Inservice Deck 4 - ortho

Question 1

tx and disposition for afebrile pt with recurrent knee pain/toe pain, 21k WBC on knee aspiration?

Answer 1

gout!

tx - indomethacin, colchicine, steroids, d/c home

Question 2

How do you splint achilles rupture?

Answer 2

splint in passive equinus (plantar flexion)

Question 3

Patient with severe pain, tenderness to palpation, unable to fully extend knee. What is diagnosis?

Answer 3

patellar tendon rupture (can’t extend)

Question 4

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?

Answer 4

quadriceps tendon rupture

Question 5

what is best method of diagnosis for child with painful septic appearing hip?

Answer 5

tap (with US guide)

Question 6

which nerve is injured in fx of distal 1/3 of humerus?

Answer 6

radial inability to extend wrist

Question 7

what does a positive drop arm test indicate?

Answer 7

rotator cuff tear (supraspinatus tendon injury)

Question 8

inability to oppose or abduct thumb indicates injury to what nerve?

Answer 8

median nerve

Question 9

most common nerve injury with olecranon fx?

Answer 9

ulnar nerve

Question 10

how will injury site typicall appear in a patient with high pressure paint gun injury?

Answer 10

looks innocuous

Question 11

what specialist should be called to evaluate a patient with known cancer who presents with cord compression syndrome?

Answer 11

radiation oncologist - for radiation

not NSGY - surgeon removes pus and blood

Question 12

what nerve level is associated with decreased ankle reflexes? what will a patient have difficulty doing with an injury at this level?

Answer 12

S1 - difficulty walking on toes

Question 13

what is diagnosis and tx for patient with streaking and painful ROM after minor palmar injury?

Answer 13

infectious flexor tenosynovitis

surgical drainage, IV abx

knavels signs - finger held in flexion, pain with passive extension, fusiform swelling, tenderness along tendon

Question 14

earliest symptom of compartment syndrome

Answer 14

pain with passive stretch

Question 15

what is tx for nondisplaced 1st metatarsal fx?

Answer 15

splint and non weight bearing, if displaced, refer for ORIF

Question 16

13 year old male with bilateral knee pain for 1 month and tender on the tibial tuberosity?

Answer 16

osgood-schlatter’s disease

Question 17

what test is required for patients in whom you are concerned about knee dislocation?

Answer 17

angio

worried about pop artery?

Question 18

patient with history of RA presents after minor fall holding his head as if it may fall off. What condition should be considered/

Answer 18

subluxation of C1 on C2, atlanto-occipital dissociation

Question 19

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?

Answer 19

carpal tunnel syndrome

reproducible pain when wrist is held in flexion (phalen sign) and pain elicited when tapping on median nerve (tinel sign)

Question 20

what is most common FOOSH (fall on outstretched hand) carpal bone injury in adults?

Answer 20

scaphoid fracture - most common carpal bone fx

Question 21

what is most common ligament injury in the wrist? what is the radiographic abnl called?

Answer 21

scapholunate ligament

widening of scapholunate joint of > 3 mm - terry thomas sign

Question 22

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?

Answer 22

thoracic outlet syndrome

with syncope - be concerned for subclavian steal

Question 23

tx for patient with fluctuance of the lateral nail?

Answer 23

paronychia

I&D without abx

Question 24

IVDA presents with fever and midline back pain - what is the most likely diagnosis?

Answer 24

epidural abscess

MRI for dx - needs emergent decompression

Question 25

tx for a patient with upper extremity weakness who improves with edriphonium?

Answer 25

myasthenia gravis

tx is neostygmine or physos

Question 26

patient has myasthenia gravis, but worsens after edriphonium test, what does this indicate?

Answer 26

cholinergic crisis - over tx

Question 27

red/white/blue fingers in patients with HTN, what is it?

Answer 27

raynauds

Question 28

most common bursa to become infected?

Answer 28

prepatellar

Question 29

obese male adolescent with painful walking. Radiologic views important?

Answer 29

Slipped capital femoral epiphysis

AP and bilat frog views of hip are best

call ortho, non weight bearing

Question 30

4 year old non-toxic limping child. Diagnosis?

Answer 30

toxic synovitis (transient)

Question 31

8 year old non-toxic limping child. Diagnosis?

Answer 31

legg - calve- perthe

Question 32

12 year old non-toxic limping, obese or athletic diagnosis

Answer 32

SCFE

Question 33

best test to rule out osteomyelitits?

Answer 33

radionucleotide scan

Question 34

what is diagnosis in a patient who presents with ankle arthralgias, conjunctivitis and urethritis?

Answer 34

reiter’s syndrome

reactive arthritis

Question 35

most sensitive test for ACL tear?

Answer 35

lachmans, knee in 30 degree flexion

Question 36

how does one reduce posterior hip dislocation?

Answer 36

flexion of hip and knee, traction and rotation

Question 37

what nerve root helps one stand from a squat?

Answer 37

L2 hip flexor, L3 quad - knee extension

Question 38

best approach to tap an elbow?

Answer 38

laterol

Question 39

pain and erythema to finger pad?

Answer 39

felon

Question 40

knee pain with rhomboidpositive birefringence crystals is what etiology?

Answer 40

pseudogout

Question 41

70 year old with back pain thatimproves with leaning forward and sitting indicates what etiology?

Answer 41

spinal stenosis

Question 42

dequervain’s tenosynovitis diagnosed?

Answer 42

increased pain with thumb held in closed fist and ulnar deviation

Question 43

what are ottawa ankle rules?

Answer 43

XR if

• not weight bearing 4 steps of injury and in ED
• tender over post med or lateral malleolus

Question 44

ottawa knee rules for XR?

Answer 44

not weight bearing 4 steps at injury and in ED

• > 55
• tenderness at fibular head
• isolated patella tenderness
• inability to flex knee 90 degrees

Question 45

patient injures thumb while skiing. Pain at MCP joint. What injury and what indicates need for surgery?

Answer 45

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

Question 46

angulations acceptable for metacarpal neck fractures in each of the fingers?

Answer 46

10, 15, 20, 40 (2nd to 5th) no rotational deformity