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ortho/rheumatology > Ortho/rheu pictures > Flashcards

Ortho/rheu pictures Flashcards

1
Q

grabs medial knee, ABDucts hip while applying anterior force to femur.
mechanism?

A

ortolani reduce hip

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2
Q

adducts fully flexed hip while applying posterior force to femur. mechanism?

A

barlow to dislocate hip

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3
Q
A

posterior hip dislocation

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4
Q

internal vs ext rotation hip

A
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5
Q

how will a pt present with a hip fracture

A
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6
Q

+ crescent sign

loss of what 2 motions

painful?

A

leg calve perthes

no abduction and IR

painless

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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

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8
Q
A
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9
Q
A
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10
Q
A
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11
Q

inversion vs eversion ankle sprain. what gets damaged?

A
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12
Q
A

maisonneuve fx

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13
Q
A

pilon fracture

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14
Q
A
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15
Q
A
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16
Q

elevated what on labs

A

charcot arthropathy

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17
Q

metaphysis one: risk of what, tx

A

Stress fx, risk of nonunion or malunion

NWB short leg cast 6-8 weeks

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18
Q

transverse avulsion fx at base(tuberosity) of 5th metatarsal

A

Pseudojones fx

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19
Q

location of Jones and pseudo Jones fx

A

Jones is a transverse fx through DIAPHYSIS of 5th metatarsal

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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

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21
Q

describe periosteum

A

intact periosteum on bowing side

Green stick

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22
Q

what junction affected?

what motion causes this

A

buckle fx

metaphyseal and diaphyseal junction

axial loading

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23
Q

describe SALTER harris fx with the epiphyseal plate

A
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24
Q

codman triangle

mets where

A

osteosarcoma
mets to lung MC

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25
Q

Hair on end

A

osteosarcoma

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26
Q

mets where

common locations

A

no mets

prox femur, pelvis, prox humerus

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27
Q

“onion skin” “moth eaten”

mets where

found where most common

A

ewing sarcoma

mets to bone marrow and lung

lung mets is MC cause of death

femur most common

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28
Q

patho

pain relief?

A

osteiod osteoma

nidus produces high levels of prostaglandins

NSAIDs within 20 min

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29
Q

gottrons papules

heliotrope rash

shawl sign

order what test

A

dermatomyositis

IT: muscle enzymes(CK and adolase)

anti Jo antibodies!

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30
Q

malar rash, young female,

labs: anti-double stranded DNA and anti smith

antiphospholipids antibodies

ANA screening of choice

A

lupus

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31
Q

positive schirmer test

def test what

inc risk for what

A

sjogren syndrome

lip or parotid gland bx

non hodgkin lymphoma

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32
Q

erythema nodosum, uveitis

dx how

tx

A

corticosteroids

pathergy: sterile skin papules from minor trauma

bx(D)

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33
Q

anti centromere antibodies
anti SCL-70 antibodies

A

scleroderma

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34
Q

large vessels: aorta and branches

LE claudication

dx with what

A

angiography(MRA or CTA)

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35
Q

affects what vessels
tx

A

coronary

IV immunoglobulin and aspirin

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36
Q

labs and what angiograph

A

polyarteritis nodosa

classic PAN is ANCA neg

renal or mesenteric angiography: micoranerysms (beading)

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37
Q

tx

A

granulomatous with polyangitis(wegeners)

glucorticoids with cyclophosphamide

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38
Q

renal: acute glomerulonephritis rapidly progressive

+ what on labs

A

microscopic polyangitis

+ P-ANCA

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39
Q
A

henoch schonein purpura

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40
Q
A

anti-gmb antibody (goodpasture ds)

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41
Q

1st line

A

psoriatic arthritis

nsaids

methotrexate for severe

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42
Q

bamboo spine
+HLAB27

A

ankylosing spondylitis

43
Q
A

reactive arthrit9s

44
Q
A
45
Q
A
46
Q
A

juvenile idiopathic rheumatoid arthritis

47
Q
A
48
Q

+ bifregent

A

gout left/pseudogout

49
Q

which one is calcium pyrophosphate?

A

pseudogout- right column

50
Q

how to treat

A

kawasaki

IV immunoglobulin and aspirin

51
Q
A

polyarteritis nodosa

tx is glucocorticoids

52
Q

what is a hallmark lab

nec vasculitis small-med vessels

A

eosinophillic granulamatous

P-ANCA positive

53
Q

necrosis is what?

bx shows necrotizing granulomas

tx?

A

granulomatosis with polyangitis/Wegener’s

glucocorticoids with cyclophophasmide

54
Q

affects what that is not seen in PAN?

Not associated with nasopharyngeal sx, necrosis, or granulomatous inflammation like GPA.

what is rapid progressive?

A

microscopic polyangitis

acute glomerulonephritis

55
Q

Nml PT, PTT, platelets why

A

Immumoglobulin A vasculitis (Henoch Schonlein purpura)

mesangial IgA deposits on bx

the purpura is due to vasculitis, not due to thrombocytopenia or coagulopathy

56
Q

check for what nn injury

A

anterior shoulder dislocation

axillary with deltoid pinprick

57
Q

what xray series to get?

presentation?

A

posterior shoulder dislocation

ADDucted and IR

58
Q

pain with what

testing what

A

hawkins test

pain with IR

test rotator cuff

59
Q

pronated or supinated?

A

thumbs down- pronated

neers

test rotator cuff

60
Q
A

drop arm test.

61
Q
A

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
Q

Prox humeral head fx

present how?

common site for what cancer

A

prox humeral head fx

present ADDucted position.

metastatic breast cancer

63
Q

mechanism of injury?

non op tx what?

r/o radial nn injury- may develop what?

A

humeral shaft fx

fall on an outstretch hand, direct trauma

wrist drop

coaptation splint or sling & swathe

64
Q

most common on what part of bone?

non tx what

A

clavicle fx

midshaft 1/3 of the time

sling immobilization

65
Q

Mechanism of injury?

what nerve injury to watch for

tx

A

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
Q

from what

A

medial and brachial artery injury.

think supracondylar humeral head fx

67
Q

+ fat pad sign

non op tx

A

radial head fx

immobilize with sling or long arm splint 90 degrees

68
Q

most common organism?

what is definitive dx test

A

suppurative flexor tenosynovitis

kanavel’s signs (FLEX)

staph aureus

aspiration and/or biopsy

69
Q

mechanism of injury?

inability of do what motion?

what nerve are you worried about?

non op tx?

A

olecranon fracture

direct blow(fall on flexed elbow)

ulnar neuropathy

reduction and posterior long arm splint(90 degrees of flexion)

70
Q

WBC < 500 means what

WBC > 2,000 means what

A

olecranon bursitis

under 500: non infectious, non crystalline bursitis

over 2000: septic

71
Q

nondisplaced distal third tx?

nondisplaced mid-proximal third tx?

displaced > 50% tx?

A

nondisplaced distal third tx? short arm cast

nondisplaced mid-proximal third tx? long arm cast

displaced > 50% tx? ORIF

72
Q

17% may have a ____ nerve injury

A

Monteggia fx
radial

73
Q

temp tx before ORIF(if unstable)

complication?

A

galeazzi fx

long arm/sugar tong splint

anterior interosseous nerve injury (loss of pinch between thumb and index finger); compartment syndrome

74
Q

presents how?

what ligament?

how to reduce?

A

nursemaids elbow (annular ligament)

arm slightly flexed, TTP to lateral elbow

75
Q

Tennis elbow

what is this muscle?

what disorder?

presentation

A

lateral epicondylitis/tennis elbow
EXTENSOR carpi radialis brevis muscle

lateral elbow pain with pronation, and pain with wrist extension against resistance

76
Q
A
77
Q

inflammation of what muscles?

how to reproduce pain?

pain worse with what activities?

A

pronator teres FLEXOR carpi radialis

wrist flexion against resistance with the elbow fully extended

pulling activities

78
Q

falling on an outstretched hand with hyperextension and axial loading

on exam, will not be able to do what

tx if stable and unstable

A

posterior(most common) elbow dislocation

inability to fully extend elbow

emergent! reduction with posterior splint at 90 degrees

unstable: ORIF

79
Q

what disorder?

what nerve?

pain worse with what motion

A

cubital tunnel syndrome

ulnar neuropathy

elbow flexion

80
Q

mechanism of injury?

fx may not be evident for up to ___ weeks.

worry about what?

splint? or ORIF

A

scaphoid fx

fall on outstretch hand on extended wrist

2 weeks

AVN or nonunion

thumb spica splint. ORIF if >1mm

81
Q

mechanism of injury?

pain increased with what?

dx is widened spaces > ____ mm

tx?

A

scapholunate dislocation

fall on outstretch hand

worse with dorsiflexion

3 mm

radial gutter splint

82
Q

confirmed how?

genetics?

A

osteogenesis imperfecta

DNA or protein testing

autosomal dominant

83
Q

mechanism of injury?

tx

A

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
Q

ORIF if what?

xrays show dorsally or ventrally displacement?

complication: what tendon rupture?

A

colles fx

DORSALLY

extensor pollicis longus tendon

ORIF if comminuted or unstable (>20 degrees angulation, intraarticular, > 1 cm shortening)

85
Q

mechanism of injury?

may develop what nerve problems?

tx

this bone does not articulate with what

A

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
Q

why is the most serious carpal fx?

complications?

tx

A

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
Q

the difference?

A

perilunate dislocation on the left.

perilunated does not articulate with the capitate but still articulates with the radius

88
Q

finklestein test has pain with what?

A

de quervain tenosynovitis

pain with ulnar deviation

abductor pollicis longus
extensor pollicis brevis

thumb spica splint

89
Q

non op tx for 1st one

A

uninterrupted extension splint 6-8 weeks

90
Q

tx

A

splint PIP in ext 4-6 weeks

91
Q

what metacarpals usually?

tx?

check for what else?

A

5th, then 4th

ulnar gutter splint with at least 60 degrees of flexion. reduction first.

check for bite wounds.

92
Q

involves what finger

rolando?

tx

A

base of thumb.
bennett fx

rolando if comminuted

immediate thumb spica splint.

93
Q
A

carpel vs pronator teres syndrome

94
Q

tx

what differentiates this from pronator teres syndrome

A

carpel tunnel syndrome

volar splint initial mgmt

CTS has pain at night

95
Q
A

dupuytren’s

96
Q
A

L5

97
Q
A

L4

98
Q
A

S1

99
Q

dx test and tx

A

cauda equina syndrome

get MRI, emergent decompression

100
Q

organism

triad

test of choice

A

spinal epidural abscess

staph aureus

fever, spinal pain, neurologic defects

mri with gadolinium

101
Q

Scoliosis

what curve is considered abn?

cobbs angle is positive when

A

a 7 degree curve

cobb angle over 10 degrees

102
Q

when to wear this

A

if cobb angle increases 5 degrees or more over a 3-6 month period

or cobb angle 30-39 degrees

103
Q

what neuropathy should you worry about?

vascular compression of wht

A

thoracic outlet syndrome.
ulnar nerve neuropathy.

vascular compression with ABDuction of arm.

104
Q

confirmed how

A

+ if loss of radial pulse with head rotated to affected side.

thoracic outlet sydrome.

confirmed w/ MRI

ortho/rheumatology (13 decks)

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