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ER EOR > Ortho Rosh > Flashcards

Ortho Rosh Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Ottawa Ankle Rules: ankles

A

pain in the malleolar region with any of the following:

bone tenderness at the posterior edge of the distal 6 cm or the top of the lateral malleolus

bone tenderness at the posterior of the distal 6 cm or the tip of the medial malleolus

inability to bear weight for at least 4 steps both immediately after the injury and at the time of the evaluation

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2
Q

Ottawa Ankle Rules: foot

A

pain in the mid foot region with any of the following:

bone tenderness at the navicular bone

bone tenderness at the base of the 5th metatarsal

inability to bear weight for at least 4 steps both immediately after the injury and at the time of evaluation

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3
Q

sx of plantar fasciitis

A

pain in the plantar region of the foot that is worse in the morning and when initiating walking

points of discrete tenderness at the anteromedial calcaneus where the proximal plantar fascia inserts

heel pain with dorsiflexion (pointing toes up at the sky)

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4
Q

MC ankle injury

A

lateral ankle sprain

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5
Q

mechanism for lateral ankle sprain

A

plantar-flexed foot is inverted

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6
Q

Kanavel signs for Flexor tenosynovitis (surgical emergency)

A

pain on passive extension of the affected finger (often the first finding)
finger held in partial flexion
tenderness of the full tendon sheath
fusiform swelling of the digit

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7
Q

tx for flexor tenosynovitis

A

intravenous antibiotics such as vancomycin plus extended-spectrum penicillins

emergency hand surgery consultation

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8
Q

how to diagnose gout and pseudogout

A

arthrocentesis

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9
Q

MC shoulder dislocation

A

anterior shoulder dislocation

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10
Q

how will the shoulder appear with anterior shoulder dislocation

A

The acromion will appear prominent and the shoulder often loses its normal rounded contour

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11
Q

Which nerve is most commonly injured in shoulder dislocations?

A

axillary nerve

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12
Q

Bankart vs Hill-sachs deformities

A

Bankart lesions occur when a bony fragment is avulsed from the glenoid labrum during a dislocation. A Hill-Sachs deformity is a cortical depression in the humeral head created by the glenoid rim during dislocation.

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13
Q

initial treatment for a nondisplaced humerus fracture

A

immobilization in a sling

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14
Q

what is the most severe complication associated with knee dislocations

A

injury to the popliteal artery

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15
Q

MC nerve injury in knee dislocation

A

peroneal nerve

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16
Q

sx if peroneal nerve damage

A

decreased sensation to the dorsum of the foot
weakness with dorsiflexion at the ankle

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17
Q

predisposing conditions for septic arthritis

A

a history of surgical replacement of the joint, skin infection, other joint surgery, rheumatoid arthritis, age > 80 years, diabetes mellitus, and kidney disease

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18
Q

MC bacterial cause of septic arthritis

A

staph aureus

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19
Q

do you need imaging for radial head subluxation

A

no

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20
Q

sx osteoarthritis

A

symmetric, polyarticular, mild joint pain, and stiffness that worsens with use and ultimately leads to joint deformity and loss of locomotion in advanced disease. It most commonly affects the distal interphalangeal (DIP) joints, the thumb, knees, and hips

Heberden’s nodes - bony, hard swelling of the distal interphalangeal joints

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21
Q

Which hand joints are most commonly affected in rheumatoid arthritis?

A

Metacarpophalangeal and proximal interphalangeal joints.

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22
Q

mallet finger injury results from

A

forced flexion of the distal interphalangeal joint –> inability to actively extend the dorsal interphalangeal joint

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23
Q

What views should radiographs of a mallet finger injury include?

A

Anterior-posterior, lateral, and oblique views

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24
Q

tx for mallet finger

A

splinting the distal interphalangeal joint in full extension without flexion at any time for a period of six to eight weeks

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25
Q

tx for scaphoid fx/tenderness over anterior snuffbox

A

immobilized in a thumb spica splint and referred for repeat clinical evaluation and radiographs in approximately 7–10 days

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26
Q

3 MC features of septic arthritis

A

joint pain, joint swelling, and fever

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27
Q

olecranon bursitis vs septic bursitis

A

Patients with olecranon bursitis will lack significant tenderness and erythema overlying the bursa and will not have fever. Passive range of motion should be normal. If the diagnosis is in question, bursal fluid should be aspirated for analysis

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28
Q

smith fx vs colles fx

A

Smith fracture also involves the distal radius, however palmar (volar) displacement is seen rather than dorsal displacement

Colles fractures are characterized by dorsal displacement of the distal radius fragment; dinner fork deformity

29
Q

What is the most common fracture site in the upper extremity?

A

the distal radius

30
Q

Which rotator cuff muscle is most commonly injured, inflamed, or torn?

A

The supraspinatus muscle.

31
Q

what 2 tests are best for shoulder impingement

A

hawkins-kennedy
neer

32
Q

positive obrien test may indicate

A

labral tear

33
Q

a positive speed test may indicate

A

bicipital tendonitis

how to perform: the clinician has the patient elevate the arm against resistance when the elbow is extended and the forearm is supinated

34
Q

PE for ruptured biceps tendon

A

weak flexion and supination of the injured arm

35
Q

What is the innervation of the biceps muscle?

A

The musculocutaneous nerve. The nerve roots for the musculocutaneous nerve are C5, C6, and C7

36
Q

MC fracture involved in compartment syndrome

A

tibia

37
Q

Normal compartment pressure

A

10-12 mmHg

38
Q

sx of compartment syndrome

A

Passive stretching of involved muscle groups produces intense pain, as does manual compression of an affected compartment. Active movement is likely to be painful as well, while the nerves passing through the affected compartment may be compromised and produce paresthesias. Paresis and muscle weakness are late findings. Pulses are usually maintained unless the presentation is particularly late

5 ps: pain, paresthesias, pallor, pulselessness, and paresis

39
Q

delta pressure and compartment syndrome

A

obtained by subtracting the intracompartmental pressure from the DBP

A delta pressure ≤ 30 mm Hg is regarded as concerning and indicative of needing fasciotomy

40
Q

Compartment syndrome of the deep posterior compartment of the lower leg will lead to which passive movement producing intense pain?

A

toe extension

41
Q

tx greenstick fracture

A

immobilization

42
Q

buckle (torus) fracture

A

the bony cortex on the side opposite the force is compressed and “buckles” outward without true cortical disruption

43
Q

tx buckle/torus fracture

A

removable splint

44
Q

function of deep peroneal nerve

A

deep peroneal nerve provides sensation between the first and second toes and motor function to the tibialis anterior (dorsiflexion and eversion of the ankle) and extensor hallucis longus (extension of the great toe)

45
Q

what nerve is commonly damaged after femur head fx

A

common peroneal nerve

46
Q

brachial plexus consists of nerve roots

A

C5 - T1which merge and divide to form the median, ulnar, and radial nerves

47
Q

The primary function of the ACL is

A

to control anterior translation of the tibia

48
Q

MC injured ligament of the knees

A

ACL

49
Q

Three physical exam maneuvers help test the ACL stability:

A

the Lachman test, pivot shift, and the anterior drawer.

Lachman&raquo_space;>

Lachman test is performed with the knee flexed to 30 degrees, followed by stabilization of the distal femur with one hand while pulling the proximal tibia anteriorly with the other hand. The pivot shift test is performed by having the clinician hold the lower leg with one hand and internally rotating the tibia, while applying a valgus stress to the knee with the other hand. Then, while maintaining these forces, the clinician flexes the knee, and in ACL-deficient patients, this causes a reduction of a subluxed tibia resulting in a “clunk.” This test is highly specific for ACL rupture, but is very difficult to perform in an awake patient due to patient guarding and pain. The anterior drawer test is performed with the patient lying supine and the knees flexed to 90 degrees. The proximal tibia is grabbed with both hands and pulled anteriorly.

50
Q

Lisfranc joint (tarsometatarsal joint complex) is comprised of

A

articulations of the bases of the first three metatarsals with the cuneiforms and the fourth and fifth metatarsals with the cuboid, joined together with multiple ligaments

51
Q

sx for lisfranc dislocation

A

severe pain in the midfoot and inability to bear weight. Ecchymosis on the plantar surface of the foot is often considered pathognomonic for Lisfranc injuries

52
Q

what X-ray views should be ordered for lisfranc

A

Anterior-posterior, lateral, and oblique radiographs

53
Q

dx lisfranc

A

Any widening or malalignment > 1 mm in these areas is considered pathological.

54
Q

tx lisfranc

A

immobilization with a short-leg cast, elevation, and pain control. The patient should be non-weight bearing. Orthopedic consultation is necessary

55
Q

What technique may improve the chance of diagnosing a Lisfranc injury on plain radiograph?

A

Including weight-bearing (stress) views

56
Q

What is the antibiotic regimen of choice if an open fracture is deemed to be large (> 10 cm) or very contaminated?

A

First-generation cephalosporin and gentamicin

otherwise, can just do 1st generation cephalosporin (cefazolin)

57
Q

olecranon bursitis is also called

A

student elbow

58
Q

tx olecranon bursitis

A

joint protection and anti-inflammatory medications

59
Q

The most common complication from a midshaft humerus fracture

A

radial nerve injury

60
Q

radial nerve injury sx

A

radial nerve palsy with wrist drop

61
Q

tx humeral shaft fx

A

coaptation splint and sling and swathe

62
Q

what does patella Alta indicate

A

patellar tendon rupture

62
Q

what nerve can be damaged during shoulder dislocation and reduction?

A

Axillary nerve

63
Q

what does patella Baja indicate

A

quadriceps tendon rupture

64
Q

tx for patella tendon rupture

A

rest, ice, compression, elevation, analgesics, non-weight-bearing status with crutches, and prompt orthopedic referral

65
Q

Characteristic findings of osteomyelitis on plain radiograph

A

periosteal reaction, periosteal elevation, and lytic lesions or sclerosis

66
Q

what imaging modality has the greatest sensitivity for osteomyelitis

A

MRI

67
Q

tx osteomyelitis

A

debridement and antibiotics with a prolonged duration of therapy

68
Q
A

ER EOR (28 decks)

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