Inservice Deck 4 - ortho Flashcards
tx and disposition for afebrile pt with recurrent knee pain/toe pain, 21k WBC on knee aspiration?
gout!
tx - indomethacin, colchicine, steroids, d/c home
How do you splint achilles rupture?
splint in passive equinus (plantar flexion)
Patient with severe pain, tenderness to palpation, unable to fully extend knee. What is diagnosis?
patellar tendon rupture (can’t extend)
60 year old patient develops sudden leg pain while walking down stairs, now has inability to extend knee, and a mass superior to patella. Most likely diagnosis?
quadriceps tendon rupture
what is best method of diagnosis for child with painful septic appearing hip?
tap (with US guide)
which nerve is injured in fx of distal 1/3 of humerus?
radial inability to extend wrist
what does a positive drop arm test indicate?
rotator cuff tear (supraspinatus tendon injury)
inability to oppose or abduct thumb indicates injury to what nerve?
median nerve
most common nerve injury with olecranon fx?
ulnar nerve
how will injury site typicall appear in a patient with high pressure paint gun injury?
looks innocuous
what specialist should be called to evaluate a patient with known cancer who presents with cord compression syndrome?
radiation oncologist - for radiation
not NSGY - surgeon removes pus and blood
what nerve level is associated with decreased ankle reflexes? what will a patient have difficulty doing with an injury at this level?
S1 - difficulty walking on toes
what is diagnosis and tx for patient with streaking and painful ROM after minor palmar injury?
infectious flexor tenosynovitis
surgical drainage, IV abx
knavels signs - finger held in flexion, pain with passive extension, fusiform swelling, tenderness along tendon
earliest symptom of compartment syndrome
pain with passive stretch
what is tx for nondisplaced 1st metatarsal fx?
splint and non weight bearing, if displaced, refer for ORIF
13 year old male with bilateral knee pain for 1 month and tender on the tibial tuberosity?
osgood-schlatter’s disease
what test is required for patients in whom you are concerned about knee dislocation?
angio
worried about pop artery?
patient with history of RA presents after minor fall holding his head as if it may fall off. What condition should be considered/
subluxation of C1 on C2, atlanto-occipital dissociation
patient presents with complaint of recurrent palmar thumb and index pain and paresthesias when driving. What is likely diagnosis, and what tests will be positive?
carpal tunnel syndrome
reproducible pain when wrist is held in flexion (phalen sign) and pain elicited when tapping on median nerve (tinel sign)
what is most common FOOSH (fall on outstretched hand) carpal bone injury in adults?
scaphoid fracture - most common carpal bone fx
what is most common ligament injury in the wrist? what is the radiographic abnl called?
scapholunate ligament
widening of scapholunate joint of > 3 mm - terry thomas sign
patient with history of repetitive upper extremity movements, leading to: arm paresthesias, supraclavicular tenderness, worsening sx with raising the arm, arm and hand weakness, pain, or edema, may be due to what compressive condition?
thoracic outlet syndrome
with syncope - be concerned for subclavian steal
tx for patient with fluctuance of the lateral nail?
paronychia
I&D without abx
IVDA presents with fever and midline back pain - what is the most likely diagnosis?
epidural abscess
MRI for dx - needs emergent decompression
tx for a patient with upper extremity weakness who improves with edriphonium?
myasthenia gravis
tx is neostygmine or physos
patient has myasthenia gravis, but worsens after edriphonium test, what does this indicate?
cholinergic crisis - over tx
red/white/blue fingers in patients with HTN, what is it?
raynauds
most common bursa to become infected?
prepatellar
obese male adolescent with painful walking. Radiologic views important?
Slipped capital femoral epiphysis
AP and bilat frog views of hip are best
call ortho, non weight bearing
4 year old non-toxic limping child. Diagnosis?
toxic synovitis (transient)
8 year old non-toxic limping child. Diagnosis?
legg - calve- perthe
12 year old non-toxic limping, obese or athletic diagnosis
SCFE
best test to rule out osteomyelitits?
radionucleotide scan
what is diagnosis in a patient who presents with ankle arthralgias, conjunctivitis and urethritis?
reiter’s syndrome
reactive arthritis
most sensitive test for ACL tear?
lachmans, knee in 30 degree flexion
how does one reduce posterior hip dislocation?
flexion of hip and knee, traction and rotation
what nerve root helps one stand from a squat?
L2 hip flexor, L3 quad - knee extension
best approach to tap an elbow?
laterol
pain and erythema to finger pad?
felon
knee pain with rhomboidpositive birefringence crystals is what etiology?
pseudogout
70 year old with back pain thatimproves with leaning forward and sitting indicates what etiology?
spinal stenosis
dequervain’s tenosynovitis diagnosed?
increased pain with thumb held in closed fist and ulnar deviation
what are ottawa ankle rules?
XR if
- not weight bearing 4 steps of injury and in ED
- tender over post med or lateral malleolus
ottawa knee rules for XR?
not weight bearing 4 steps at injury and in ED
- > 55
- tenderness at fibular head
- isolated patella tenderness
- inability to flex knee 90 degrees
patient injures thumb while skiing. Pain at MCP joint. What injury and what indicates need for surgery?
gamekeeper’s thumb (ulnar collateral ligament rupture)
- anyone with weakness of pincer function and point tenderness or greater than 20% laxity when compared to unaffected thumb needs ortho referral
angulations acceptable for metacarpal neck fractures in each of the fingers?
10, 15, 20, 40 (2nd to 5th) no rotational deformity
