wounds
single finger in adults
multilevel injury
142
what fx's are unique to peds
buckle
greenstick
143
what is nursemaid's elbow
radius dislocation
annular ligament
144
what are you thinking if a child aged 2-12 is limping
transient synovitis
145
what are you thinking if a male child aged 5-9 is limping
idiopathic avascular necrosis
146
what are you thinking if an overweight, male child aged 10-16 is limping and complaining of groin pain
SCFE
147
what is a SCFE injury
slipped capital femoral epiphysis → assymetry of femoral neck
148
what are scfe injuries concerning for
damage to growth plate
149
what does the iced cream sign make you think of
scfe
150
how do you diagnose septic arthritis
us
151
how do you dx idiopathic avascular necrosis
mri
152
what is the ice cream sign
153
what is this xray showing and what condition does it suggest
ice cream sign
scfe
