MSK Complaints

Question 1

which 2 situations are considered an orthopedic emergency?

Answer 1

open fracture
neurovascular injury

Question 2

what are the 2 most common etiologies of open fractures and neurovascular injuries?

Answer 2

subluxation
dislocation

Question 3

how should xrays be done?

Answer 3

xray joint above and below the injury

Question 4

what should be done if a patient is suspicious for a fracture but there isn’t a visible fracture on the 1st day of injury? (2)

Answer 4

splint as if fractured
f/u for another xray in 7-10 days

Question 5

what S/S are highly suspicious for an extremity fracture? (3)

Answer 5

point tenderness
pain w/ PROM
pain w/ tuning fork test

Question 6

what is the first thing to check if a patient has an extremity fracture?

Answer 6

neurovascular status

Question 7

what should be done for an extremity fracture to immobilize the injured bone/joint and prevent pressure-related skin breakdown?

Answer 7

splint with plenty of padding

Question 8

what should be done for an extremity fracture if we attempt to reduce angulation, shorten, or displace the fracture while splinting?

Answer 8

repeat xray in splint + document

Question 9

what is the Salter Harris Fracture?

Answer 9

Straight through growth plate
Above growth plate
Lower than growth plate
Through everything
Ram/compression of growth plate

Question 10

when should all patients with an extremity fracture follow up with ortho?

Answer 10

within 2-3 days of fracture

Question 11

what can lead to a loss of full hand function in hand burns? (2)

Answer 11

healing process + scar tissue tightening

Question 12

what should we instruct the patient to do to expose possible tendon injuries of the hand?

Answer 12

fully flex and extend digits

Question 13

what type of injuries of the hands must always be repaired?

Answer 13

tendon injuries

Question 14

what kind of injury of the hand leads to dissection along planes of least resistance; the neurovascular bundles and facial planes?

Answer 14

high pressure injuries

Question 15

what is the treatment for a hand high pressure injury caused by air or water? (3)

Answer 15

tetanus
antibiotics
immobilization

Question 16

what is the treatment for a hand high pressure injury caused by things other than air or water? (4)

Answer 16

tetanus
antibiotics
immobilization
immediate debridement

Question 17

what is the treatment for a hand infection? (4)

Answer 17

drain pus
immobilize + elevate in position of function
antibiotics
admit for observation + ortho f/u

Question 18

a closed space infection of the flexor tendon sheath that is considered an orthopedic emergency

Answer 18

flexor tenosynovitis

Question 19

a patient presents with fusiform swelling, finger is held in slight flexion, they have pain with passive extension and pain w/ palpation. Dx?

Answer 19

flexor tenosynovitis

Question 20

what is the treatment for flexor tenosynovitis? (2)

Answer 20

IV antibiotics w/ elevation
emergency ortho consult

Question 21

a patient presents with back pain. what can indicate an infection (red flag)? (3)

Answer 21

fever
immune compromise
IV drug use

Question 22

a patient presents with back pain. what can indicate a fracture (red flag)?

Answer 22

recent trauma

Question 23

a patient presents with back pain. what can indicate cauda equina or central cord compression (red flag)? (5)

Answer 23

numbness of LE

saddle paresthesias

LE weakness/foot drop

bowel/bladder incontinence / retention

hyporeflexia

Question 24

a patient presents with back pain. what can indicate an aortic dissection/aneurysm (red flag)? (3)

Answer 24

abdominal pain
pulsating mass
upper back pain w/ neuro deficit

Question 25

a fast spreading, gas producing infection

Answer 25

necrotizing fasciitis

Question 26

what should be done if we suspect a patient has necrotizing fasciitis? (3)

Answer 26

outline cellulitis palpate for crepitus + severe TTP Xray / CT

Question 27

what is the most common treatment for necrotizing fasciitis?

Answer 27

amputation

Question 28

what is the treatment for an open fracture? (3)

Answer 28

cefazolin (1st gen) + gram (-) antibiotic tetanus schedule surgery

Question 29

which antibiotic should be used for a large open fracture/wound?

Answer 29

gentamicin (aminoglycoside)

Question 30

in a joint infection that is associated with an injury, how can you check if the joint capsule is compromised?

Answer 30

injecting sterile saline/methylene blue into capsule = no resistance

Question 31

what is the treatment for a joint infection? (2)

Answer 31

surgery + culture/arthrocentesis IV antibiotics

Question 32

a patient presents with a fever, erythematous joint that is warm, swollen, and has effusion. There is + pain with all ROMA and axial load, and the patient has an elevated WBC count. Dx?

Answer 32

joint infection

Question 33

what must all erythematous, warm, painful joints have before an infection is ruled out?

Answer 33

arthrocentesis

Question 34

what are the synovial results that indicate septic arthritis? (3)

Answer 34

looks purulent leukocytes > 50K + gram stain/culture

Question 35

what can compartment syndrome lead to?

Answer 35

necrosis

Question 36

where is compartment syndrome most common?

Answer 36

lower extremities

Question 37

what should be suspected in all crush injuries, fractures, and soft tissue injuries with severe pain?

Answer 37

compartment syndrome

Question 38

a patient presents with pain out of proportion, pain with passive stretch of muscle, paresthesia, pallor, poikilothermia, and pulselessness. Dx?

Answer 38

compartment syndrome

Question 39

what diagnostic can be used for compartment syndrome?

Answer 39

direct compartment pressure testing

Question 40

compartment syndrome treatment?

Answer 40

fasciotomy

Question 41

management for laceration? (3)

Answer 41

tetanus if > 5yrs clean with antiseptic closure

Question 42

what are 3 definitive closure options for a laceration? 2 temporary options?

Answer 42

glue staples suture suture gauze/occlusive dressing

Question 43

what are 3 abrasion considerations?

Answer 43

stop the bleeding assess depth and area assess cosmetic impact of wound

Question 44

management for abrasion? (2)

Answer 44

tetanus if > 5 yrs clean with antiseptic

Question 45

what is the treatment for an abrasion wound? (2)

Answer 45

antibiotic ointment iodoform bandage

Question 46

what may severe abrasions of palms and over joints require? why?

Answer 46

physical therapy avoid contractures + maintain ROM

Question 47

a patient presents with an animal bite and the animal was found. what is done?

Answer 47

animal services holds animal and monitors for disease

Question 48

what is the treatment for all bites? (3)

Answer 48

clean with antiseptic tetanus amoxicillin-clavulanate (augmentin)

Question 48

a patient presents with an animal bite but the animal cannot be found. what is done? (3)

Answer 48

1st rabies dose in ED rabies immunoglobulin in ED 2nd - 4th rabies dose in local clinic

Question 49

in a case of bite, what are the only 2 places to do closure d/t high vascularity and cosmesis?

Answer 49

face scalp