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PANCE > Bones and Joints > Flashcards

Bones and Joints Flashcards

1
Q

Acute osteomyelitis MC seen in ___
Chronic osteomyelitis MC seen in ___

MC organism in osteomyelitis

A

Acute osteomyelitis MC seen in CHILDREN
Chronic osteomyelitis MC seen in ADULTS

Staph. Aureus

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2
Q

Salmonella* osteomyelitis seen in ____

Tx:

A

Sickle cell disease

Tx: 3rd gen ceph (Cipro) OR Flouroquinolone (Levofloxacin)

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3
Q
  1. Most sensitive test in early osteomyelitis

2. Gold standard in dx of osteomyelitis

A
  1. MRI

2. Bone Aspiration

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4
Q
  1. Tx of acute osteomyelitis

2. Tx of chronic osteomyelitis

A
  1. IV abx for 4-6 weeks; 6-8 weeks overall of abx

2. 4 weeks - 24 months of IV and PO abx

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5
Q

Tx of acute osteomyelitis from puncture wound

MC organism:

A

Cipro* or Levofloxacin

Pseudomonas

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6
Q

Tx of acute osteomyelitis w/

  1. Methicillin sensitive
  2. Methicillin Resistant
A
  1. Nafcillin OR Oxacillin;
    PCN allergy –> Clindamycin or Vancomycin
  2. Vancomycin
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7
Q

Osteosarcoma MC in ____
Occur in ____ bones
MC metastasize to ___
X ray shows ____

A

Adolescents (<20 y/o), 2nd peak in 50-60 y/o
Metaphysis of long bones ( MC in femur*, tibia, humerus)
Metastasize to lung

“hair on end”, “sun ray/burst”
Codman’s triangle

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8
Q

Ewing’s Sarcoma MC in ____
Occur in ____ bones
X ray shows ____

A

Children, Males 5-25 y/o
Diaphysis of long bones, ribs, flat bones (MC in femur, pelvis)

“Onion peel” = lytic lesion w/ layered periosteal reaction

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9
Q

Chondrosarcoma MC in ___

X ray shows ___

A

Adults (40-75 y/o)
3rd MC primary malignancy of bone

Matrix punctate or ring and arch appearance pattern of calcifation

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10
Q

Osteochondroma MC in ___
Diagnosis:
Tx:

A

MC benign bone tumor
Males, 10-20 y/o

Pedunculated, grows away from growth plate*, involves medullary tissue

Observation. Resection if painful, located in pelvis

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11
Q

Intracompartmental pressure of _____ is diagnosis of Compartment syndrome

A

> 30-45 mm Hg

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12
Q

Primary osteoporosis Type I associated with ____ .
____ bone affected.
MC fracture sites (3)

A

loss of estrogen in postmenopausal women, testosteron deficiency in men

Trabecular bone

Vertebrae, hip, distal radius

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13
Q

Primary osteoporosis Type II associated with ____.
____bone affected.
MC fracture sites (2)

A

> 75 y/o w/ poor calcium absorption

Trabecular and cortical bone

Hip, pelvis

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14
Q

Screening DEXA scan recommended for:

A

Postmenopausal women >65 y/o

Postmenopausal women <65 y/o w/ 1 or more additional RF

RF: alcohol, smoking, low body weight, sedentary, low calcium and vit D intake, corticosteroid use, recurrent falls
Advanced age, Caucasian/Asian, female

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15
Q

1st line treatment of osteoporosis

How should it be taken?

Long term use complications

A

Bisphosphonate

On empty stomach, sit upright for 30-60 min after ingestion

Weakened bones, Jaw necrosis –> monitor closely

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16
Q 
MC wrist injury
MOI:
Diagnosis:
Complication: 
Tx:
A

Colles Fracture
MOI: FOOSH –> extension fracture –> dorsal displacement of bone fragment
Diagnosis: “dinner fork deformity”
Complication: Extensor pollicus longus tendon rupture
Tx: Sugar tong splint/cast

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17
Q

Smith fracture =

Diagnosis:

A

Flexion fracture –> volar displacement of bone fragment

Dx: Garden Spade Deformity

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18
Q

Radial nerve injury causes

A

wrist drop

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19
Q

Colles and Smith fracture may cause injury to ___ nerve, ___ artery

A

Median nerve, radial artery

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20
Q

Median nerve injury causes

A

Inability of thumb opposition

Numbness/tingling in thumb and 2nd,3rd and 1/2 4th digit

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21
Q

Study of choice to diagnose occult hip fracture

A

MRi

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22
Q

IV abx of choice for open fractures

A

1st and 2nd gen cephalosporins
aminoglycosides

48 hrs after fracture, 48 hrs after surgical procedures

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23
Q

Salter Harris Classification

A

Straight through epiphyseal plate = Type 1
Above epiphyseal plate, involve metaphyseal fragment = Type 2
Lower/beLow, through epiphysis into articular surface = Type 3
Through distal metaphysis, epiphyseal plate and epiphysis = Type 4
c(E)Rush of epiphyseal plate = Type 5

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24
Q

Lisfranc fracture

A

dislocation of tarsometatarsal joint complex

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25
Q

Inability to straighten distal finger/flexed @ DIP joint

A

Mallet (Baseball) Finger = avulsion of extensor tendon

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26
Q

MC MOI of shoulder dislocation

A

Fall on outstretched arm in abduction and extension

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27
Q

____ shoulder dislocation more common than ____ shoulder dislocation

A

Anterior more common than posterior

28
Q

X ray views to determine ant. vs post. shoulder dislocation

A

Axillary

“Y” view

29
Q

Anterior shoulder dislocation most likely will injure ___ nerve, manifests as ____.

A

Axillary nerve

Pinprick over deltoid

30
Q

Hill-Sachs lesion =

A

Humeral head deformities

Seen in recurrent anterior shoulder dislocations

31
Q

Bankart lesion =

A

Glenoid inferior rim fracture

Seen in anterior shoulder dislocations

32
Q

MC fracture in children

A

Clavicle fracture (mid 1/3)

33
Q

MOI of acromioclavicular joint dislocation:
Xray:
Ligaments involved:

A

Direct blow to adducted shoulder
AP w/ weights
Acromioclavicular ligament, coracoclavicular ligament

34
Q

Proximal humerus fracture must r/o ___injury.

Humeral shaft fracture must r/o ____ injury.

A

Brachial plexus injury. Check deltoid sensation.

Radial nerve –> wrist drop

35
Q

Anterior fat pad in children indicate ____

In adults indicate ___

A

Children –> supracondylar fx

Adults –> radial head fx

36
Q

____ nerve and ____ artery injury causes Volkmann’s ischemic contracture.

Seen in ____

A

= claw-like deformity from ischemia w/ flexion/contracture of wrist

MEDIAN nerve, BRACHIAL artery

Seen in Supracondylar fractures

37
Q

Kienbock disease

A

Osteonecrosis of the lunate

38
Q

Dupuytren disease

Tx:

A
  • Palmar aponeurosis, ring, little and middle fingers causing painful nodules, pitting and contractures
  • Fixed flexion deformity @ MCP joint

Tx: intra-lesional steroid injection, collagenase injection

39
Q

Carpal tunnel syndrome involves compression of _____.
Symptoms:
Management:

A

Median nerve

  • Parasthesias and pain of palmar 1st 3 and 1/2 of 4th digit ESPECIALLY AT NIGHT
  • Thenar muscle wasting
  • Weakness in thumb

Volar splint, NSAIDs

40
Q

Boxer’s fracture

Tx:

A

Metacarpal neck of 4th and 5th finger

Tx; 25-30 degrees of angulation –> reduced, ULNAR splint, f/u 1-2 weeks

41
Q

Eikenella corrodens

A

organism specific to human mouth

42
Q

Gamekeeper’s thumb

Tx:

A

Sprain or tear of ulnar collateral ligament of thumb –> instability of MCP joint, weakness of pinch

Gamekeeper's = chronic
Skier's = acute

Tx: Thumb spica

43
Q

Lateral epicondylitis (a.k.a. ____) = inflammation of tendon insertion of ____ d/t repetitive (pronation/supination) of forearm and excessive wrist (flexion/extension).

A

“Tennis elbow”
Extensor carpi radialis brevis
Pronation of forearm
Extension of wrist

44
Q

Medial epicondylitis (a.k.a. ____) = inflammation of tendon insertion of ____ worse with ___ activities.

A

“golfer’s elbow” or “baseball elbow”
Pronator teres-flexor carpi radialis
Pulling activities

45
Q

Monteggia Fracture =
____ nerve injury in 17%

Management:

A

Proximal ULNAR shaft fx w/ anterior radial head dislocation

Radial nerve –> wrist drop

ORIF

46
Q

Galeazzi Fracture =

Management:

A

Mid-distal RADIAL shaft fracture w/ dislocation of distal radio-ulnar joint

Unstable! —> ORIF

47
Q

Scaphoid gets blood supply from ___, runs ___ to ___.

A

Radial artery, distal to proximal

Proximal pole scaphoid has poor blood supply –> avascular necrosis

48
Q

Scaphoid fx management

A

Long-arm thumb spica cast –> referral to ortho

Displacement of >1 mm –> ORIF

49
Q

De Quervain’s Tenosynovitis = stenosing tenosynovitis of ____ and ___.

Clinical manifestation:

Management:

A

abductor pollicus longus (APL)
Extensor pollicus brevus (EPB)

Pain along radial aspect of wrist, radiating to forearm

Thumb spica splint x 3 weeks, NSAIDs x 10-14 days, steroid injections (no more than 3), PT

50
Q

Finkelstein Test

A

pain w/ ulnar deviation or thumb extension

Dx of De Quervain’s Tenosynovitis

51
Q

Most common level of scoliosis

A
  1. Right thoracic curves @ T7 and T8 (left thoracic curves are rare)
  2. Double major: right thoracic, left lumbar
52
Q

Most sensitive test of Scoliosis

Tx:

A

Adams forward bending test

10-15 degrees: 6-12 month f/u
15-20 degrees: serial AP radiographic f/u Q 3-4 months (large curves) or 6-8 months (smaller curves)
20-40 degrees: bracing
>40 degrees: surgery

53
Q

Scheuermann disease =

A

Juvenile kyphosis = idiopathic osteochondrosis of thoracic spine

54
Q

Pott disease =

A

Progressive kyphosis caused by TB of spine

55
Q

Kyphosis =

Tx:

A

Increased convex curvature of thoracic spine (hump back)

45-60 degrees: observe Q 3-4 months
>60 degrees: Milwaukee brace

56
Q

Legg-Calve_Perthes Disease =

Presentation:

A

Avascular osteonecrosis of femoral head in CHILDREN d/t ischemia of CAPITAL FEMORAL EPIPHYSIS

PAINLESS limping x weeks, worsen w/ continued activity
Loss of ABDUCTION and INTERNAL rotation

57
Q

Tests to evaluate meniscal tears

A

McMurray’s sign = pop/click while tibia is externally and internally rotated

Apley test

58
Q

Most sensitive test for dx of ACL tear

A

Lachman test

59
Q

Thompson test

A

Achilles tendon rupture

60
Q

Morton’s Neuroma

Complication of surgical resection

A

Degeneration/proliferation of plantar digital nerve –> painful mass near tarsal heads

Permanent numbness of affected toes

61
Q

Fleck sign

A

Fracture @ base of 2nd metatarsal

Pathognomonic for disruption of tarsometatarsal ligament (Lisfranc injury)

62
Q

Jones Fracture = Transverse fx through ____ of ____

A

diaphysis of 5th metatarsal

63
Q

Pseudojones Fracture = Transverse avulsion fx ____ of ____ d/t ____ w/ ____

A

Transverse avulsion fx @ BASE of 5th METATARSAL d/t PLANTAR FLEXION w/ INVERSION.

64
Q

Maisonneuve Fracture = Proximal _____ fx d/t rupture of talofibular syndesmosis and interosseus membrane as a result of _____.

A

Proximal SPIRAL FIBULAR fx d/t rupture of talofibular syndesmosis and interosseus membrane as a result of DISTAL MEDIAL MALEOLAR FX and/or DELTOID LIGAMENT RUPTURE.

65
Q

Ober Test

A

Pain or resistance to adduction

Dx of Iliotibial Band Syndrome

66
Q

Class of abx that increases risk of tendon rupture

A

Fluoroquinolones

67
Q

Apophysitis =

A

inflammation of growth plate

PANCE (20 decks)

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