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PANCE > Orthopedic - 8% > Flashcards

Orthopedic - 8% Flashcards

1
Q

Acromioclavicular Joint Sprains

A

Direct blow to tip of shoulder or upward force on long axis of radius

Sxs:

  • Pain/point tenderness over tip of shoulder
  • +/- deformity
  • can’t reach above head

Dx:

  • weight X ray

Tx

  • Sling
  • analgesics
  • PT
  • +/- Surgery
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2
Q

Ankle Sprain

A

Inversion sprain - Lateral malleolus strain AFTL

Ecchymosis and edema

Xray to r/o fracture

Dx - Canadia-Ottawa ankle to get X ray

  • Pain in malleolar zone +
    • pain in lateral malleolus (tip or posterior edge)
    • pain in medial malleolus (tip or posterior edge)
    • inability to bear weight immediately or in EM for 4 steps

Tx:

  • RICE
  • Splinting and casting
  • PT
  • acute vs chronic
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3
Q

Back Strain/Sprain

A

Thoracic and Lumbar MCC

Sxs:

  • D/t lifting, twisting or strenuous activity
  • worse with activity, better with rest
  • Stiffness, Axial back pain, Difficulty bending
  • No radicular sxs, No neuro changes (below knee)

Tx

  • Bed Rest < 2 days
  • NSAIDs
  • +/- muscle relaxant - cyclobenzaprine or short term Benzo Re-eval if no improvements in 4 wks
  • Resume activities as tolerated
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4
Q

Bicep Tendonitis

A

Sxs

  • Pain at bicep groove
  • Ant shoulder pain - r-> biceps
  • Pain w/ resisted supination of elbow
  • Popeye deformity

Dx

  • Speed’s + pain in bicep groove when elevate shoulder against examiner’s resistance
  • Yergason’s - elbow flexed at 90degrees, wrist supination against resistance, + if pain produced

Tx

  • NSAIDs
  • PT strengthening
  • Steroid injections
  • Surgical release
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5
Q

Carpal Tunnel Syndrome

A

Compression of Median Nerve, dt overuse, repetitive motions

SxS:

  • numbness thumb to mid of ring finger (no pinky)
  • tingling
  • thenar wasting

Dx:

  • Tinel’s
  • Phalen’s
  • Electrodiagnostic studies - gold standard

Tx

  • wrist splint - cock up
  • NSAID
  • ergonomic adjustments
  • PT, steroid
  • Surgery
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6
Q

Cervical Radiculopathy

A

MC C5-C6 or C6-C7, nerve root irritation or impingement

Posterolateral

Sxs:

  • pain into arms/shoulders
  • tingling with pain at rest, +/- numbness
  • Loss of reflexes
  • C7 is nerve root

Dx:

  • lateral X-Ray - must see all 7 vertebrate
  • Spurling’s test - Compression Test (head pressed backwards towards spine) = Pain reproduced
  • Cervical distraction = pain relieved
  • MRI - soft tissue, nerves

Tx:

  • Rest - immobilization
  • NSAIDs/ analgesics
  • CS and PT
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7
Q

Cervical Sprain/Strain

A

Sxs

  • Headache, Stiffness in Neck
  • Paraspinal muscle
  • Tenderness and spasms
  • Numbness and tingling in extremities

Dx

    • Spurling test for cervical radiculopathy
  • Lateral X ray - 7 vertebrae

Tx

  • Rest
  • NSAIDs
  • muscle relaxants - cyclobenzaprine
  • PT = gental ROM
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8
Q

Compartment Syndrome

A

Pressure incr in compartment - EMERGENCY

MC anterior compartment in Lower leg

Sxs

  • 5 P-s
  • Volkman’s contracture

Dx

  • Normal pressure < 10mm Hg
  • Delta pressure - diastolic BP - measured compartment pressure - if > 30 mmhG, fasciotomy

Tx

  • Fasciotomy
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9
Q

Costochondritis

A

Acute inflammation of the costochondral, costosternal or sternoclavicular joints

Common after viral infx or MSK trauma

sxs:

  • Pleuritic chest pain - sharp, stabbing
  • Worse with inspiration, coughing, & certain mvmts

Dx:

  • localized tenderness and pain 2-5th costochondral junction
  • no edema
  • pain reproducible with palpation
    • Tietze’s Syndrome is at 2-3rd ICS
  • R/o cardiac and PE = EKG, Trop, echo

Tx:

  • NSAIDs, tylenol
  • heating pads
  • PT, and Steroids
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10
Q

deQuervain’s Tenosynovitis

A

W 30-50yo

Sxs:

  • pain, swelling, point tenderness along dorsal aspect of wrists

Dx:

  • +Finkelstein’s

Tx:

  • Rest
  • Thumb spica/splint immbolization
  • NSAIDs, PT, CS
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11
Q

Epicondylitis

Medial and Lateral

A

Lateral Epicondylitis - Tennis Elbow

overuse of injury of extensors and supination

Medial Epicondylitis - Golfer’s / Litter league

Pronator and flexor muscles groups

Tx

  • ICe/Heat
  • NSAID, PT
  • Elbow scrap
  • Steroid injection
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12
Q

Fifth Metatarsal Fracture vs Jones

A

heels and twisting ankle inversion

Jones Fracture

  • base of 5th MT at metaphyseal diaphyseal junction
  • ORIF = high risk of avascular necrosis
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13
Q

Boxer’s Fracture

A

Fracture of neck of 5th/4th metacarpal;

Eikenella, Staph and Strep

  • Punch with clenched fist
  • no knuckle sign

Tx:

  • Reduce to anatomic position
  • Abx if skin breakdown - with Augmentin
  • Ulnar gutter split w/ joints in 60 degree flexion
  • Immobilization 4-6 wks
  • Surgical repair => cast immobilization
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14
Q

Colle’s Fracture

A

FOOSH - distal radius fracture

  • Dorsal angulation (top of hand) extra-articular
  • dinner fork deformity

Dx - lateral xray

Tx

  • Conservative
    • close reduction
    • sugar tong splint, immobilization with cast for 4-6 wks
  • Surgery
    • ORIF followed by cast/splint immobilization for 4-6 weeks
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15
Q

Shoulder Fracture (Proximal Humerus)

A

MC in elderly for low velocity

complications = adhesive capsulitis/RC Tear

Sxs:

  • inability to hold wrist up = radial n palsy aka wrist drop

Dx:

  • Xray

Tx

  • immobilize 4-6 wks - sling and swathe
  • then begin gentle passive ROM and modalities
  • Progress to light strengthening after 6 wks
  • Surgery if displaced or rotated
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16
Q

Scaphoid Fracture

A

FOOSH

Sxs:

  • pain on radial surface of wrist at anatomical snuffbox
  • leads to avascular necrosis - radial artery

Dx:

  • X-Ray = Fracture may not be evident for >2wks, if no frx on Xray - tx as fracture and immobilize.
  • Repeat Xray in 2 wks

Tx:

  • Non-displaced = Long vs short thumb spica 10-12wks
  • Displaced = surgical fixation
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17
Q

Smith’s fracture

A

Fracture of distal radius w/ volar angulation and displacement

garden spade deformity - fall w/ palm closed, hands flexed, blow to back of wrist

Median n injury –> develop carpal tunnel over time

Sugar tong Splint

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18
Q

Supracondylar Fracture

eti, sxs

A

MC Peds elbow frx - FOOSH

Gartland Classification:

  • I, II, III - Extension Type
  • IV - Flexion Type

*Anterior Interosseous Nerve (AIN) MC injured in Type I-III

Brachial Artery MC Vascular Structure Damaged → Volkmans Contracture (Radial nerve contracture)

  1. Type I - FOOSH, non-displaced, posterior fat pad sign
  2. Type II - FOOSH, angulated fx w/ distal posterior segment
  3. Type III - FOOSH, complete frx through cortext and posterior displacement of distal frx
  4. Type IV - Flexed frx, fall on flexed elbow, anterohumeral line falls posteriorly to capitulum
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19
Q

Supracondylar Fracture

Dx, tx

A

Lateral X Ray

Type I:

  • Without NV compromise
  • Cast in flexion <90 degrees for 3wks
  • Re-evaluate & x-ray

Type II:

  • Refer same day
  • Closed Reduction and +/- pinning/fixation
  • Casting

Type III:

  • Refer same day
  • Reduction and Internal Fixation
  • Casting

Type IV:

  • Refer same day
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20
Q

Radial Head Fracture

A

Pain and tenderess along lateral aspect of elbow; limited ROM elbow/forearm

MCC FOOSH

  • Usu see anterior fat pad sign/sail sign
  • Posterior Fat pad sign - occult elbow fracture

Tx

  • Splint, sling
  • Analgesic
  • PT
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21
Q

Galeazzi Fracture

A

Distal radial shaft fracture, dislocation of ulna d/t FOOSH on pronated hand

sxs:

  • wrist pain
  • swelling
  • pain with extension/flexion

Radial n injury

ORIF

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22
Q

Ganglion Cyst

A

Painless, swelling on wrist and hand, dorsal MC

Dx - transilluminate

Tx

  • observe and reassurance
  • Surgical excision if pt really bothered
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23
Q

Hip Dislocations

A

High impact trauma - usu from MVA dashboard => 90% posterior

Sxs:

  • limbed shortened
  • internally rotated

Dx:

  • XR and CT r/o frx

Tx:

  • Reduction promptedly
24
Q

Hip Fractures

A

Subcapital/Femoral Neck = wary of avascular necrosis of femoral neck

intertrochanteric; Subtrochanteric

Sxs:

  • Pain
  • inability to wb
  • shortened leg - external rotation

Dx:

  • XR

Tx - ORIF

25
Q

Hip Osteoarthritis

A

breakdown, loss of articular cartilage btwn bones - age, injury

Sxs:

  • pain in groin region
  • decrease ROM, abduction
  • pain with ambulation, climbing stairs

Dx:

  • X-ray

Tx

  • Activity mod
  • Shoewwear
  • NSAIDs
  • Wt loss
  • joint CS injection
  • Total joint replacement
26
Q

Humerus Shaft fracture

A

MOI - direct blow

MCC radial n. injury, posterior fat pad/sail sign

  • pain, swelling, deformity, shortened extremity
  • motion at fracture site

Tx with sugar tong splint

ortho f/u in 24-48 hrs

27
Q

Anterior Cruciate Ligament Tear

A

Twisting motion - change in motion/speed, direction

Sxs:

  • Pain with instability - knee giving out
  • Hemarthrosis - swell up with blood

Dx:

  • Anterior drawer
  • Lachman’s

Tx:

  • RICE, PT, bracing, Progressive return to activity
  • Surgical reconstruction w/ patellar tendon or hamstring or cadaver’s tendon
28
Q

Medial and Lateral Collateral Ligament Injury

A

Knee forced into VALGUS - hit on outside of knee L

  • MCL tear

Knee forced into VARUS - hit on inside of knee (inner thigh)

  • LCL tear

Dx - MRI gold ***

Tx

  • RICE
  • Brace
  • WBAT - crutches
  • PT/surgery
29
Q

Meniscus Injury

A

Traumatic vs degenerative

Sxs:

  • Twisting injury
  • Triad
    • joint line pain
    • effusion - 6-24 hrs post injury
    • locking

Dx:

  • MRI- Gold ****
  • McMurray’s - knees flexed and
    • Tibial Externally rotated - medial meniscus
    • Tibia Internal rotated - lateral meniscus
  • Apley’s Compression
    • ​axial loading = pain

Tx:

  • Rest
  • Activity Mod
  • NSAIDs
  • PT
  • CS
  • Surgery
30
Q

Lisfranc Injury

A

Fracture/dislocation of 1st/2nd TMT joint

MOI - MVA, fall from height

Low energy - stepping off curb or hole

Swelling in mid foot, non WB

Dx:

  • X ray
  • CT

Tx:

  • Displacement > 2mm not good = surgery ORIF
  • Non-displaced NWB cast immobilization x 4-6wks
31
Q

Lumbar Radiculopathy

A

Compression of nerve caused by disc

pain in dermatomal region

incr pain with coughing, straining, sitting, bending

Dx

  • MRI - non contrast
  • ​Straight Leg Raise = + if numbess and tingling
    • ​15-30 degrees = severe
    • 30-60 degrees = mild to moderate
  • red flags of back pain

Tx:

  • Rest
  • NSAIDs
  • CS injection - epidural steroid injections
  • PT
32
Q

Monteggia Fracture

A

Proximal 1/3 ulnar shaft fracture w/ radial head dislocation d/t FOOSH

sxs

  • elbow pain and swelling
  • tenderness to palp along elbow
  • decreased elbow ROM

tx

radial n injury

ORIF

33
Q

Nightstick Fracture (ulna)

A

MCC Direct blow to midshaft of ulna

Pain and bruising at site

eval for abuse victims

Tx

  • functional brace w/ good interosseous mold for isolated/nondisplaced
  • ORIF for displaced
34
Q

Olecranon Bursitis

A

Painless inflammation of bursa;

swelling dev’s gradually (chronic) or acutely (infx)

Dx:

  • X ray if trauma
  • Aspirate and culture if septic

Tx:

  • RICE
  • elbow pad***
35
Q

Osgood-Schlatter Syndrome

A

Pain at tibial tuberosity d/t growth spurt

Self limiting

ice

quad strengthening

Knee patellar strap

36
Q

Osteomyelitis

A

Infection and inflammation of bone and bone marrow

d/t hematogenous spreading or inoculation from trauma/surgery

MCC S aureus, Pasteurella for dog/cat bites, Mycobact TB - vertebral involvement; human bites mixed anaerobes

​Sxs:

  • Fever
  • Throbbing pain, mvmt restriction

Dx

  • Bone aspiration and bx - gold std
  • MRI
  • XR (lags 7-10d after sxs) triad - demineralization, bone destruction, periosteal rx​
  • ele CRP 4-6 wks, ESR, WBC

Tx

  • Empiric abx for targeted organism
  • Amox-Clauv (Augmentin) = Dog/cat and human bites
  • Targeted after cultures
  • IV Abx 4-6 wks for acute OM, > 8 wks for chronic OM or MRSA
37
Q

Osteoporosis

A

Body loses too much bone or doesn’t make enough

F > M, White and Asian, smoking, etoh, underlying dz

Sxs

  • more likely to have compression fractures

Dx

  • Radiographs
  • DEXA - bone mineral density, bone loss, risk of fracture
    • < -2.0 is osteoporosis

Tx

underlyiing patho

38
Q

Patellar tendinitis

eti, sxs

A

anterior knee pain - activity related @ focal patellar tendon Jumper’s knee

Swelling over tendon tenderness at inferior border of patella

39
Q

Plantar Fasciitis

A

Plantar heel pain - worse in morning, better with moving stretching - overuse activity

Dx - XRay

Tx:

  • Stretching
  • PT
  • NSAID
  • CS injection
  • Patience
40
Q

Prepatellar Bursitis

A

MC in wrestlers

Sxs:

  • Pain w/ direct pressure on knees (kneeling)
  • Swelling over patella

Dx

  • Septic bursitis - aspiration Gram stain and culture

Tx:

  • Compressive wraps
  • NSAIDs +/- aspiration and immobilization
41
Q

Radial head Subluxation (Nursemaid’s Elbow)

A

MC young children < 4yo

MOI - pulling upwards motion

Lateral elbow pain

hold elbow in slight flexion and forearm pronated

Pain and tenderness in lateral asp of elbow

42
Q

Red flag signs of Herniated Disc

A
  • fecal/urinary incontinence
  • Saddle anesthesia
  • Urinary retention
  • IVDU
  • Fevers
  • Chronic steroid use
  • focal neuro deficitys
  • hx of Cancer
  • weight loss
  • no improvements after 6 wks of conservative management
43
Q

Rotator Cuff Injuries

A

Stabilizes the shoulder; Comprised of Four muscle groups

  1. Supraspinatus - MCC of tears - ext rot, abdc
  2. Infraspinatus - ext rot, abd
  3. Teres minor - ext rot, abd
  4. Subscapularis - internal rotation

Eti:

  • <40 yo = Impingement, tendonitis
  • >40 yo = cuff tears

Sxs:

  • Can’t abduct arm above horizontal plane
  • pain when elbow higher than shoulder

Dx:

  • Special tests
    • ​Drop Arm
    • Empty can
    • Neer Impingement Test
  • Radiographs - shoulder series
  • MRI - gold standard

Tx

  • Conservative - NSAID, PT, Rest, Steroid
  • Surgical - arthroscopic vs open
44
Q

Sciolosis

A

Lateral curvature of spine - F MC, R side more common than left

paravertebral humping

20 < PT and bracing

40 degress + typically surgical

45
Q

Septic Arthritis

A

EMERGENCY

Direct bacterial invasion of joint space MC knees and hips

MCC - S aureus, N gonorrhea in sexually active YA, streptococcus; Pseudomonas

sxs:

  • Single, swollen, warm, painful joint, TTP
  • constitutional sxs (fever, sweats, myalgia, malaise, pain)

Dx:

  • Arthrocentesis - joint fluid aspirate - gold std
    • WBC > 50k, primarily PMNs
    • WBC > 1000 is + for prosthetic joints

Tx:

  • 2-4 wks of abx + arthrotomy w/ joint drainage
  • S aureu - Vanco/Nafcillin (vanco or clindamycin if pcn allergic)
  • Gonorrrhea - ceftriaxone
  • IVDU - cipro/levaquin
46
Q

Shoulder Dislocation (Glenohumeral Joint)

A

MC anterior - arm is abducted and externally rotated

Posterior - arm is adducted and interally rotated

Sxs:

  • Pain, deformity, loss of function

Dx:

  • XRay - AP, Axillary and Y-view
    • Bankart Lesion - tear on shoulder; anterior inferior labrum
    • Hill-Sachs Lesion - divet in humerus - prev shoulder d/l
  • Axillary nerve assessment

Special Tests - to dx prev shoulder d/l

  • Apprehension test
  • Relocation test
  • Sulcus test

Tx:

  1. Reduce
  2. postreduction films
  3. Sling and swath
  4. PT
47
Q

Slipped Cap Femoral Epiphysis

A

Obese kid, adolescent

Bilateral within 18 mos

Xray - slipped femoral cap

Tx - ORIF

48
Q

Spinal Stenosis

A

narrowing of spinal canal w/ impingement on nerve root; >60yo

Sxs

  • Back pain w/ paresthesias in one or both extremities
  • R-> thighs
  • Pain worse with extension - prolonged standing/walking
  • relieve with flexion - sitting, walking uphill/on cart (Hoffman’s)

Tx

  • Rest, NSAIDs, PT
  • epidural injection of CS
  • decompression laminectomy
49
Q

Subacromial Bursitis

A

Btwn superior surface of supraspinatus tendon & coracoacromial ligament, acromion, and coracoid (acromial arch)

Pain on motion and at rest - fluid to accumulate

Not a/w trauma

Tx

  • Prevention of precipitating factors
  • NSAIDs
  • Rest Brace/support
  • Steroid injections
50
Q

Thoracic Outlet Syndrome

A

Idiopathic compression of bracial plexus, subclavian vein, or subclavian artery as they exit out shoulder girdle and 1st rib

MC Young F 20-50

Sxs

  • Nerve compression - pain/paresthesia to forearm, arm, or ulnar side of hand
  • Vascular compression - swelling/discoloration of arm, w/ abduction of arm
  • +adson test = loss of radial pulse w/ head rotated to affected side

Dx - MRI

Tx

  • ortho consult +/- surgery
51
Q

Torticollis

A

Wry neck - unilat contraction of Sternocleidomastoid muscle (shorten)

Breech deliveries, and adults and slept weird

Sxs - r/o radicular sxs

Dx - XR to r/o bone abn

Tx

  • passive stretching
  • self limited in 2-4 wks
52
Q

Legg Calve-Perthes Syndrome

A

Interruption of blood to proximal femoral epiphysis

3-12 yo (young kids, ~5yo)

Painless limp but knee pain

decr internal rotation and abduction

Tx

  • Rest
  • PT
  • Bracing/casting
  • Sx
53
Q

Developmental Hip Dysplasia

A

Barlow

adduct - dislocation hip

Ortolani

abduct - reduce the hip

54
Q

Salter Harris Fracture

A

Type II is more common

I - physis

II - Metaphysis + physis

III - Physis + epiphysis

IV - physis + metaphysis + epiphysis

V - compressed

55
Q

Osteoarthritis

A

Loss of cartilage from old age causing bone breakdownf rom friction

MC in hips, knees, hands; a/w Baker’s cyst

Sxs

  • pain worse with weight bearing, better w/ rest
  • pain & stiffness lasting < 30 mins
  • Heberden (DIP) and Bouchard (PIP) Nodes

Dx

  • XRay - narrowing of joint, osteophytes
  • normal CRP/ESR

Tx

  • Acetaminophen or NSAID
  • definitive - Total joint replacement

PANCE (15 decks)

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