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Clinical Med II > Ortho > Flashcards

Ortho Flashcards

1
Q

Spondylolisthesis

A

slip or listehsis
vertebral body slips in relation to one below it
defect in junction of lamina with pedical (pars intra-articularis) spondylolysis

deminished lumbar lordosis
step off
px with extension

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2
Q

Valgus

A

knock knee, legs inward

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3
Q

Varus

A

bowlegged

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4
Q

Monteggia’s fracture

A

fracture of prox third of the ulna with dislocation of the prox head of the radius

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5
Q

Dupuytren’s contracture

A 
palmar fibromatosis (thickening of the palmer fascia)
Males>40
note a tendon problem
starts with painless nodule
contracture/cord is late problem
May also have peyronie's of penis
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6
Q

Boutonnières deformity

A

DIP Hyperextended
PIP flexed
loss of central tendon, volar subluxation of lateral bands

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7
Q

Paronychia

A

infection of soft tissue around nail
Staph (acute)
candida albicans (chronic)
trauma induced (manicure/hangnail)

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8
Q

DeQuervain’s syndrome

A

Inflamed 1st dorsal tendon compartment

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9
Q

Gamekeeper’s thumb

A

UCL tear at MCP joint of thumb

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10
Q

Hallux valgus

A

medial deviation of the first metatarsal and lateral deviation and/or rotation of the hallux, with or without medial soft-tissue enlargement of the first metatarsal head., bunion

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11
Q

Lisfranc fracture

A

Lisfranc injury, also known as Lisfranc fracture, is an injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus.
foot is in high heel position when comes down…

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12
Q

Mallet toe

A

Mallet toe is a deformity of the toe that can cause pain and disability in the affected person. It is similar to hammertoe; in both conditions, the toe bends downward, causing it to resemble a mallet or hammer.

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13
Q

Pott’s disease

A

TB of the spine
destruction of vertebral bodies
xray shows vertebral osteolysis or compression fx
tx = rest, anti-TB meds

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14
Q

Cauda equine syndrome

A

Compression of Cauda Equina roots
? large midline disc herniation
C/o incontinence, severe leg px, numbness, diff walking
Emergent MRI >Surgery

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15
Q

Swollen flex tendon catches on A-1 pulley

A

Trigger finger

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16
Q

What test is done for DeQuervain’s Tenosynovitis?

A

Finklestein’s test

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17
Q

deformity characterized by:
flexed DIP
Hyperexteded PIP

A

Swan Neck Deformity

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18
Q

Swan Neck Deformity

A

Loss of terminal ext tendon

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19
Q

Define volar

A

relating to palm of hand or sole of foot

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20
Q

Tests for flexor tendon lacerations

A

Profundus test

sublimus test

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21
Q

results from a direct blow to extended digit

A

mallet finger

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22
Q

Tx of mallet finger

A

extension splint 8 weeks (avulsion likely)

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23
Q

GameKeeper’s thumb

A

Ulnar collateral ligament tear at the MCP of the thumb

aka skier’s thumb

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24
Q

interarticular fx base of thumb

A

Bennett’s fx (unstable)

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25
Q

FOOSH

A

Fall on outstretched hand

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26
Q

tilt of the colles fracture

A

dorsal tilt

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27
Q

Tx of scaphoid fx

A

spica splint 8-12 wks

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28
Q

scapholunate dislocation

A

4-5 mm widening

Terry Thomas or David Letterman sign

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29
Q

Human bite organism

A

Staph aureus or Eikenella

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30
Q

Rx for Human bite

A

Augmentin 7-10 days

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31
Q

Cat/Dog bite organism

A 
Alpha Strep
pasturella multicoda (cats)
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32
Q

Rx Cat/Dog bite

A

Augmentin 7-10 days

DO NOT CLOSE PUNCTURE WOUNDS

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33
Q

complication of penetrating trauma or puncture to hand

A

Deep Space Infection (thenar space)

2% of all hand infections

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34
Q

Flexor Tenosynovitis

A

Flexor tendon sheath infection
10% of all hand infections
penetrating trauma
staph or strep is usual organism

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35
Q

Kanaval’s signs (4 signs)

A

Semi-flexed posture of digit
fusiform swelling
tenderness, erythema along tendon
severe pain with passive motion (extension)

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36
Q

Tx flexor tenosynovitis

A

urgent surgical drainage
irrigation catheter flush
IV antibiotics for at least 24 hours then oral 7-10 days

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37
Q

Deep pulp infection

A

Felon

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38
Q

Felon Tx

A

X-ray to r/o fb

surgical drainage,

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39
Q

Paronychia Tx

A

early-nail trimming, soaks, antibiotics

late-partial nail removal, drain abcess

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40
Q

OA nodes at DIP

A

Heberdens nodes (85%)

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41
Q

OA nodes at PIP

A

Brouchard’s nodes (45%)

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42
Q

Nerve compression: Median Nerve

A

Carpal tunnel
Pronator syndrome
anterior interosseous syndrome

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43
Q

Nerve compression: Ulnar nerve

A

guyon’s canal, cubital tunnel

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44
Q

Nerve Compression: Radial Nerve

A

Post. Interosseous nerve compression

radial tunnel

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45
Q

Carpal Tunnel Syndrome: physical exam

A

thenar atrophy
loss of 2 point discrimination
tests: Tinel’s, Phalen’s, compression
Electrodiagnostic studies (gold standard)

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46
Q

Tx of Dupuytren’s

A 
excise cords surgically >30 degrees
inject collagenase (xiaflex)
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47
Q

Lederhosen’s disease

A

plantar fibramatosis (similar to dupuytren’s but of foot)

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48
Q

Peyronie’s disease

A

(penile contracture)

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49
Q

Pseudoarthrosis

A

failure of bone healing causing a “false joint” consisting of soft tissue

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50
Q

Nerve injury recovery times:
Contusion
Crush

A

Contusion : 2-3mo

Crush: 2 cm/mo

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51
Q

radial nerve > spiral fracture to humerus> ______

A

Wrist drop

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52
Q

Peroneal nerve > fracture to fibular neck > ______

A

foot drop

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53
Q

Ultimate goals of Fx Tx

A
  1. Alignment of bones (angular and rotational)
  2. Restoration of proper length
  3. Restoration of apposition of the bone ends
  4. Adequate immobilization
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54
Q

acceptable angular deformity in child reduction of fx

A

15-20 degrees that is close to a joint and in same plane of motion

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55
Q

Top Ten principles of setting fx

A
  1. comparison xrays
  2. xrays in two planes
  3. look for an injury in another bone
  4. correct a both angular and rotational misalignment
  5. take stress xrays
  6. Do not be satisfied with one dx (always look for another injury.
  7. Reduce the fx ASAP
  8. evaluate for joint instability and tendon function
  9. usefulness of extremity (not just xray)
  10. Irreducibility may signify soft tissue interposition
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56
Q

Fracture healing overlap stages

A

Inflammation
Repair
Remodeling

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57
Q

Volkman’s Ischemic Contracture

A

acute ischemia and necrosis of muscle fibers of the flexor group of muscles in the forearm. especially the FDP and FPL. the muscles become fibrotic and shortened

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58
Q

time… delayed union or delayed healing

A

fracture not healed after 16-20 weeks.

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59
Q

time… non-union fracture

A

not healed after 60 or absence of evidence of progression of callus formation over 3 mo

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60
Q

osteonecrosis

A

fracture that results in compromised blood supply to bone and ultimately results in bone death

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61
Q

bones at risk for osteonecrosis

A

talus
scaphoid
femoral head

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62
Q

compartment syndrome P’s

A 
Pain!!
Pallor
paresthesias
Paralysis
Pressure
Pulselessness
Poikilothermia
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63
Q

Compartment Syndrome: direct measurement of pressure in mmHg

A

< or equal to 30 mmHg

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64
Q

Volkmann’s Ischemic Contracture is a result of

A

Untreated arterial injury

compartment syndrome secondary to swelling in a tight cast.

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65
Q

Reflex Sympathetic Dystrophy- AKA

A

Complex regional Pain syndrome

66
Q

Pathology of Reflex Sympathetic Dystrophy

A

Disturbance of the sympathetic nervous system which leads to intense pain and vasomotor symptoms.

EXTREME sensitivity to light touch
Pain out of proportion to injury (can’t have clothes touch it)
extremity is swollen, warm and excessive perspiration may occur

67
Q

Reflex sympathetic dystrophy: clinical features

A 
Joint motion restricted
area becomes cool
atrophy (skin and muscle)
skin (dry, shiny and glossy)
stiffness and intractable pain
anxiety and depression
68
Q

Principles of treatment, fracture in children

A
  1. Mild angular deformities in the plane of motion frequently correct themselves with growth
  2. rational misalignment does not currect itself
  3. apposition and mild shortening are of less importance in young children
  4. remodeling is greater when fractures closer to the physis.
  5. physical therapy after the fracture has headled is usually unnecessary and may even be unwise.
  6. A tender growth plate after an inury usually means that a fracture is present, even though a fracture may not be apparent on x-ray.
  7. nonunion is almost impossible in children
  8. malposition may not be correctable after 7-10 days.
69
Q

slater-Harris Classification

A 
S-Separation>Type 1
A-Above>Type 2
L-Lower>Type III
T-Through>Type IV
R-Ram>Type V
70
Q

Thurstan Holland fragment

A

small metaphyseal triangular portion of bone carried with physis in type II and IV Salter-Harris Fx.

71
Q

SCFE fx

A

Slipped capital femoral epiphysis

72
Q

Distal Tibia Ossific nucleus:

ages appears and closes

A

Appears => 2-3yo
Fuses: Girls => 15yo
Boys => 17 yo

Fuses central to meadial and then lateral over 18 mo

73
Q

Ages for elbow occification

A

6 mo - 2 years capitellum
5 - 9 years med epicondyle
7 - 13 years trochlea
8-13 years lat epicondyle

74
Q

Kocher criteria

A 
septic hip
Fever (greater that 38.5 degree C)
Not-weight bearing
ESR (greater than 40 mm/hr)
WBC count (greater than 12,000)

Modified to include:
CRP
Prospective study of 53 pts???

75
Q

Labs for septic hip

A

Blood cultures
CRP
ESR
CBC with differential

76
Q

Definitive Dx for septic hip

A 
Joint aspiration
(cloudy appearance, WBC b/t 80-200k
77
Q

TX Septic hip

A

I&D
IV abx followed by oral abx
serial CRPs

78
Q

nerve roots of cervical spine exit _____

A

above corresponding pedicle

79
Q

never roots of the thoracic and lumbar spine exit _____

A

below the corresponding pedicle

80
Q

cafe au lait spots are associated with

A

neurofibromatosis

81
Q

Normal range of motion of c-spine

A

flexion:50
extension: 60
rotation: 80
lateral bend: 45

82
Q

Motor examination for cervial nerve roots

A 
C5: deltoid, shoulder abduction
C6: biceps-elbow felsion
       ECR: wrist extension
C7: Tricpes-Elbow extension
       FCR-wrist flexion
C8: FDP- flexion middle finger
T1: Hand Interossei-Spread Fingers
83
Q

Reflex examination

A

Biceps C5,C6
Brachioradialis C5,C6
Triceps C7

84
Q

congenitial torticollis most common position

A

Lateral flexion and rotation

85
Q

congenital torticollis causes

A

birth trauma SCM muscle damage

breech or difficult forceps delivery

86
Q

torticollis

A

cervical dystonia

87
Q

cervical strain vs sprain

A

strain - muscle or tendon

sprain - ligament

88
Q

Spurling’s test

A

perform for nerve root compression (c-spine)

patient in slight extension and lateral flexion, apply axial force

89
Q

Hoffman’s sign

A

Myelopathy cervical spine

flick middle finger will have involuntary contraction of the thumb and index finger IP joints

90
Q

Ankle Clonus

A

Myelopathy

5 beats or more abnormal

91
Q

Babinski reflex

A

Myelopathy

+ when hallux dorsiflexes and other toes fan out

92
Q

Hangman’s fx

A

facture of pars interarticularis pedicle of C2

93
Q

Jefferson Fx

A

Burst of C1-diving accidents

94
Q

Chance fx

A

lapbelt injury
thoracolumbar junction
include abdominal injuries

95
Q

3 columns of spine

A

Anterior:ALL (ligament) and anterior 2/3 of body and disc
Middle Column: Posterior 1/3 of body and disc to include PLL (ligament)
Posterior: everything posterior to the PLL

96
Q

Types of Thoracic outlet syndrome

A

Neurogenic: compression of lower bachial plexus usually by tissue band that connects C7 to 1st rib

Vascular:
Subclavian artery compression: color changes, claudication or vague px in arm.

Subclavian vein: swelling of arm, distension of veins or px in arm or hand. (may be thrombus)

97
Q

Adson test

A

test for subclavian artery compression by cervical rib or tightening anterior and midle scalene muscles (TOS)

passively extend, abduct and externally rotate arm while palpating radial pulse
take deep breath and hold in
extend neck and rotate head towards affected side

+ = loss of radial pulse

98
Q

Rpps pr East Test

A

sit up with good posture
shoulders abducted to 90 and externally rotated (stick em up)
open and close fist for 1 min
+ if reproduces symptoms

TOS test

99
Q

L4 neurologic level

A

sensory top of leg
reflex: patellar
weak quad

100
Q

L5 Neuologic level

A

sensory top of foot
reflex: none
can stand on heels
difficulty pulling big toe up

101
Q

S1 neurologic level

A

sensory bottom of foot
relfex ahillies
can’t stand on toes

102
Q

spinal stenosis treatment

A

lumbar epidural steroid injections
NSAIDS
Surgical Decompression
Refer: bladder/bowel incontinence or failed conservative treatment

103
Q

Nerve roots motor L4-S1

A

L4: quadriceps
L5 EHL (big toe)
S1 Ankle pantar flexion

104
Q

Nerve roots Reflex L4-S1

A

L4: knee jerk
L5: none
S1: Achilles

105
Q

Nerve roots sensation L4-S1

A

L4: Anterior thigh
L5: Shin, top and medical foot
S1: Calf, lat foot

106
Q

Kyphoplasty

A

fixes compression fx

107
Q

“Hip Px”

A

Buttock= referred back pain
Groin=true hip joint pain (arthritis)
Lateral=trochanteric bursitis

108
Q

Talipes Equinovarus

A

Congenital defority of hindfoot equinus, forefoot adduction and varus

commonly associated wtih spina bifida, arthrogryposis, myelodysplasia
r/o hip dyspasia and torticollis

109
Q

Congenitial club foot

A

Cavus
adductus
varus
equinus

110
Q

galeazzi sign

A

The Galeazzi test, also known as the Allis sign, is used to assess for hip dislocation, primarily in order to test for developmental dysplasia of the hip.It is performed by flexing an infant’s knees when they are lying down so that the feet touch the surface and the ankles touch the buttocks.

111
Q

Ortalani and Barlow tests

A

check for hip dysphagia posterior hip dislocation

112
Q

pavlic harness

A

bace for hip dysplagia less than 6 mo

113
Q

Osteomyelitis

A 
generally secodnary to hematogenous spread
s. aureus most common
sudden onset of fever, systemic illness
slower onset in adolescents
bone destruction on x-ray
114
Q

transient synovitis

A 
most common cause of lower ext pain
children 3-8 yrs
rapid onset hip pain
limited ROM
limping or inability to bear weight
frequent preceding viral illness
DDX: septic arthritis
115
Q

Legg-Calve-Perthes Dx

A

4-12 yo

a childhood hip disorder initiated by a disruption of blood flow to the head of the femur. avascular necrosis

116
Q

SCFE

A

slipped capital femoral epiphysis

displaces posterior and medially
high rate of AVN
antalgic gait, hip pain, obligate external rotation

117
Q

How to think more important than you know (12 things)…

A 
Toxins
Tumors
Trauma
infection
inflammation/immunologic
metabolic
endocronologic
hematologic
vascular
neurologic
congenital 
psychologic
118
Q

trigger thumb

A

nodular enlargment of flexor tendon that becomes locked at A1 pulley

119
Q

erb’s palsy vs klumpke’s Palsy

A

Erb’s:
most common
C5-C6
Position (waiter’s tip)

Klumpke’s
C8-T1
Hand paralysis but shoulder/elbow maintained

120
Q

ligaments that reinforce hip capsule

A

ilio, ischio and pubofemoral ligaments

121
Q

Steroid/EtOH use can cause what in the hip?

A

AVN

122
Q

thomas test

A

hip flexor test

123
Q

trendelenburg test

A

gluteus medius injury

124
Q

Patrick’s Faber test

A

Hip for Limited ROM patient on back, leg at 90, foot folded over top of other leg. (looks like a 4)

125
Q

FAIR test

A

piriformis syndrome, on back, leg at 90 degree across other leg way out past bed, (like granny sleeping)

126
Q

labs for hip pain

A

CBC, ESR, CRP, rheumatoid factor

joint aspiration: cell count, gram stain, culture

127
Q

Myocitis Ossificans

A

formation of bone tissue inside muscle tissue after a traumatic injury to the area

128
Q

injury tot eh acetabular labrum and cartilage

A

FAI, femoral acetabular impingement… hip impingement

129
Q

pain over lateral hip described as deep (C sign)

A

hip impingment
catching locking and clicking
decreased flexion and internal rotation

130
Q

FADIR and FADIR test

A

Flexion, adduction, and internal rotation

Patient over back, hip and knee flexed, knee over midline

131
Q

two types of hip impingement

A

Pincer and Cam

132
Q

sign of AVN

A

progressive pain to groin, lateral hip or buttock, lip and LOM… dragging leg behind, antalgic gait

133
Q

crescent sign-hip

A

well defined sclerotic region beneath articular surface representing subchondral fracture

134
Q

meniscus blood supply

A

peripheral 1/3 only

135
Q

McMurray’s test

A

for medial and lateral meniscal tears

136
Q

Apley test

A

patient prone, knee 90 degree with axial load

137
Q

primary and anterior stabilizer of the knee

A

ACL

138
Q

Lachman’s test

A

ACL test, more sensitive, knee at 30 degrees, anterior and posterior translation of tibia

139
Q

Pivot shift test

A

Knee fully extended
valgus and upward force applied to knee
tibia subluxes anteriorly on femur

140
Q

collateral ligament tears:
Valgus force?
Varus force?

A 
valgus = MCL
Varus = LCL
141
Q

patellar fx

A

extensor mechanism usually intact if two main fragments < 6 mm apart
Immobilize in extension 6 weeks

142
Q

chondromalacia patellae

A

Patellofemoral pain syndrome, most common anterior knee problem, worse with sitting with knee flexed or going down stairs.

143
Q

foot anatomy refresher, # of bones

A

26 bones, 34 joints

144
Q

haglund’s deformity

A

deformity of calcaneus

145
Q

most ankle sprains involve what MOI

A

lateral ligament complexes as a result of plantar flexion and inversion

146
Q

anterior drawer test of the ankle is for what?

A

anterior talofibular ligament

147
Q

talar tilt test

A

INVERSION stress on ankle at 90 degrees

tests stability of calcaneofibular and anterior talofibular ligaments

tests stability of the ATF…

148
Q

Deltoid ligament stability-ankle

A

evert foot stress used to assess tear of deltoid ligament

149
Q

squeeze test-ankle

A

provocative test for syndesmotic injury

150
Q

Ottawa Ankle rules

A

Determines the need for xrays in patients with an ankle injury
Pain in the malleolar zone and any of the following:
1. Bone tenderness along the dist 6 cm of the posterior edge of the fibular or tip of the lateral malleolus.
2. Bone tenderness along the distal 6 cm of th eposterior edge of the tibia or tip of the medial malleolus.
3. inability to bear weight for more than 4 steps both immediately and in the ED

151
Q

chronic osteomyelitis antibiotic therapy

A

IV antibiotics for 2-6 weeks with transition to oral antibiotics for total treatment of 4-8 weeks

152
Q

acute osteomyelitis

A

beta-lactam antibiotics

if MRSA is suspected, then IV vancomycin

153
Q

antibiotic to use in diabetic foot infections or PCN allergy. (osteomyelitis)

A

fluoroquinilone

154
Q

treatment for jones fracture

A

strict non-weight bearing for 6-8 weeks

walking boot for additional 2-4 weeks

155
Q

Morton’s neuroma

A

perineural firosis of the plantar nerve where lateral and plantar branches communicate.
Located between the 3rd web space

156
Q

“Walking on a marble” or “wrinkle in sock”

A

Morton’s neuroma

157
Q

arthritis of the MTP joint

A

hallux rigidus - most common sight of arthritis in the foot.

158
Q

normal hallux valgus angle

A

< 15 degrees

159
Q

toe deformity with flexion at DIP

A

Mallet toe

160
Q

toe deformity with flexion of PIP

A

Hammer toe

161
Q

toe deformity with flexion of both PIP and DIP

A

claw toe

Clinical Med II (6 decks)

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