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Musculoskeletal > Musculoskeletal in the ER > Flashcards

Musculoskeletal in the ER Flashcards

1
Q

Most common Musculoskeletal symptom in the ER

A

Pain

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2
Q

Most common joints seen in order

A

AWKHSE

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3
Q

Most common ankle injury

A

Lateral INVERSION

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4
Q

Treatment of ankle sprain

A

PRICE…protection, rest, ice, compression, elevation

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5
Q

The vast majority of ankle fractures are what type?

A

Malleolar

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6
Q

Complications of ankle fractures

A

joint space disruptions, dsilocation, soft tissue necrosis, nerve damage, arterial damage

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7
Q

Dislocation pressuring skin needs what?

A

REDUCTION ASAP. (reduction= putting it back in place) to avoid necrosis of the overlying skin.

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8
Q

Loss of arterial blood supply is what

A

SURGICAL EMERGENCY

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9
Q

Most common type of wrist injury

A

fracture of radius, or ulna, or carpal bones, due to fall on outstretched hands

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10
Q

Most common fracture of the wrist=

A

Colles fracture at the distal radial metaphysis

Usually a proximal and dorsal displacement, creating a “dinner fork deformity”

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11
Q

70% of ppl with an ACL tear report what

A

Hearing an audible pop at the time of injury. Very good clue.

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12
Q

Most ligamentous injuries of the knee present with>

A

hemarthoses (blood in the joint)

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13
Q

75% of hemarthroses are caused by?

A

Disruption of the ACL

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14
Q

Hip fractures are twice as common in women and one-third more common in whites

A

yes

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15
Q

90% of hip fractures in the elderly are associated with simple fall from standing position. What is the reason of the fall in most cases?

A

Femoral neck breaks

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16
Q

What is teh sign that a hip fracture is displaced?

A

The leg is shortened and rotated externally

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17
Q

What is the most severe risk for hip fracture

A

DVT in the leg

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18
Q

Only 1% of pts with back pain have sciatica, but 95% of ppl with back pain due to disk herniation have sciatica

A

true

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19
Q

Cauda equina syndrome is

A

compression of the cauda equina causing some low back pain, leg weakness, bladder dysfunction, saddle anesthesia, fecal incontinence, sexual dysfunction

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20
Q

Incomplete cauda equina syndrome is

A

altered urinary sensation, loss of desire to void, poor urinary stream. must strain to micturate

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21
Q

Complete cauda equina syndrome

A

painles urinary retention, overflow incontinence, inability to pass urine

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22
Q

Signs of cauda equina syndrome

A

bladder distension, decreased anal tone, absent ankle, knee reflex, saddle anethsia, BILATERAL Sciatica

23
Q

All pts with Cauda Equina syndrome have

A

500 ml urinary retention

24
Q

Opioid pain relievers account for more overdose deaths than heroin and cocaine combined

A

truth

25
Q

NEcrotizing fascitis usually spreads how?

A

along muscle fascia due to relatively poor blood supply

26
Q

What is the definition of necrotizing facitis?

A

rare, acute, progressive destruction of muscle fascia and overlying subcutaneous fat

27
Q

Histologic manifestations of necrotizing fasciitis?

A

coagulative necrosis+ acute inflammation + nuclear dust+ hemorrhage

28
Q

Skin color changes from red to purple to?

A

blue grey

29
Q

Most common site of necrotizing fasciitis

A

legs

30
Q

After the legs, the next most common site of necrotizing fasciitis is?

A

Perineum

31
Q

Subcutaneous gas is characteristic of what type of necrotizing fasciitis?

A

Type 1 (aerobes+ anaerobes= polymicrobial)

32
Q

Compartment syndrome

A

Occurs when increased pressure within a compartment compromises the circulation within that space.

33
Q

Compartment syndrome often follows?

A

Trauma. Long bone fractures in the leg or forearm

34
Q

Symptoms of compartment syndrome

A

Pain out of proportion to injury, deep ache or burning, parasthesias

35
Q

Signs of compartment syndrome?

A

Pain with passive stretch of muscles in the affected compartment.
Tense compartment with a firm wood-like feeling
Diminished sensation
Muscle Weakness

36
Q

Normal compartment pressure is

A

0-8 mmHg

37
Q

Pain in a compartment develops when pressure hits

A

20-30 mmHg

38
Q

Capillary blood flow through that compartent becomes compromised when?

A

tissue pressure increases to within 25 mmHg of mean arterial pressure

39
Q

A perfusion pressure of less than 30mmHg =

A

do something

40
Q

What is clostridial myonecrosis

A

Gas gangrene

41
Q

Clostridial myonecrosis is:

A

a life threatening muscle infection from a contiguous area of trauma or hematogenous muscle seeding from GI tract

42
Q

2 major forms of clostridial myonecrosis are?

A

traumatic and spontaneous

43
Q

Traumatic clostridial myonecrosis is most commonly caused by

A

C. Perfringens

44
Q

Spontaneous clostridial myonecrosis most commonly caused by

A

C. Septicum

45
Q

C. Perfringens virulence factors

A

Alpha Hemolytic toxin: causes platelett aggregation and also is a negative ionotrope (inhibits cardiac pumping). The alpha toxin causes rapid decline in muscle blood flow and ischemic necrosis due to the formation of occlusive intravascular masses of activated pateletts
ALSO, the alpha toxin is the reason neutrophils can’t get into the infected tissue, Alpha toxin makes them bind to the endothelium.
Theta toxin:

46
Q

What is rhabdomyolysis

A

A condition of muscle necrosis and release of intracellular muscle constituents into the circulation.

47
Q

Classic rhabdo triad?

A

muscle pain, weakness, dark urine

48
Q

Symptoms of rhabdo outside of the triad

A
  • pain is typically in shoulders and thighs, lower back and calves
  • Reddish brown urine in half of cases
  • Remember that many cases are asymptomatic
  • muscle swelling with rehydration
  • muscle tenderness may be present
  • muscle weakness can occurr
  • many patients have no signs of rhabdo
49
Q

Top 3 causes of rhabdo

A

trauma
Exertion
Miscellaneous- toxins, infections, meds

50
Q

The hallmark lab finding of Rhabdo is

A

elevation in serum muscle enzymes, particularly creatine kinase which is usually five times the upper limit of normal

51
Q

Myoglobinuria presents in 50-75 % of cases

A

It is positive for blood on urine dipstick but without red blood cells on microscopic urine exam

52
Q

What can myoglobin do to the kidneys?

A

Can clog the renal tubules leading to acute renal failure

53
Q

Treatment for compartment syndrome

A

Fasciotomy

Musculoskeletal (23 decks)

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