JH IM Board Review - Office Orthopedics II

Question 1

Collateral ligament injury - Cause:

Answer 1

1. Overuse.

2. Trauma.

Question 2

Collateral ligament injury - CP:

Answer 2

Medial or lateral knee pain.

Question 3

Collateral ligament injury - Dx and evaluation:

Answer 3

1. Tenderness over affected ligament.

2. Provoke pain with medial or lateral stress in 20 degrees of flexion.

Question 4

Collateral ligament injury - Tx:

Answer 4

1. Rest.
2. Physical therapy.
3. Surgery if unstable.

Question 5

Anterior cruciate ligament injury - Cause:

Answer 5

Twisting injury to knee with foot planted.

Question 6

Anterior cruciate ligament injury - CP:

Answer 6

1. Pain.
2. Swelling.
3. Instability.

Question 7

Anterior cruciate ligament injury - Dx and evaluation:

Answer 7

1. Swelling.

2. Anterior instability of the tibia at the knee (anterior drawer sign).

Question 8

Anterior cruciate ligament injury - Tx:

Answer 8

Orthopedic evaluation.

Question 9

Posterior cruciate ligament injury - Cause:

Answer 9

Hyperextension injury to knee.

Question 10

Posterior cruciate ligament injury - Cause:

Answer 10

Hyperextension injury to knee.

Question 11

Posterior cruciate ligament injury - CP:

Answer 11

1. Pain.
2. Swelling.
3. Instability.

Question 12

Posterior cruciate ligament injury - Dx and evaluation:

Answer 12

1. Swelling.

2. Posterior instability of the tibia at the knee (posterior drawer sign).

Question 13

Posterior cruciate ligament injury - Tx:

Answer 13

Orthopedic evaluation.

Question 14

Prepatellar bursitis - Cause:

Answer 14

1. Overuse.
2. Trauma.
3. Infection.
4. Gout.

Question 15

Prepatellar bursitis - CP:

Answer 15

1. Anterior knee pain.

2. Swelling.

Question 16

Prepatellar bursitis - Dx and evaluation:

Answer 16

1. Swollen and tender prepatellar bursa.

2. Aspirate to diagnose cause.

Question 17

Prepatellar bursitis - Tx:

Answer 17

1. Rest.
2. NSAIDs.
3. Antibiotic if needed.

Question 18

Anserine bursitis - Cause:

Answer 18

1. Overuse.

2. OA.

Question 19

Anserine bursitis - CP:

Answer 19

Anteromedial pain 4-5cm below joint line.

Question 20

Anserine bursitis - Dx and evaluation:

Answer 20

1. Tender with palpation.

2. Pain with knee flexion.

Question 21

Anserine bursitis - Tx:

Answer 21

1. Rest.
2. NSAIDs.
3. Steroid injection.
4. Physical therapy.

Question 22

Ruptured baker cyst (pseudothrombophlebitis) - Cause:

Answer 22

One-way flow of knee effusion to gastrocnemius-semimembranous bursa.

Question 23

Ruptured Baker cyst (pseudothrombophlebitis) - CP:

Answer 23

1. Popliteal fullness.
2. Calf pain.
3. Swelling.
4. Ecchymosis on rupture.

Question 24

Ruptured Baker Cyst (pseudothrombophlebitis) - Dx and evaluation:

Answer 24

R/o DVT with US.

Question 25

Ruptured Baker cyst (pseudothrombophlebitis) - Tx:

Answer 25

1. Rest. 2. Elevation. 3. Steroid injection.

Question 26

Achilles tendinitis - Cause:

Answer 26

1. Overuse, poor training habits, and improper footwear in athletes. 2. FLUOROQUINOLONES. 3. Associated with SPONDYLOARTHRITIS.

Question 27

Achilles tendinitis - CP:

Answer 27

Pain along the Achilles tendon.

Question 28

Achilles tendinitis - Dx and evaluation:

Answer 28

1. Tenderness and thickening along the tendon. | 2. Dorsiflexion of foot is painful.

Question 29

Achilles tendinitis - Tx:

Answer 29

1. NSAIDs. 2. Heel lift. 3. Stretching program. 4. If underlying spondyloarthritis is detected (AS, PA, RA, or IBD-related), treatment is directed at the underlying condition with a rheumatology referral.

Question 30

Achilles tendon rupture - Cause:

Answer 30

1. Forced DORSIFLEXION of the foot as the gastrocnemius muscle contracts. 2. MALE affected MORE THAN FEMALES..

Question 31

Achilles tendon rupture - CP:

Answer 31

TEARING AND POPPING SENSATION IN THE CALF.

Question 32

Achilles tendon rupture - Dx and evaluation:

Answer 32

1. Swelling of the calf. 2. Weakness of foot flexion. 3. Palpation of gap caused by tendon rupture. 4. ABNORMAL THOMPSON TEST.

Question 33

Abnormal Thompson test:

Answer 33

Failure of the foot to plantar flex when squeezing the gastrocnemius muscle.

Question 34

Achilles tendon rupture - Tx:

Answer 34

Orthopedic evaluation and possible repair.

Question 35

Tarsal tunnel syndrome - Cause:

Answer 35

1. POSTERIOR TIBIAL NERVE entrapment behind the medial malleolus. 2. Associated with PES PLANUS (flat feet), Ganglion cyst, and lipomata.

Question 36

Tarsal tunnel syndrome - CP:

Answer 36

1. Burning pain over the MEDIAL + PLANTAR aspects of the foot. 2. Aggravated by activity.

Question 37

Tarsal tunnel syndrome - Dx and evaluation:

Answer 37

1. Posterior tibial nerve (Tinel sign) posterior to the medial malleolus. 2. Decreased sensation over medial malleolus + plantar aspects of foot. 3. Nerve condution study if examination equivocal.

Question 38

Tarsal tunnel syndrome - Tx:

Answer 38

1. Orthotics. | 2. Surgery occasionally necessary.

Question 39

Foot - Plantar fasciitis - Cause:

Answer 39

1. Overuse, causing inflammation of plantar fascia. 2. Heel spur. 3. Associated with spondyloarthritis.

Question 40

Plantar fasciitis - CP:

Answer 40

1. Heel and posterior foot pain. 2. Classically, with the first steps of the morning and after prolonged sitting. 3. Improves with use.

Question 41

Plantar fasciitis - Dx and evaluation:

Answer 41

Tenderness on plantar aspect of heel.

Question 42

Plantar fasciitis - Tx:

Answer 42

1. Stretching. 2. Orthotics/night splints to stretch the plantar fascia. 3. NSAIDs. 4. Steroid injection. 5. Rarely surgery.

Question 43

Morton neuroma - Cause:

Answer 43

Neuroma formation causing COMPRESSION OF DIGITAL NERVE IN FOOT.

Question 44

Morton neuroma - CP:

Answer 44

Pain and paresthesia MC between the 3rd and 4th toes.

Question 45

Morton neuroma - Dx and evaluation:

Answer 45

1. Tenderness to deep palpation BETWEEN TOES. 2. Neuroma may be palpable. 3. US/MRI to visualize the neuroma.

Question 46

Morton neuroma - Tx:

Answer 46

1. Metatarsal bar orthotic. 2. Steroid injection. 3. Surgical excision of neuroma.

Question 47

Cervical spine strain - Cause:

Answer 47

1. Overuse. 2. Poor posture. 3. Hyperextension injury.

Question 48

Cervical spine strain - CP:

Answer 48

1. Neck pain and stiffness. | 2. No symptoms or signs of radiculopathy.

Question 49

Cervical spine strain - Dx and evaluation:

Answer 49

1. Localized tenderness over cervical musculature. | 2. ABSENCE of neurologic deficits.

Question 50

Cervical spine strain - Tx:

Answer 50

1. NSAIDs. 2. Mobilization and supervised physical therapy. 3. Soft cervical collar (short term only).

Question 51

Cervical disk disease - Cause:

Answer 51

Disk herniation.

Question 52

Cervical disk disease - CP:

Answer 52

1. Neck pain and stiffness. 2. Radicular complaints (weakness, numbness, paresthesias along involved nerve root). 3. Symptoms worse with straining.

Question 53

Cervical disk disease - Dx and evaluation:

Answer 53

1. Symptoms exacerbated with neck compression. | 2. Abnormal neurologic examination.

Question 54

Cervical disk disease - Tx:

Answer 54

1. Initially conservative. 2. NSAIDs. 3. Soft collar. ==> Surgical evaluation for intractable pain or progressive neurologic deficits.

Question 55

Lumbar spine - Basic info - Low back pain ...?

Answer 55

Is the MC musculoskeletal complaint in the outpatient setting.

Question 56

Lumbar spine - ...% of the population experience low back pain at some time in their life.

Answer 56

80%.

Question 57

Low back pain is generally a ...?

Answer 57

SELF-LIMITED CONDITION. 50% are better in ONE WEEK. 90% are better in 6 WEEKS.

Question 58

Sciatica can have a ...?

Answer 58

More protracted course. ==> 50% recover in 4 weeks.

Question 59

Low back pain - LOCAL CAUSES:

Answer 59

1. Muscle strain. 2. Lumbar spine osteoarthritis. 3. Degenerative disk disease. 4. Vertebral body infection. 5. Disk space infection. 6. Vertebral body malignancy. 7. Compression fracture. 8. Spinal stenosis.

Question 60

Low back pain - Referred/Distant causes:

Answer 60

1. Ulcer disease. 2. Pancreatitis. 3. Nephrolithiasis. 4. Prostatitis. 5. Aortic dissection. 6. Subacute BACTERIAL ENDOCARDITIS. 7. Pelvic pathology.

Question 61

Low back pain - Worrisome findings:

Answer 61

1. NOCTURNAL PAIN ==> Malignancy, infection. 2. WRITHING PAIN ==> Aneurysm, perforated viscus. 3. Evolving neurologic deficits (leg weakness, bowel/bladder incontinence) ==> Epidural abscess, hemorrhage, disk herniation, cauda equina syndrome. 4. Fever ==> Infection.

Question 62

Spinal stenosis:

Answer 62

1. Caused by impingement on lumbosacral spinal cord. 2. Associated with degenerative arthritis. 3. Pseudoclaudication (non vascular claudication improving with flexion at the waist).

Question 63

Straight leg raise test:

Answer 63

1. Sensitive (more than 90%) but NOT specific. 2. Pain should be radicular. 3. Helpful in ruling out sciatica. 4. Crossed straigth leg test less sensitive (25%) but more specific (80%).

Question 64

Indication for radiographic evaluation:

Answer 64

1. Preceding significant trauma. 2. Evolving neurologic findings. 3. Suggestion of malignancy or infection. 4. New onset pain at an older age. 5. Persistent pain.

Question 65

Low back pain - Tx:

Answer 65

1. Rest. 2. Heat and cold. 3. NSAIDs. 4. Physical therapy. 5. Surgery may be indicated (eg infection, intractable pain, neurologic defects, and spinal stenosis).