Ortho/rheu pictures Flashcards
1
Q
grabs medial knee, ABDucts hip while applying anterior force to femur.
mechanism?
A
ortolani reduce hip
2
Q
adducts fully flexed hip while applying posterior force to femur. mechanism?
A
barlow to dislocate hip
3
Q
A
posterior hip dislocation
4
Q
internal vs ext rotation hip
A
5
Q
how will a pt present with a hip fracture
A
6
Q
+ crescent sign
loss of what 2 motions
painful?
A
leg calve perthes
no abduction and IR
painless
7
Q
which part of bone affected
presents how
anterior or posterior displacement?
painful?
limited in what 2 motions
A
epiphysis
presents ER
posterior
painful
limited IR abduction and flexion of hip
8
Q
A
9
Q
A
10
Q
A
11
Q
inversion vs eversion ankle sprain. what gets damaged?
A
12
Q
A
maisonneuve fx
13
Q
A
pilon fracture
14
Q
A
15
Q
A
16
Q
elevated what on labs
A
charcot arthropathy
17
Q
metaphysis one: risk of what, tx
A
Stress fx, risk of nonunion or malunion
NWB short leg cast 6-8 weeks
18
Q
transverse avulsion fx at base(tuberosity) of 5th metatarsal
A
Pseudojones fx
19
Q
location of Jones and pseudo Jones fx
A
Jones is a transverse fx through DIAPHYSIS of 5th metatarsal
20
Q
mid foot injury
what is fleck sign
what foot bone is involved besides metatasal
tx?
A
lisfranc injury
fx at base of 2nd Metatarsal pathognomic for disruption of tarsometatarsal ligaments
cuneiform
ORIF then NWB 12 weeks
21
Q
describe periosteum
A
intact periosteum on bowing side
Green stick
22
Q
what junction affected?
what motion causes this
A
buckle fx
metaphyseal and diaphyseal junction
axial loading
23
Q
describe SALTER harris fx with the epiphyseal plate
A
24
Q
codman triangle
mets where
A
osteosarcoma
mets to lung MC
25
Hair on end
osteosarcoma
26
mets where
common locations
no mets
prox femur, pelvis, prox humerus
27
"onion skin" "moth eaten"
mets where
found where most common
ewing sarcoma
mets to bone marrow and lung
lung mets is MC cause of death
femur most common
28
patho
pain relief?
osteiod osteoma
nidus produces high levels of prostaglandins
NSAIDs within 20 min
29
gottrons papules
heliotrope rash
shawl sign
order what test
dermatomyositis
IT: muscle enzymes(CK and adolase)
anti Jo antibodies!
30
malar rash, young female,
labs: anti-double stranded DNA and anti smith
antiphospholipids antibodies
ANA screening of choice
lupus
31
positive schirmer test
def test what
inc risk for what
sjogren syndrome
lip or parotid gland bx
non hodgkin lymphoma
32
erythema nodosum, uveitis
dx how
tx
corticosteroids
pathergy: sterile skin papules from minor trauma
bx(D)
33
anti centromere antibodies
anti SCL-70 antibodies
scleroderma
34
large vessels: aorta and branches
LE claudication
dx with what
angiography(MRA or CTA)
35
affects what vessels
tx
coronary
IV immunoglobulin and aspirin
36
labs and what angiograph
polyarteritis nodosa
classic PAN is ANCA neg
renal or mesenteric angiography: micoranerysms (beading)
37
tx
granulomatous with polyangitis(wegeners)
glucorticoids with cyclophosphamide
38
renal: acute glomerulonephritis rapidly progressive
+ what on labs
microscopic polyangitis
+ P-ANCA
39
henoch schonein purpura
40
anti-gmb antibody (goodpasture ds)
41
1st line
psoriatic arthritis
nsaids
methotrexate for severe
42
bamboo spine
+HLAB27
ankylosing spondylitis
43
reactive arthrit9s
44
45
46
juvenile idiopathic rheumatoid arthritis
47
48
+ bifregent
gout left/pseudogout
49
which one is calcium pyrophosphate?
pseudogout- right column
50
how to treat
kawasaki
IV immunoglobulin and aspirin
51
polyarteritis nodosa
tx is glucocorticoids
52
what is a hallmark lab
nec vasculitis small-med vessels
eosinophillic granulamatous
P-ANCA positive
53
necrosis is what?
bx shows necrotizing granulomas
tx?
granulomatosis with polyangitis/Wegener's
glucocorticoids with cyclophophasmide
54
affects what that is not seen in PAN?
Not associated with nasopharyngeal sx, necrosis, or granulomatous inflammation like GPA.
what is rapid progressive?
microscopic polyangitis
acute glomerulonephritis
55
Nml PT, PTT, platelets why
Immumoglobulin A vasculitis (Henoch Schonlein purpura)
mesangial IgA deposits on bx
the purpura is due to vasculitis, not due to thrombocytopenia or coagulopathy
56
check for what nn injury
anterior shoulder dislocation
axillary with deltoid pinprick
57
what xray series to get?
presentation?
posterior shoulder dislocation
ADDucted and IR
58
pain with what
testing what
hawkins test
pain with IR
test rotator cuff
59
pronated or supinated?
thumbs down- pronated
neers
test rotator cuff
60
drop arm test.
61
The Empty Can Test, also known as the Jobe or Supraspinatus test, is used to assess for lesions of the rotator cuff, specifically the supraspinatus muscle and supraspinatus tendon.
62
Prox humeral head fx
present how?
common site for what cancer
prox humeral head fx
present ADDucted position.
metastatic breast cancer
63
mechanism of injury?
non op tx what?
r/o radial nn injury- may develop what?
humeral shaft fx
fall on an outstretch hand, direct trauma
wrist drop
coaptation splint or sling & swathe
64
most common on what part of bone?
non tx what
clavicle fx
midshaft 1/3 of the time
sling immobilization
65
Mechanism of injury?
what nerve injury to watch for
tx
supracondylar humeral fx
fall on outstretched hand with hyperextended elbow
radial nn injury.
medial and brachial artery injury may lead to a contracture
long arm posterior splint followed by long arm casting
66
from what
medial and brachial artery injury.
think supracondylar humeral head fx
67
+ fat pad sign
non op tx
radial head fx
immobilize with sling or long arm splint 90 degrees
68
most common organism?
what is definitive dx test
suppurative flexor tenosynovitis
kanavel's signs (FLEX)
staph aureus
aspiration and/or biopsy
69
mechanism of injury?
inability of do what motion?
what nerve are you worried about?
non op tx?
olecranon fracture
direct blow(fall on flexed elbow)
ulnar neuropathy
reduction and posterior long arm splint(90 degrees of flexion)
70
WBC < 500 means what
WBC > 2,000 means what
olecranon bursitis
under 500: non infectious, non crystalline bursitis
over 2000: septic
71
nondisplaced distal third tx?
nondisplaced mid-proximal third tx?
displaced > 50% tx?
nondisplaced distal third tx? short arm cast
nondisplaced mid-proximal third tx? long arm cast
displaced > 50% tx? ORIF
72
17% may have a ____ nerve injury
Monteggia fx
radial
73
temp tx before ORIF(if unstable)
complication?
galeazzi fx
long arm/sugar tong splint
anterior interosseous nerve injury (loss of pinch between thumb and index finger); compartment syndrome
74
presents how?
what ligament?
how to reduce?
nursemaids elbow (annular ligament)
arm slightly flexed, TTP to lateral elbow
75
Tennis elbow
what is this muscle?
what disorder?
presentation
lateral epicondylitis/tennis elbow
EXTENSOR carpi radialis brevis muscle
lateral elbow pain with pronation, and pain with wrist extension against resistance
76
77
inflammation of what muscles?
how to reproduce pain?
pain worse with what activities?
pronator teres FLEXOR carpi radialis
wrist flexion against resistance with the elbow fully extended
pulling activities
78
falling on an outstretched hand with hyperextension and axial loading
on exam, will not be able to do what
tx if stable and unstable
posterior(most common) elbow dislocation
inability to fully extend elbow
emergent! reduction with posterior splint at 90 degrees
unstable: ORIF
79
what disorder?
what nerve?
pain worse with what motion
cubital tunnel syndrome
ulnar neuropathy
elbow flexion
80
mechanism of injury?
fx may not be evident for up to ___ weeks.
worry about what?
splint? or ORIF
scaphoid fx
fall on outstretch hand on extended wrist
2 weeks
AVN or nonunion
thumb spica splint. ORIF if >1mm
81
mechanism of injury?
pain increased with what?
dx is widened spaces > ____ mm
tx?
scapholunate dislocation
fall on outstretch hand
worse with dorsiflexion
3 mm
radial gutter splint
82
confirmed how?
genetics?
osteogenesis imperfecta
DNA or protein testing
autosomal dominant
83
mechanism of injury?
tx
colles on left; smith fx on right.
colles: fall on outstretch hand with wrist EXTENSION
smith: fall on outstretch hand with wrist FLEXION
sugar tong splint or cast
84
ORIF if what?
xrays show dorsally or ventrally displacement?
complication: what tendon rupture?
colles fx
DORSALLY
extensor pollicis longus tendon
ORIF if comminuted or unstable (>20 degrees angulation, intraarticular, > 1 cm shortening)
85
mechanism of injury?
may develop what nerve problems?
tx
this bone does not articulate with what
lunate dislocation
high energy injuries while wrist is extended and ulnarly deviated.
medial nerve
emergent closed reduction and splint followed by ORIF
does not articulate with the capitate and radius
86
why is the most serious carpal fx?
complications?
tx
lunate fx
lunate occupies 2/3 of radial articular surface. xays usually neg
AVN of lunate bone (kienbock disease)
immobilization and ortho f/u
87
the difference?
perilunate dislocation on the left.
perilunated does not articulate with the capitate but still articulates with the radius
88
finklestein test has pain with what?
de quervain tenosynovitis
pain with ulnar deviation
abductor pollicis longus
extensor pollicis brevis
thumb spica splint
89
non op tx for 1st one
uninterrupted extension splint 6-8 weeks
90
tx
splint PIP in ext 4-6 weeks
91
what metacarpals usually?
tx?
check for what else?
5th, then 4th
ulnar gutter splint with at least 60 degrees of flexion. reduction first.
check for bite wounds.
92
involves what finger
rolando?
tx
base of thumb.
bennett fx
rolando if comminuted
immediate thumb spica splint.
93
carpel vs pronator teres syndrome
94
tx
what differentiates this from pronator teres syndrome
carpel tunnel syndrome
volar splint initial mgmt
CTS has pain at night
95
dupuytren's
96
L5
97
L4
98
S1
99
dx test and tx
cauda equina syndrome
get MRI, emergent decompression
100
organism
triad
test of choice
spinal epidural abscess
staph aureus
fever, spinal pain, neurologic defects
mri with gadolinium
101
Scoliosis
what curve is considered abn?
cobbs angle is positive when
a 7 degree curve
cobb angle over 10 degrees
102
when to wear this
if cobb angle increases 5 degrees or more over a 3-6 month period
or cobb angle 30-39 degrees
103
what neuropathy should you worry about?
vascular compression of wht
thoracic outlet syndrome.
ulnar nerve neuropathy.
vascular compression with ABDuction of arm.
104
confirmed how
+ if loss of radial pulse with head rotated to affected side.
thoracic outlet sydrome.
confirmed w/ MRI
