Dr. Pestana's Notes--Orthopedics Flashcards
1
Q
Developmental dysplasia of the hip should ideally be diagnosed ______
A
right after birth
2
Q
Developmental dysplasia runs in families and physical exam shows ____ and ______
A
uneven gluteal folds; easily posteriorly dislocation w/ a “click” and returned w/ a “snapping”
3
Q
Dx Developmental hip dysplasia; why not Xrays?
A
sonogram; hip is NOT calcified in newborn
4
Q
Tx Developmental hip dysplasia
A
abduction splinting w/ Pavlik harness for about 6mo
5
Q
Hip pathology in children may show up as hip or ___ pain
A
knee
6
Q
What is Legg-Calvé-Perthes dz?
A
avascular necrosis of capital femoral epiphysis
7
Q
Clinical presentation Legg-Calvé-Perthes dz
A
about 6yo; insidious limping w/ dec hip motion and hip/knee pain; antalgic gait
8
Q
Dx Legg-Calvé-Perthes dz; Tx
A
AP/lat hip xrays; can cast and use crutches
9
Q
Clinical presentation Slipped capital femoral epiphysis
A
fat/lanky 13yo boy w/ groin or knee pain and are limping
10
Q
Slipped capital femoral epiphysis: when legs dangling, sole of foot on affected side points _____ other foot
A
toward
11
Q
Slipped capital femoral epiphysis: on PE, hip is [flexed/extended] and thigh goes into [internal/external] rotation
A
flexed; external
12
Q
Tx Slipped capital femoral epiphysis
A
surg emergency–pins to put femoral head back in place
13
Q
Clinical pres Septic hip
A
toddlers w/ febrile illness suddenly refuse to move hip
14
Q
Septic hip: on PE, pts hold leg with hip [flexed/extended] in slight [abduction/adduction] and [internal/external] rotation; pts won’t allow passive movement!!
A
flexed; abduction; external
15
Q
Dx/Tx Septic hip
A
high ESR; aspiration of hip (under gen anesthesia) and open drainage if pus
16
Q
Clinical presentation Acute hematogenous osteomyelitis
A
little kids w/ febrile illness w/ severe localized bone pain
17
Q
CanNOT see Acute hematogenous osteomyelitis on ____ until a couple of wks later; therefore must use ____ for diagnosis; tx w/ ____
A
xrays; MRI; antibiotics
18
Q
Bowlegs, aka ____, is normal up to age ____, after which it is known as Blount dz
A
genu varum; three
19
Q
Define Bount dz; tx
A
disturbance of medial proximal tibial growth plate; surgery
20
Q
Knock-kneed, aka _____, is normal btwn 4 and 8yo; no tx needed
A
genu valgus
21
Q
Osgood-Schlatter, aka _____, is seen in ____ w/ persistent localized pain and is aggravated by ______
A
osteochrondrosis of tibial tubercle; teenagers; contraction of quadriceps
22
Q
In Osgood-Schlatter, there is NO _____; tx includes ____ before seeing an orthopedic surgeon
A
knee swelling; Rest Ice Compression Elevation
23
Q
If RICE tx is unsuccessful for Osgood-Schlatter, ortho surg will use extension cylinders or cast leg for _____
A
4 to 6 wks
24
Q
Talipes equinovarus, aka _____, is seen at ____.
A
club foot; birth
25
Talipes equinovarus: both feet turned [in/out] and plantar [flexion/extension] of ankle, [eversion/inversion] of foot, [adduction/abduction] of forefoot and [internal/external] rotation of tibia
in; flexion; inversion; adduction; internal
26
Primary tx Talipes equinovarus; tx refractory to primary
serial plaster casts +/- Achilles tenotomy and part/long-term braces; surgery between 9 and 12 mo old
27
Clinical pres Scoliosis: adolescent ____ w/ thoracic spines curved toward ____. Tx includes ___ or ___.
girls; RIGHT; bracing; surgery
28
Severe cases of scoliosis can cause ___
decreased pulmonary function
29
Greater degrees of angulation in fractures are okay to leave alone in children because ____ happens to a high degree; in adults, ____ and ___ is usually done.
remodeling/healing; reduction; immobilization
30
Child fractures that can cause problems (2)
(1) supracondylar fractures of humerus
| (2) fractures involving growth plate
31
Cause of supracondylar fractures of humerus
hyperextension of elbow falling onto outstretched hand (child)
32
Volkmann contracture
happens w/ supracondylar fractures of humerus--vascular and nerve injuries
33
(A) Tx child supracondylar fractures of humerus (B) pay careful attention to prevent this complication because often times vasculature/nerves are involved
(A) casting or traction; (B) compartment syndrome
34
Tx of growth plate fracture is _____ if the epiphyses and growth place are displaced laterally from the metaphysis and are in one piece.
closed reduction
35
Tx of growth plate fracture is ____ if the growth plate is in two pieces [need careful alignment or deformity will occur]
open reduction and internal fixation
36
Primary malignant bone tumors are diseases of ____ people.
young
37
MC primary malignant bone tumor
osteogenic sarcoma
38
Osteogenic sarcoma is seen in ages _____, usually around the _____; has a typical ____ pattern on xrays
10 to 25yo; knee (lower femur or upper tibia); sunburst
39
2nd MC primary malignant bone tumor
Ewing sarcoma
40
Ewing sarcoma is seen in ages ____ and grows in _____ of long bones; has a typical ___ pattern on xrays
5 to 15yo; diaphysis; onion-skinning
41
Most malignant adult bone tumors are mets from ____ in women and ____ in men
breast (lytic); prostate (blastic)
42
Earliest finding of most malignant adult bone tumors; best imaging (put in descending order--MRI, xray, CT)
localized bone pain; MRI > CT > xray
43
Pathologic fractures can be indicative of _____ lesions
lytic
44
Multiple myeloma is seen in _____ men with these 3 sxs.
old; fatigue, anemia, localized bone pain in different places on several bones
45
Dx Multiple myeloma
xrays showing punched-out lytic lesions; Bence-Jones proteins in urine; abnormal IgG in serum
46
If chemo fails in multiple myeloma patient, ____ is the next drug of choice
thalidomide
47
Soft tissue sarcomas grow for ______ anywhere in the body and have these 2 main characteristics:
several months; (1) firm (2) fixed to surrounding structures
48
Soft tissue sarcomas mets to ___ but not to ____
lungs; LN
49
Dx soft tissue sarcoma
incisional bx +/- MRI (shows only location)
50
Tx soft tissue sarcoma
wide local excision + rad + chemo
51
Xrays of suspected fractures should ALWAYS have ___ views that are ____ degrees to one another and ALWAYS include the ____ above and below the broken bone.
at least 2; 90; joints
52
Broken bones not badly displaced or angulated can be treated via ____ and/or _____; otherwise sx is required
external manipulation; immobilized by cast (closed reduction)
53
Clavicular fractures are typically located at the junction of the ______ of the clavicle.
middle and distal thirds
54
Tx clavicular fractures
figure-of-eight device that aligns bones + sling; can also do open reduction and internal fixation if cosmetically desired
55
MC type of shoulder dislocation; Dx imaging
anterior; AP/lat xrays
56
Pts w/ anterior shoulder dislocation hold their arm [close to/away from] their body but rotated [inward/outward]
close to; outward
57
Stretching of the _____ nerve can cause numbness in a small area over the deltoid post-anterior shoulder dislocation
axillary
58
MCC posterior shoulder dislocation
massive uncoordinated muscle contractions--epileptic seizure or electrical burn
59
Pts w/ posterior shoulder dislocation hold their arm [close to/away from] their body but rotated [inward/outward]
close to; inward
60
Because regular xrays can miss a posterior shoulder dislocation, ____ views or ____ views are needed
axillary; scapular lateral
61
An old osteoporotic woman who falls on an outstretched hand could get a _____ fracture. Tx
Colles; close reduction and long-term cast
62
Colles fracture is a dorsally displaced, dorsally angulated fracture of the _____
distal radius
63
A direct blow to the ulna (protective arm hit by a nightstick) causing a broken bone is called a _____ fracture.
Monteggia
64
Monteggia fracture: [epiphyseal/diaphyseal/metaphyseal] fracture of the [distal/proximal] ulna w/ [anterior/posterior] dislocation of radial head
diaphyseal; proximal; anterior
65
Galaezzi fracture: distal third of ____ gets direct blow causing fracture, [ventral/dorsal] dislocation of the [proximal/distal] radioulnar joint
radius; dorsal; distal
66
In Monteggia (ulnar) and Galaezzi (radius) fractures, broken bones call for ____ tx and dislocated bones only call for ____ tx.
open reduction + internal fixation; closed reduction
67
Fracture of the scaphoid (carpal navicular) affects _____ who fall on outstretched hand; pt complains of ____ localized to _______
young adults; wrist pain; anatomic snuffbox
68
(A) Tx of undisplaced carpal navicular fractures (B) Tx displaced and angulated carpal navicular fractures
(A) thumb spica cast (B) open red + internal fixation
69
_____ carpal navicular fractures won't show up on xrays until ___ weeks later.
undisplaced; three
70
Scaphoid fractures are known for a VERY high rate of ____
nonunion
71
Tx of metacarpal neck fractures (usually ___ or ____ metacarpal) depends on these 3 things
fourth; fifth; (1) degree of angulation (2) displacement (3) rotary malalignment
72
Tx of (A) mild and (B) severe metacarpal neck fractures
(A) closed reduction + ulnar gutter splint (B) Kirschner wire or plate fixation
73
Hip fractures (elderly) present when pt is on a stretcher w/ affected leg ______ and [internally/externally] rotated
shortened; externally
74
Displaced femoral neck fractures can compromise _____ of the femoral head; faster healing/earlier mobilization can be achieved by _______
blood supply; replacing the femoral head w/ prosthesis
75
Most risk of having a intertrochanteric fracture is _____. How do we prevent this?
the immobilization post open reduction + internal fixation; can cause DVT/PE; tx w/ anticoagulation
76
Tx femoral shaft fractures
intramedullary rod fixation
77
Bilateral multiple-fractured femoral shafts can cause ____ or ____. If they are open wounds, they are an ortho emergency requiring ______ within _____ hours.
shock (lots of blood loss); fat emobli; cleaning/closure; 6
78
Knee injuries often present with _____ and are viewed best with [this imaging]
swelling; MRI
79
(A) A medial blow to the knee causes pain when the patient [adducts/abducts] the leg at the knee flexed 30 degrees. (B) What is the pain test that adduction elicits on the knee? (C) What is the pain test that abduction elicits on the knee?
(A) abducts [Lateral blow = adduct causes pain]
(B) Varus stress test
(C) Valgus stress test
80
Tx Collateral ligament injuries
hinged cast or surgery (if severe)
81
MC collateral knee ligament injury? Presentation...
ACL; knee swelling + pain + positive anterior drawer
82
What is the Lachman test?
knee flexed 20 degrees by grasping thigh with one hand and pulling leg with other
83
Dx for ACL/PCL tears. Tx
MRI; immobilize/rehab or surgery (if athletic)
84
Dx meniscal tears; Tx
MRI; repair to save as much meniscus as possible (otherwise can cause degenerative arthritis)
85
Clinical presentation meniscus tear
protracted pain with swelling post-knee injury; catching and locking w/ "click" when forcefully extended
86
The three most simultaneously injured ligaments
medial meniscus, medial collateral, anterior cruciate
87
Clinical presentation tibial stress fracture
tenderness to palpation over specific point on bone w/ normal xrays initially; [young men marching lots]
88
Tx tibial stress fracture
cast plus repeat xrays in 2 weeks +/- crutches (usually due to pedestrian hit by a car)
89
(A) Tx easily reduced tibia/fibula fractures (B) Tx extremely angulated tibia/fibula fractures
(A) casting (B) intramedullary nailing
90
Increasing pain after long leg last has been applied requires immediate removal due to potential _____
compartment syndrome
91
Clinical picture Achilles tendon rupture
as plant foot, loud popping noise heard and fall, clutching ankle; limited plantarflexion possible; palpation of tendon reveals gap
92
Tx Achilles tendon rupture
casting in equinus position or surgery
93
When fall on inverted/everted foot and break ankle, ______ breaks.
both maleoli
94
Dx ankle fracture. Tx.
AP/lateral/mortise xrays; open reduction and internal fixation (if fragments displaced)
95
Which orthopedic events can precipitate compartment syndrome?
ischemia followed by reperfusion, crushing injuries, other trauma, fracture w/ closed reduction
96
Major physical exam finding for compartment syndrome
excruciating pain w/ passive extension [PULSES MAY BE NORMAL]
97
Open fractures require cleaning and suitable reduction within _____ from time of injury
6 hours
98
In a MVA, ____ is caused when someone's knees hit the dashboard
posterior hip dislocation
99
Describe the position in which someone lying on a stretcher with a posterior hip dislocation would be found
leg shortened, adducted and internally rotated
100
In a broken hip, the leg would be shortened, adducted and _____ rotated
externally
101
Tx posterior hip dislocation
EMERGENCY reduction; must avoid vascular necrosis
102
After acquiring gas gangrene from a rusty nail and/or dirty wound, it takes about ____ days for the patient to look extremely sick.
three
103
Sxs gas gangrene
site tender, swollen, discolored, gas crepitation
104
Tx gas gangrene
IV PCN, surgical debridement, hyperbaric oxygen
105
Galloping soft tissue infections are seen in ______ pts; consist of _____ and ____
immunocompromised; synergistic bacterial gangrene; necrotizing fasciitis
106
___ infections can be seen in pts w/ extensive burns or widespread trauma; the worst one is ____
fulminating fungal; mucormycosis (turn black)
107
Dx mucormycosis. Tx
tissue bx. debridement and amphotericin B
108
Middle to distal third of humerus fracture can injure the ______ nerve; pt is unable to ______ [movement]
radial; dorsiflex wrist
109
Tx of middle/distal third humerus fracture
reduction and arm on handing cast or coaptation sling [will regain radial nerve motor ability, if not, must do surgery]
110
_____ artery injuries can occur with posterior dislocation of the knee
popliteal
111
Dx popliteal artery injury
pulses, doppler studies, CT angio
112
Tx popliteal artery injury
reduction of posterior knee dislocation [if don't fix right away, need prophylactic fasciotomy]
113
Hidden injuries: falls from height
fractures lumbar and/or thoracic spine; foot/leg fractures
114
Hidden injuries: head-on MVA
femoral heads driven backward into pelvis or out of acetabulum
115
Hidden injuries: facial fractures and closed head injuries
cervical spine problems
116
Sxs carpel tunnel syndrome
numbness/tingling in hands, particularly at night [distribution of median nerve]
117
Numbness and tingling from carpel tunnel can be reduced by ____
hanging hand limply for few minutes OR taping/pressuring median nerve over carpal tunnel
118
Ddx carpel tunnel syndrome imaging
wrist xray; clinical diagnosis
119
Tx carpel tunnel syndrome
splints and anti-inflammatories; surgery preceded by electromyography
120
_____ and _____ are hand problems that affect women primarily
Carpel tunnel syndrome; trigger finger
121
In trigger finger, pts are unable to ____;Tx
extend their finger; steroid injection is first line, surgery is last resort
122
______ is seen in young mothers who, when carrying baby, force hand into wrist flexion and thumb extension to hold the baby's head
De Quevrvain tenosynovitis
123
Sxs De Quevrvain tenosynovitis
pain along radial wrist w/ first dorsal compartment; pain reproduced by asking pt to hold thumb inside closed fist then forcing wrist into ulnar deviation
124
Tx De Quevrvain tenosynovitis
splint and anti-inflammatories and/or steroid injection; [surgery rarely needed]
125
Sxs Dupuytren contracture. Tx
contracture of palm of hand and presence of palmar fascial nodules; surgery [when hand not flat on table]; [also Norwegian ancestry in older men]
126
_____ is an abscess of the pulp of a fingertip. Sxs include throbbing pain and fever
Felon
127
In a felon, why does pressure build up to lead to tissue necrosis? Tx
pulp is closed space w/ mult fascial trabecula; surgical drainage [urgent!]
128
Gamekeeper thumb is an injury of the ______ ligament sustained by forced hyperextension of the thumb.
ulnar collateral [usually due to skiing injury]
129
Sxs Gamekeeper thumb; can lead to ____ if not treated w/ ____.
collateral laxity at thumb-metacapophalangeal joint; arthritis; casting
130
Jersey finger is injury to ______ sustained when flexed finger is forcefully extended.
flexor tendon
131
Sxs Jersey finger
when making fist, distal phalanx doesn't flex
132
Mallet finger is injury to _____ sustained when the extended finger is forcefully flexed (common in volleyball)
extensor tendon
133
Sxs Mallet finger
when hand extended, affected finger remains flexed
134
Tx both Jersey and Mallet finger
splinting
135
Traumatically amputated digits are surgically reattached when possible by preserving with [these 4 steps].
(1) cleaned w/ sterile saline
(2) wrapped in saline-moistened gauze
(3) placed in sealed plastic bag
(4) bag on ice
136
Amputated digit should NOT be placed in ____ solutions or put on ______ or allowed to _____.
antiseptic/alcoholic; dry ice; freeze
137
Surgeons can use _____ to preserve muscular functions of entire amputated extremities that are reattached.
electric nerve stimulation
138
Where does lumbar disk herniation almost exclusively occur? At what age usually?
L4-L5 or L5-S1; 45-46yo
139
Sxs lumbar disk herniation; exacerbations
vague aching pain [pressure on anterior spinal ligament] w/ sudden neurogenic pain caused by doing activities like lifting a heavy object, (+) straight leg test; coughing/sneezing/defecating
140
If the radicular pain in lumbar disk herniation radiates to the big toe, the pt most likely has the herniation between ____; if it radiates to the little toe, then the herniation is between _____
L4-L5; L5-S1
141
Dx lumbar disk herniation
MRI
142
Spontaneous resolution usually occurs as the body _____ the disk, which usually takes ____ weeks and the pain is controlled most often with nerve blocks.
reabsorbs; three
143
Tx severe lumbar disk herniation that doesn't heal and/or has neurological deficits that are progressing; emergency if sxs of ______
surgical intervention; cauda equina syndrome
144
Sxs cauda equina syndrome
distended bladder, flaccid rectal sphincter, perineal saddle anesthesia
145
Sxs Ankylosing spondylitis
young men (30s or 40s) w/ chronic back pain and morning stiffness; pain worse at rest and improves w/ activity
146
Dx Ankylosing spondylitis
bamboo spine on xray; many have HLAB27 antigen
147
Tx Ankylosing spondylitis
ani-inflammatories and PT
148
HLAB27 antigen dzs
uveitis, IBD, ankylosing spondylitis
149
Elderly w/ progressive back pain that is worse at night and unrelieved by rest or positional changes indicates potential _____.
metastatic malignancy [seen on xrays]
150
Metastatic malignancy in spine is usually ____, seen on xray as ___, for women and ____, seen on xray as ____, for men
breast cancer; lytic lesion at pedicles; prostate cancer; blastic lesions
151
Locations of diabetic ulcers
Pressure points: heel, metatarsal head, tip of toes
152
Progression of diabetic ulcers, starting with neuropathy
neuropathy, microvascular disease, injury, failure to heal, possible amputation/debridement
153
Ulcers from arterial insufficiency are usually located _____ and appear ____
at tips of toes; dirty w/ pale base devoid of granulation tissue
154
Workup and tx of ulcers due to arterial insufficiency
Doppler studies [look for pressure gradient], CT angio, MRI angio, arteriograms, surgical revascularization/angioplasty/stents
155
Common morbidities (2) of pts w/ chronic foot ulcers
diabetes, arteriosclerotic occlusive dz
156
Ulcers from venous stasis are usually located ____ and appear ____
above medial malleolus; chronically edematous, indurated and hyperpigmented, painless w/ granulating bed [pt usually has varicose veins and PMH of cellulitis
157
Dx and tx ulcers due to venous stasis
Duplex scan, support stockings, surgery [vein stripping/grafting], endovascular ablation
158
Marjolin ulcer
SqCC of skin that develops into chronic leg ulcer; dirty-looking ulcer w/ heaped up tissue growth at edges
159
Cause of Marjolin ulcers
untreated 3rd degree burns, chronic draining sinuses secondary to osteomyelitis
160
Dx and Tx Marjolin ulcer
Bx; wide local excision and skin grafting
161
Sxs Plantar fasciitis
older, overweight patients w/ disabling, sharp heel pain when foot hits ground; pain worse in AM
162
Plantar fasciitis: xray shows ____ and PE shows local tenderness to palpation, but that is NOT cause of the problem. Spontaneous resolution in _____ months
bony spur; 12-18 months [symptomatic tx]
163
Morton neuroma
inflammation of common digital nerve at third interspace btwn third and fourth toes; palpable and tender
164
Cause Morton neuroma
usually high-heeled shoes or pointy cowboy boots
165
Tx Morton neuroma
analgesics and sensible shoes; sometimes surgical excision
166
Sxs Gout
swelling, redness, pain of sudden onset at first metatarsal-phalangeal joint in middle-aged obese man w/ high serum uric acid;
167
Dx and Tx gout
uric acid crystals on aspirate of joint; Acute attack = indomethacin and colchicine, Chronic = allopurinol and probenicid
