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Emergency Medicine > Ortho > Flashcards

Ortho Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

A splintered or crushed fracture is known as a _____ fracture.

A

Comminuted

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2
Q

____ is the study of choice for the dx of an occult hip fx.

A

MRI

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3
Q

The treatment of simple fractures often involves:

A

Closed reduction with cast placement

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4
Q

Complicated or unstable fractures require:

A

ORIF

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5
Q

_____ (type of fracture) occurs when one side of the cortex buckles as a result of compression injury (e.g. FOOSH). Differs from a greenstick fracture by the mechanism of injury.

A

Torus fracture

*Treatment= 4-6 weeks in cast

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6
Q

____ (type of fracture) occurs in long bones when bowing causes a break in one side of the cortex.

A

Greenstick fx

*If angulation >15 degrees you need referral to an ortho surgeon

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7
Q

Salter-Harris fractures involve the growth plate of long bones in pediatric patients. The classification is:

A

• I → entire physis
• II → entire physis + portion of metaphysis
• III → portion of the epiphysis
• IV → portion of epiphysis + portion of the metaphysis
• V → compression injury of epiphyseal plate
S-A-L-TE-R

S- Straight across
A- Above (Most common!)
L- Lower
TE- Through Everything
R- cRush
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8
Q

Dislocation v. Subluxation…

A

o Dislocation → total loss of congruity that occurs between the articular surfaces of the joint
o Subluxation → any less serious loss of congruity, or a less than complete dislocation.

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9
Q

____ is the MC type of shoulder dislocation.

A

Anterior glenohumeral

*Humeral head is anterior and inferior to glenoid

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10
Q

Clinical manifestation of an anterior shoulder dislocation is:

A

Arm is ABDUCTED, EXTERNALLY ROTATED

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11
Q

How is an anterior shoulder dislocation managed?

A

Reduction

*Must RULE OUT axillary nerve injury

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12
Q

A posterior shoulder dislocation is most commonly associated with _____ (type of medical event).

A

Seizures (electric shock and trauma)

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13
Q

Clinical manifestations of a posterior shoulder dislocation are:

A

Arm ADDUCTED, INTERNALLY ROTATED; Anterior shoulder is flat, humeral head is prominent

*Management- reduction and immobilization

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14
Q

Axillary and Y views are the most helpful in determining _____ v. _____ dislocations.

A

Anterior v. Posterior Shoulder

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15
Q

_____ injuries are MC in athletes or laborers performing repetitive overhead movements. They are the MC cause of shoulder pain in people > 40y.

A

Rotator cuff

*SUPRASPINATUS MC!!

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16
Q

Some PE findings with rotator cuff injuries include:

A
  1. Passive ROM greater than active!
  2. Supraspinatus strength test- empty can test
  3. Impingement tests of subscapular nerve/supraspinatus:
    - Hawkins test
    - Drop arm test
    - Neer test
  4. Subacromial lidocaine test: can help distinguish tendinopathy from tears (normal strength with pain relief= tendinopathy)
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17
Q

Management of tedinitis and tears includes:

A
  1. Tendinitis: shoulder pendulum/wall climbing exercises, ice, NSAIDs, stop offending activity
  2. Tear: Conservative- rehab, NSAIDs, intraarticular corticosteroids, ROM preservation- surgery
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18
Q

AC joint dislocation (“shoulder separation”) dx using ____ to reveal mild separations.

A

Weights

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19
Q

There are 5 classes of AC joint dislocation that progressively worsen (5 is worse than 1). In class ___ the AC ligament is ruptured and the coracoclavicular ligament is sprained.

A

2

*Class 3- Rupture of BOTH AC and CC ligaments- may need SURGERY

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20
Q

In humeral shaft fractures you must r/o ___ nerve injury. This injury may cause wrist drop.

A

Radial nerve

*Check deltoid sensation to assess for brachial plexus injury

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21
Q

The MOI for humeral shaft fractures is:

A

FOOSH or direct trauma

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22
Q

The MC fractured bone in children, adolescents, and newborns during birth is the _____.

A

Clavicle

*If proximal 1/3 get ortho consult

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23
Q

Thoracic outlet syndrome can cause nerve compression, especially on ____ side of hand.

A

Ulnar

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24
Q

A PE of Thoracic Outlet Syndrome may reveal a positive Adson sign which is:

A

Loss of radial pulse with head rotation to affected side.

*TOS diagnosed by MRI

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25
Q

____ fractures are most commonly seen in children 5-10y and manifest by swelling, tenderness at the elbow and prominent olecranon.

A

Supracondylar Humerus Fx

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26
Q

Xray of a supracondylar fx may show-

A
  1. Abnormal anterior humeral line

2. Anterior or posterior fat pad sign

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27
Q

Median nerve damage and brachial artery injury is known as:

A

Volkmann ischemic contracture

*RADIAL NERVE INJURY

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28
Q

Management humerus fractures involve:

A
  1. Nondisplaced- posterior splint

2. Displace- ORIF

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29
Q

____ fractures often result from a FOOSH and result in the inability to fully extend the elbow.

A

Radial head fx

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30
Q

Suppurative flexor tenosynovitis is an infxn of the flexor tendon synovial sheath of the finger. MC skin flora is ____.

A

Staph aureus

*MOI- often penetrating trauma or spread from other tissues

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31
Q

Kanavel’s signs: FLEXor tenosynovitis

A
  1. Finger held in flexion
  2. Length of tendon sheath is tender
  3. Enlarged finger
  4. Xtension of the finger causes pain
  • Definitive Dx- aspiration and/or biopsy
  • *Treatment- I&D with irrigation and debridement +/- abx
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32
Q

Olecranon fx may cause ____ nerve dysfunction.

A

Ulnar

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33
Q

An abrupt “goose egg” swelling of the elbow (boggy, red) with limited ROM with flexion is suspicious for:

A

Olecranon bursitis

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34
Q

Monteggia fx v. Galeazzi fx

A

SEE P. 182

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35
Q

Radial head subluxation (nursemaid’s elbow) MC occurs in ___ (age group) from ____ (activity).

A

2-5y from lifting/swinging/pulling (of a child)

  • Manifestations- children show up with arm slightly flexed, refusing to use it
  • *Treatment- reduction (pressure on radial head with supination and flexion)
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36
Q

Lateral elbow pain especially with gripping, forearm pronation, and wrist extension against resistance is seen with ____.

A

Lateral epicondylitis (Tennis Elbow)

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37
Q

_____ is most commonly seen in golfers and patients who do household chores.

A

Medial epicondylitis

*Worse with pulling activities and wrist flexion against resistance!

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38
Q

____ is the MC type of elbow dislocation.

A

Posterior!

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39
Q

Management of an elbow dislocation involves:

A

EMERGENT reduction! Posterior splint at 90 degrees. If unstable then ORIF.

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40
Q

A positive Tinel’s sign at the elbow is indicative of:

A

Cubital Tunnel Syndrome- ulnar nerve compression

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41
Q

The MC carpal fracture is _____ fracture. Often caused by a FOOSH.

A

Scaphoid (Navicular)

*Look for snuffbox tenderness! Concern for avascular necrosis

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42
Q

How is a scaphoid fracture treated?

A

If nondisplaced–> thumb spica

Displaced–> ORIF

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43
Q

____ fracture is common after a FOOSH in a postmenopausal woman or a woman with osteoporosis.

A

Colles fracture

*distal radius fracture with dorsal/posterior angulation

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44
Q

MC complication of a colles fracture is a rupture of the ____ tendon.

A

Extensor pollicus longus

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45
Q

Management of a colles fracture is:

A

Stable–> sugar tong splint/cast

Unstable or comminuted–> ORIF

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46
Q

Ventral angulated fracture (of wrist) is seen with a _____ fx.

A

Smith fracture

47
Q

When the lunate doesn’t articulate with the ____ or the _____ it is known as a lunate dislocation and needs ORIF immediately!

A

Capitate or the Radius

*piece of pie and spilled teacup signs (p. 185)

48
Q

____ fx is the most serious carpal fx :(

A

Lunate- worry about avascular necrosis (Kienbock’s dz)

49
Q

An extensor tendon avulsion after a sudden blow to tip of an extended finger with forced flexion can cause a _____ finger.

A

Mallet (baseball) finger

*Management- splint the DIP x 6wks (or surgical pinning)

50
Q

When the finger is flexed at the PIP joint and hyperextended at the DIP joint this is known as a _____ deformity.

A

Boutonniere

51
Q

When the finger is hyperextended at the PIP joint and flexed at the DIP joint this is known as a ____ deformity.

A

Swan neck

52
Q

_____ thumb is seen when there is a sprain or tear of the ulnar collateral ligament and the thumb is far away from the other digits.

A

Gamekeeper’s/Skier’s

53
Q

Fracture of the 5th metacarpal is known as a _____ fracture.

A

Boxer’s

  • MOI: Punching with a clenched fist
  • *Always check for bit wounds- if present treat with Augmentin!!
54
Q

Bennett v. Rolando fractures

A
  1. Bennett- Intraarticular fx through the base of the 1st metacarpal (MCP)
  2. Rolando- COMMINUTED Bennett’s fx
55
Q

Excessive thumb use with repetitive action can lead to _____ which manifests with pain along the radial aspect of the wrist radiating to the forearm.

A

de Quervain Tenosynovitis

  • Positive Finkelstein test!
  • *Treated- thumb spica splint x 3 weeks
56
Q

Carpal tunnel syndrome can lead to ____ nerve entrapment.

A

Median

57
Q

Clinical manifestations of carpal tunnel syndrome include:

A

Paresthesias, pain of palmar 1st 3 digits (especially at NIGHT), Thenar muscle wasting

*Dx- + Tinel’s sign, + Phalen’s sign

58
Q

Carpal tunnel syndrome is managed with a ___ splint.

A

Volar

59
Q

Contractures of the palmar fascia due to nodules/cords is known as _____.

A

Dupuytren contracture

*Genetic predisposition, ETOH abuse, DM

60
Q

____ is the MC cause of a hip dislocation.

A

Trauma- MVA, fall

61
Q

____ (Anterior/Posterior) is the most common type of hip dislocation. Complications include:

A

Posterior

-Complications: avascular necrosis, sciatic nerve injury, DVT, bleeding

62
Q

With hip dislocations the leg is often shortened and ____ (internally/externally) rotated.

A

Internally

63
Q

With hip fractures the leg is often shortened and _____ (internally/externally) rotated.

A

Externally

*High incidence of AVASCULAR NECROSIS with femoral neck fractures

**Legg-Calve-Perthies Disease- avascular osteonecrosis of the femoral head in KIDS–>PAINLESS LIMPING

64
Q

_____ (type of fracture) is MC in 7-16y, obese, A.A., males during growth spurt (due to weakness of growth plate and hormonal changes at puberty).

A

Slipped Capital Femoral Epiphysis

*if seen before puberty suspect hormonal/systemic d/o like HYPOthyroidism

65
Q

SCFE manifestations include a _____ limp (painless/painful).

A

PAINFUL (hip, thigh, or knee pain)

*Treatment- non weigh-bearing with crutches–> ORIF

66
Q

MCL injury is associated with ____ (valgus/varus) stress and LCL injury is associated with ____ (valgus/varus) stress.

A

MCL- Valgus

LCL- Varus

  • +/- Surgical repair for Grade III (complete tears)
67
Q

The MC knee ligament injury is _____.

A

ACL injury

  • 70% sports related- NONCONTACT PIVOTING INJURY
  • *Think pop, swelling, and hemarthrosis
68
Q

Tests for ACL injury include ___ & ___.

A

Lachman’s & Anterior drawer

69
Q

____ injuries are most commonly associated with dashboard injury.

A

PCL

  • Tests- pivot shift and posterior drawer
  • *Almost always treated SURGICALLY
70
Q

____ (Medial/Lateral) meniscal tear is 3x more common than ____ (medial/lateral).

A

Medial more common than lateral

*Positive McMurray Sign!

71
Q

MC cause of a patellar fracture is _____.

A

A direct blow

  • MC in young patients
  • *Sunrise view radiographs are best for dx
72
Q

A forceful quadriceps contraction (fall on flexed knee) can lead to a _____ rupture.

A

Patellar or Quadriceps tendon

  • MC males > 40y, hx of DM, gout, obesity, renal dz
  • *(Patellar rupture usually < 40y)
73
Q

Patella baja- palpable defect above knee is seen with a ____ (quad/patellar) rupture.

Patella alta- palpable defect below knee is seen with a ____ (quad/patellar) rupture.

A

Baja- Quad rupture

Alta- Patella tendon rupture

*Treatment- knee immobilizer, RICE, NWB, surgical repair within 7-10 days

74
Q

Patellar dislocations are MC in ____ (males/females) and usually occur ____ (medially/laterally).

A

Females, laterally

75
Q

A knee (tibial-femoral) dislocation is SEVERE LIMB THREATENING!! (popliteal artery rupture severe complication)

A

Needs prompt reduction via longitudinal traction

76
Q

_____ fractures are MC in children in MVAs. The lateral plateau is MC.

A

Tibial plateau

  • Check for peroneal nerve injury- foot drop!
  • *May need to confirm with CT or MRI
77
Q

MC cause of chronic knee pain in young, active adolescents is ______.

A

Osgood-Schlatter Disease

  • Manifestation- tenderness to anterior tibial tubercle
  • *Treatment- NSAIDs, RICE, Quad stretching
78
Q

Anterior knee pain around the patella that MC’ly seen in runners is ______.

A

Patellofemoral Syndrome (idiopathic softening of the patellar articular cartilage)

79
Q

MC cause of knee pain in runners is ____.

A

Iliotibial Band Syndrome (ITB)

*Causes LATERAL knee pain during onset of running

80
Q

_____ (Posterior/Anterior) is the MC type of ankle dislocation.

A

Posterior

*Treatment- closed reduction and posterior splint

81
Q

There is an increased risk of an achilles tendon rupture with _____ (medication class) use.

A

Fluoroquinolone

82
Q

Sudden, sharp calf and heel pain with a positive Thompson’s test is associated with ____ rupture.

A

Achilles tendon

*Treatment- splint in plantar flexion with subsequent splinting employing gradual dorsiflexion towards neutral

83
Q

Weber ankle fracture classification

A

p. 199

84
Q

____ fracture is common in athletes and military personnel due to overuse. 3rd Metatarsal MC!

A

Stress (March) Fracture

85
Q

Heel pain and tenderness of the plantar fascia of the medial foot that gets worse with rest is known as _____.

A

Plantar Fasciitis

86
Q

Pain/numbness at the medial malleolus, heel, & sole AND posterior tibial nerve compression is associated with:

A

Tarsal Tunnel Syndrome

*Pain increases throughout the day (v. plantar fasciitis)

87
Q

Charcot’s Joint is also known as _____.

A

Diabetic Foot

88
Q

Transverse fracture through the diaphysis of the 5th metatarsal is known as a ____ fracture.

A

Jones

89
Q

Lisfranc Injury

A

p. 203

90
Q

_____ is associated with sciatica- back pain radiating to the thigh/buttock–> down L5-S1 dermatome (increases with Valsalva).

A

Herniated disc (nucleus pulposus)

91
Q

Herniated disc findings:

A
  1. Positive SLR
  2. L4- Weakness= ankle dorsiflexion, loss of knee jerk
  3. L5- Walking on toes is easier than heels (Think (L)5- you have 5 toes!)
  4. S1- Walking on heels is easier than toes (Think (S)1- you have 1 heel), loss of ankle jerk
92
Q

With _____ you may have new onset urinary/bowel retention/incontinence with Saddle Anesthesia, uni/bilateral leg radiation, and DECREASED anal sphincter tone on rectal exam (no “anal wink”)

A

Cauda Equina

*Neurosurgical emergency!! Corticosteroids to reduce inflammation

93
Q

Lumbosacral sprain/strain

A

Acute strain or tear of the paraspinal muscles, especially after twisting/lifting injuries

-Manifestations: Back muscle spasms!, decreased ROM, No neurologic changes :)

94
Q

Spondylolysis & Spondylolisthesis

A
  1. Spondylolysis- pars interarticularis defect from either failure of fusion or stress fracture (can be seen in football players and gymnasts)
  2. Spondylolisthesis- forward slipping of a vertebrae on another (high grade requires surgical management)
95
Q

_____ (Acute/Chronic) osteomyelitis is MC seen in children (S. aureus MC organism).

_____ (Acute/Chronic) osteomyelitis is MC in adults, secondary to open injury (trauma or recent surgery).

A

Acute in children

Chronic in adults

96
Q

Clinical manifestations of osteomyelitis include:

A
  1. Gradual onset. Signs of bacteremia- high fever, chills, malaise
  2. Local signs: inflammation/infxn, pain over the involved bone, decreased ROM in adjacent joint
  3. Refusal to use extremity/bear weight (Hip MC in kids)
97
Q

How is Osteomyelitis diagnosed?

A
  1. Increased WBC and ESR
  2. MRI is most sensitive test in early dz.
  3. Radiographs
  4. Bone aspiration (increased activity seen, not specific)
98
Q

Management of acute osteomyelitis involves…

A

Abx 4-6 weeks (at least 2 weeks via IV)- may need debridement

  1. Newborn (< 4mos)- Group B Strep, gram negative= Nafcillin or 3rd gen Ceph.
  2. > 4 mos Staph aureus-
    - MSSA: Nafcillin or Cefazolin (Ancef)
    - MRSA: Vancomycin
  3. Sick Cell Disease- Salmonella= 3rd gen Ceph. or FQ
  4. Puncture wound- Pseudomonas= Cipro or Levo
99
Q

Management of chronic osteomyelitis involves…

A
  1. Surgical debridement
  2. Cultures- abx depends on biopsy culture and sensitivities
  3. Antibiotics- empiric abx usually NOT recommended
100
Q

____ is an infection of the joint cavity. It is a MEDICAL EMERGENCY because it can rapidly destroy the joint.

A

Septic Arthritis

101
Q

___ is the most common site of septic arthritis.

A

Knee

*Usually have a single, swollen, warm, painful joint with decreased ROM with fever!

102
Q

How is septic arthritis diagnosed?

A

Arthrocentesis- WBCs > 50,000- primarily PMNs

103
Q

How is septic arthritis treated?

A
  1. Prompt abx guided by gram stain

2. Arthrotomy with joint drainage (2-4 week course)

104
Q

Gram stain & Abx regimen for septic arthritis

A
  1. Gram positive cocci–> Nafcillin (Vanc if MRSA suspected)
  2. Gram negative cocci or GC suspected –> Cetraixone
  3. Gram negative rods –> Ceftriaxone + Gentamicin
  4. No organism seen –> Nafcillin or Vanc + Ceftriaxone
105
Q

Acute inflammation of the costochondral, costosternal, or sternoclavicular joints is known as ______.

A

Costochondritis

*Common after viral infxn or MSK trauma (physical strain, excess coughing)

106
Q

Pleuritic chest pain that is worse with inspiration, worse with coughing, and worse with certain movements of the upper limbs or torso is can be _____.

A

Costochondritis

*Palpation reproduces the pain

107
Q

Uric acid deposition in the soft tissues, joints, & bone is known as ____.

A

Gout

*MC due to underexcretion of uric acid

108
Q

Secondary causes of gout include: foods and meds (name some)

A

Foods- alcohol, liver, seafood, yeasts

Meds- Diuretics, ACEI, Aspirin, ARBs (EXCEPT Losartan)

109
Q

Clinical manifestations of gout include:

A
  1. Acute gouty arthritis- severe joint pain, erythema, swelling and stiffness (1st MTP joint MC, also knees, feet, and ankles)
  2. Tophi deposition
  3. Uric acid nephrolithiasis & nephropathy
110
Q

How is gout diagnosed?

A
  1. Arthrocentesis- Negatively birefringent needle-shaped urate crystals!!
  2. Radiographs- Punched out erosions with overhanging margins
  3. Clinical- increased ESR and WBC during acute attacks
111
Q

Acute management of gout involves:

A
  1. NSAIDs (Indomethacin, Naprosyn)–> AVOID aspirin

2. Colchicine

112
Q

Chronic management (prophylaxis) of gout involves:

A
  1. Allopurinol- reduces production and increases excretion (caution with renal dz)
  2. Febuxostat
  3. Colchicine
113
Q

Pseudogout…

A

Acute arthritis- red, swollen, tender joint. Knee MC! MC in females!!

  1. Dx- Arthrocentesis- POSITIVELY BIREFRINGENT, RHOMBOID SHAPED CPPD CRYSTALS
  2. Treatment- Acute attacks: Intraarticular steroids, NSAIDs, Colchicine; Chronic: Colchicine
114
Q

_______ has the ability to cause analgesia when used for acute compression fracture of the vertebral body.

A

Calcitonin

Emergency Medicine (11 decks)

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