Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

EOR- ER > Ortho/Rheum > Flashcards

Ortho/Rheum Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

Stiffness/pain in the neck; presents with paraspinal muscle tenderness and spasm and + Spurling test

A

Cervical sprain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Tx of Cervical Sprain

A

Treat with soft cervical collar (2-3 days), application of ice /heat, analgesics, gentle active ROM soon after injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

MC cause of back pain usually due to lifting, twisting, or strenuous activity

A

Back strain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Sx of back strain

A
  • Stiffness, difficulty bending, axial back pain, and no radicular symptoms
  • No neurological changes (no pain below the knees)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Tx of back strain

A

Treatment: in the absence of “red-flag” symptoms treat conservatively with NSAIDs, heat, ice, PT, home-based exercise

  • Bed rest < 2 days + NSAIDs ± muscle relaxants (cyclobenzaprine) or short-term benzodiazepine
  • Resume activity as tolerated; re-eval if not improved in 4 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Inflammation of the bursa (thin-walled sac lined with synovial tissue); caused by trauma/overuse

A

Bursitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tx of Bursitis

A
  • Tx: prevention of precipitating factors, rest, brace/support, NSAIDs, steroid injections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tx of olecranon bursitis

A
  • Treat with PT, rest and ice, systemic antibiotics based on culture if septic, NSAIDS, injected corticosteroids and joint, operative bursectomy.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MCC of nonseptic bursitis

A
  • Nonseptic bursitis: acute trauma or repetitive trauma causes inflammation of the olecranon bursa.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Housemaids knee MC in what population

A
  • Pain with direct pressure on the knee (kneeling)
    • Swelling over the patella
  • Common in wrestlers: concern for septic bursitis in wrestlers - aspiration with gram stain and culture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tx of prepatellar bursitis (housemaids knee)

A
  • Treatment: compressive wrap, NSAIDs, +/- aspiration, and immobilization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon from the overlying coracoacromial ligament, acromion, and coracoid (the acromial arch) and from the deep surface of the deltoid muscle

A

Subacromial bursitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Tx of subacromial bursitis

A
  • Treatment includes prevention of the precipitating factors, rest, and NSAIDs. Cortisone injections can be helpful.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Tx of tendonitis

A
  • Tx: ice, rest, stretching for inflammation
    • NSAIDs help but don’t penetrate tendon circulation; steroid injection + anesthesia may be beneficial
    • Surgery for excision of scar tissue / necrotic debris if conservative measures fail
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  • Activity-related anterior knee pain associated with focal patellar tendon tenderness. Also known as “jumper’s knee” (up to 20% of jumping athletes)
A

Patellar tendinitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Bassets sign?

A
  • Basset’s sign: tenderness to palpation at the distal pole of the patella in full extension and no tenderness to palpation at the distal pole of the patella in full flexion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What sign is associated with patellar tendinitis

A

Bassets sign = tenderness to palpation at the distal pole of the patella in full extension and no tenderness to palpation at the distal pole of the patella in full flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Patellar tendinitis signs on xray

A
  • Radiographs - AP, lateral, skyline views of the knee - usually normal -may show inferior traction spur (enthesophyte) in chronic cases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What dx would you perform for patellar tendinitis

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tx of patellar tendinitis

A
  • Ice, rest, activity modification, followed by physical therapy. Surgical excision and suture repair as needed
  • Cortisone injections are contraindicated due to the risk of patellar tendon rupture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q
  • pain at the biceps groove
  • Anterior shoulder pain - may have pain radiating down the region of the biceps, symptoms may be similar in nature and location to the rotator cuff or subacromial impingement pain
  • Pain with resisted supination of the elbow
A

Biceps tendonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What dx would you perform for biceps tendonitis

A
  • X-Ray to r/o fracture. Ultrasound: can show thickened tendon within the bicipital groove
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What would an MRI show with Biceps tendonitis?

A
  • MRI: can show thickening and tenosynovitis of proximal biceps tendon - increased T2 signal around the biceps tendon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What deformity indicates rupture of biceps tendonitis

A

Popeyes deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Tx of biceps tendonitis

A
  • Treat with NSAIDS, PT strengthening, and steroid injections
  • Surgical release reserved for refractory cases for bicep pathology seen during arthroscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What special tests are performed w/ biceps tendonitis

A
  • Special tests:
    • Speed test: Pain elicited in the bicipital groove when the patient attempts to forward elevate shoulder against examiner resistance while the elbow extended, and forearm supinated. Positive if the pain is reproduced. May also be positive in patients with SLAP lesions.
    • Yergason’s test: Elbow flexed 90 degrees, wrist supination against resistance. Positive if the pain is reproduced.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What level does cauda equina syndrome occur?

A

L4/L5

  • s/sx: Leg pain, numbness, saddle anesthesia, bowel/bladder dysfunction and/or paralysis.
  • dx: MRI – new-onset urinary symptoms with associated back pain/sciatica need and MRI
  • tx: This is a surgical emergency requiring immediate referral.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Pain and tenderness on the breastbone, pain in more than one rib, or pain that gets worse with deep breaths or coughing

A

Costochondritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

RF of costochondritis

A

age >40, high-impact sports, manual labor, allergies, rheumatoid arthritis, ankylosing spondylitis, reactive arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Tx of costochondritis

A
  • Anti-inflammatories acetaminophen, nonsteroidal ibuprofen
  • Applying heat with compresses such as heating pads
  • Physical therapy, local steroid injection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is Tiezte syndrome

A

is an inflammatory process causing visible enlargement of the costochondral area “slipping rib syndrome”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

MC site of radial nerve injury

A

Humerus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

posterior fat pad/sail sign seen with what fracture/dislocation?

A

Humerus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How to tx humerus fracture/dislocation

A

treat with sugar tong splint (distal) and coaptation splint (shaft) with ortho follow up in 24-48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

MC cause is falling on an outstretched arm causing what type of fracture/dislocation

A

Radial head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Tx of radial head fxr/dislocation

A

treat with a sling, long arm splint at 90 degrees, ORIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

(proximal ulnar shaft fracture with radial head dislocation)

A

Monteggia

MonteggiA = ulnA

vs Galaeazzi = Radial fracture

MUGR = Monteggia = Ulna; Proximal

Galaezzi = Radius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

orsally angulated extra-articular distal radius fracture; “fragility fracture”; FOOSH; causes dinner fork deformity;

A

Colles fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

FOOSH, snuffbox tenderness = treat as a fracture; pain on radial surface of the wrist at anatomical snuffbox, the fracture may not be evident for up to 2 weeks

A

Scaphoid fracutre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

MC type of shoulder dislocation

A

Anterior: MC (arm = anterior) ⇒ arm is abducted and externally rotated (FOOSH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is a bankart lesion associated with shoulder dislocation

A

fracture of anterior inferior glenoid following impaction of the humeral head against glenoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Which nerve is MC affected in shoulder dislocation

A

Axillary nerve C5, C6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

MC area of clavicular fracture

A

Middle third

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Tx of clavicular fracture

A
  • simple arm sling or figure of eight sling: 4-6 weeks adults, ortho consult if proximal 1/3; begin PT after 4 weeks with light strengthening after 6 weeks
45
Q

Which artery is MC affected in hip fracture with femoral neck?

A

medial circumflex femoral artery

46
Q

Which maneuver is used to assess for hip fracture?

A

Log roll maneuver (internal and external rotation of leg elicits hip pain) which suggests femoral neck fracture

47
Q

ip pain with leg shortened and internally rotated/adducted after trauma = MC cause (fall from heigh, MVA);

A

Hip dislocation

48
Q

MC type of hip dislocation

A
  • Posterior dislocation in 90% = adducted, flexed, internally rotated; anterior dislocation = abducted, flexed, externally rotated
49
Q

Tx of hip dislocation

A
  • Tx: closed reduction under conscious sedation; open reduction if failure of closed reduction; repeat XR and neurovascular exam after reduction
50
Q

Ottawa knee rules

A
  1. Age > 55
  2. Tenderness to the head of the fibula
  3. Isolated tenderness to the patella
  4. Inability to flex the knee to 90 degrees
  5. Inability to bear weight for 4 steps both immediately and in examination room regardless of limp
51
Q

Which rules of obtaining xrays of knee or more sensitive?

A

Ottawa = More sensitive

Pittsburgh = More specific

52
Q

Pittsburgh rules of knee xray

A
  1. Recent fall or blunt trauma
  2. Age < 12 y/o or > 50 y/o
  3. Unable to take 4 unaided steps
53
Q

Which artery is of concern in a knee dislocation

A

worry about popliteal artery injury

54
Q

If knee dislocation is of concern , what imaging should be obtained?

A

CT angiogram = Popliteal artery evaluation

Get pre and post-reduction X-ray

MRI required to eval soft tissue injury for surgical planning

55
Q

Foot drop should make you concerned of what type of fracture?

A

Tibial plateau fracture

56
Q

Ottawa ankle rules

A

Need for X-ray based on Ottawa ankle rules:

  1. Pain along lateral malleolus, medial malleolus
  2. Midfoot pain, 5’th metatarsal or navicular pain
  3. Unable to walk more than four steps in the ER or exam room
57
Q

Which type of fracture affects the 5th metatarsal? What about the 3rd?

A

5th = Jones fracture ; Proximal 5’th metatarsal diaphysis fracture; pain over the lateral border of the foot; not benign (poor blood supply to that area)

3rd = Stress ; common in athletes, military (overuse), Most common in 3’rd metatarsal

58
Q

What is the weber ankle classification?

A

Level of fibular fracture relative to the syndesmosis

  1. fibular fracture below mortise, tibiofibular syndesmosis intact, usually unstable
  2. fibular fx at the level of the mortise, tibiofibular syndesmosis intact or mild tear, deltoid ligament intact or may be torn, stable or unstable
  3. fibular fx above Mortise, tibiofibular syndesmosis torn with a widening of talofibular joint, deltoid ligament damage or medial malleolar fracture, unstable = ORIF
59
Q

What causes gout?

A

Altered purine metabolism and sodium urate crystal precipitation into the synovial fluid, M>W (9:1) until menopause (1:1)

60
Q

How do you diagnose gout?

A

Diagnosis is by arthrocentesis – rod-shaped negatively birefringent. Serum uric acid level >8 (not diagnostic)

  • Imaging: small, punched-out lesions on XR = high likelihood diagnosis
61
Q

Drug of choice for tx of gout

A

pharm: NSAIDs = drug of choice (indomethacin TID); colchicine = effective but bad GI s/e; steroid injections for those who can’t take NSAIDs, oral pred if other meds not tolerated

62
Q

posterolateral at C5-C6/C6-C7; pain into arm/shoulder, numbness/tingling pain into the arm with pain at rest vs rotator cuff no pain at rest until there’s movement; confirmed with MRI

A

Cervical herniated disc

63
Q

Which nerve root would be affected if threre is diminished triceps reflex

A

affects C7 nerve root – pain at the shoulder blade, pectoral area, medial axilla, posterolateral upper arm, dorsal elbow and forearm, index, and medial digits or all of the fingers; diminished triceps reflex

64
Q

pain in a dermatomal pattern – increases with coughing, straining, bending, and sitting

A

Lumbar herniated disc - (L5-S1 is most common)

65
Q

back pain radiating through thigh/buttocks (lower leg below the knee down L5-S1)

A

Sciatica

straight leg raise, crossover test; dx = non-contrast MRI; tx: NSAIDs, rest, steroids, PT, epidural steroid injection, surgery if warranted

66
Q

Which vertebrae is MC affected in lumbar pain

A

L5 = MC radiculopathy: lateral aspect of the leg into the foot; strength can be reduced in foot dorsiflexion, toe extension, foot inversion, and foot eversion.

67
Q

MCC of lower back pain

A

The most common causes of lower back pain = prolapsed intervertebral disk and low back strain. Usually occurs within 24 hours of injury/overuse

68
Q

MC organism in osteomyelitis

A
  • S. aureus is the most common organism (80%)
69
Q

Dx of osteomyleitis

A

Diagnose with bone aspiration = gold standard

  • X-ray triad: demineralization, periosteal reaction, bone destruction (lags behind symptoms 7-10 days); MRI shows changes before XR
  • Labs: CRP elevated for 4-6 weeks, WBC and ESR high in most cases
  • Definitive diagnosis = blood culture or by needle aspiration/bone biopsy
70
Q

Tx of osteo

A

Treat with empiric therapy directed toward most probable organism and tailored once culture results are available

  • All hardware removed
  • IV antibiotics ⇒ 4-6 weeks for acute OM and > 8 weeks for chronic or MRSA
  • If diabetic foot ulcer is > 2 cm x 2 cm or bone is palpable osteomyelitis is likely
71
Q

MC organisms in septic arthritis

A
  • S. aureus is most common (40-50%); N. gonorrhea in sexually active young adults, streptococci; pseudomonas in IVDU
72
Q

How is septic arthritis diagnosed

A
  • Diagnose with arthrocentesis: joint fluid aspirate for definitive diagnosis (WBC > 50,000 primarily PMNs)
73
Q

Tx of septic arthritis:

Staph

Gonorrhea

IVDU

A

Treatment is based on gram stain- 2–4-week course of antibiotics + arthrotomy with joint drainage

  • Staph aureus = Vanco/nafcillin (Vanco or Clindamycin if PCN allergic)
  • Gonorrhea = ceftriaxone
  • IVDU = Cipro/Levaquin
74
Q

Tests associated w/ diagnosis of carpal tunnel

A

pain/paresthesia in median nerve distribution (first 3 digits and radial half of 4th digit; sx worse at night); + Phalen (pushing backs of hands together) and + Tinel test (tapping over nerve); cli

75
Q

pain and swelling at base of thumb that radiates into the radial aspect of forearm

A

De Quervains tensosynovitis

pain and swelling at base of thumb that radiates into the radial aspect of forearm; + Finkelstein; tx = thumb spica splint x 3 weeks, NSAIDs 10-14 days, steroid injections, PT

76
Q

lnar collateral ligament injury from fall on an abducted thumb

A

Thumb collateral ligament injury

Gamekeeper = chronic; skier = acute

77
Q

avulsion of extensor tendon ⇒ forced flexion; can’t straighten distal finger,

A

Mallet finger

tear at DIP joint

78
Q

PIP flexion and DIP hyperextension; usually from jammed finger;

A

Boutonniere deformity (tear at PIP joint – jammed finger

79
Q

noncancerous mucin-filled synovial cyst caused by trauma, mucoid degeneration, synovial herniation usually on the dorsal aspect of the wrist; usually asymptomatic,

A

Ganglion cyst

80
Q

What test is associated with ganglion cysts

A

Allens test = Ensure radial + ulnar artery flow

81
Q

fall directly on shoulder or FOOSH, may have an elevation of the clavicle (step off deformity) and point tenderness

A

AC Joint separation of the shoulder

82
Q

2 tests to assess for biceps tendonitis

A
  • Speed’s: pt attempts to forward elevate shoulder against examiner resistance while the elbow extended and forearm supinated; positive with pain (SLAP lesion)
  • Yergason’s elbow flexed at 90, wrist supination against resistance
83
Q

MC injury in rotator cuff tear/tendinopathy

A

supraspinatus = MC injury;

84
Q

Which 3 tests are used to assess rotator cuff injuries

A
85
Q

What imaging is used for rotator cuff injuries

A

XR = initial imaging (loss of subacromial space due to upward migration of humeral head), MRI = most accurate; tx = NSAIDs, steroid injection and surgical repair if you fail 3-6mo of conservative

86
Q

Pain with reaching/lifting and pain with overhead motion

A

Subacromial impingement

87
Q

3 tests associated with subacromial impingement

A
  • Neer test: arm fully protonated with pain during forward flexion while shoulder is being held
  • Hawkins: elbow/shoulder flexed at 90 with sharp anterior shoulder pain with internal rotation
  • Drop arm: pain with inability to lift the arm above shoulder or hold it
88
Q

pop and swelling along with instability or “giving out” the knee after plant and twist injury; quickly stopping movement and changing direction while running / landing jump

A

ACL tear

89
Q

Most sensitive test for ACL tears

A

Lachman’s = most sensitive, MRI confirms the diagnosis; PT and lifestyle modifications for low demand pt; surgery for young/active

90
Q

Valgus stress injury (hit in football); “pop” along with medial joint line pain,

A

MCL

91
Q

LCL test

A

trauma to the inside of the knee; rare; MRI = definitive study; conservative treatment with bracing and therapy usually effective; surgery for grade III injury; Varus stress test

92
Q

fter twist injury with locking, feeling of knee giving away, a triad of joint line pain, effusion, locking; effusion usually 6-24 hours after injury;

A

Meniscal tear of knee

93
Q

Ankle sprians MC involve which ligaments

A

85% are in collateral ligaments → anterior talofibular ligament during inversion; deltoid affected by eversion

94
Q

pop” then weakness, palpable gap + increased resting ankle dorsiflexion in a prone position with knees bend

A

Achilles tendon rupture

Thompson test

95
Q

painful mass near tarsal heads; MC in women with tight-fitting shoes, high heels; sharp pain with ambulation at 3rd metatarsal head; associated with numbness/paresthesia

A

Mortons Neuroma

96
Q

The most common location for a sprain is the

A

Ankle

97
Q

Classifications of sprain

A
  1. First-degree sprain (mild) the fibers of the ligament are stretched but intact
  2. Second-degree sprain (moderate) is a tear of a ligament, from a third to almost all its fiber
  3. Third-degree sprain (severe) is a complete rupture of the ligament, sometimes avulsing a piece of bone
98
Q

Which 2 locations are MC locations for muscle strain

A

hamstring muscle and the lower back

99
Q

When assessing swelling/deformities what is important to asses first?

A

vascular area distal to the swelling and/or the deformity is intact

100
Q

Mallet finger deformity tx

A

Splint in extension for 6-8 weks

101
Q

History of forced hyperflexion of the DIP + Inability to extend the DIP

A

Mallet finger

Tx = Splint in extension 6-8 wks

102
Q

Most sensitive finding in cauda equina syndrome?

A

Urinary retention

  • Diagnosis is made by MRI or CT myelogram
  • Most commonly caused by a herniated disc
  • Treatment is operative decompression
103
Q

A 54-year-old woman presents with a swollen knee. On examination, a large joint effusion is present. With which of the following spaces does the knee joint communicate?

A

Suprapatellar bursa

The suprapatellar bursa, the largest of the bursae, is not a true bursa but rather an extension of the knee joint capsule. When a knee effusion or hemarthrosis is present, fluid can freely flow into and distend the suprapatellar bursa. One technique to increase detection of small effusions is to “milk” the suprapatellar bursa, forcing fluid back into the knee joint.

104
Q

What condition is caused by prolonged or frequent kneeling?

A

Prepatellar bursitis.

105
Q

What is the most common site of compartment syndrome?

A

Anterior compartment of lower leg

106
Q

Skiers/gamekeepers thumb is rupture of what ligament

A

Ulnar collateral ligament

Gamekeeper’s Thumb, Skier’s Thumb

  • History of skiing
  • Pain, swelling, and tenderness on the ulnar side of the metacarpophalangeal joint of the thumb
  • Most commonly caused by the forceful radial abduction of the thumb
  • Treatment is thumb spica splint
107
Q

GRUesome MURder mneumonic

A
  • Galeazzi: Radius fracture, Ulna (radioulnar joint) dislocation
  • Monteggia: Ulna fracture, Radial head dislocation
108
Q

What are two primary physical exam techniques used to diagnose shoulder impingement?

A

The Neer test (passively flexing the glenohumeral joint while simultaneously preventing shoulder shrugging) and the

Hawkins test (internally rotating the shoulder while the shoulder is forward flexed 90 degrees and the elbow is flexed at 90 degrees).

EOR- ER (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions