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IPAP > Ortho Block 1 Cram > Flashcards

Ortho Block 1 Cram Flashcards

1
Q

Define Crystal Deposition Dz

What causes the main Sx

A

Arthritis characterized by episodes of pain and swelling of a single joint

Pain/swelling from lysis of PMN cells due to engulfing of crystals

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2
Q

Most PTs with radiographic evidence of CPDD are ???

What are the 5 manifestations of Crystal Deposition Dz

A

ASx

ASx Dz, Pseudogout, Pseudorheumatoid, Pseudoosteoarthritis, Pseudoneuropathic Joint Dz

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3
Q

What are the 3 phases of Gout?

What diagnostic lab tests are run on a serum analysis for gout?

A

Acute gouty arthritis, Interval Gout, Chronic Tophaceous gout

PCM FATISH
Phosph, Ca, Mg, Ferritin, Alkaline Phosph., Transferring, Fe, TSH

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4
Q

What are the 3 common findings seen in Pseudo/Gout?

When serum uric acid is checked, what result is found?

A

Fever, Leukocytosis, Elevated ESR

Normal during acute episodes

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5
Q

What lab test is critical for distinguishing gout from septic arthritis

Define Chondrocalcinosis and when is it seen?

A

Gram stain and culture

CPDD
Radiographic findings of punctate/linear calcification of articular cartilage and internal joint structures

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6
Q

What 4 metabolic d/os are associated with CPDD

How is gout treated?

A

Hyperparathyroid, Hypothyroid, Hypophosphaasia, Hemochromatosis

1st- Indomethacin, Naproxen,
2nd- Colchicine, PO glucocorticoids, injections
Long term- Allopurinol, Probenecid

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7
Q

How do long term gout control meds work?

A

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

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8
Q

How is CPDD treated

What are the 3 red flags of Gout/Pseudo gout

A

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

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9
Q

DVTs are caused by ? and PEs are caused by?

What imagines modalities are used?

A

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)

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10
Q

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?

A

Enoxaparin

Enoxaparin and heparin

Heparin is used for PTs w/ renal insufficiency

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11
Q

What agent is most commonly used for anti-coagulation?

What is this drug best for?

A

Warfarin w/ target INR 2-2/5

Prevents proximal clots in PTs undergoing hip arthroplasty

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12
Q

? and mechanical prophylaxis are effective when combined for DVT prevention

How does mechanical prophylaxis reduce VTE Dz?

A

ASA

Secondary to increased fibrinolysis and decreased stasis w/ accelerated venous emptying

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13
Q

Define DISH

What path does this issue follow?

A

Lateral x-rays prove osteophyte formation on 3 spaces or 4 bodies in thoracic/lumbar region

Anterior longitudinal ligament and peripheral disc margins

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14
Q

What are the principles Sxs of DISH

What non-CN Sxs can present

A

Morning and evening stiffness w/ mild localized back pain

Dysphagia if anterior osteophyte presses on esophagus

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15
Q

PE of DISH shows ?

What are the two most common causes of cervical myelopathy

A

Stiffness w/ flexion and extension

Cervical spondylosis
Ossification of PLL in DISH

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16
Q

How is DISH treated?

What is an adverse outcome of DISH treatment?

A

Exercise and NSAIDs

Heterotrophic ossification post-hip replacement 5x more often in DISH PTs

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17
Q

In order for Dx of Fibromyaliga to be given, pain must be present where?

What odd place is considered a quantifiable pain location?

A

Widespread= L, R, Superior/Inferior to waist
Axial skeleton pain- neck, anterior chest, thoracic, lower back

Low back pain= below the waist pain

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18
Q

What tool is used to measure for fibromyalgia pain?

What are the 5 posterior locations to test?

What are the 4 anterior locations tested?

A

Dolorimeter- causes 4kg of pressure

Occiput, Supraspinatus, Traps, Glueal, Greater trochanter

Low cervical, Second rib, Lateral epicondyle, knee

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19
Q

Other than the 3 FDA approved drugs, what drugs are used for fibromyalgia?

What non-pharm treatment methods are used?

A

DBC DNR
Anti-depressant/convulsant, Non-Benzos, Relaxants, Dopamine agonists, NSAIDs

Needling and infiltration w/ lidocaine (NS if allergic) is MOST effective

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20
Q

How andwWhere does osteomyelitis grow in Peds?

How does it get access inside of adults?

A

Hematogenous spread to metaphysis

Open Fx, Surgical fixation of Fxs

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21
Q

How does osteomyelitis present in older children and adults?

How does it present in post-op PTs?

A

Fever, pain and swelling at site

Drainage or substantial delayed healing

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22
Q

What imaging modality is used to Dx osteomyeltits?

What will lab results show?

A

MRI to assess marrow changes

Inc WBC, may be normal in chronic/immunosuppressed PTs
Inc ESR and CRP

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23
Q

What is the most common organism causing osteomyelitis in Peds?

What is the most common microbe in adults?

A

Staph A, GAS, Hem Influenza

Staph A, Pseudomonas Aeurginosa

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24
Q

How is osteomyelitis treated?

What microbe causes Lyme Dz and what bug carries the microbe?

A

Surgical excision and implanted methyl methacrylate beads

Spirochete Borrelia Burgdorferi
Deer tick Ixodes Dammini

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25
Q

What are the 3 phases of Lyme Dz Sxs

What is the characteristic skin lesion?

A

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

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26
Q

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?

A

Synovitis and Dec joint ROM

24-36hrs

27
Q

What ABX are used for Lyme Dz

A

Doxy 100mg BID x 28 days
Amoxicillin 500mg TID x 28 days

Under 8yrs= Amoxicillin 20mg/kg

28
Q

What are the different forms of osteoporosis

A

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)

29
Q

How does a DEXA scan provide info on bone mass?

Bone density is characterized by the lower value in what locations?

A

Real density and compared to peers (Z score) and young/healthy (T score)

Spine, femoral neck, trochanter or total femur

30
Q

What values are indicative of osteoporosis?

What is the best test for assessing/monitoring treatment?

A

0 – -1= norm

  • 1 - -2.5= osteopenia
  • 2.5 and lower= osteoporosis

DEXA

31
Q

What class of drug needs to be avoided to reduce risk of osteoporosis complications?

What is the ideal exercise program for these PTs?

A

Long acting benzos

Walking, strength and balance training

32
Q

Overuse syndrome is secondary to ? and can produce what two reactions?

What causes reactive/acute inflammatory overuse syndrome?

A

Repetitive microtrauma
Acute inflammation, chronic degeneration

Microtrauma causing fatigue and inflammation

33
Q

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

A

Epitenon

Degeneration to musculotendinous unit which is reversed by persistent inflammation

34
Q

Chronic tendon injuries are ? process rather than a ? process

Define Apophysitis
Define Epiphysiolysis

A

Degeneration, not an inflammatory

Inflammation of growth plate
Traumatic widening of growth plate

35
Q

When conducting PE of overuse syndrome in an extremity, it’s inspected for ? 4 things?

How is this syndrome treated?

A

Swelling, Erythema, Pallor, Atrophy

PRICE
PT w/ eccentric strengthening
NSAIDs/analgesics

36
Q

What is the recommended treatment protocol for a muscle strain in the LE?

A

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

37
Q

What is the single most valuable imaging modality when assessing bone lesions?

When is CT or MRI superior?

When are bone scans useful

A

X-ray

MRI- superior to visualize soft tissues and marrow issues
CT- better for bone detail

Infection, trauma, tumors

38
Q

In PTs over 40y/o w/ a bone tumor what is the most likely Dx?

Growing pains are through to be a result of ?

A

Metastases or myeloma

Over activity- muscle strain or fatigue

39
Q

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?

A

Skeletal survey

Baby gram

40
Q

What Fxs are moderately suspicious for abuse?

What Fxs are strongly suspicious for abuse?

A

Bilateral, Different ages, Epiphyseal separation, Vertebral body, fingers and complex skull Fxs

Multiple Fxs at various stages of healing w/out explanation

41
Q

How can you tell how old a Fx is?

How are Fxs older than 6wks distinguished?

A

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

42
Q

Define Toddler Fx

What are the typical Sxs of CRPS

A

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
43
Q

How is CRPS Type 1 Dx?

What type of PE results will be seen?

A

Dx of exclusion

Limited AROM, PROM cause severe pain
Brushing skin causes burning pain

44
Q

What is the mainstay of Tx for CRPS

What types of SALTAR Fxs need surgery?

A

Rehab, Amitriptyline, Gabapentin

3 and 4, involve growth plate and articular surface

45
Q

What is a s/e risk to SATAR 3, 4 and open Fxs

What Sx is common to all seven types of JIA

A

Physeal bars

Chronic arthritis lasting longer than 6wks in PTs under 16

46
Q

Define the 6 types of JIA

Which ones have uveitis

A 
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

47
Q

What PE exam is done for JIA?

What labs are drawn for these PTs?

What caution is taken with these results

A

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

48
Q

How is JIA treated?

What two drugs are used for refractory uveitis?

A

NSAIDs, Methotrexate, a-TNFs

Infliximab and Adalimumab

49
Q

Where does Osteochondritis Dissecans occur

What causes it?

A

Medial condyle of knee, elbow, talus and distal humerus, rarely in patella

Repetitive small stress that disrupts blood

50
Q

How is PE exam done to assess osteochondritis dissecans?

How is it best viewed w/ imaging?
When are MRIs ordered?

A

W/ knee flexed at 90*

Tunnel- AP view w/ knee flexed
Lateral
Assess integrity of cartilage and lesion staging

51
Q

How is osteochondritis dissicans treated?

When is it referred for surgery?

A

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

52
Q

Define Sequestrate

Define Involucrum

A

infection in medullary canal penetrates metaphyseal cortex causing abscess causing necrosis leading to fragments

Periosteum remains viable and new bone forms to stabilize area

53
Q

What finding is typical on exam for ped osteomyelitis?

What images are used to assess?

A

Fever +100.4/38*C and tenderness over site

MRI w/ contrast

54
Q

What labs are ordered for peds osteomyeltis?

How is it treated?

A

CBC w/ diff, CRP (will be abnormal first, within first 8hrs) and blood culture

IV ABX after gathering samples
Surgery for debrisment

55
Q

How does septic arthritis occur in kids?

How do they present in clinic?

A

Hematogenous seeding after poneumonia, impetigo/skin infection

Guarding of joint and systemic Sxs
Painful ROM

56
Q

How is pediatric septic arthritis Dx

Seronegative Spond have what 4 characteristics in common?

A

Aspiration w/ +15K WBC count and +50K in synovium

Inflammation, Pauciarticular arthritis in LE, extra articular inflammation, HLA-B27

57
Q

How does ankylosing spondylitis present in kids under 9?

What can cause Reiters in adolescents?

A

Asymmetric pauciarticular arthritis in LE

YCSS
Non-gonoccocal- Chlamydia or Trachoma

58
Q

What two spots in adolescents w/ Retiers is extremely painful?

What joint issue is seen in kids w/ IBDz Arthritis?

A

Achilles tendonitis, Plantar fasciitis

Arthralgia w/out effusion is 2x more common in kids under 21

59
Q

What is a key visual PE finding indicative of juvenile seronegative spondyloropathy

What lab result supports a Dx of Reiters in Peds?

A

Purple discoloration around joint

Sterile pyuria

60
Q

How are juvenile seronegative ailments treated?

Conus medularis stops at ?
Cauna equina starts at ?

A

NSAIDs, PT, orthoses and counseling

L1-2
L2-S4

61
Q

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?

A

Cervical Radiculopathy

Shock of electricity produced by neck flexion in cervical spondylosis
Hoffmann reflex, Clonus, Hyperflexia and Babinksi

62
Q

What are the findings on PE for cervical strains?

Where is pain associated with cervical strains most commonly located?

A

Pain w/ movement, paraspinal spasm, occipital HAs x 6mon post accident

Cervicothroacic junction

63
Q

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?

A

Instability greater than 3.5mm and/or angulation greater than 11*

Cross table view of C1-C7

64
Q

PTs w/ cleared C-spine but have persistent pain need to have ? precaution?

A

Soft collar worn x 7-10 days

IPAP (212 decks)

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