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First Aid Step 2 > MS/ Orthopedic Surgery > Flashcards

MS/ Orthopedic Surgery Flashcards

1
Q

Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips

A

Spinal stensis

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2
Q

Joints in the hand affected in RA

A

MCP and PIP joints, DIP spared

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3
Q

Joint pain and stiffness that worsen over the course of the day and are relieved by rest

A

OA

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4
Q

Genetic disorder that is associated with multiple fractures and blue sclerae and is commonly mistaken for child abuse

A

Osteogenesis imperfecta

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5
Q

Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Dx test?

A

Suspect ankylosing spondylitis

Check HLA-b27

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6
Q

Arthritis, conjunctivitis, urethritis in young men. Associated organisms?

A

Reactive (Reiter’s) arthritis
Bugs: Chlyamydia, also think Camplylobacter, Shigella, Salmonella, Ureaplasma
HLA B27
Can follow enteric infection

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7
Q

55 yo man has sudden excruciating MTP joint pain after a night of drinking red wine. Dx, workup, and chronic Tx?

A

Gout
Needle shaped negatively birefringent crystals
Chronic Tx: allopurinol or probenecid

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8
Q

Rhomboid shaped positively birefringent crystal on joint fluid aspirate

A

Pseudogout

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9
Q

Elderly woman with pain and stiffness in shoulders and hips, cannot lift arms above head. Labs show inc ESR and anemia

A

Polymyalgia rheumatic

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10
Q

Active 13 yo boy has anterior knee pain, Dx?

A

Osgood Schlatter disease

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11
Q

Bone fx in fall on outstretched hand

Describe position of Fx

A

Distal radius = Colles fracture - dinner fork

Dorsally displaced, dorsally angulated

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12
Q

Complication of scaphoid fracture

A

vasular necrosis

may not see on x-ray for 1-2 wks

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13
Q

Signs suggesting radial nerve damage with humeral fracture

A

Wrist drop, loss of thumb abduction

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14
Q

Young child presents with proximal mm weakness, waddling gait, pronounced calf mm

A

Duchenne muscular dystrophy

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15
Q

First born female born in breech position found to have asymmetric skin folds on newborn exam. Dx? Tx?

A

Developmental dysplasia of hip

If severe, consider Pavlik harness to maintain abduction

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16
Q

11 yo African Am boy presents with sudden onset of limp. Dx? Workup?

A

SCFE

AP and frog leg lateral X-rays

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17
Q

Most common primary malignant tumor of bone

A

Multiple myeloma

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18
Q

Anterior dislocation of shoulder hits what nerve

A

Axillary n

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19
Q

Anterior dislocation of shoulder- position pt holds arm in?

A

Abduction and ER

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20
Q

What would cause posterior dislocation of shoulder?

A

seizure, electrocution

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21
Q

Posterior dislocation of shoulder- hold in what position?

A

ADDuction and IR

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22
Q

Anterior dislocation of hip can damage what nerve

A

Obturator n

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23
Q

Most common hip dislocation

A

Posterior

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24
Q

Cause of posterior hip dislocation

A

Anteriorly directed force on IR, F, ADD hip = Dashboard injury

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25
Q

Risks of posterior hip dislocation

A

Sciatic n injury

Avascular necrosis

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26
Q

Tenderness in anatomical snuffbox

Fall on radially deviated outstretch hand

A

Assume scaphoid Fx

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27
Q

Tx scaphoid Fx

A

Thumb spica cast

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28
Q

Fx 5th metatarsal neck

Due to forward trauma of closed fist - punching a wall

A

Boxer’s Fx

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29
Q

Tx Boxer’s FX

A

closed reduction and ulnar gutter splint

If open: assume infection by human oral pathogens - irrigate, debridement, abx (cover Eikenella)

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30
Q

Humerus Fx caused by

A

Direct trauma

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31
Q

Neuro complication humerus Fx

A

Radial n palsy = wrist drop, loss of thumb extension

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32
Q

Tx humerus Fx

A

Hanging arm cast vs coaption splint and sling, bracing

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33
Q

Ulnar shaft Fx resulting from self defense with arm against blunt object
Tx

A

Nightstick Fx

ORIF if significantly displaced

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34
Q

Diaphyseal Fx of proximal ulna with subluxation radial head

Tx

A

Monteggia’s Fx

ORIF of shaft and closed reduction radial head

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35
Q

Diaphyseal fracture of radius with dislocation of distal radioulnar joint, 2/2 direct blow to radius
Tx?

A

Galeazzi’s fx

ORIF of radius and casting forearm in supination to reduce distal radioulnar joint

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36
Q 
Hip Fx:
What puts at increased risk?
Presentation
Major complications (2), esp if femoral neck Fx
Radiology problems
A

Osteoporosis
Shorted leg and ER
DVT, AVN w/ femoral Fx
Can be radiographically occult, CT or MRI

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37
Q

Tx hip Fx

A

ORIF, may need hip hemiarthroplasty

Anticoagulate

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38
Q

Cause femoral Fx

Major complication

A

Direct trauma

Fat emboli

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39
Q

S/S fat emobli

A 
Fever
Changes mental status
Dyspnea
Hypoxia
Petechiae
Dec platelets
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40
Q

Cause tibial Fx

Major complication

A

Direct trauma

Compartment syndrome

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41
Q

Open fractures

A

Orthopedic emergency

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42
Q

Sudden pop like rifle shot, 2/2 decreased physical conditioning
Limited plantar flexion
+ Thompson

A

Achilles tendon rupture

Tx: long leg cast 6 wks

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43
Q

Unhappy triad

A

ACL
MCL
Medical meniscus

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44
Q

Causes ACL injury

A

Twisting mechanism
Forced hyperextension
Impact to extended knee

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45
Q

Cause PCL injury

A

Posteriorly directed force on flexed knee

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46
Q

Cause meniscal tears

Exam shows

A

Acute twisting or degenerative tear in elderly pts

Joint line tenderness, + McMurrays

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47
Q

Test of knee injuries

A

MRI

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48
Q

Cause Volkmann’s contracture of wrist and fingers

A

Compartment syndrome which can be 2/2 humeral Fx

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49
Q

Compartment pressure = compartment syndrome

A

> 30 mmHg

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50
Q

Tx compartment syndrome

A

Immediate fasciotomy

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51
Q

CTS nerve affected

A

Median

52
Q

Association of CTS

A

Overuse wrist flexors, DM, thyroid, pregnant

53
Q

Positive tests CTS

A

Phalen’s

Tinel’s

54
Q 
Raidal nerve
Motor fcn
Sensory
Cause injury
Clinical finding
A

Wrist extension
Dorsal forearm and first 3 fingers
Humeral Fx
Wrist drop

55
Q 
Median n
Motor fcn
Sensory
Cause injury
Clinical finding
A

Pronation, thumb opposition
Palmar surface first 3 fingers
Carp tunnel
Weak wrist flexion and flat thenar eminence

56
Q 
Ulnar
Motor fcn
Sensory
Cause injury
Clinical finding
A

Finger adduction, 4 and 5 finger flexion, lumbricals
Palmar and dorsal surface last 2 fingers
Elbow dislocation- medial epicondyle
Claw hand- clawed 4 and 5 digits

57
Q

Axillary
Motor fcn
Sensory
Cause injury

A

Abduction
Lateral shoulder
Anterior humeral dislocation

58
Q 
Peroneal
Motor fcn
Sensory
Cause injury
Clinical finding
A

Dorsiflexion, eversion
Dorsal foot and lat leg
Knee dislocation
Foot drop

59
Q

Wrist drop - n

A

Radial

60
Q

Claw hand - n

A

ulnar

61
Q

Foot drop- n

A

Peroneal

62
Q

Causes bursitis - 4

A 
Repetitive use
Trauma
Infection 
Systemic inflammatory disease
TX: RICE
63
Q

Rx with increased risk tendon rupture and tendonitis

A

Fluoroquinolones

64
Q

Red flags LBP

A 
age > 50
>6 wks pain
Previous cancer Hx
Constitutional Sx
Severe pain
Neuro deficits
Loss of anal sphincter tone
65
Q

Bowel or bladder dysfunction, impotence, saddle anesthesia

A

Cauda equina

66
Q

Most common location herniated disc

A

L5-S1

67
Q

L4
Motor
Sensory
Reflex

A

Foot dorsiflexion- tibialis anterior
Medial aspect lower leg
Patellar

68
Q

L5
Motor
Sensory
Reflex

A

Big toe dorsiflexion - extensor hallucis longus; foot eversion (peroneus)
Dorsum foot and lat lower leg
None

69
Q

S1
Motor
Sensory
Reflex

A

Foot eversion- peroneus longus and brevis; plantarflexion-gastrocnemius
Plantar and lat foot
Achilles

70
Q

Most common benign bone tumor

A

Osteochondroma

71
Q

Child 10-20 yrs of age with multilayered onion skinning on X-ray in diaphysis

A

Ewing sarcoma

72
Q

Female 20-40 yrs w/ knee pain and mass; X-ray shows soap bubble appearance, epiphyseal/metaphyseal region long bones

A

Giant cell tumor

73
Q

Male, 20-30, metaphyseal bone tumor in distal femur or proximal tibia, mets to lungs common, pain worsens at night

A

Osteosarcoma

74
Q

Codman’s triangle

A

Triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone
Osteosarcoma
Ewing sarcoma

75
Q

Onion skinning

A

Ewing

successive layers of periosteal development;

76
Q

Soap bubble

A

Giant cell``

77
Q

Most common organisms in septic arthritis

A

STAPH
Streo
Gram - rods

78
Q

Tx septic arthritis

A

Ceftriaxone and vacomycin

79
Q

Child w/ gout and inexplicable injuries

A

Lesch Nyhan syndrome

80
Q

Type of crystal in gout

A

Monosodium urate crystals

81
Q

Mechanism colchicine

A

inhibits neutrophil chemotaxis
good for acute flare
cause diarrhea, BM suppression - neutropenia

82
Q

Fx of distal radius with fall on flexed wrist

Displaced ant or post

A

Smith

Ant

83
Q

Major risk of pelvic fracture

A

Major blood loss

84
Q

Deltoid malfunction- cannot extend or abduct arm or shoulder numbness after dislocation

A

axillary n injury

ANTERIOR DISLOCATION

85
Q

Exertional compartment syndrome

A

Young athlete
Resolves when stop activity
Minimal risk tissue ischemia

86
Q

6 P Compartment syndrom

A 
Pain
Paresthesias
Paralysis
Poikilothermia
Pallor
Pulselessness
87
Q

C5
Motor
Sensory
Reflex

A

Deltoid and biceps
Ant shoulder
Biceps

88
Q

C6
Motor
Sensory
Reflex

A

Biceps, wrist extensors
Lat forearm
Brachioradialis

89
Q

C7
Motor
Sensory
Reflex

A

Triceps, wrist flexors, finger extensors
Post forearm
Triceps

90
Q

C8
Motor
Sensory
Reflex

A

Finger flexors
4 and 5 fingers, medial forearm
NOne

91
Q

T1
Motor
Sensory
Reflex

A

Finger interossei
Axilla
None

92
Q

Erb Duchenne Palsy
Where is injury
Cause
Clinical

A

Super trunk: c5-c6
Hyperadduction of arm- birth = shoulder dystocia
Waiter’s tip: arm extended and adducted in pronation

93
Q

Klumpke palsy
Where
Cause
Clinical

A

Posterior or medial cords:c8-t1
Hyperabduction of arm
Clas hand- poor wrist and hand fcn, assoc Horner syndrome

94
Q

Etiology osteopetrosis vs Paget

A

Osteo: increased bone density due to impaired osteoclast
Paget: disorganized bone due to overactive osteoblast and osteoclast

95
Q

Labs osteopetrosis vs Paget

A

Paget: Inc ALP, urine hydroxyprolone, normal Ca and Phos
Osteo: Dec H and H, inc acid phosphatase and CK

96
Q

Tx osteopetrosis vs Paget

A

Osteo: transfuse marrow components to stimulate osteoclast
Paget: bisphosphonates, calcitonin

97
Q

Leukocytes:

OA, trauma vs Inflammatory arthropathies (RA, pseudogout) vs septic joint

A

50000

98
Q

Bouchard nodes

A

OA

DIP

99
Q

Heberdon nodes

A

OA

PIP

100
Q

Swan neck deformities

A

RA

flexed DIP plus hyperextended PIP

101
Q

Boutenierre deformity

A

RA

Flexed PIP

102
Q

Red heliotropic rash

A

Dermatomyositis/polymyositis

103
Q

Bamboo spine

A

Ankylosing spondyltitis

104
Q

Seronegative arthopathies

A 
PEAR
Psoriatic
Enteropathic (IBD)
Ankylosing
Reactive
105
Q

Tumors that met to bones

A 
Permanently Relocated Tumors Like Long Bones
Prostate
Renal
Thyroid
Lung
Lymphonma
Breast
106
Q

Sunburst on X-ray

A

Osteosarcoma

mixed lytic sclerotic pattern

107
Q

Most effective Dx testing for developmental dysplasia of the hip

A

US, X ray no good until 4 months

108
Q

2 types rickets

A

Hypocalcemic

Hypophosphatemic

109
Q

Rickets with Inc ALP, Dec P, Dec Ca, Dec 25 Vit and 1, 25 Vit D, inc PTH

A

Hypocalcemic

110
Q

Rickets with Inc ALP, Dec P, Increased 25 and 1,25 Vit D

A

Hypophosphatemic

111
Q

Joints involved JRA: pauci, poly, systemic and ages of each

A

Pacui: less than 4 joints, 2-3 yrs
Poly: 5+ joints, 2-5 and 10-14 yrs
Poly: any number, < 17

112
Q

Problem with Osgood schlatter

A

inflammation of bone-cartilage interface of tibial tubercle

113
Q

Reduction of nursemaids elbow

A

Supinate, flex from 0-90

114
Q

Club foot position

A

Inverted, planter flexion, adduction

115
Q

Gower maneuver

A

push on hips to stand

Duchenne MD

116
Q

Noninfectious vegetations seen on MV in SLE and antiphospholipid syndrome

A

Libman Sachs Endocarditis

117
Q

SLE Criteria

A 
DOPAMINE RASH
Discoid rash
Oral ulcers
Photosensitivity
Arthritis
Malar rash
Immunologic
Neuro sx
Elevated ESR
ANA
Serositis- pleural or pericardial
Heme abnormal
118
Q

CREST

A 
Calcinosis
Raynaud
Esophageal dysmotility
Sclerodactyly
Telangiectasia
119
Q

DIP: spared in, involved in = OA and RA

A

DIP spare RA

DIP affected OA

120
Q

Felty’s syndrome

A

RA
Splenomegaly
Neutropenia

121
Q

Charcot joint

A

DM

122
Q

Mosaic lamellar bone pattern

A

Pagets

123
Q

Caplan syndrome

A

RA + pneuoconiosis

124
Q

20s man, painful oral and genital ulcers, uveitis, arthritis, erythema nodosum

A

Behcet

Tx: steroids

125
Q

Dermatomyositis
S/S
Dx
Complication

A

Polymyositis plus skin (heliotrope rash around eyes with periorbital edema)
Trouble rising from chair/climbing stair b/c proximal mm affected

Dx: mm biopsy

Increased incidence of malignancy

First Aid Step 2 (22 decks)

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