Ortho Flashcards
What are features of SCFE
Adolescent 10-14 years, obese, minority boys
Present with painful limp, referred pain to thigh or knee
Limited internal rotation
Xray frog leg view are diagnositc
What are features of Carpal Tunnel Syndrome
Numbess and Paresthesia of palmar aspect of thumb and first 2 fingers
Pain may awaken person at night
Then eminence atrophy
Positive Phalen test (wrist flexed 90 degrees)
Positive Tinel Sign (wrist percussion)
What causes Scapular Winging
Injury to Long Thoracic Nerve and secondary Serratus Anterior
What does the Lachman Test look for
How does it work
Anterior Cruciate Ligament
Knee flexed at 20-30 degrees with patient supine. Examiner places one hand behind tibia and grasps patient’s thigh. Tibia is pulled forward to assess anterior motion of tibia in comparison to femur.
Lots of laxity indicates ACL injury
What does the Apley’s Test look for
How does it work
Meniscus
Patient lies prone and flexes knee to 90 degrees. Examiner places hand across posterior aspect of patient’s thigh between posterior knee. Tibia is compressed onto knee joint while externally rotated.
Pain, clicking or popping indicates damaged meniscus
What does the McMurray test look for
How does it work
Meniscus
Patient lies supine. Knee is flexed to 90 degrees. Examiner places one hand on heel, the other hand on knee joint line. Passive external rotation is done by stabilizing knee joint while externally rotating from the heel/ankle, introduces valgus force (this tests medial meniscus). Do the same but with internal rotation, introducing varus force (this tests lateralmeniscus)
Pain, popping, or clicking indicates positive test, and meniscus tear.
What does Thompson’s Test look for
How does it work
Achille’s Tendon Rupture
Patient lies prone with feet hanging off bed. Normally, foot does plantar flexion in this position and calf muscles are engaged.
No plantar flexion indicates Achille’s Tendon Rupture
What do the following T-scores with DEXA scan indicate
T Score 0 to -1.0
T score -1.0 to -2.5
T Score -2.5 or less
T Score 0 to -1.0 = Normal
T score -1.0 to -2.5 = Osteopenia
T Score -2.5 or less = Osteoperosis
What is the number 1 treatment for Osteoperosis
What drugs are used for Osteopenia
Bisphosphonates like Alendronate
For Osteopenia use Calcium, Estrogen, or SSRI (Raloxifene)
What is Phalen Sign
What is Tinnel Sign
How do they work
Test for Carpal Tunnel
Phalen: Flex wrist at 90 degrees, produces pain
Tinnel: Tap the Median nerve, produces pain
What should you think of when you hear Heberden Nodes and Bouchard Nodes
Osteoarthritis
What are features of Gamekeeper’s Thumb
Tx
Ulnar Collateral Ligament of MCP joint is injured
Usually occurs in skiers
Results in poor pinching and thumb to finger opposition
Tx is immobilzation with thumb spica split
What are the 6 P’s of Compartment Syndrome
Pallor Paresthesia Pulselessness Pain paralysis Poikilothermy (cold)
What should you think of if a child comes in post-Upper Respiratory Infection with painful limp and mild thigh pain
Transient Synovitis
What are features of a Mallet Finger
Tx
Inability to extend fingers at DIP joint
Usually results from trauma to extended finger with forced flexion
Tx: Splint DIP with uninterrupted extension for 6 weeks
What is the forward slipping of the vertebrae on the other
Sx
Tx
Spondylolisthesis
Sx: Lower back pain, sciatica sx, may cause bowel and bladder dysfunction
Tx: Modification of activities
What is a defect in the pars interarticulars from stress fracture
Sx
Tx
Spondylolysis
Usually due to repetitive hyperextension trauma (football players, gymnasts)
Sx: Lower back pain with sciatica symptoms
Dx: Can bee seen on Xray
Tx: Sx relief, activity restriction, physical therapy, bracing
What do the following nerves do
Radial Nerve
Ulnar Nerve
Median Nerve
Radial nerve: Extends wrist and forearm
Ulnar Nerve: Flexes and Adducts Wrist (ulnar deviation)
Median Nerve: Opponens Pollicus, Abductor Pollicis Brevis, Flexor Pollicis Brevis
Axillary Nerve: Deltoid Muscles
Medial Right Elbow Pain
Pain with resisted wrist flexion
Medial Epicondylitis
Lateral right elbow pain
Pain with resisted wrist extension
Lateral Epicondylitis
Knee pain for 3 weeks
Mass is felt on posterior aspect of femur
Xray shows lytic lesions and soft tissue involvement
Osteosarcoma
Pain over anatomical snuffbox
Wrist pain and swelling
Scaphoid Fracture
How should you perform an xray when Acromioclavicular separation is suspected
Weight bearing AC joint views
Intermittent numbness in fifth finger
Person grips a lot in day-to-day
What is it and what test reproduces sx?
Ulnar Nerve Entrapment
Guyon’s Canal: apply pressure over Guyon’s canal through which ulnar nreve runs
What is considered a positive straight leg raise
What is it assessing
Pain radiating along sciatic nerve at 60 degrees of PASSIVE elevation of ipsilateral leg
Testing for Disk Disease/Disk Herniation
Asymmetric Polyarticular joint pain in knees, hands, elbows
Morning stiffness for 30 minutes
Bilateral dactylitis, nail pitting, scaly plaques on elbows
Pencil-in-Cup Deformity on Xray
HLA-B27
Psoriatic Arthritis
Young male with diffuse low back pain, morning stiffness that lasts for hours, activity makes it better
Positive HLA-B27, Elevated ESR
What is it and what is tx
Ankylosing Spondylitis
NSAIDS
What foods should be avoided in Gout
Purine rich foods
Organ meats, sardines, mussels, liver, trout, alcohol and beer can elevate uric acid levels
What drugs have been known to induce lupus
Procainamide, Hydralazine, Isoniazid, Methyldopa, Chlorpromazine, Minocycline
Scleroderma is positive for what
ANA
1st line treatment for Raynaud’s
CCB
1st line treatment for Rheumatoid Arthritis
DMARDS ASAP, NSAIDS for relief
Periarticular pain and stiffness in several joints
Pain is worse in morning and lasts >60min
Ulnar Deviation, DIP spared, Swan Neck Deformity
Positive Anti-CCP
What is it and what is Tx
Rheumatoid Arthritis
DMARDS right away
Rheumatoid Arthritis is positive for what
Anti-CCP
Systemic Lupus is positive for what
ANA
Anti-Smith Antibodies (more specific)
Anti-Single Stranded DNA (Anti-ssDNA)
What crystals are noted with Gout vs. Pseudogout
Gout: Uric Acid (negatively birefringent needle shaped crystals)
Pseudogout: Calcium Pyrophosphate (positively birefringent rhomboid crystals)
What are features of Polymositis vs. Polymalgia Rheumatics
Both cause symmetric issues in proximal muscle groups
Polymyositis is WEAKNESS
Polymalgia is PAIN and STIFFNESS
Fever, Malaise, weight loss in 5 months Pain at extremities, particularly calves Right foot drop and ulcers at bilateral malleloi New onset HTN Livedo Reticularis What is it
Polyarteritis Nodosa
What are ways the Systemic Lupus can present
General Malaise, Fever, Anorexia, Weight Loss Malar Rash, Discoid Rash, Photosensitivity Oral Ulcers Arthritis, SErositis Kidney Disease, Neurologic disease Hematologic Disorders (thrombocytopenia) Immunologic Abnormalities Positive ANA
1st line treatment for Polymalgia Rheumatica
Steroids
What is the most important complication that can occur with Temporal Arteritis. What is it associated with
Vision Loss
Polymalgia Rheumatica
What Cardiac Condition is often found in a person with Marfan’s
Mitral Valve Prolapse
Aortic Aneurysm
What should you think of when you see Chondrocalcinosis on an Xray
Pseudogout which indicates calcium pyrophosphate deposition
What is Hydroxychloroquine used for
What are side effects/complications and therefore what should be monitored
An antimalarial drug used for Systemic Lupus Erythematosus
Retinal exams needed due to increased retinal toxicity risk, baseline exam needed then yearly
