ortho Flashcards
is RA or OA pain worse in the morning?
RA
joints in the hand affected by OA
DIP (Heberden) and PIP (Bouchard)
the MCP joints of the hand are usually spared, except one…
the thumb
mild and non inflammatory OA, first line therapy?
Acetaminophen, if it fails move to NSAIDS
what joint is usually spared in RA?
DIP
name two labs that are not specific but usually positive in RA?
Rheumatoid factor (RF) and anti-CCP antibodies CPR and ESR will most likely be elevated
what is seen on X-ray of RA joints
juxta-articular demineralization
two classes of medical treatment for RA?
NSAIDS and DMARDs (methotrexate, steroids, antimalarials, etanercept, rituximab, infliximab
Explain a Lisfranc fx
Junction of the 2nd metatarsal and cuneiforms leading to unstable arch of foot
Dancers Fx
allusion of 5th MT
do heel spurs develop b/c of Plantar Fascitis
no-separate process
what type of injuries cause achielle’s ruptures?
jumping/explosion, fluoroquinalone and steroids
how remember tennis elbow
Lively Exciting Tennis= Lateral epicondylitis w/ extensors
how to remember gofers elbow
Mundane Foul Golf=Medial epicondylitis w/flexors
what would you see on X-ray of a supracondylar humerus fracture.
The most common elbow fracture in pediatric trauma is supracondylar humerus fracture. Occult supracondylar fracture may present with a posterior fat pad and/or positive sail sign (distended anterior fat pad) on the lateral x-ray study of the elbow
A 45 year old carpenter presents to your clinic complaining of right shoulder pain that is worse in the evenings. On physical exam he has pain on range of motion, a positive Neer’s and Hawkins tests, but strength appears to be normal bilaterally. What is the initial diagnostic test that should be ordered in this patient?
x-ray for suspected subacromial impingement, then move on to MRI
A 23 year old male was admitted to the hospital following a motor vehicle accident. He sustained a crush injury to his left leg and was kept as a precaution since otherwise he seemed to be stable. You are rounding on him on day three, and he is complaining of severe pain in his left leg. Which of the following findings would suggest the absence of compartment syndrome in this patient?
Compartment syndrome is often described using the ‘5 P’s’: pulselessness, paralysis, paresthesias, poikilothermia, and pallor - and one could add pain out of proportion to visible injury. A finding of intact pulses decreases one’s suspicion for compartment syndrome.
A patient who has recently begun treatment for systemic lupus erythematosus with hydroxychloroquine, what is the most likely side effect?
Night vision, macular degeneration
What is the most common side effect associated with Colchicine?
GI side effects
Jefferson’s fracture involves which of the following bones?
Jefferson’s fracture is a fracture of C1
Which of the following is the most common side effect of methotrexate?
Stomatitis
What anatomic abnormality may predispose a person to develop impingement syndrome or rotator cuff tendonitis?
type 2 or type 3 acromion processes however, the underside of the acromion is not flat, but curved or hooked respectively and thus may predispose a patient to those conditions.
Joint fluid analysis revealing negatively birefringent crystals, is a finding of?
Gout
joint abnormality that follows an viral upper respiratory infection?
Transient synovitis
name the fracture of the distal radius with dislocation of distal radioulnar joint and an intact ulna.
Galeazzi fracture-dislocation
Which of the following is the most common site affected by osteoarthritis?
the knee
This joint fluid analysis is most consistent with RA.
Turbid yellow fluid with low viscosity WBC 2500 52% Neutrophils Crystals - absent Glucose low Culture - negative
Sensation in which of the following places would indicate that sensory function is intact for median, radial, and ulnar nerve distributions?
First dorsal web space, the thenar eminence, and the 5th digit
The radiographic finding of a ‘Collar on the Scottie Dog’ on oblique view of a lumbar spine xray indicates which condition?
Spondylolysis reveals the ‘Scottie dog’ sign (representing pars interarticularis defect) on oblique views of the spine.
A 14 year old boy presents to your clinic complaining of ‘bumps’ on his legs. Physical exam reveals non-tender bony protuberances on the distal femur and proximal tibia. Which of the following is the most likely diagnosis?
.
Osteochondroma
Which blood pressure medications can increase gout attacks
HTCZ ends to increase serum uric acid levels, and may therefore precipitate a gouty
Microfractures along the tibia due to repetitive stressors
shin splints
what is the most specific test used for diagnosing Sj green’s syndrome.
Anti-La is the most specific test used for diagnosing Sj gren’s syndrome.
In a patient with a separated acromioclavicular joint, which of the following treatment modalities is most important for restoring normal functioning?
Gentle range of motion exercises
What degree of rotational deformity is acceptable (meaning not requiring surgical correction) in a fracture of the fifth metacarpal?
none. ps this is a boxer’s fracture
Which nerve root is likely to have been damaged if on physical exam you observe an inability to maintain plantar flexion of the foot, and an asymmetric ankle jerk reflex?
S1
What is the hallmark sign or symptom of herniated disc disease?
Lumbosacral radiculopathy
Which is the most common bone cancer?
Metastasize to bone from distant cancer
A tibial plateau fracture needs surgical repair in the vast majority of patients
TRUE
Which of the following is the most commonly affected site by osteomyelitis?
hip
Which of the following physical exam tests, if positive, is most suggestive of inferior instability of the glenohumeral joint?
The sulcus sign is performed by applying inferior traction to the arm and observing the shoulder for the formation of a sulcus at the lateral edge of the acromion process. This test is indicative of inferior instability.
Duchenne’s muscular dystrophy
exam shows hip girdle weakness, enlargement of the distal muscles of the leg, and atrophy of the proximal thigh muscles. Lab studies reveal an elevated serum creatinine kinase.
