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Precision > MSK/EENT > Flashcards

MSK/EENT Flashcards

1
Q

Achilles tendon rupture clinical intervention

A

Non operative - serial splinting in mild plantar flexion with subsequent splinting w/ gradual dorsiflexion towards neutral

Operative - reattachment allowing for early range of motion

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2
Q

Acute compartment syndrome (FMLD)

A

MC after fxr of LONG BONES, crush injuries, tight casts/pressure dressings, thermal burns

Pain out of proportion to injury (persistent/deep/burning)

Increased compartmental pressure>30-45

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3
Q

Boxers fracture (scientific concepts)

A

Fx at neck of 5th metacarpal

Mechanism: punching with a clenched fist. If at base of thumb look at associated carap injuries

If bite wound - treat with AUGMENTIN

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4
Q

Cervical spine injury - 2 types

A

C1- Jefferson burst fracture vertical compression on atlas “ thomas jefferson was the first president and patted peopleon the head”

C2 - Hangmans - hyperextension then flexion axis pedicle

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5
Q

Complication of orthopedic device (clinical intervention)

A

Removal of hardware

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6
Q

Congenital talipes equinovarus (clinical intervention)

A

Ponseti method of serial manipulation and casting

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7
Q

Fingernail contusion dx and labs

A

Perform xray on finger with subungal hematoma if hematoma is >50% of nail to evaluate for phalanx fracture

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8
Q

Dermatomyositis (FMLD)

A

Progressive symmetric proximal muscle weakness + decreased muscle strength + GOTTRONS papules + helitrope rash

Anti-jo1 and AntiMi-2 antibodies

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9
Q

Joint effusion, knee (Hx and PE)

A

Bulge sign, ballottment (in increased patella waving motion or spongy joint feeling)

patellar tap test

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10
Q

Jones fracture (foot) FMLD

A

Transverse fracture through diaphysis of 5th Metatarsal @ metaphyseal diaphseal junction

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11
Q

Hip fracture (pharm therapeutics)

A

Prophylaxis = Ancef (first gen cephalosporin) + morphine + ketorlac

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12
Q

Radius wrist fracture clinical intervention

A

Closed reduction with sugar tong splint

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13
Q

Gout is a problem with what type of molecule?

A

Purine

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14
Q

Compound that precipitates into synovial fluid?

A

Sodium urate

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15
Q

When to do nail trephenation?

A

Evacuation via trephination or nail removal if >25% OR painful

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16
Q

Ankle dislocation clinical intervention

A

Closed reduction + posterior splint +/- ORIF in severe cases

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17
Q

Joint dislocation, shoulder (dx and labs)

A

Xray = X & Y axillary

Must r/o axillary nerve injury (pinprick sensation over deltoid)

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18
Q

Anterior shoulder joint dislocation (scientific concepts)

A

Mechanism = Blow to an abducted externally rotated arm that is extended

Anterior dislocation - MC shoulder dislocation

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19
Q

Lateral epicondylitis (scientific concepts)

A

Occurs at tendinous insertion of extensor carpi radialis brevis

Extra crispy red beautiful apples

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20
Q

Lumbar spondylosis with myelopathy (dx and labs)

A

Radiographs, CT scan, MRI used in events of complications

DEXA scan

Ensure no osteophytes

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21
Q

MCL injury (scientific conepts)

A

Mechanism = Blow to outside of knee

Femoral attachment is to medial epicondyle

Tibial attachment are semimembranosus muscle and posteromedial tibia

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22
Q

Meralgia paresthetica (clinical intervention)

A

Thigh tingling = lateral femoral nerve entrapment

Wt loss, loose clothing, focal nerve block at inguingal ligament with a combo of lido + steroids

Surgical decompression

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23
Q

C5 nerve injury (hx and PE)

A

Cervical radiculopathy with bone spurs or disc herniation

PE = weakness in deltoid (shoulder ABduction)
Bicep (elbow flexion)
Loss of bicep jerk reflex

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24
Q

Osteomyelitis (scientific concepts)

A

Inflammation/infection of bone

RF = Sickle cell = Salmonella
Hip = MC in children

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25
Q

Pagets dz of bone (FMLD)

A

Abnormal bone remodeling markedly elevated alk phos

Skull enlargement + COTTON WOOL appearance + deafness

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26
Q

Pes Anserine bursitis (FMLD)

A

Inflammation of bursa locate between shinbone (tibia) + 3 tendons of hamstring muscles at inside of knee

Pain occurs when arising from seated position at night or with ascending/descending stairs, local swelling

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27
Q

Posterior tibial tendon dysfunction (FMLD)

A

Player of high-impact sports

Pain + Swelling to medial foot and ankle; flattened arch “too many toes sign”

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28
Q

Pyogenic arthritis/Septic arthritis (Pharmaceutical tx)

A

Empiric abx therapy
G+ cocci = vanco
G - = Ceftriaxone

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29
Q

Rhabdo (pharm interventions)

A

IV saline, mannitol, bicarb, calcium gluconate

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30
Q

RA (pharm interventions)

A

Methotrexate = 1st line
Nsaids for pain control
Steroids if no relief with NSAIDS

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31
Q

What is the best view to assess SCFE and what is usually seen?

A

Best view = Frog leg lateral pevlis or lateral hio

Seen = Posterior and medial displacement of epiphysis

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32
Q

Spondylolisthesis

A

Forward slipping of vetebra on another on imaging from bilateral defect/fracture of pars

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33
Q

Synovial cyst (hx taking + PE)

A

MC in lumbar region of spine
+/- back/leg pain thats better with sitting, worse with standing/walking

Associated with age related degeneration (65+)

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34
Q

Thoracic outlet syndrome (FMLD)

A

Ulnar neuropathy + swelling/discoloration of arm with abduction of arm in affected side

ADSON sign = loss of radial pulse with head rotated to affected side

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35
Q

Torus fracture (FMLD)

A

Aka buckle fracture

Pediatric patient s/p fall with a “wrinkling/bump” on xray of distal radius

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36
Q

Open foot wound (Dx + Labs)

A

Labs - CBC, BMP, coag studies

Tissue culture

Dx - XR, CT, MRI
Vascular US = evaluate blood flow or occlusions
T99 = for osteo eval

37
Q

Acoustic neuroma (Dx and labs)

A

MRI = Imaging of choice

Audiometry = Lab of choice

This is unilateral sensorineural hearing loss**

38
Q

Acute narrow angle closure glaucoma (scientific concepts)

A

OPTHO EMERGENCY

Increased IOP = Optic nerve damage = Decrease in visual acuity

Decreased drainage of aquous humor via trabecular meshwork and canal of schlemm in patients with preexisting conditions

Leading cause of preventable BLINDNESS in the US

Factors: Dim lights, sympathomimetics, anticholinergics

39
Q

Acute narrow angle closure glaucoma (Pharm tx)

A

Azetazolamide = first line to decrease IOP

Timolol reduces IOP without affecting vision

40
Q

Acute sinusitis (dx and labs)

A

Mainly clinical sx (present less than 1 week(

CT w/o contrast = test of choice
Sinus radiographs = order WATERS view

41
Q

Amarousis Fugax (FMLD)

A

Temporar MONOCULAR vision loss lasting minutes with complete resolution

Due to retinal emboli or ischemia; temporary “curtain” that resolves within 1 hr

42
Q

Ambylopia (Hx and PE)

A

Hx of lazy eye and reduced vision in one eye caused by abnormal visual development early in life

Amblyopia (also called lazy eye) is a type of poor vision that usually happens in just 1 eye but less commonly in both eyes.

43
Q

Barotrauma (pharm tx)

A

Abx only if tympanic membrane is rupture + middle ear contaminated = Cipro/Ofloxacin

NSAIDS for pain relief

No evidence that steroids speed recovery

44
Q

BPPV (Hx + PE)

A

Recurrent episodes of sudden episodic peripheral vertigo <60sec. provoked with specific head movement

NO HEARING LOSS; tinnuts or ataxia; +/- NV

45
Q

Central retinal artery occlusion (FMLD)

A

Acute, sudden monocular vision loss preceded by amaurosis fugas

Pale retina with cherry-red macula (red spot) “box car” appearance of retinal vessels

MC in 50-80yo with atherosclerotic dz

46
Q

Cholesteatoma (scientific concepts)

A

Abnormal keritinized collection of desquamated squamous epithelium causing mastoid bony erosion

MC due to ET dysfunction = CONDUCTIVE hearing loss

47
Q

Conductive hearing loss (FMLD)

A

Weber = Lateralized to affected ear
Rinee = Bone greater than Air

Etiologies: cerumen, foreign body, otitis, cholesteatoma

48
Q

Conjunctivitis neonatal (scientific concepts)

A

Day 1 = Chemical due to silver nitrate
Day 2-5 = Gonococcal
Day 5-7 = Chlaymydia

49
Q

Dacrocystitis (FML)D

A

Infection of lacrimal sac, tearing, tenderness, edema and redness to medial canthal side of lower lid (+/- purulent)

50
Q

Diabetic retinopathy (scientific concepts)

A

MCC of new permanent vision loss/blindness in 25-74
1. Nonproliferative = Microaneurysms aka blot and dot hemorrhages, flame shaped hemorrhages, cotton wool spots, hard exudates

  1. Proliferative = Neovasculatization
  2. Maculopathy= macular edema or exudates, nblurred vision, central vision loss. Can occur at any stage
51
Q

Diptheria (health maint + prevention)

A

Prophy = Erythromycin 7-10days or PCN G x 1 dose

Prevention = DTap at 2,4,6,15-18mo and 4-6yo booster

52
Q

Diptheria (pharm tx)

A

Diptheria antitoxin (horse serum) + erythrymycin or pcn G for 2 weeks

Clinda or Rifampin are alternatives

PCNM + Aminoglycoside for endocarditis

53
Q

Diptheria pharyngitis (scientific concepts)

A

Caused by Gram (+) rod Corynebacterium

rare due to vaccine

Transmission = resp secretions

54
Q

Drug effect adverse from intranasal steroids

A

Rhinitis medicamentosa = MC = rebound congestion if used more than 3-5 days

55
Q

Epidemic keratoconjunctivitis (scientific concepts)

A

MCC = Adenovirus types 8.19.37

Inflammatory response that involves conjunctiva + superficial cornea

56
Q

Maxillary orbital fracture (FMLD)

A

Fx to orbital floor as result of trauma

Decreased visual acuity, diplopia with upward gaze if INFERIOR RECTUS MUSCLE ENTRAPMENT

Eyelid swelling after blowing nose

57
Q

Glaucoma (Pharm tx)

A

First line = Prostaglandin analogs like Lantanoprost

Can use Brimonidine or carbonic anyhydrase inhibitors like acetazolamide

58
Q

Hypertensive retinopathy (hx + pe)

A

Longstanding hx of HTN

Fundoscopic exam = Decreased cup to disc ratio

AV Nicking
Flame Hemorrhages
Papilledema = Seen at end stage = MALIGNANT HTN

59
Q

Superficial keratitis (clinical intervention)

A

Topial abx; DO NOT patch eye

60
Q

Larynx cancer (clinical intervention)

A

Surgical resection +/- chemo/radiation

61
Q

Macular degeneration (scientific concepts)

A

MCC of PERMEANENT LEGAL BLINDNESS

Central vision loss = Seen on Amsler grid

62
Q

Malignant otitis externa (Scientific concepts)

A

Invasive infection of external auditory canal and skull base (temporal bone, soft tissue)

COMPLICATION OF OTITIS EXTERNA

MCC = psuedomonase; MC in elderly +/- immunocompromised

63
Q

Mastoiditis (clinical intervention)

A

Acute = Myringotomy and +/- tympanostomy

Refractor or complicated = Mastoidectomy

64
Q

Nasal polyps (Pharm tx)

A

Intranasal steroids = Treatment of choice

Surgical removal if tx unsuccessful

65
Q

Open angle glaucoma (hx + pe)

A

Slow progressive, painless bilateral peripheral vision loss

Asymptomatic until vision is loss - Tunnel vision progressing to central vision loss

PE = Increased IOP and cup/disc ratio

66
Q

Optic neuritis (FMLD)

A

Loss of color vision, visual field defects, loss of vision over a few days (usually unilateral), associated with ocular PAIN WORSE WITH EYE MOVEMENT

Marcus Gunn Pupil = Relative afferent pupil defect

May need MRI; Usually clinical dx

67
Q

Oral hairy leukoplakia (scientific concepts)

A

Caused by EBV virus

MC in immunocompromised

NOT considered cancerous

68
Q

Orbital cellulitis (FMLD)

A

Usually secondary to sinus infection (ETHMOID)

MC in children 7-12

Decreased vision, pain with eye movements, proptosis, eyelid erythema and edema around orbit

69
Q

Orbital cellulitis (dx + labs)

A

High resolution CT of orbits WITH IV contrast

70
Q

Periorbital cellulitis (FMLD)

A

Infection of eyelid and periocular tissue; May have ocular pain and swelling; NO pain with ocular movements

71
Q

Peritonsillar abscess (Dx +labs)

A

CT scan = 1st line to differentiate between cellulitis and abscess

MCC = Group A betahemolytic strep, staph, anaerobes

72
Q

Peutz-Jerghens Syndrome (hx + pe)

A

Autosomal dominant

First presentation often from bowel obstruction secondary to intussusception from polyps

Dark blue, brown, black macules on lips, perioral areas, buccal mucosa, eyes, nostrils, fingertips, palms, perianal areas

73
Q

Recurrent sinusitis (dx + labs)

A

Biopsy or histology is diagnostic rest of choice to identify organism and appropriate tx

74
Q

Retinal detachment (scientific concepts)

A
  1. Rhegmatgenous = MC = Retinal tear - Retinal inner sensory layer detaches from choroid plexus

2.Traction = Adhesions separate from retina from its base

  1. Exudative = fluid accumulates beneath retina and deatement from HTN, CRVO, papillaedema
75
Q

Retinal detachment (dx + labs)

A

Fundoscopy = Retinal tear/detached tissue flopping in vitreous humor

+Shafers sign

76
Q

Retinal detachment, Spontaneous (hx + pe)

A

Curtain coming down over vision, flashing lights,floaters, NO pain or redness

Fundoscopy = Retinal tear/detached tissue flopping in vitreous humor

+Shafers sign (tobacco dust in anterior vitreous humor)

77
Q

Retinitis (scientific concepts)

A

Threatens vision by damaging retina

REtinitis pigementosa = genetic

CMV retinitis = CMV herpes virus

78
Q

Sialadenitis (scientific concepts)

A

Bacterial infection of parotid or submandibular salivary glands

May be due to dehydration or chronic illness

Staph = MC organism

79
Q

Sialadenitis (Hx + PE)

A

Acute pain and swelling near gland with meals; local pain, dysphagia, trismus, May develop fever/chills if severe

80
Q

Soft tissue traumatic injury (clinical intervention)

A

If contusion of the pinna or nasal fracture with septal hematoma = Blood requires drainage

81
Q

Strep pharyngitis (pharm tx)

A
  1. PCN G or VK, Amox, Amox/Clauv
  2. Macrolides of PCN allergy
  3. Other alternatives = Clindamycin or Cephalosporins
82
Q

Thyroglossal duct cyst (FMLD)

A

Mobile midline neck mass near hyoid bone ranging from asx to abscess w/ draining sinus

Elevates with tongue protrusion or swalloing

US = Ideal initial imaging of mass and thyroid

83
Q

Torus palatines (clinical intervention)

A

Refer to maxofacial surgeon (Bony growth on the roof of the mouth)

84
Q

Uveitis (hx + pe)

A

Hx of systemic inflammatory disease (HLA-B27, sarcoid etc)

Infectious CMV, toxoplasmosis, TB, Truama

PE = Ciliary injection (limbic flush), Consensual photophobia, vision changes

85
Q

Uveitis (pharm tx)

A
  1. Anterior = Topical steroids
  2. Posterior = Systemic steroids
86
Q

Uveitis (iritis) (FMLD)

A

Anterior = Inflammation of iris or ciliary body; unilateral ocular pain/redness/photophobia; Usually occurs w/ blunt trauma

Posterior = Choroid inflammation; blurred/decreased vision, floaters, absent sxs of anterior involvement; NO pain

87
Q

Vasomotor rhinitis (pharm tx)

A

Oral antihistamines, decongestants, intranasal steroids, mast cell stabilizers, anticholinergics

88
Q

Vitreous hemorrhage (hx and pe)

A

Blurred vision: floaters, faint cobweb like appearance through the visual vield

Reddish tint to vision, photopsia = brief flashes of light in peripheral

Precision (5 decks)

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