Miscellaneous Flashcards
What should you order if you suspect posterior shoulder dislocation?
Axillary or scapular shoulder radiographs
Best mgmt of clavicular fractures
Figure eight sling
Best mgmt of Colles fracture (distal radius)
Closed reduction and casting
Monteggia and Galeazzi fractures lead to to a fracture/dislocation combination. How are they managed?
Monteggia (ulnar fracture) and Galeazzi (radius fracture) will cause diaphyseal fracture and a dislocation. Open reduction and internal fixation for diaphyseal fracture and closed reduction for dislocation
Best mgmt of scaphoid fracture
Thumb spica case to prevent nonunion. Repear radiographs if uncertain
Best mgmt of trigger finger and/or De Quervain tenosynovitis
Steroid Injections
Best mgmt of Dupuytren contracture
Try collagenase and if fails then surgery
Best mgmt of posterior hip dislocation
Extra: How does the leg present?
Emergency reduction to prevent avascular necrosis
Internally rotated
Best mgmt of MCL/LCL injuries
Hint: depends on how many ligaments involved
Single ligament: Casting
Multiple ligaments: Surgical repair
Best mgmt of ACL/PCL injuries
Hint: depends on age
Young: arthroscopic repair
Old: immobilization and rehabilitation
Best mgmt of meniscal injury
Arthroscopic repair
Best mgmt of Achilles tendon rupture
Casting in equinus position or surgical repair
Best mgmt of tibial stress injury
Radiographs may be negative; cast, don’t bear weight, and repeat radiographs in 2 weeks
What is a more specific test for CTS, Phelan’s or Tinel’s?
Tinel’s (tapping on flexor retinaculum)
What nerve roots control cremasteric response?
Absence of cremasteric response suggests what urologic pathology?
L1-L2
Testicular torsion
How do you manage testicular torsion?
Don’t have to wait on US if high suspicion, emergent surgery with bilateral orchiopexy
How is acute epidydimitis treated?
Hint: depends on age
35 (treat as UTI): Levofloxacin
Should urologic obstructions accompanied by fever be treated electively, urgently, or emergently?
How are they treated?
Emergently!
Need to relive the obstruction bc it can lead to kidney damage and sepsis soon. Place urethral stent or percutaneous nephrostomy. Also provide IV antibiotics
A 1 week old boy is having issues with voiding and has a distended abdomen. What do you suspect? How do you diagnose it? How do you treat it?
Posterior urethral valves
Voiding cystourethrogram
Catheterization
Should you circumcise a child with hypospadias?
No
What does a child with UTI have until proven otherwise? How are they treated?
Vesicoureteral reflux
Antibiotics until they “grow out of it”
A young girl presents with constant wetting into her vagina. What is the likely dx?
Low implantation of ureter
A teenager presents with colicky abdominal pain every time he shotguns 6 beers. What’s going on?
Ureteropelvic junction obstruction which causes colicky pain whenever he drinks large volumes
How can you distinguish subclavian steal from thoracic outlet syndrome?
Subclavian steal causes neurologic and vascular symptoms
Thoracic outlet syndrome causes vascular symptoms only
How does subclavian steal present classically?
Atherosclerotic plaque of subclavian allows the arm to be capable of doing normal level of activity however when exercising it there is claudication symptoms of arm and also a “steal” of blood supply from vertebral arteries causing syncopal episodes
How is subclavian steal diagnosed and how is it treated?
Diagnose: Angiography
Treatment: Bypass surgery
How is AAA recommended to be screened for?
Men 65-75 who have ever smoked should have one time US
What is biggest RF for thoracic aortic aneurysm progression?
Poor BP control
Do you need to work-up claudication symptoms in patients where it doesn’t affect their daily living?
No, just recommend to quit smoking and give cilostazol and aspirin
