ortho/sports medicine Flashcards
What is the appropriate immediate treatment for an ankle sprain ?
Ice for 20min at a time over the first 48 hours
In defining varus vs valgus, which one refers to when the distal part of the deformity points away from midline ?
Valgus
What is the likely diagnosis in a pre-adolescent child with bone pain over the physis who has a normal X-ray?
Salter Harris 1 fracture
What is a grade 1 ankle sprain?
Minor stretching of ligament with minimal discomfort or loss of function
What is the difference between grade 2 and grade 3 sprain?
Grade 2 has partially torn ligaments whereas grade 3 has complete tear
What is the appropriate treatment for a child who sustained an ankle injury after being stepped on…exam shows bruise and swelling with strong pulses and diminished sensation to light touch
Obtain compartment pressures
What are the 5 symptoms of compartment syndrome ?
Pain Paresthesias Pallor Paralysis Pulselessness
What diagnosis should you consider in a patient who presents with fracture who is found to have blue sclera? What other condition is associated with this disease?
Osteogenesis imperfecta type 1 - conductive and sensorineural hearing loss
What disease presents with an infant born with multiple fractures with a large head who is born either stillborn or died shortly after birth?
Osteogenesis imperfecta type 2
What disease presents with an infant who is born with fractures and sustain progressive deformities and has gray sclera, macrocephaly and short stature?
Osteogenesis imperfecta type 3
What is the inheritance pattern of achondroplasia ?
Autosomal dominant 20%
Spontaneous mutation 80%
What is the most likely cause of sudden death in an infant with achondroplasia ?
Cervicomedullary junction compression
What syndrome presents with fusion of cervical vertebrae, short neck,scoliosis, spina bifida, deafness and renal problems?
Klippel Feil syndrome
What diagnosis may present with torticollis and upper motor neuron findings such as increased DTRs?
Posterior fossa tumor
What other abnormality is associated with congenital torticollis?
Hip dysplasia
What is the treatment for congenital torticollis?
Daily stretching and PT - if continued after one year, surgical intervention
What is the cause of muscular torticollis?
Positioning or trauma
What is the diagnosis in a patient with repeated attacks of torticollis that lasts a few minutes and is accompanied by vomiting, pallor and irritability ?
Paroxysmal torticollis
What is the sprengel deformity?
Affected side of the neck is broader and shorter and mimics torticollis
What is the cause of sprengel deformity?
Poor fetal development and failure of the scapula to descend to the normal position
What are the 4 risk factors for developmental dysplasia of the hip?
Breech
Female
First born
Family hx
You are presented with a patient who recently immigrated from a developing country, he presents with painful ankle that is swollen and red. He had similar symptoms in the knee yesterday and now has macular rash. What is the likely diagnosis?
Rheumatic fever
What is the treatment of choice for an adolescent with septic joint?
Ceftriaxone plus azithromycin (to cover GC)
What organisms are commonly the cause of septic joint in a neonate?
GBS, staph and gram negative bacillus
What is legg calve perthes disease?
Avascular necrosis of the femoral head
What is the most common etiology of osteomyelitis in the neonatal period and what is the most common complication?
E. coli and GBS
Septic joint
What is the likely diagnosis in an adolescent male with chronic knee pain that locks up and swells? How would you diagnose this?
Osteochondritis dissecans (necrosis of the articulate surface) MRI
What is the appropriate treatment of osteochondritis dissecans?
Immobilization and surgical removal of fragments if no improvement
How might a pelvic osteomyelitis present, other than hip or thigh pain ?
Abdominal pain
What is the treatment for osgood schlatter disease?
Weeks of rest with gradual return to activity
NSAIDs
What is the mechanism behind the pain caused by osgood schlatter disease ?
Excessive activity at the insertion of the patellar tendon at the anterior tibial tubercle (apophysis)
At what curvature does scoliosis require surgery?
Curvature >40 degrees
At what curvature may you simply observe a child with scoliosis?
<25
What determines when to brace a child with scoliosis curvatures 25-40 degrees?
Bracing required if there is more than 2 more years of growth expected
What should you do if a child with scoliosis has >1 degree per month of increased curvature during the growth spurt ?
MRI to rule out a cause other than idiopathic scoliosis
What is the cause of congenital scoliosis? What can this be associated with?
Failed segmentation or formation of spinal elements - can be associated with fused ribs or spinal cord anomalies
What is idiopathic scoliosis and what is the normal progression?
Isolated scoliosis with no cause - worsens by 1 degree per month during the growth spurt
What diagnosis should you consider in a patient with rapidly progressive scoliosis and neurological deficits?
Neurofibromatosis
What type of screening is warranted in patients with congenital scoliosis? (3 answers)
Renal ultrasound and ECHO as well as spinal MRI
What is the normal range of thoracic kyphosis and at what degree is intervention indicated ? What is the first study to perform in these cases?
Normal range: 20-40
PFTs if >60 degrees
What is the likely diagnosis in a teenager who can’t stand up straight and has chronic upper back pain? What is the treatment?
Scheuermann disease - NSAIDs and physical therapy
What is the diagnosis in an infant with swelling of the bones and progressive cortical thickening on X-ray?
Caffey disease (infantile cortical hyperostosis)
How can caffey disease be distinguished from non accidental trauma?
Abuse involves the periosteum but caffey disease involves only the cortex
What is the difference between unicameral and aneurysmal bone cysts? (Comment on location, symptoms and complications)
Unicameral - found on proximal humerus or femur. Asymptomatic and not precancerous.
Aneurysmal - found on tibia or femur. Present with pain and associated with bone tumors
What is the diagnosis for a patient with pain over the distal clavicle with area of prominence ?
Acromioclavicular Injury
What diagnosis presents as shoulder pain with elevation of the arm, but no deformity ?
Rotator cuff injury
When is intervention needed for genu varus (bow legged) ?
If unilateral, worsening after age 1 or unresolved by age 2
What are the two major concerns if genu varus is present after age 2?
Rickets or Blounts disease
What is the cause of adolescent Blount disease? What is the treatment ?
Overweight adolescent develops distortion of proximal tibial physis and epiphysis
Bracing or surgery is needed
What is the treatment for infantile Blounts disease?
No treatment indicated
What type of fracture presents as a separation of the epiphysis and metaphysis? What is the treatment?
Salter Harris type 1 - casting 2-3 weeks
What type of fracture goes through the growth plate and extends through the epiphysis? What is the treatment ?
Salter Harris type 3 - open reduction needed
What type of fracture involves a splitting of the metaphysis and physis? What is the treatment?
Salter Harris type 2 - closed reduction with casting 3-6 weeks
What is the cause of an anterior and posterior fat pad on X-ray of the elbow?
Anterior - normal
Posterior - fracture
What is the diagnosis in a patient with pain over the anatomical snuffbox (even with a negative X-ray)?
Scaphoid bone fracture
What type of fracture does through the metaphysis/physis/epiphysis? What is the treatment ?
Salter Harris type 4 - open reduction
What is the likely diagnosis in a patient who heard a pop after twisting of the knee and pain over the lateral patella ? What is the treatment?
Patella subluxation - maintain quadriceps and hamstring strength and flexibility
What diagnosis would you consider in an obese teenager with left knee pain?
SCFE (hip pain commonly presents as knee pain)
What is the appropriate treatment for tibial torsion and femoral anteversion?
Nothing!!! Resolves spontaneously
What are 3 situations where acute illness makes a child ineligible for participation in sports?
Fever
Carditis
Hepatosplenomegaly
What is the definition of heat exhaustion?
Mild dehydration with core temp <104
When is power lifting safe for pre-adolescents ?
Low resistance weight training is permitted but power lifting is not safe for preadolescents
What should be done for a patient participating in sporting events who presents with headache, nausea or confusion and is sweating on physical exam?
Stop exercising and drink fluids
What are the 4 criteria for heat stroke ?
Temp >105
Hot dry skin (not sweating)
CNS depression
Severe dehydration
What is the risk involved in heat stroke and why?
End organ damage due to release it endotoxins and cytokines
What should be done in a patient who presents with diagnosis of heat stroke?
Decrease core body temperature (down to 102, avoid hypothermia)
Rehydrate with IVF only
Vasopressors if needed
What is the diagnosis in a patient who sustains eye trauma and develops a collection of blood between the cornea and iris?
Hyphema
What is the appropriate treatment for hyphema?
Referral to ophthalmology
Bed rest and HOB at 30 degrees to decrease intraocular pressure (should not patch the eye)
What diagnosis should you consider in a patient with blunt eye trauma who presents with double vision when looking to one side and disconjugate gaze but intact pupillary reflexes ?
Blowout fracture of orbital wall
What diagnosis would you consider in a patient who sustains eye injury and presents with pain and tearing but no Diplopia or dysconjugate gaze? What would confirm this diagnosis ?
Corneal abrasion
Focal uptake of fluorescein
What diagnosis presents as a visual deficit in the peripheral fields but no dysconjugate gaze?
Detached retina
What diagnosis should you consider in a patient who wears contacts and presents with redness and irritation of the eye, normal pupil exam and diffuse uptake of fluorescein stain? What is the appropriate treatment?
Gram negative infection or ulcer of corneal epithelium - urgent management by ophthalmology
What diagnosis presents as anterior knee pain over the patella and visible swelling? What is the treatment ?
Prepatellar bursitis - NSAIDs and padding during sports
What is the most likely diagnosis in a patient who presents with large area of swelling on anterior thigh after blunt trauma ? How would you treat?
Hematoma of soft tissue - NSAIDs, Ice and rest
What is the most likely diagnosis in a patient with pain over the dorsum of the hand near the base of the thumb?
Scaphoid fracture
What is the most likely diagnosis in a 12y/o gymnast with left wrist pain x 3 months without any significant trauma and normal physical exam with tenderness only at distal radius? How would you treat?
Distal radial epiphyseal injury - rest and splint until wrist is healed to avoid growth plate disruption
Hep would you treat a non displaced mid shaft clavicle fracture ?
Sling (no reduction needed)
What is the appropriate treatment for a patient with medial clavicle fracture?
CT scan may be needed to rule out complications
What diagnosis should you consider In a patient with distal clavicle pain after trauma injury who has negative clavicle X-ray ?
AC separation
What is the next step in a patient with hemophilia who sustains hand injury and presents with numbness of the hand?
Measure compartment pressure
What should be done to secure an airway in a patient who sustains a neck injury while playing football?
Never remove helmet or should pads - may remove face guard only!
What are potential risks involved in anabolic steroid use in females?
Hirsutism and early closure of growth plates
What are 6 potential side effects of Anabolic steroid use in males?
Acne Gynecomastia High pitched voice Hypogonadism Aggression HTN
Until what age are children required to wear a face guard when batting during baseball games?
Up to age 14
What are 4 common lab findings consistent with anabolic steroid use?
Elevated LFTs
Low HDL
High LDL
Oligospermia
How long are anabolic steroids detected after PO vs IM use?
PO steroids remain in urine up to a few weeks
iV steroids remain in the system >6 months
What would you do in an athlete who presents for sports clearance and is found to have LVH?
No sports restriction as this is normal in athletes
What is part of sports clearance in a patient with Down syndrome?
Plan neck X-ray to rule out AA instability
What should diabetic patients do in preparation for exercise?
Increased caloric intake or decreased insulin to avoid hypoglycemia
