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Clinical Medicine > Finals - Summer 2014 > Flashcards

Finals - Summer 2014 Flashcards

1
Q

Pain associated w rotator cuff tendinitis and the treatment

A

Pain in shoulder that radiates to upper arm (but not past elbow), worse w/ overhead activity and lying on it

Conservative tx
If fails –> steroid injection
DO NOT USE SLING

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2
Q

How to dx calcific tendinitis and what is it’s first line tx?

A

Dx via x-ray showing calcium deposits overlying the supraspinatus

1st line tx: steroid injection

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3
Q

The most common cause of shoulder pain

A

Impingement Syndrome

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4
Q

What are the 3 stages of impingement syndrome and which is most common?

A

Stage 1: edema & hemorrhage
Stage 2: Fibrosis and tendinitis
Stage 3: Rotator cuff tear (MOST COMMON)

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5
Q

What is the definitive tx for impingement syndrome?

A

Surgical subacromial decompression

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6
Q

Gold standard imaging for rotator cuff tear

A

MRI

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7
Q

A pt comes into the ER w/ a partial rotator cuff tear. What is the initial tx?

A

It may heal itself in 6 weeks

If not healed in 6 weeks –> surgery

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8
Q

Gold standard imaging for SLAP and Bankart Tears

A

MRI

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9
Q

Phases of Adhesive Capsulitis/Frozen Shoulder

A
  1. Initial painful phase: severe disabling pain lasting 2-9 months
  2. Intermediate phase: stiffness and severe loss of ROM, pain is lessened; lasts 4-12 mos
  3. Recovery Phase: grad return of ROM that takes 5-24 months
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10
Q

Diagnostic of frozen shoulder:

A

Clinical basis: reduction in active AND PASSIVE ROM in 2 or more planes w/ ER and abduction being most effected

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11
Q

Define tendonitis/tenosynovitis of the bicep

A

Inflammation of the long head of biceps tendon

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12
Q

What is the Yergason’s Test? What does a postitive test mean?

A

Elbow flexed at 90 degrees and forearm is supinated. Pain = tendonitis (bicipital long head)

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13
Q

Biceps Tendon Rupture

A

Males > 50
Results from heavy lifting
MUST HAVE HX OF CHRONIC TENDINITIS
“Popeye” muscle

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14
Q

For who would you consider non-surgical tx for the biceps tendon rupture? Surgical tx?

A

Non-surgery: elderly and inactive pts

Surgical: reattach muscle; long recovery time

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15
Q

A patient points to their AC joint saying that it is painful and x-ray findings show osteolysis of the distal clavicle. What is the tx?

A

Osteolysis of AC Joint

tx: inject lidocaine & steroid directly into AC joint. This is diagnositc

Definitive tx is distal clavicle resection

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16
Q

Most common organism found in septic olecranon bursitis and what do you treat it with?

A

Staph/MRSA
Tx w/ Doxy, Bactrim, Keflex
–> In unresponsive, aspirate and C&C to identify pathogen and specifically treat it

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17
Q

What is the best tx for trigger finger?

A

Steroid injections are most successful

Surgery is last option: done if pt fails two steroid injection treatments

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18
Q

Pt has a fixed flexed 4th finger with nodular thickening of the palmar fascial cords. Tx?

A

Surgical release

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19
Q

A pt w/ a positive finklestein’s test and pain in the anatomical snuff box has _____ and will be treated how?

A

DeQuervian’s Tendonitis

Thumb spica splint, NSAIDs, ice, rest

  • -> If fails then steroid injection
  • -> surgery if all else fails
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20
Q

Gold standard dx for Carpal Tunnel Syndrome

A

EMG

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21
Q

Cubital Tunnel Syndrome is compression of what nerve?

A

Ulnar Nerve

22
Q

A _____ can occur w/ wooden splinter or minor cuts and is usually effected by staph/MRSA. Tx?

A

Felon

Tx: I&D w/ longitudinal incision that does not cross the DIP joint…pack w/ gauze and change q2-3 days…abx to cover staph

23
Q

5 P’s of Acute Compartment Syndrome

A 
Pain
Pallor
Paresthesia (early sign)
Pulselessness (late sign)
Paralysis (late sign)
24
Q

What is a compartment pulse pressure in acute compartment syndrome and what is the tx?

A

> 30 mmHg

Surgical decompression via fasciotomy (opening of fascia)

25
Q

An obese pt who wears tight fitted clothing comes in complaining of pain over the front of her thigh and upon exam has diminshed pin prick sensation. Dx? Tx?

A

Meralgia Paresthetica

Tx: wear loose clothing and lose weight
Cortisone if no improvement

26
Q

Grade I-III MCL injuries

A

I: Little-no laxity (0-5mm), no ecchymosis, small amt of swelling

II: 5-10 mm laxity, delayed ecchymosis, swelling

III: >10 mm laxity, swelling and ecchymosis…pain w/ initial injury but resolves more quickly

27
Q

When can a patient return to full activities/sports?

A
  1. No MCL tenderness w/ palpation or valgus stress
  2. No functional laxity
  3. Full ROM and ADL’s
  4. Normal endurance and good strength
28
Q

Mechanism of Injury: ACL v. MCL

A

MCL: lateral or valgus stress often w/ a planted foot

ACL: hyperextended knee in IR or valgus force applied to an externally rotated knee w/ the foot planted…often pts feel a pop w/ ACL tear

29
Q

Dashboard injury to knee

A

PCL tear

30
Q

Gold standard imaging for meniscal injuries

A

MRI

31
Q

+ McMurray’s sign and + Apley’s grind test w/ tenderness upon joint line palpation

A

Meniscal injury

32
Q

A mensicus that is too big and not C-shaped is called ______ meniscus and is corrected with ______.

A

Discoid Meniscus

Corrected with arthroscopy

33
Q

A female comes in complaining of achy anterior knee pain and it is especially worse when she goes down the stairs. Upon exam you notice she has a large Q angle, crepitus, + squeeze test and a + apprehension sign w/ lateral displacement of the patella. What do you suspect and what is your initial tx?

A

Patellofemoral Disorders

Conservative tx w/ knee brace or McConell taping technique

  • Can do rehab to stregthen VMO and ham’s
  • Avoid leg extension machines at gym
34
Q

How do you reduce a patellar dislocation?

A

Flex the hip, lift the heel and extend the knee

35
Q

Can you inject steroids in a pt diagnosed w/ patella tendinitis?

A

NOOOOOO!

36
Q

Patella alta v. patella baja

A

Patella alta: patella tendon rupture

Patella baja: quadriceps tendon rupture

37
Q

A pt comes in w/ a traumatic injury over the patella that is causing pain and tightness. You collect the fluid over the patella and r/o septic bursitis. What is your tx plan?

A

Conservative tx initially. If infection cover w/ 7-10 days of abx (cover staph…so Doxy/Bactrim) and if no improvement then aspirate fluid for C&C…if no infection give cortisone shot

38
Q

What is the definitive tx of OA of the knee and what is the best x-ray view to get?

A

AP view standing

TKA is the definitive tx

39
Q

Does a high ankle sprain need an x-ray?

A

Yes, to r/o fracture

40
Q

Post-op care after a total hip arthroplasty

A

All pts get anticoagulation (warfarin) 2-6 weeks

Always abx prophyalxis w/ dental work
Rehab facility…maybe but not usually

41
Q

MOI: Whiplash

A

First, acute hyperextension and then 2nd head recoils into flexion

42
Q

If you expect a C1 fracture then what kind of imaging would you get?

A

Open mouth odontoid view xray

43
Q

Odontoid fx and hangman’s fx are both fractures of what vertebrae?

A

C2

44
Q

A fx of the pedicle of the axis resulting from hypextension is called….

A

Hangman’s Fracture

45
Q

Types of cervical compression fractures (5)

A

Type I: Simple wedge fx; stable

Type II: “teardrop”, isolated anterior vertebral body fx w/ intact posterior elements

Type III: Posterior intact but bony fragments may be displaced into spinal meduallary canal resulting in neurological injury

Type IV&V: complex vertebral fx involving posterior elements

46
Q

Most common type of kyphosis and the least common type of kyphosis?

A

MC: Postural Kyphosis

Least common: Congenital kyphosis

47
Q

When do you image if a pt comes in w/ lower back pain?

A 
50+ yo and < 20 yo
Major trauma
neuro deficiets
weight loss/fever
bowel dysfunction
fx of CA, AAA, ectopic pregnancy
48
Q

A shopping cart sign suggests

A

lumbar spinal stenosis

49
Q

Bamboo spine appearance…what is tx

A

Ankylosing Spondylitis… tx: NSAIDs, DMARDs, anti-TNFs, refer to rheum and PT

50
Q

Loss of bladder/bowel function and saddle anesthesia suggests _____ and needs to be tx how?

A

Cauda Equina Syndrome

tx: surgical decompression

Clinical Medicine (4 decks)

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