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EM EOR > Ortho/Rheum > Flashcards

Ortho/Rheum Flashcards

1
Q

What is a Bankart lesion?

A

Injury of anterior glenoid labrum following dislocated shoulder

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2
Q

What is a Hill-Sachs lesion?

A

Compression chondral injury of posterior superior humeral head following impaction against glenoid

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3
Q

What is present in 5% of shoulder dislocations and how does it present?

A

Transient neurapraxia of the axillary nerve
Numbness or tingling over lateral shoulder

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4
Q

What causes a clavicular fracture?

A

Direct fall on shoulder
Direct blow to lateral aspect of shoulder
Birth trauma in newborn

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5
Q

What is the MC location of clavicular fracture?

A

Middle third

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6
Q

What will PE of clavicular fracture show?

A

Swelling
Erythema
Tenderness to palpation
Tenting of skin

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7
Q

What is the MC injured rotator cuff muscle in clavicular fracture?

A

Supraspinatus

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8
Q

X-ray views in clavicular fracture

A

Anteroposterior and clavicle view

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9
Q

Treatment of clavicular fracture

A

Simple arm sling or figure of eight sling for 4-6 weeks
Orthopedic consult if proximal 1/3
Begin PT after 4 weeks with light strengthening after 6 weeks

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10
Q

What is a big complication with femoral neck fracture?

A

Damage to medial circumflex femoral artery which is main blood supply to femoral head

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11
Q

Which maneuver may suggest femoral neck fracture?

A

Log roll maneuver (internal and external rotation of leg elicits hip pain)

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12
Q

There is a high incidence of ______ in femoral neck fractures

A

A vascular neck fractures

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13
Q

Tx of hip fracture

A

Manage wit ORIF, hip arthroplasty, DVT prophylaxis until ambulatory

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14
Q

Physical exam on hip dislocation?

A

Leg shortened and internally rotated/adducted

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15
Q

PE finding in posterior hip dislocation? Anterior?

A

Posterior: adducted, flexed, internally rotated
Anterior: abducted, flexed, externally rotated

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16
Q

X-ray findings for hip dislocation

A

Posterior: femoral head superior to acetabulum; anterior: femoral head inferior to acetabulum

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17
Q

Tx of hip dislocation

A

Closed reduction under conscious sedation, open reduction if fails, repeat X-RAY and Neurovascular exam after

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18
Q

Ottawa knee rules

A

1) Age >55
2) Tenderness to head of 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

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19
Q

Pittsburgh knee rules (greater specificity)

A

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

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20
Q

What injury do you worry about with knee dislocation?

A

Popliteal artery injury, diagnosed with CT angiogram

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21
Q

MC mechanism of injury for tibial plateau fracture?

A

Children in MVA

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22
Q

Diagnosis of tibial plateau fracture

A

AP, lateral, oblique XR
If displaced check peroneal nerve (foot drop)

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23
Q

Tx of tibial plateau fracture

A

No displaced cast 6-8 weeks
displaced ORIF

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24
Q

Tx of patella fracture

A

6-8 week immobilization, displaced ORID

25
Presentation of knee osteoarthritis
Pain worse with activities Swelling Stiffness Palpable crepitus on exam
26
XR findings of knee osteoarthritis
Joint space narrowing Osteophytes Subchondral sclerosis
27
Tx of knee osteoarthritis
Weight reduction Moderate activity NSAIDs Intra-articular steroid injection Bracing Canes Muscle strengthening PT Acetaminophen = first line NSAIDs = second line Total joint replacement in advanced cases
28
Ottawa ankle rules
Pain along lateral malleolus, medial malleolus Mid foot pain, 5th metatarsal or navicular pain Unable to walk more than four steps in the ER or exam room
29
Jones fracture
Proximal 5th metatarsal diaphysis fracture; pain over the lateral border of the foot
30
Radiographs for Jones fracture
AP, lateral, oblique
31
Tx of Jones fracture
Walking boot/cast RICE Surgery if displaced 6 weeks non-weight bearing
32
Where is stress fracture most common in foot?
3rd metatarsal
33
Talus fracture
High force impact with X-ray showing talus fracture
34
Treatment of talus fracture
Non-weight bearing cast for non-displaced, surgery for displaced
35
Weber ankle fracture classification
A. Fibular fracture below mortise, tibiofibular syndesmosis intact, usually unstable B. Fibular fracture at level of mortise, tibiofibular syndesmosis intact or mild tear, deltoid ligament intact or may be torn, stable or unstable C. Fibular fracture above mortise, tibiofibular syndesmosis torn with a widening of talofibular joint, deltoid ligament damage or medial malleolar fracture, unstable = ORIF
36
Ankle dislocation treatment
Reduction +/- ORIF
37
Typical patient pop of gout
Young, male, >30 yo
38
MC symptoms of gout
Podagra (attack of MTP of great toe); pain, swelling, redness, exquisite tenderness
39
Diagnosis of gout
Arthrocentesis with negatively birefringent crystals, serum uric acid >8
40
Management of gout
NSAIDs (drug of choice indomethacin); colchicene (has bad GI s/e), steroids if can’t take NSAIDs AVOID aspirin and thiazide diuretics Management between attacks: colchicene, allopurinol
41
Pseudogout characteristics
>60 yo Large joints Lower extremity No tophi Positively birefringent; XR shows fine, linear calcifications in cartilage
42
Tx of pseudogout
NSAIDs, colchicene, intra-articular steroid injections Colchicene = prophylaxis, NSAIDs = acute attacks
43
Cervical herniated disk location and symptoms
Posterolateral at c5-c6/c6-c7 Pain into arm/shoulder Numbness/tingling pain into the arm with pain (Confirmed with MRI)
44
C4 disk herniation
Weakness in shoulder elevation May affect levator scapular and trapezius muscles
45
C5 disk herniation
Weakness of rhomboid, deltoid, bicep, and infraspinatus muscles Weakness of shoulder abduction and external rotation Bicep reflex may be diminished
46
C5-C6 herniated disk
Affects C6 nerve root and pain at shoulder tip and trapezius with radiation to anterior upper arm, radial forearm, and thumb Sensory impairment in these areas Affects infraspinatus, bicep, brachioradialis, pronation teres, and triceps Weakness of flexión at elbow or shoulder external rotation Bicep or brachioradialis reflex may be diminished
47
C6-C7 herniation
Affects C7 nerve root Produces pain at shoulder blade, pectoral area, medial axilla with radiation to posterolateral upper arm, dorsal elbow and forearm, index and medial digits or all of the fingers, and sensory impairment in these areas C7 radiculopathy —> weakness of triceps, pronation teres, flexor carpi radialis Weakness of elbow extensors and forearm pronators Diminished triceps reflex
48
C7-T1 radiculopathy
C8 radiculopathy Weakness in opponens pollicis, flexor digitorum profundus, flexor pollicis longus, and hand intrinsic muscles Similar to ulnar or median motor neuropathy with weakness of finger abductors and grip strength May also have median motor neuropathy
49
Lumbar radiculopathy general symptoms
Increase with coughing, straining, bending, and sitting (L5-S1 is most common)
50
Presentation of sciatica
Back pain radiating through thigh/buttocks (lower leg below the knee down L5-S1) Straight leg raise, crossover test +
51
Diagnosis of sciatica
Non-contrast MRI
52
Tx of sciatica
NSAIDs, rest, steroids, PT, epidural steroid injection, steroid if needed
53
Red flag symptoms of lumbar pain
Fecal/urinary incontinence Saddle anesthesia Urinary retention Immunosuppression IVDU Fevers Chronic steroid use Focal Neuro deficit Fracture/infection trauma >50 with mild trauma Neoplasm or fracture History of CA Unexplained weight loss No improvement after 6 weeks of conservative management
54
L1 herniated disk
Pain, parenthesis, and sensory loss in inguinal region
55
L2, L3, L4 herniated disk
Spinal stenosis Innervation of anterior thigh muscles Acute back pain radiating around anterior aspect of thigh down into knee
56
L5 radiculopathy
MC!! Back pain radiating to lateral aspect of leg into foot Strength reduced in foot dorsiflexion, toe extension, foot inversion, and foot eversión Reflexes are generally normal
57
S1 radiculopathy
Pain down posterior leg into foot from back Strength reduced in leg extension and plantar flexión Sensation generally reduced on posterior aspect of leg and lateral foot Ankle reflex loss typical
58
S2, S3, S4 disk herniation presentation
Sacral or buttock pain that radiates down posterior aspect of leg or into the perineum Weakness may be minimal, with urinary and fecal incontinence as well as sexual dysfunction

EM EOR (2 decks)

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