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My ABFM Important > AAFP Ortho > Flashcards

AAFP Ortho Flashcards

1
Q

Low back pain for which imaging needed?

A

History Findings Exam Findings
* Cancer metastatic to bone (breast, lung,
thyroid, renal, prostate)
* Urinary or fecal incontinence
* Urinary retention
* Progressive lower extremity motor
or sensory loss
* Significant trauma related to age
* Severe pain and lumbar spine
surgery in the prior 12 months

Exam Finding:
* Major motor weakness or
sensory loss
* Saddle anesthesia
* Loss of anal sphincter tone
These are all STRONG findings and the presence

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2
Q

Acute LBP treatment

A
  • Beneficial Therapies
    NSAIDs (A)
    Advice to remain active (A)
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3
Q

Chronic LBP treatment

A

Beneficial
2nd NSAID, tramadol, duloxetine

1st: Mindfulness-based stress reduction
- Acupuncture
- Exercise therapy (walking prgm = PT)
- Yoga
- Massage
- Superficial heat
- Physical therapy
Intensive multidisciplinary

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4
Q

Role of Duloxetine in LBP

A

Similar to Cox-2 inhibitor, tramadol, opioids

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5
Q

Role of opioids in LBP

A

there is uncertainty about the efficacy of opiates in chronic or acute LBP

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6
Q

Short term treatment for LBP

A

Topiramate effective

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7
Q

Lumbar Disc Herniation

A

80% resolves within 90 days
90% resolves by 12 weeks
Steroids and NSAID weak evidence
Conservative management up to 6 weeks.

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8
Q

Lumbar Spinal Stenosis findings?

A

Pain improve with lumbar flexion
Worsen with walking
Relief with sitting

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9
Q

Overuse Injuries?

A

Tendinosis
Tendinopathy

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10
Q

Lower extremity tendinopathy treatment

A

Patellar tendinosis (Jumper’s Knee)
Achilles Tendinosis

Both eccentric strengthening

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11
Q

Upper extremity tendinopathy treatment

A

Lateral epicondylosis

Eccentric strengthening

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12
Q

Chronic tendopathies

A

Topical nitroglycerin (1/4 of a 5 mg patch)

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13
Q

Tests for shoulder impingement

A
  1. Neer’s
  2. Hawkin’s
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14
Q

Shoulder Impingement treatment?

A

[SA CSI + exercise + manual therapy] vs. [exercise + manual
therapy] resulted in similar outcomes at 3 months but with less
pain in the CSI group

SA: Subacromial
CSI: Corticosteroid injection
PT: Physical therapy

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15
Q

Limited ROM with pain at end ranges of motion. Dx?

A

Adhesive Capsulitis

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16
Q

Adhesive Capsulitis associated with?

A
  1. Diabetes
  2. Parkinson’s
  3. Thyroid dysfunction
  4. Cardiac disease
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17
Q

Adhesive Capsulitis treatment?

A

3-4 week of oral prednisone 20 mg or CSU provided short-term relief

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18
Q

Anterior knee pain after recently started running. Dx?

A

Patellofemoral Pain Syndrome

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19
Q

Patellofemoral Pain Syndrome treatment

A

PT and modification of activity are best
Bracing in runners

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20
Q

Carpal tunnel syndrome associated with?

A
  1. Thyroid disease
  2. Diabetes
  3. Pregnancy
  4. Alcoholism
  5. RA
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21
Q

Most sensitive PE test in carpal tunnel?

A

Flick sign

22
Q

Carpal tunnel syndrome treatment

A

wrist splint

23
Q

Heel pain worse with first steps?

A

Plantar Fasciitis

24
Q

Plantar Fasciitis management

A
  1. Initiate patient-directed therapies
    Relative rest, ice massage, analgesics, stretching, weight loss
  2. Initiate physician-directed therapies
    Physical therapy, stretching, deep myofascial massage

Night splint use for up to 3 weeks (B)

OTC orthotics (B)
Corticosteroid injection (B) – for short term pain relief
Autologous blood injection (B)
Extracorporeal shock wave therapy can be used in recalcitrant plantar fasciitis (B)

25
Q

Morton’s neuroma?

A

3rd and 4th web space most common
- Mulder’s sign
Treatment: Shoes with wide toe box and low heels, orthotics, injection

26
Q

Tarsal Tunnel Syndrome?

A

Entrapment of posterior tibial nerve posterior to medial malleolus
- Provoked by subtalar pronation

27
Q

Tarsal Tunnel Syndrome VS Plantar Fasciitis?

A

On TTS nontender medial calcaneal tubercle

28
Q

Trigger finger

A
  1. 40-60 yo
  2. Seen in DM, RA and repetitive hand activities
  3. Stuck finger. Tender lump in palm of hand.
  4. Splinting the finger in a neutral position
  5. Dexamethasone preferred over triamcinolone with lower recurrence at 3 months
29
Q

Chronic exertional compartment syndrome

A

Chronic anterior leg pain
Risk: Anabolic steroids, creatine use, eccentric exercise, military recruits.
Tx: Resolve with 2–30 min rest
Definitive: Fasciotomy

30
Q

Orthopedic Milestones

A
  • 6 months - Sits with support.
  • 9 months - pulls to standing.
  • 12 months - walks independently or with hand support.
  • 2 years - climbs steps
  • 3 years - stands on 1 foot for a few seconds.
31
Q

What causes unable to move the shoulder but able to move fingers?

A

Erb’s Palsy

32
Q

Polydactyly treatment age?

A

Surgery at 1-2 year

33
Q

Developmental Dysplasia of the hip

A
  • Left hip most common
  • Clunk is positive not the click
  • Tx: Pavlik harness: birth to 6 month
    Spica casting: 6 month to 2 years
34
Q

Pavlik harness position of hip?

A

Hips in flexion and abduction.

35
Q

Club foot treatment?

A
  1. Serial casting
  2. Surgical correction: 9-12 months if needed
36
Q

Most common childhood bone cancer?

A

1st Osteosarcoma: At physis of long bone (Knee and shoulder). <19 year old.
2nd Ewing’s sarcoma: At long bone. In teenage years

37
Q

Most common benign bone tumor in children?

A

1st Nonossifying fibroma
2nd Osteochondroma

38
Q

Nonossifying fibroma treatment?

A

Common in distal femur or distal tibia
Resolves with skeletal maturity.

39
Q

Osteochondroma treatment?

A
  • Solitary or multiple
  • Grows as child grows
  • Monitor and treat symptomatically.
40
Q

Intoeing in children?

A
  1. Metatarsus adductus: MC congenital foot deformity. Resolve by 1 year
  2. Internal tibial torsion: MC intoeing. Patella facing forward and feet intoeing. Resolve by age 8.

PT, orthotics, splints are not effective.

  1. Femoral anterversion: Both knee and feet point inward. Improve by 9-10 years. Surgery at age 9-10 if more severe.
41
Q

Risk from SCFE?

A

AVN is 30%

42
Q

Little league elbow tx?

A

Rest for 3-6 weeks
Proper throwing mechanics

42
Q

Transient synovitis vs Septic Hip?

A

Patient presents with fever, hip pain, and limp. Temp, x-ray, CBC, labs
recommended

  1. T> 38.1
  2. CRP >2.0
  3. ESR >40
  4. WBC >12
  5. Non-weight bearing
43
Q

Types of Apophysitis?

A
44
Q

What is Osgood schlatter’s?

A

Tibial tuberosity
Bilateral anterior knee pain

45
Q

What is sever’s disease?

A

Calcaneus
Achilles
Posterior heel pain

46
Q

Cramping pain that often awakens from sleep in children?

A

Growing pain.
Benign Noctural Limbs Pains
No LIMP
Reassurance, heat, massage, warm baths, exercise to non-aggravating levels, mild analgesics.

47
Q

Scoliosis with Cobb angles?

A
  1. Cobb angles 30-40: Brace
  2. Cobb angles >40: Surgery
48
Q

MC congenital hand deformitiy?

A

Syndactyly

49
Q

Most common congenital foot deformity.

A

Metatarsus adductus

My ABFM Important (4 decks)

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