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Internal Medicine > JH IM Board Review - Office Orthopedics II > Flashcards

JH IM Board Review - Office Orthopedics II Flashcards

1
Q

Collateral ligament injury - Cause:

A
  1. Overuse.

2. Trauma.

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2
Q

Collateral ligament injury - CP:

A

Medial or lateral knee pain.

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3
Q

Collateral ligament injury - Dx and evaluation:

A
  1. Tenderness over affected ligament.

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

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4
Q

Collateral ligament injury - Tx:

A
  1. Rest.
  2. Physical therapy.
  3. Surgery if unstable.
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5
Q

Anterior cruciate ligament injury - Cause:

A

Twisting injury to knee with foot planted.

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6
Q

Anterior cruciate ligament injury - CP:

A
  1. Pain.
  2. Swelling.
  3. Instability.
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7
Q

Anterior cruciate ligament injury - Dx and evaluation:

A
  1. Swelling.

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

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8
Q

Anterior cruciate ligament injury - Tx:

A

Orthopedic evaluation.

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9
Q

Posterior cruciate ligament injury - Cause:

A

Hyperextension injury to knee.

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10
Q

Posterior cruciate ligament injury - Cause:

A

Hyperextension injury to knee.

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11
Q

Posterior cruciate ligament injury - CP:

A
  1. Pain.
  2. Swelling.
  3. Instability.
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12
Q

Posterior cruciate ligament injury - Dx and evaluation:

A
  1. Swelling.

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

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13
Q

Posterior cruciate ligament injury - Tx:

A

Orthopedic evaluation.

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14
Q

Prepatellar bursitis - Cause:

A
  1. Overuse.
  2. Trauma.
  3. Infection.
  4. Gout.
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15
Q

Prepatellar bursitis - CP:

A
  1. Anterior knee pain.

2. Swelling.

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16
Q

Prepatellar bursitis - Dx and evaluation:

A
  1. Swollen and tender prepatellar bursa.

2. Aspirate to diagnose cause.

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17
Q

Prepatellar bursitis - Tx:

A
  1. Rest.
  2. NSAIDs.
  3. Antibiotic if needed.
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18
Q

Anserine bursitis - Cause:

A
  1. Overuse.

2. OA.

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19
Q

Anserine bursitis - CP:

A

Anteromedial pain 4-5cm below joint line.

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20
Q

Anserine bursitis - Dx and evaluation:

A
  1. Tender with palpation.

2. Pain with knee flexion.

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21
Q

Anserine bursitis - Tx:

A
  1. Rest.
  2. NSAIDs.
  3. Steroid injection.
  4. Physical therapy.
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22
Q

Ruptured baker cyst (pseudothrombophlebitis) - Cause:

A

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

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23
Q

Ruptured Baker cyst (pseudothrombophlebitis) - CP:

A
  1. Popliteal fullness.
  2. Calf pain.
  3. Swelling.
  4. Ecchymosis on rupture.
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24
Q

Ruptured Baker Cyst (pseudothrombophlebitis) - Dx and evaluation:

A

R/o DVT with US.

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25
Q

Ruptured Baker cyst (pseudothrombophlebitis) - Tx:

A
  1. Rest.
  2. Elevation.
  3. Steroid injection.
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26
Q

Achilles tendinitis - Cause:

A
  1. Overuse, poor training habits, and improper footwear in athletes.
  2. FLUOROQUINOLONES.
  3. Associated with SPONDYLOARTHRITIS.
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27
Q

Achilles tendinitis - CP:

A

Pain along the Achilles tendon.

28
Q

Achilles tendinitis - Dx and evaluation:

A
  1. Tenderness and thickening along the tendon.

2. Dorsiflexion of foot is painful.

29
Q

Achilles tendinitis - Tx:

A
  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.
30
Q

Achilles tendon rupture - Cause:

A
  1. Forced DORSIFLEXION of the foot as the gastrocnemius muscle contracts.
  2. MALE affected MORE THAN FEMALES..
31
Q

Achilles tendon rupture - CP:

A

TEARING AND POPPING SENSATION IN THE CALF.

32
Q

Achilles tendon rupture - Dx and evaluation:

A
  1. Swelling of the calf.
  2. Weakness of foot flexion.
  3. Palpation of gap caused by tendon rupture.
  4. ABNORMAL THOMPSON TEST.
33
Q

Abnormal Thompson test:

A

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

34
Q

Achilles tendon rupture - Tx:

A

Orthopedic evaluation and possible repair.

35
Q

Tarsal tunnel syndrome - Cause:

A
  1. POSTERIOR TIBIAL NERVE entrapment behind the medial malleolus.
  2. Associated with PES PLANUS (flat feet), Ganglion cyst, and lipomata.
36
Q

Tarsal tunnel syndrome - CP:

A
  1. Burning pain over the MEDIAL + PLANTAR aspects of the foot.
  2. Aggravated by activity.
37
Q

Tarsal tunnel syndrome - Dx and evaluation:

A
  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.
38
Q

Tarsal tunnel syndrome - Tx:

A
  1. Orthotics.

2. Surgery occasionally necessary.

39
Q

Foot - Plantar fasciitis - Cause:

A
  1. Overuse, causing inflammation of plantar fascia.
  2. Heel spur.
  3. Associated with spondyloarthritis.
40
Q

Plantar fasciitis - CP:

A
  1. Heel and posterior foot pain.
  2. Classically, with the first steps of the morning and after prolonged sitting.
  3. Improves with use.
41
Q

Plantar fasciitis - Dx and evaluation:

A

Tenderness on plantar aspect of heel.

42
Q

Plantar fasciitis - Tx:

A
  1. Stretching.
  2. Orthotics/night splints to stretch the plantar fascia.
  3. NSAIDs.
  4. Steroid injection.
  5. Rarely surgery.
43
Q

Morton neuroma - Cause:

A

Neuroma formation causing COMPRESSION OF DIGITAL NERVE IN FOOT.

44
Q

Morton neuroma - CP:

A

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

45
Q

Morton neuroma - Dx and evaluation:

A
  1. Tenderness to deep palpation BETWEEN TOES.
  2. Neuroma may be palpable.
  3. US/MRI to visualize the neuroma.
46
Q

Morton neuroma - Tx:

A
  1. Metatarsal bar orthotic.
  2. Steroid injection.
  3. Surgical excision of neuroma.
47
Q

Cervical spine strain - Cause:

A
  1. Overuse.
  2. Poor posture.
  3. Hyperextension injury.
48
Q

Cervical spine strain - CP:

A
  1. Neck pain and stiffness.

2. No symptoms or signs of radiculopathy.

49
Q

Cervical spine strain - Dx and evaluation:

A
  1. Localized tenderness over cervical musculature.

2. ABSENCE of neurologic deficits.

50
Q

Cervical spine strain - Tx:

A
  1. NSAIDs.
  2. Mobilization and supervised physical therapy.
  3. Soft cervical collar (short term only).
51
Q

Cervical disk disease - Cause:

A

Disk herniation.

52
Q

Cervical disk disease - CP:

A
  1. Neck pain and stiffness.
  2. Radicular complaints (weakness, numbness, paresthesias along involved nerve root).
  3. Symptoms worse with straining.
53
Q

Cervical disk disease - Dx and evaluation:

A
  1. Symptoms exacerbated with neck compression.

2. Abnormal neurologic examination.

54
Q

Cervical disk disease - Tx:

A
  1. Initially conservative.
  2. NSAIDs.
  3. Soft collar.

==> Surgical evaluation for intractable pain or progressive neurologic deficits.

55
Q

Lumbar spine - Basic info - Low back pain …?

A

Is the MC musculoskeletal complaint in the outpatient setting.

56
Q

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

57
Q

Low back pain is generally a …?

A

SELF-LIMITED CONDITION.

50% are better in ONE WEEK.

90% are better in 6 WEEKS.

58
Q

Sciatica can have a …?

A

More protracted course.

==> 50% recover in 4 weeks.

59
Q

Low back pain - LOCAL CAUSES:

A
  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.
60
Q

Low back pain - Referred/Distant causes:

A
  1. Ulcer disease.
  2. Pancreatitis.
  3. Nephrolithiasis.
  4. Prostatitis.
  5. Aortic dissection.
  6. Subacute BACTERIAL ENDOCARDITIS.
  7. Pelvic pathology.
61
Q

Low back pain - Worrisome findings:

A
  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.
62
Q

Spinal stenosis:

A
  1. Caused by impingement on lumbosacral spinal cord.
  2. Associated with degenerative arthritis.
  3. Pseudoclaudication (non vascular claudication improving with flexion at the waist).
63
Q

Straight leg raise test:

A
  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%).
64
Q

Indication for radiographic evaluation:

A
  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.
65
Q

Low back pain - Tx:

A
  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).

Internal Medicine (107 decks)

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