Ortho Block 1 Cram Flashcards
Define Crystal Deposition Dz
What causes the main Sx
Arthritis characterized by episodes of pain and swelling of a single joint
Pain/swelling from lysis of PMN cells due to engulfing of crystals
Most PTs with radiographic evidence of CPDD are ???
What are the 5 manifestations of Crystal Deposition Dz
ASx
ASx Dz, Pseudogout, Pseudorheumatoid, Pseudoosteoarthritis, Pseudoneuropathic Joint Dz
What are the 3 phases of Gout?
What diagnostic lab tests are run on a serum analysis for gout?
Acute gouty arthritis, Interval Gout, Chronic Tophaceous gout
PCM FATISH
Phosph, Ca, Mg, Ferritin, Alkaline Phosph., Transferring, Fe, TSH
What are the 3 common findings seen in Pseudo/Gout?
When serum uric acid is checked, what result is found?
Fever, Leukocytosis, Elevated ESR
Normal during acute episodes
What lab test is critical for distinguishing gout from septic arthritis
Define Chondrocalcinosis and when is it seen?
Gram stain and culture
CPDD
Radiographic findings of punctate/linear calcification of articular cartilage and internal joint structures
What 4 metabolic d/os are associated with CPDD
How is gout treated?
Hyperparathyroid, Hypothyroid, Hypophosphaasia, Hemochromatosis
1st- Indomethacin, Naproxen,
2nd- Colchicine, PO glucocorticoids, injections
Long term- Allopurinol, Probenecid
How do long term gout control meds work?
Probenecid- inc urine excretion of uric acid, not for PTs w/ renal insufficiency
Allopurinol- XOI, decreases production of uric acid from purine synthesis; not used in acute settings
How is CPDD treated
What are the 3 red flags of Gout/Pseudo gout
Aspirate, Injection (1-2 joints), PO NSAIDs/Colchicine for multiple joints, immobilization
3+ attacks/year= prophylaxis colchicine
Joint deformity/destruction
Large tophi masses or drainage
DVTs are caused by ? and PEs are caused by?
What imagines modalities are used?
DVT- morbidity and mortality
PE- venous thrombosis (most preventable cause on in hospital deaths and 3rd cause of death to polytrauma PTs)
US to r/o
Venogram for PTs w/ suspected DVT (endomatous limb)
What is the most common form of LMWH used during hip and knee arthroplasty
What are used for polytraumas/long bone Fxs
What is better for PTs w/ renal issues?
Enoxaparin
Enoxaparin and heparin
Heparin is used for PTs w/ renal insufficiency
What agent is most commonly used for anti-coagulation?
What is this drug best for?
Warfarin w/ target INR 2-2/5
Prevents proximal clots in PTs undergoing hip arthroplasty
? and mechanical prophylaxis are effective when combined for DVT prevention
How does mechanical prophylaxis reduce VTE Dz?
ASA
Secondary to increased fibrinolysis and decreased stasis w/ accelerated venous emptying
Define DISH
What path does this issue follow?
Lateral x-rays prove osteophyte formation on 3 spaces or 4 bodies in thoracic/lumbar region
Anterior longitudinal ligament and peripheral disc margins
What are the principles Sxs of DISH
What non-CN Sxs can present
Morning and evening stiffness w/ mild localized back pain
Dysphagia if anterior osteophyte presses on esophagus
PE of DISH shows ?
What are the two most common causes of cervical myelopathy
Stiffness w/ flexion and extension
Cervical spondylosis
Ossification of PLL in DISH
How is DISH treated?
What is an adverse outcome of DISH treatment?
Exercise and NSAIDs
Heterotrophic ossification post-hip replacement 5x more often in DISH PTs
In order for Dx of Fibromyaliga to be given, pain must be present where?
What odd place is considered a quantifiable pain location?
Widespread= L, R, Superior/Inferior to waist
Axial skeleton pain- neck, anterior chest, thoracic, lower back
Low back pain= below the waist pain
What tool is used to measure for fibromyalgia pain?
What are the 5 posterior locations to test?
What are the 4 anterior locations tested?
Dolorimeter- causes 4kg of pressure
Occiput, Supraspinatus, Traps, Glueal, Greater trochanter
Low cervical, Second rib, Lateral epicondyle, knee
Other than the 3 FDA approved drugs, what drugs are used for fibromyalgia?
What non-pharm treatment methods are used?
DBC DNR
Anti-depressant/convulsant, Non-Benzos, Relaxants, Dopamine agonists, NSAIDs
Needling and infiltration w/ lidocaine (NS if allergic) is MOST effective
How andwWhere does osteomyelitis grow in Peds?
How does it get access inside of adults?
Hematogenous spread to metaphysis
Open Fx, Surgical fixation of Fxs
How does osteomyelitis present in older children and adults?
How does it present in post-op PTs?
Fever, pain and swelling at site
Drainage or substantial delayed healing
What imaging modality is used to Dx osteomyeltits?
What will lab results show?
MRI to assess marrow changes
Inc WBC, may be normal in chronic/immunosuppressed PTs
Inc ESR and CRP
What is the most common organism causing osteomyelitis in Peds?
What is the most common microbe in adults?
Staph A, GAS, Hem Influenza
Staph A, Pseudomonas Aeurginosa
How is osteomyelitis treated?
What microbe causes Lyme Dz and what bug carries the microbe?
Surgical excision and implanted methyl methacrylate beads
Spirochete Borrelia Burgdorferi
Deer tick Ixodes Dammini
What are the 3 phases of Lyme Dz Sxs
What is the characteristic skin lesion?
Localized- Viral syndrome Sxs
Disseminated- Cardiac/Neurological Sxs- meningitis, cranial neuropathy, radicuploapthy (Bells Palsy most common)
Late- arthritis and neurological manifestations, Lyme encephalopathy, distal paresthesia
Erythema Migrans
PTs with erythema migrans and Sxs need to be examined for ?
How quickly should a tick be removed and have little/no risk of Lyme Dz?
Synovitis and Dec joint ROM
24-36hrs
What ABX are used for Lyme Dz
Doxy 100mg BID x 28 days
Amoxicillin 500mg TID x 28 days
Under 8yrs= Amoxicillin 20mg/kg
What are the different forms of osteoporosis
Primary Type 1- post menopause, 6x w>m
Primary Type 2- senile, 2x w>m and older than 70yrs due to altered Ca metabolism and intrinsic problems
Secondary- m>f, Dz process causing bone loss, commonly seen in long term steroid therapy, hyper thyroid, hypo parathyroid (neoplastic, metabolic, CT Dz)
How does a DEXA scan provide info on bone mass?
Bone density is characterized by the lower value in what locations?
Real density and compared to peers (Z score) and young/healthy (T score)
Spine, femoral neck, trochanter or total femur
What values are indicative of osteoporosis?
What is the best test for assessing/monitoring treatment?
0 – -1= norm
- 1 - -2.5= osteopenia
- 2.5 and lower= osteoporosis
DEXA
What class of drug needs to be avoided to reduce risk of osteoporosis complications?
What is the ideal exercise program for these PTs?
Long acting benzos
Walking, strength and balance training
Overuse syndrome is secondary to ? and can produce what two reactions?
What causes reactive/acute inflammatory overuse syndrome?
Repetitive microtrauma
Acute inflammation, chronic degeneration
Microtrauma causing fatigue and inflammation
What part of the tendon has to be involved for the Dx tendonitis to be given?
In acute settings, overuse syndrome injury typically isn’t associated with ? and what event reverses this absence
Epitenon
Degeneration to musculotendinous unit which is reversed by persistent inflammation
Chronic tendon injuries are ? process rather than a ? process
Define Apophysitis
Define Epiphysiolysis
Degeneration, not an inflammatory
Inflammation of growth plate
Traumatic widening of growth plate
When conducting PE of overuse syndrome in an extremity, it’s inspected for ? 4 things?
How is this syndrome treated?
Swelling, Erythema, Pallor, Atrophy
PRICE
PT w/ eccentric strengthening
NSAIDs/analgesics
What is the recommended treatment protocol for a muscle strain in the LE?
Acute: 1-5 days, control pain/swelling w/ RICE
Subacute: 3-21 days, control pain and AROM
Remodeling: 1-6wks, exercise and stretch
Functional: 3wk-6mon, avoid re-injury
What is the single most valuable imaging modality when assessing bone lesions?
When is CT or MRI superior?
When are bone scans useful
X-ray
MRI- superior to visualize soft tissues and marrow issues
CT- better for bone detail
Infection, trauma, tumors
In PTs over 40y/o w/ a bone tumor what is the most likely Dx?
Growing pains are through to be a result of ?
Metastases or myeloma
Over activity- muscle strain or fatigue
What is the x-ray series called that’s ordered for kids under 2yrs w/ suspected abuse?
What form of x-ray doesn’t provide enough info for dx?
Skeletal survey
Baby gram
What Fxs are moderately suspicious for abuse?
What Fxs are strongly suspicious for abuse?
Bilateral, Different ages, Epiphyseal separation, Vertebral body, fingers and complex skull Fxs
Multiple Fxs at various stages of healing w/out explanation
How can you tell how old a Fx is?
How are Fxs older than 6wks distinguished?
7-14 days: new periostal bone and callous are visible
14-21: loss of Fx line, mature callous w/ trabecular formation
21-42 days: dense callous
Fusiform sclerotic thickening best seen compared to normal contra lateral bone
Define Toddler Fx
What are the typical Sxs of CRPS
Spiral Fx of tibia in kids 1-3yrs old from fall
Ecessive pain Hypersensitivity to light touch Cold intolerance Transient swelling Skin discoloration- most commonly foot and ankle
How is CRPS Type 1 Dx?
What type of PE results will be seen?
Dx of exclusion
Limited AROM, PROM cause severe pain
Brushing skin causes burning pain
What is the mainstay of Tx for CRPS
What types of SALTAR Fxs need surgery?
Rehab, Amitriptyline, Gabapentin
3 and 4, involve growth plate and articular surface
What is a s/e risk to SATAR 3, 4 and open Fxs
What Sx is common to all seven types of JIA
Physeal bars
Chronic arthritis lasting longer than 6wks in PTs under 16
Define the 6 types of JIA
Which ones have uveitis
Systemic- arthritis, fever, rahs Oligoarticular- liver, heart, nopathy, arthritis in 4 or less joints, ASx uveitis RF-neg Poly- 5 or more joints w/ no RF Psoriatic- skin, nail and FamHx Enthesitis- HLA-B27 pos, sacroiliitis
Oligoarticular, Psoriatic, Enthesits
What PE exam is done for JIA?
What labs are drawn for these PTs?
What caution is taken with these results
Observe, Palpate, Assess A/PROM, Assess for pain at end of PROM
CBC w/ Diff, ESR/CRP, Metabolic and UA
Normal results don’t r/o and positive results are not Dx
How is JIA treated?
What two drugs are used for refractory uveitis?
NSAIDs, Methotrexate, a-TNFs
Infliximab and Adalimumab
Where does Osteochondritis Dissecans occur
What causes it?
Medial condyle of knee, elbow, talus and distal humerus, rarely in patella
Repetitive small stress that disrupts blood
How is PE exam done to assess osteochondritis dissecans?
How is it best viewed w/ imaging?
When are MRIs ordered?
W/ knee flexed at 90*
Tunnel- AP view w/ knee flexed
Lateral
Assess integrity of cartilage and lesion staging
How is osteochondritis dissicans treated?
When is it referred for surgery?
Lesions smaller than 1cm wide:
Activity mod, no impact,
Immobilize refractory Sxs
1-2cm- treat Sxs and images
Lesions larger than 2cm:
Skeletal maturity and lesion has caused cartilage to separate
Define Sequestrate
Define Involucrum
infection in medullary canal penetrates metaphyseal cortex causing abscess causing necrosis leading to fragments
Periosteum remains viable and new bone forms to stabilize area
What finding is typical on exam for ped osteomyelitis?
What images are used to assess?
Fever +100.4/38*C and tenderness over site
MRI w/ contrast
What labs are ordered for peds osteomyeltis?
How is it treated?
CBC w/ diff, CRP (will be abnormal first, within first 8hrs) and blood culture
IV ABX after gathering samples
Surgery for debrisment
How does septic arthritis occur in kids?
How do they present in clinic?
Hematogenous seeding after poneumonia, impetigo/skin infection
Guarding of joint and systemic Sxs
Painful ROM
How is pediatric septic arthritis Dx
Seronegative Spond have what 4 characteristics in common?
Aspiration w/ +15K WBC count and +50K in synovium
Inflammation, Pauciarticular arthritis in LE, extra articular inflammation, HLA-B27
How does ankylosing spondylitis present in kids under 9?
What can cause Reiters in adolescents?
Asymmetric pauciarticular arthritis in LE
YCSS
Non-gonoccocal- Chlamydia or Trachoma
What two spots in adolescents w/ Retiers is extremely painful?
What joint issue is seen in kids w/ IBDz Arthritis?
Achilles tendonitis, Plantar fasciitis
Arthralgia w/out effusion is 2x more common in kids under 21
What is a key visual PE finding indicative of juvenile seronegative spondyloropathy
What lab result supports a Dx of Reiters in Peds?
Purple discoloration around joint
Sterile pyuria
How are juvenile seronegative ailments treated?
Conus medularis stops at ?
Cauna equina starts at ?
NSAIDs, PT, orthoses and counseling
L1-2
L2-S4
PT w/ loss of cervical curvature, decreased range of motion and spasms has ?
Define Lhermitte sign and where is it seen
What other special tests/neuro findings will be seen with this issue?
Cervical Radiculopathy
Shock of electricity produced by neck flexion in cervical spondylosis
Hoffmann reflex, Clonus, Hyperflexia and Babinksi
What are the findings on PE for cervical strains?
Where is pain associated with cervical strains most commonly located?
Pain w/ movement, paraspinal spasm, occipital HAs x 6mon post accident
Cervicothroacic junction
PTs w/ persistent neck pain from cervical strains get x-rays to look for ?
What is the most important x-ray image to get in multiple trauma PTs?
Instability greater than 3.5mm and/or angulation greater than 11*
Cross table view of C1-C7
PTs w/ cleared C-spine but have persistent pain need to have ? precaution?
Soft collar worn x 7-10 days
