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Ortho Flashcards

1
Q

What is the most common accident and cause of hospitalization in pts > 65 yo?

A

Falls

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2
Q

What is the most common primary bone cancer of childhood?

A

Osteosarcoma

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3
Q

How do x-rays look in a pt who has osteosarcoma?

A

Moth eaten
Sunburst
Codman triangle
Fluffy

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4
Q

What is the gold standard diagnostic test for osteosarcoma?

A

MRI

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5
Q

What is the 2nd most common primary malignant bone tumor that mostly affects adolescents?

A

Ewing sarcoma

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6
Q

What appearance does Ewing sarcoma have on x-ray?

A

Onion skin

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7
Q

What is the gold standard diagnostic test for Ewing sarcoma?

A

CT guided core-needle biopsy

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8
Q

What is the 3rd most common primary malignancy of bone that primarily affects pts > 50 yo

A

Chondrosarcoma

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9
Q

What is the gold standard diagnostic test for chondrosarcoma?

A

Core-needle biopsy

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10
Q

What symptoms might direct you to consider that a pt may have metastatic bone tumors?

A

Progressive pain that is unresponsive to typical MSK treatment
Night pain
Weight loss
Pain w/weight bearing

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11
Q

Where do most bone mets originate from?

A

Breast
Prostate
Lung cancer

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12
Q

What is the classic symptoms of osteoid osteoma?

A

Severe intermittent pain at night that is relieved with NSAIDs

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13
Q

Does osteoid osteoma become malignant?

A

No

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14
Q

What is the gold standard diagnostic test for osteoid osteoma?

A

CT

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15
Q

What is the curative treatment for osteoid osteoma?

A

Surgical excision

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16
Q

What is the most common mesenchymal tumor of the human body?

A

Lipoma

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17
Q

What are the most common signs/symptoms of a lipoma?

A

Rubbery mass that grows slowly

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18
Q

What size lipoma would you get imaging for?

A

> 10cm

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19
Q

What % of lipomas return even if surgically removed?

A

50%

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20
Q

What presents with anterior shoulder pain that gets worse with activity and has a popping sensation when reaching behind or overhead?

A

Bicipital tendinitis

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21
Q

What presents with a decreased ROM in the shoulder, weakness, pain that is ongoing for months, has a “grating” or “catching” sensation, and has pain when reaching or lying on the affected side?

A

Rotator cuff disorder

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22
Q

What muscles are part of the rotator cuff?

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

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23
Q

What is the imaging of choice for a rotator cuff disorder?

A

MRI

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24
Q

What can occur in a pt that has prolonged immobilization of the shoulder?

A

Frozen shoulder

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25
Q

What presents as lateral elbow pain that is worse with lifting, gripping, and wrist twisting motion?

A

Epicondylitis

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26
Q

What presents with pain over the olecranon process?

A

Olecranon bursitis

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27
Q

What are the signs/symptoms of a nursemaid’s elbow?

A

Child < 5 yo
Acute elbow pain that rapidly subsides
Reluctance to use injured arm
Positive “popsicle test”

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28
Q

How do you treat a pt with a nursemaid’s elbow injury?

A

Manual manipulation

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29
Q

What is the difference between tennis elbow and golfer’s elbow?

A

Tennis: lateral epicondylitis
Golfer: medial epicondylitis

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30
Q

How does carpal tunnel occur?

A

The median nerve is compressed through the carpal tunnel

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31
Q

What 2 diagnostic tests will be positive in a pt with carpal tunnel?

A

Phalen
Tinel

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32
Q

What presents with pain at the base of the thumb that gets worse with abduction?

A

De Quervian’s tenosynovitis

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33
Q

What test will be positive in a pt with De Quervian’s?

A

Finkelstein

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34
Q

What fingers are commonly affected by trigger finger?

A

1st (thumb)
2nd (index)
3rd (middle)

35
Q

What are the signs/symptoms of trigger finger?

A

Progressively more frequent “locking” of the finger in the flexed position without a preceding injury

36
Q

What commonly affects the 4th (ring) and 5th (pinky) finger and presents with fingers flexed toward the palm?

A

Dupuytren’s contracture

37
Q

What presents with lateral hip pain that increases with walking, running, or lying on the affected side and does NOT radiate below the knee?

A

Trochanteric bursitis

38
Q

What presents after a twisting injury to the knee that gets worse with going up/down stairs, and “pops” and “clicks” with flexion/extension?

A

Meniscus tear

39
Q

What is the most common synovial cyst in the knee?

A

Baker’s cyst

40
Q

What diagnostic test will be positive in a pt with a meniscus tear?

A

McMurray’s
Thessaly

41
Q

How do collateral ligament injuries occur?

A

ACL: deceleration injury w/immediate “pop”/pain
MCL: valgus force (knees go towards each other)
LCL: varus force (knees away from each other)

42
Q

How are collateral ligament injuries graded?

A

Grade I: < 5mm joint space opening
Grade II: 5-10mm joint space opening
Grade III: > 10mm joint space opening

43
Q

What grade collateral ligament tears require surgical reconstruction?

44
Q

What is the Ottawa criteria?

A

Used to determine if imaging should be done for an ankle injury
1. inability to bear weight AND/OR
2. direct bony tenderness of the medial or lateral malleolus

45
Q

How many of the Ottawa criteria must be met to get an x-ray for an ankle injury?

46
Q

What are the classic symptoms of plantar fasciitis?

A

Pain to the arch of the foot/heel that is the worst with the 1st step of the day, improves with walking, and worsens at the end of the day

47
Q

What disorder occurs when there is more osteoclast activity (bone breakdown) than osteoblast (bone building) activity?

A

Osteoporosis

48
Q

When do you start screening pts for osteoporosis?

A

Women at 65 yo
Men at 70 yo

49
Q

What tests are used to screen for osteoporosis?

A

DEXA (bone density) scan
FRAX (fracture risk assessment score)

50
Q

Most ortho disorders/injuries are treated conservatively first with what?

A

Tylenol/NSAIDs
Therapy/activity mods
Steroid injections
RICE

51
Q

What is the treatment for osteoporosis?

A

Decrease fracture risk
Bisphosphonates, hormones/SERMs
Lifestyle: calcium, Vit D3, weight bearing exercise, fall prevention

52
Q

What is the 2nd most common bone remodeling disease?

A

Paget’s disease

53
Q

What disorder is commonly described as “softening” of the bone?

A

Osteomalacia

54
Q

What is the gold standard diagnostic test for osteomalacia?

A

Bone biopsy

55
Q

What is the most common ortho injury and what typically causes it?

A

Distal radius fracture
FOOSH

56
Q

What is the most common carpal fracture and presents with anatomic snuffbox tenderness?

A

Scaphoid fracture

57
Q

What presents with pain to the thumb and inability to pinch/grasp and is commonly seen in those who play soccer and football?

A

Thumb collateral ligament injury (gamekeeper’s thumb)

58
Q

What bone is injured in someone with a boxer’s fracture?

A

5th metacarpal neck

59
Q

What is the 3rd most common non-vertebral fracture in pts > 65 yo?

A

Proximal humerus fracture

60
Q

What injury is common in runners and military personnel due to overuse and repetitive stress?

A

Tibial shaft stress fracture

61
Q

What is the most common ortho disorder in newborns?

A

Developmental dysplasia of the hip (DDH)

62
Q

What tests are used to test for developmental dysplasia of the hip?

A

Barlow or Ortolani

63
Q

What diagnostic tests/tools are used for developmental dysplasia of the hip?

A

Screening at < 3 months old
Ultrasound (birth - 4 months)
Xray (> or = 4-6 months)
MRI arthrogram (adolescents & above)

64
Q

What is the most common disorder that affects adolescent hips?

A

Slipped capital femoral epiphysis (SCFE)

65
Q

What are the signs/symptoms of slipped capital femoral epiphysis (SCFE)?

A

Atraumatic
Pain lasting months
Knee pain
Abnormal gait/limp
Obligatory external rotation during passive flexion of the hip (Drehmann sign)

66
Q

What Cobb angle is diagnostic for scoliosis?

67
Q

What is the treatment for scoliosis?

A

< 20* curve: observation
20-50* curve: bracing
> 50* curve: surgery

68
Q

What is the most common cause of neck/back pain that presents to primary care?

A

Mechanical (muscular) neck and back pain

69
Q

What should you assess for in all pts who present for back pain?

A

Cauda equina syndrome

70
Q

What is commonly caused by a herniated/bulging lumbar intervertebral disc?

71
Q

What are the signs/symptoms of sciatica?

A

Mechanical lower back pain with “burning” pain to the buttocks
Radiation of pain down the lower extremity to the foot

72
Q

What presents with an increase in the forward curvature of the spine beyond normal range and pt may appear to have a rounded or humped deformity of the upper back?

73
Q

What is the gold standard diagnostic test for kyphosis?

74
Q

What Cobb angle is diagnostic for kyphosis?

75
Q

What is the treatment for kyphosis?

A

60* or <: conservative
> 75: surgery
Adolescents w/ > 60: back brace

76
Q

What are the 3 types of kyphosis?

A

Postural kyphosis (starts in adolescence)
Scheuermann disease (starts before puberty)
Congenital (starts at birth)

77
Q

What are the normal ranges of motion?

A

Flexion: 90*
Extension: 30*
Lateral side bending: 30*
Rotation: 30*

78
Q

What presents with upper/lower back pain that improves with rest and spine flexion and worsens with ambulation & spine extension?

A

Spinal stenosis

79
Q

What is the gold standard diagnostic test for spinal stenosis?

80
Q

What other disorder presents with similar symptoms as sciatica?

A

Herniated disc

81
Q

What is the gold standard diagnostic test for a herniated disc?

82
Q

What presents with saddle anesthesia and loss of bowel/bladder function and is a medical emergency?

A

Cauda equina syndrome

83
Q

What is the gold standard diagnostic test for cauda equina syndrome?

A

Urgent MRI

84
Q

What is the treatment for cauda equina syndrome?

A

Prompt neurosurg/ortho consult for decompression

Clin Med (15 decks)

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