Ortho

Question 1

Patellofemoral Pain Syndrome

Answer 1

Overuse syndrome, runners and females, maltracking/lateral subluxation within the femoral groove due to vastus medialis wkness. Get a merchant view on xr, treat with quad strengthening.

Question 2

Plica Syndrome

Answer 2

medial/inferior is most common, pain and fullness with palpation, irritated with repeated flexion, tx with rest, ice, nsaids, quad strengthening.

Question 3

Intoeing, causes and tx

Answer 3

often caused by internal tibial torsion, flexible nml foot, patellae in neutral position. Spont resolution is norm by age 7-8, do rotational osteotomy if persists.

Question 4

Scoliosis, who to brace?

Answer 4

Only screen if having sx, check from beind as pt bends at waist, look for angulation, if 20 or > degrees then bracing

Question 5

Nursemaid Elbow

Answer 5

Pt has arm in adduction, pronation, and flexed due to subluxation or dislocation of radial head. Reduce by supinating forearm, flexing elbow, while applying pressure over radial head.

Question 6

Toddler’s Fracture

Answer 6

spiral fracture of the tibia usually from insignificant rotational trauma (running and falling with twisting motion). there should not be a fibular fracture.

Question 7

Metaphyseal Corner fracture- peds

Answer 7

always think child abuse, caused by shaking of child with flailing extremities, high energy tension or shearing force.

Question 8

Metatarsus adductus

Answer 8

line bisecting the heel passes through 4th toe on each foot instead of between 2nd-3rd toes. Observe unless severe and inflexible then do serial casting. If rigid and >3mo or residual adductus >6mo then ped ortho referral.

Question 9

Cause of Osteo in Sickle cell patient?

Answer 9

Salmonella up to 85% of the time. Otherwise Staph is the culprit.

Question 10

Staight Leg Raise

Answer 10

+ when radicular symptoms occur below the level of the knee between 25-75 degrees of hip flexion, worse with ankle dorsiflexion. Crossoer pain = disc disease.

Question 11

Spondylolysis

Answer 11

pain worse with hyperextension, bilateral pars interarticularis fractures, most commonly in lumbar region. Usually symptomatic when 25% of slippage and pts in late teens to 20’s

Question 12

Spondylolisthesis

Answer 12

slippage of one vertebra on another

Question 13

Most common carpal bone fx in FOSH

Answer 13

Scaphoid fracture

Question 14

Scaphoid fractures

Answer 14

fosh injury, may not be seen on xr right away, put in spica cast with thumb and f/u, more risk if fx is near proximal pole due to nonunion and avascular necrosis, get ortho.

Question 15

Mallet finger

Answer 15

“jamming” mechanism of finger, swelling and flexion at dip, full extension splint and ortho referral.

Question 16

Colles fracture

Answer 16

most common wrist fx in adults, fx of distal radius at metaphysis, displaced dorsally and often angulated

Question 17

Test for Dequervain’s tenosynovitis

Answer 17

Finkelstein’s- full flexion of thumb into palm of hand and ulnar deviation of wrist.

Question 18

Rotator cuff muscles

Answer 18

supraspinatus, infraspinatus, teres MINOR, subscapularis

Question 19

Most commonly torn rotator cuff muscle

Answer 19

supraspinatus

Question 20

proximal vs distal bicep ruptures

Answer 20

proximal are treated conservatively, distal should refer to ortho since flexion at elbow is impaired. Proximal long head is most likely to rupture.

Question 21

female athlete triad

Answer 21

menstrual irregularity, osteoporosis, low energy availability