Banner Musculoskeletal medicine

Question 1

The most common complaint for a patient to seek medical attention is (blank)

Answer 1

musculoskeletal pain

Question 2

What is angulation of the distal extremity towards the midline called?

Answer 2

varus

Question 3

What is angulation of the dstal extremity away from the midline called?

Answer 3

valgus

Question 4

What is a comminuted fracture?

Answer 4

fracture that is in pieces

Question 5

what is the diaphysis made up of? what is the epiphysis made up of?

Answer 5

corticol bone

cancellous bone

Question 6

so explain bone formation

Answer 6

cartilage (fetus 2 months)-> compact bone begins at primary ossification center (fetus 2-3 months)-> spongy bone develops at secondary ossification center-> growth plates induce growth

Question 7

Is it normal to have varus as a child?

Answer 7

until age 1.5 years then you should have valgus until about 13

Question 8

Describe fracture healing

Answer 8

hematoma formation-> callus formation (soft) -> callus formation (hard)-> bone remodeling

Question 9

What are the two components to fracture healing?

Answer 9

biology and mechanics

Question 10

What are the stages of fracture healing in order?

Since you have these stages, should you use inflammatory meds?

Answer 10

inflammation phase (10%)
reparative phase (40%)
remodelling phase (70%)
its fine intermittently but if you have a bio issue you probably shouldnt use them

Question 11

(blank) is a procedure to set (reduce) a broken bone without surgery.

Answer 11

Closed reduction

Question 12

What do you use intramedullary rod fixation for?

Answer 12

for diaphyseal problems to allow for early mobilization in long bone fractures and since it doesn’t disrupt hematoma, you maintain biology while adding stability.

Question 13

What are these:
Fractures: open, neurovascular injury
Compartment syndrome
Dislocations: hip, knee, shoulder, elbow, ankle
Infection: septic joints        
Septic tenosynovitis

Answer 13

orthopedic emergencies

Question 14

Whats the equation for KE?

Answer 14

1/2 mV^2

Question 15

What do you do for trauma resuscitation?

Answer 15

ABC
complete body exposure
large bore IV access
evaluation for life threatening chest, abd, pelvis, head injuries
multispeciality trauma team

Question 16

When should you get an MRI?

Answer 16

for ligament, meniscus, soft tissue injuries

Question 17

When should you get a CT scan?

Answer 17

when you have a complex case and need 3D imaging, such as for inta-articular injuries

Question 18

Why do you want to immobilize the injury?

Answer 18

to protect the hematoma, decrease bleeding, pain relief, ease of transport,

Question 19

When do you give an arthroplasty (replacement hip)?

Answer 19

when there is little healing potential (especially for femoral neck fractures)

Question 20

What is this:
Serious condition of increased pressure inside a facial compartment? What are you worried about if you have this?
How do you get this?

Answer 20

compartment syndrome

Decreased perfusion leads to nerve damage and muscle death

Most common cause is trauma, fractures, crush injury and increased risk with anticoagulants

Question 21

What are the 5 P’s of compartment syndrome?

Answer 21

Pain
Paresthesia
Palor
Paralysis
Pulselessness

Question 22

What is the best indicator of compartment syndrome?

Answer 22

pain with passive stretch of muscle (ie increased pain with flexion of toes=anterior compartment syndrome)

Question 23

What can compartment syndrome result in?

Answer 23

tissue necrosis, nerve injury, and amputation

Question 24

What is exertional compartment syndrom?

Answer 24

happens with exercise and associated with neurologic symptoms

Question 25

What is septic athritis?

Answer 25

when you get an infectious agent inside synovial cavity (bacteria, mycobacteria, virus, fungus)

Question 26

What are risk factors of septic arthritis?

Answer 26

trauma, surgery, IVDA, diabetes, sickle cell, immunocompromised, sexual activity, previously damaged joint (RA)

Question 27

What are the symptoms of septic arthritis?

Answer 27

joint pain, swelling, stiffness, fever, chills

Question 28

How do you diagnose septic arthritis?

Answer 28

joint fluid analysis

Question 29

What do you want your arthrocentesis to look like>

Answer 29

yellow and clear like urine

Question 30

What are the 4 C’s of joint fluid analysis?

Answer 30

cell count-> elevated WBC
culture -> aerobic and anerobic with gram stain
crystals-> uric acid, calcium pyrophosphate
chemistry-> glucose, protein

Question 31

What does a low glucose (below 100) indicate?

Answer 31

inflammation

glucose should be the same in your serum as in your joints

Question 32

Anything over (blank) for a white count is worrisome.

Answer 32

50,000

Question 33

If you can read print through your arthrocentesis sample what does this indicate?

Answer 33

normal

Question 34

Where do you find type 1 collagen?

Answer 34

structural tissue

Question 35

Where do you find type 2 collagen?

Answer 35

articular cartilage

Question 36

What does septic arthritis lead to?

Answer 36

breakdown of cartilage matrix and chondrocyte death

Question 37

If septic arthritis goes untreated, what can happen>

Answer 37

you can get pressure built up inside joint that will disrupt blood supply.

Question 38

How does septic arthritis damage the cartilage matrix and therefore the articular cartilage?

Answer 38

via chondrocyte proteases, hyaluronidase, cytokines from WBCs

Question 39

How do you treat septic arthrtis?

Answer 39

early surgical irrigation and drainage

joint mobilization and physical therapy

Question 40

What are some common infectious agents?

Answer 40

Staph aureus, most common
Nisseria gonorrhea, sexual history
Salmonella, sickle cell disease

Question 41

What is virchows triad for blood clots?

Answer 41

blood stasis
hypercoagulation
endothelial injury