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Clin Med 3- Exam 2 > MSK 1 > Flashcards

MSK 1 Flashcards

1
Q

What are the 2 types of bone and what is the purpose of each?

A

Cortical: provides structural support and attachment points for muscles
Cancellous: “soft” interior where vascular supply is situated; site of RBC production

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2
Q

Which type of bone is where RBCs are produced?

A

Cancellous

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3
Q

What are the 3 main parts of a long bone?

A

(1) diaphysis
(2) epiphysis
(3) metaphysis

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4
Q

Which part of a long bone is also known as the shaft and provides skeletal support?

A

Diaphysis

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5
Q

Which part of a long bone is a common site of muscle attachment?

A

Diaphysis

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6
Q

Which part of a long bone is the ossification center?

A

Epiphysis

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7
Q

Tendons attach ___ to ___.

A

Tendons attach muscle to bone.

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8
Q

Ligaments attach ___ to ___.

A

Ligaments attach bone to bone

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9
Q

What are 4 examples of acute musculoskeletal complaints?

A

(1) Fractures
(2) Dislocations
(3) Ligament strains/sprains
(4) Septic joints

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10
Q

What are 3 examples of chronic musculoskeletal complaints?

A

(1) Overuse syndromes (tendonitis)
(2) Osteoarthritis
(3) Osteomyelitis

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11
Q

Define direct, indirect, and twisting forces.

A

Direct: a direct blow
Indirect: force impacts one end of limb and damage is transmitted to a distant point
Twisting: one part of extremity stationary while the rest twists

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12
Q

What 5 things would you look for on musculoskeletal physical exam?

A

(1) Swelling
(2) Deformity
(3) Neurovascular status
(4) Pain with palpation
(5) Painful/decreased ROM

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13
Q

What are 3 special tests to assess joints on PE and what is the usefulness of each?

A

Provocative tests: recreate mechanism of injury to reproduce the pt’s pain
Stress tests: apply load to test ligament stability
Functional testing: useful to assess injury severity and ADLs

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14
Q

What is the initial test of choice following skeletal trauma?

A

X-ray

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15
Q

What 4 things does an x-ray evaluate?

A

(1) Cortical integrity
(2) Articular surface congruity
(3) Joint space
(4) Lesions

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16
Q

What is a CT scan used in?

A

Trauma to identify and characterize injury pattern/severity

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17
Q

A CT scan is better than x-ray in what 3 things?

A

(1) identifying subtle fractures (2) visualizing articular extension of fracture
(3) assessing for the presence of articular step-off/gap

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18
Q

What are MRIs primarily used for? What additional 2 things are MRIs useful for?

A

Soft tissue eval; diagnosing occult fractures and when there is a concern for associated ligament or articular cartilage injury

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19
Q

What is an ultrasound used for and what are 2 injury examples for ultrasound use?

A

Used in trauma setting to assess soft tissue injury; (1) Achilles’ tendon rupture (2) Quad tendon rupture

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20
Q

What 2 fractures is a bone scan most commonly used for?

A

Occult and stress fractures

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21
Q

What are the ABCs of reading an x-ray?

A 
Alignment (long axes of bones), adequacy (of views and image quality)
Bones (lucent lines, deformities)
Cartilage (joint space, defects)
Soft tissues (swelling, effusion)
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22
Q

Define fracture. And list 2 additional things that may be affected by fractures.

A

Fracture: loss of continuity of the structure of a bone

(1) Sharp fragments may injure surrounding tissue
(2) Arteries and veins that run throughout the bones may tear or rupture and bleed

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23
Q

Differentiate open fracture from closed fracture.

A

Open: break in skin w/underlying soft tissue injury
Closed: fracture is not exposed to environment, no break in skin

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24
Q

In what amount of time after an open fracture should surgical tx be at least started?

A

6 hours

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25
Q

Salter-Harris fractures are fractures of the ____ plate.

A

Salter-harris fractures are fractures of the epiphyseal plate.

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26
Q

List the meanings of each letter in SALTER as it relates to the Salter-Harris fractures.

A 
Straight across
Above  (proximal)
Lower or below (distal)
Through (or two)
ERasure of growth plate (or crush)
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27
Q

What is the most common type of Salter-Harris fracture?

A

Type II (~75% of Salter-Harris fractures)

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28
Q

Describe a Salter-Harris type I fracture.

A

Fracture plane passes all the way through the growth plate, not involving the bone

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29
Q

Describe a Salter-Harris type II fracture.

A

Fracture passes across most of the growth plate and up through the metaphysis

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30
Q

Describe a Salter-Harris type III fracture.

A

Fracture plane passes some distance along the growth plate and down through the epiphysis (distally); proliferative and reserve zones are interrupted

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31
Q

Describe a Salter-Harris type IV fracture.

A

Contiguous through the metaphysis, physis, and epiphysis; proliferative and reserve zones are interrupted

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32
Q

Describe a Salter-Harris type V fracture.

A

Crush injury of the physis; does not displace the growth plate, but damages it by direct compression

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33
Q

What are the 5 principles of fracture immobilization?

A 
Maintain position
Prevent movement of fracture
Protect from further injury
Limit neuro injuries
Pain control
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34
Q

What are 6 methods of fracture immobilization?

A 
Splinting
Casting
Closed reduction percutaneous pinning (CRPP)
Open reduction internal fixation (ORIF)
External fixator (Ex-Fix)
Intramedullary (IM) rodding
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35
Q

What does a splinting allow for that casting does not and what does that help prevent?

A

Splinting allows for swelling; casting can cause compartment syndrome by not allowing for swelling

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36
Q

What is the first method of immobilization and what 3 principles of fracture immobilization does it cover?

A

Splinting; (1) immobilizes affected extremity/area (2) prevents further injury (3) pain control

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37
Q

What is the golden rule of immobilization?

A

Immobilize the joint above/below injury

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38
Q

What are 4 reasons to splint above/below the injury?

A

(1) Minimizes movement which decreases pain
(2) Prevents additional soft tissue injury to nerves, arteries, veins, +/- muscle
(3) Prevents closed fracture from becoming open
(4) Minimizes blood loss

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39
Q

When applying a splint that wraps an extremity, which direction do you wrap and why?

A

Wrap from distal to a more proximal point→ prevents trapping of blood distal to injury

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40
Q

What 3 things should you measure both before and after splinting?

A

(1) distal circulation (2) motor function (3) sensation

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41
Q

What type of fracture is a short arm cast (SAC) used for?

A

wrist fracture

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42
Q

What 2 types of fractures is a long arm cast (LAC) used for and what does it also help prevent?

A

(1) forearm fracture
(2) unstable wrist fracture
(3) prevents supination/pronation

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43
Q

What 2 types of fractures is a thumb spica cast used for?

A

(1) scaphoid fracture

(2) radial styloid fracture

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44
Q

What 4 things are short leg casts (SLC) used for?

A

(1) foot (2) ankle (3) Achilles’ (4) Sever’s syndrome

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45
Q

What 2 things are long leg casts (LLC) used for?

A

(1) Tib/fib fracture

(2) quad tendon repair

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46
Q

What are 2 benefits and 2 risks to closed reduction percutaneous pinning?

A

Benefits: hold unstable fx, reduces need for ORIF
Risks: skin infection around pins, nerve/vessel injury

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47
Q

Which type of fracture fixation is most definite and what does it allow for?

A

Plates/screws→ allow for anatomic reduction of fracture

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48
Q

What are 3 uses of an ex fix?

A

(1) Major non-life saving procedures must be avoided
(2) As a bridge to definitive internal fixation
(3) If pt in OR for life saving procedures, should be performed in concert w/them

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49
Q

How long does a fracture take to heal?

A

6 weeks

50
Q

What are the 3 phases of fracture healing?

A

(1) Fracture hematoma (inflammatory phase)
(2) Fibrocartilaginous callus formation (reparative phase)
(3) Bone remodeling

51
Q

What are the 4 steps to the fracture hematoma inflammatory phase and how long does it last?

A

Fracture hematoma: *lasts ~2 weeks
Hematoma and granulation tissue form
Blood vessels across fracture disrupted and leak blood
6-8 hours following fx, blood clot forms at fx site
Phagocytes (neutrophils and macrophages) and osteoclasts are recruited to remove the necrotic tissue at the fx site

52
Q

What are the 3 steps to the fibrocartilaginous callus formation reparative phase and how long does it last?

A

Fibrocartilaginous callus formation: *callus lasts 3-4 months
Fibrovascular tissue invades the hematoma
Fibroblasts develop into chondroblasts and produce fibrocartilage
Results in fibrocartilaginous “callus”

53
Q

What 2 things happen during the bone remodeling phase?

A

(1) compact bone replaces spongy bone around fracture periphery
(2) remaining dead fracture portions reabsorbed osteoclasts

54
Q

What are 8 local factors that affect fracture healing?

A 
Location of fracture in bone
Intra-articular extension
Severity of injury
Mechanical stability at fracture site
Blood supply
Infection
Underlying pathological lesion
Prior radiation to site
55
Q

What is the number one systemic factor for delayed bone healing? What are 5 other systemic healing factors?

A 
Smoking: number 1 reason for delayed bone healing
Age of pt
Nutrition status
Presence of underlying disease
Corticosteroids
NSAIDs
56
Q

What is a sprain and what are the 2 possible mechanisms of injury?

A

Stretching or tearing of ligaments; MOI: inversion, eversion

57
Q

What is the most common type of sprain?

A

An ankle sprain by inversion with plantar flexion

58
Q

What is a strain and what is it most often caused by?

A

Injury to muscle or muscle and tendon→ muscle fibers tear; often caused by overextension or over stretching

59
Q

What are 4 typical strain sx?

A

Swelling
Cramping
Pain
Muscle spasm/weakness

60
Q

What are 2 contributing conditions of tendon rupture?

A

(1) injection of steroids into tendon

(2) use of fluoroquinolones

61
Q

What are the 4 most common types of tendon rupture?

A

(1) Achilles’
(2) Biceps (proximal>distal)
(3) rotator cuff
(4) quad

62
Q

What are the 4 most common locations of tendonitis?

A

(1) shoulders
(2) elbows
(3) wrists
(4) knees

63
Q

What are the 6 treatments of tendonitis?

A 
Rest 
Ice cube massage
NSAIDs (naproxen)
Cortisone
Physical therapy
Brace
64
Q

How often should you tell pts to do ice cube massages to heal tendonitis?

A

3x/day

65
Q

What do you want to evaluate before and after reduction of a dislocation?

A

Neurovascular status

66
Q

What finding increases the severity of a dislocation injury?

A

Loss of distal pulses

67
Q

What are the 6 treatments of tendon ruptures?

A

(1) Splint/immobilization
(2) Ice
(3) NSAIDs
(4) Repair/reconstruction
(5) Early ROM
(6) Physical therapy

68
Q

What are the 4 ortho pharmacologic treatment options?

A

(1) Acetaminophen
(2) NSAIDs
(3) topicals
(4) narcotics

69
Q

Which NSAID is preferred for tx and why?

A

Naproxen is preferred b/c it is BID and ibuprofen is QID

70
Q

What is the rule of 2 when prescribing naproxen?

A

“Take 2 blue tablets, 2 times daily for 2 weeks, then as needed”

71
Q

What is the modality of choice for both disc herniations and ACL tears?

A

MRIs

72
Q

What “lights up” on T2 MRI images?

A

Occult fractures b/c they are well visualized as edema of the bone marrow “lighting up” (any fluid, blood, edema, effusions, etc. appear white on T2 images)

73
Q

What appear as “hyperintense” signals on T2 weighted images?

A

Bone bruises

74
Q

How does an MRI help in osteochondral injuries?

A

MRIs can help to characterize the fragment size and potential stability of an osteochondral injury

75
Q

When ordering an x-ray, how many views should you get?

A

Always get at least 2 views! (usually AP/lateral→ perpendicular to each other)

76
Q

If a pt is complaining of ankle pain, what view do you order and which view do you not order?

A

Order: 3-view ankle series→ don’t order a tib-fib view

77
Q

If a pt presents symptomatic and high clinical suspicion, what 2 things do you do?

A

(1) tx as a fracture and splint (2) have pt follow up w/ortho in 7-10 days (repeat x-ray may show cortical changes)

78
Q

What 7 things do you do when interpreting the x-ray?

A

(1) Open vs closed
(2) Anatomic location
(3) Morphology of fracture line
(4) Displacement (described in %)
(5) Distraction
(6) Angulation
(7) Rotation

79
Q

Overpenetrated x-rays show up ____, while underpenetrated x-rays show up ____.

A

Overpenetrated x-rays show up darker, while underpenetrated x-rays show up lighter.

80
Q

What is displacement?

A

The loss of normal anatomic position

81
Q

How is displacement graded?

A

Graded in terms of shaft width in quartiles in terms of position of the distal fragment to the proximal fragment

82
Q

Which direction of displacement does AP view describe?

A

Medial to lateral displacement

83
Q

Which direction of displacement does lateral view describe?

A

Anterior to posterior displacement

84
Q

T/F: displacement and angulation are the same thing.

A

False: you can have displacement w/o angulation and vise versa

85
Q

What is angulation?

A

A method of describing the alignment of long bones that have been affected by injury or disease

86
Q

What is a transverse fracture, what is it commonly caused by, and what is the most common location(s) of transverse fractures?

A

A fracture perpendicular to the long axis of the bone; commonly caused by direct force; most commonly located in forearm/leg

87
Q

What type of force are oblique fractures commonly caused by, and are they more or less stable than transverse fractures?

A

Indirect force; less stable than transverse

88
Q

What causes the shear force of oblique fractures?

A

Compression and angulation forces combine to cause shear force

89
Q

What causes a spiral fracture?

A

Twisting motion through the long axis- a result from rotation/shear forces

90
Q

Which type of fracture is the least stable of all?

A

Spiral fracture

91
Q

T/F: comminuted fractures contain more than 2 fracture fragments.

A

True

92
Q

What happens to produce a butterfly fragment?

A

An indirect force produces a bending of the bone w/resultant tension vector on the convex side and compression vector on the concave side

93
Q

What side is a butterfly fragment produced along?

A

Along the concave, compression side

94
Q

What is a greenstick fracture?

A

Incomplete fracture of a long bone→ produced on the convex cortex while concave cortex becomes bent w/o a visible crack

95
Q

Is a buckle fracture stable or unstable?

A

A very stable fracture

96
Q

Where does a buckle fracture typically occur and after what type of fall?

A

Typically occurs at metaphyseal diaphyseal junction after FOOSH

97
Q

What is an avulsion fracture caused by?

A

Caused by abnormal tensile stress on ligaments or tendons

98
Q

What are 3 locations of avulsion fractures?

A

Hands: dorsal distal phalanx w/extensor tendon avulsion
Feet: base of fifth metatarsal w/peroneus brevis avulsion
Pelvis: ischial tuberosity w/hamstring tendon avulsion

99
Q

What are the 2 suggested x-ray views for the AC joint?

A

(1) AP with weights

(2) AP without weights

100
Q

What are the 2 suggested x-ray views for the chest?

A

(1) PA

2) lateral (full inspiration

101
Q

What are the 2 suggested x-ray views for the clavicle?

A

(1) AP

2) oblique AP of the clavicle (15 degrees

102
Q

What are the 2 suggested x-ray views for the humerus?

A

(1) AP

(2) lateral

103
Q

What are the 2 suggested x-ray views for the SC joint?

A

(1) AP

2) obliques (bilat

104
Q

What are the 3 suggested x-ray views for the shoulder?

A

(1) AP
(2) Grashey
(3) Y-scapular view

105
Q

What are the 3 suggested x-ray views for the elbow?

A

(1) AP
(2) external oblique
(3) lateral

106
Q

What are the 3 suggested x-ray views for the fingers?

A

(1) AP
(2) oblique of hand
(3) lateral of affected finger

107
Q

What are the 3 suggested x-ray views for the hand?

A

(1) AP
(2) oblique
(3) lateral

108
Q

What are the 3 suggested x-ray views for the thumb?

A

(1) AP
(2) oblique
(3) lateral

109
Q

What are the 3 suggested x-ray views for the wrist?

A

(1) AP
(2) oblique
(3) lateral

110
Q

What are the 2 suggested x-ray views for the hip?

A

(1) AP pelvis

(2) frog lateral

111
Q

What are the 2 suggested x-ray views for the femur?

A

(1) AP

(2) lateral

112
Q

What are the 4 suggested x-ray views for the knee (under 40 y.o.)?

A

(1) AP
(2) lateral
(3) tunnel
(4) sunrise

113
Q

What are the 4 suggested x-ray views for the knee (over 40 y.o.)?

A

(1) bilat PA weight bearing (30 degree PA flexed view)
(2) bilat tunnel
(3) bilat sunrise
(4) lateral of affected knee

114
Q

What are the 2 suggested x-ray views for the tib-fib?

A

(1) AP

(2) lateral

115
Q

What are the 3 suggested x-ray views for the ankle?

A

(1) AP
(2) mortise
(3) lateral

116
Q

What are the 3 suggested x-ray views for the foot?

A

(1) AP
(2) oblique
(3) lateral

117
Q

What are the 2 suggested x-ray views for the heel?

A

(1) axial

(2) lateral calcaneus

118
Q

What are the 3 suggested x-ray views for the C-spine?

A

(1) AP
(2) lateral
(3) swimmer’s view

119
Q

What are the 2 suggested x-ray views for the T-spine?

A

(1) AP

(2) lateral

120
Q

What are the 4 suggested x-ray views for the L-spine?

A

(1) AP
(2) obliques
(3) lateral
(4) spot view

121
Q

What are the 3 suggested x-ray views for the sacrum/coccyx?

A

(1) AP
(2) axials
(3) lateral

122
Q

What are the 2 suggested x-ray views for the scoli survey?

A

(1) PA

(2) lateral

Clin Med 3- Exam 2 (15 decks)

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