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PCM Final > Orthopedic Procedures > Flashcards

Orthopedic Procedures Flashcards

1
Q

What is the process leading to an accurate diagnosis related to an orthopedic injury?

A

History

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2
Q

What do complete before you obtain an x-ray?

A

History and physical

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3
Q

Correlating point tenderness to abnormalities on the x-ray increases what?

A

Diagnostic accurary

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4
Q

Do you feel/hear a “pop” with a sprain or strain?

A

Sprain

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5
Q

What is a sprain?

A

Ligaments stretch causing tearing
Within the tearing there is bleeding outside of the ligament -> bruising
Greater the tearing the most the bruising

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6
Q

What is a strain?

A

Muscle is stretching and contracting simultaneously

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7
Q

Do you have a “grabbing sensation” with a sprain or strain?

A

Strain

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8
Q

When do sprinters commonly get a hamstring injury?

A

During late swing phase as hamstring muscle contracts while lengthening to decelerate

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9
Q

Fractures tend to have what type of tenderness?

A

Point tenderness

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10
Q

What aspects of MSK eval require emergent assessment?

A

Loss of pulses or capillary refill distal to area of concern

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11
Q

When is an ankle x-ray series required (Ottawa Ankle Rules)?

A

1) Bone tenderness along the distal 6cm of posterior tibia OR tip of medial malleolus
2) Bone tenderness along the distal 6cm of the posterior fibula OR tip of the lateral malleolus
3) Inability to bear weight for four steps BOTH immediately after the injury and in the office

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12
Q

When is a foot x-ray series required (Ottawa Rules)?

A

1) Bone tenderness at the base of the fifth metatarsal bone
2) Bone tenderness at the navicular bone
3) Inability to bear weight for four steps BOTH immediately after injury and in the office

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13
Q

What is the process for analyzing foot/ankle x-rays?

A

1) Follow boney margins
2) Note any disruption or blurring
3) Identify joint spaces

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14
Q

Which degree of ankle sprain requires surgical intervention?

A

Third

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15
Q

What are the treatment options for ankle sprain?

A 
Ice 48-72 hours
Elevate
Compression
Rest
Splint
Aircast
Stabilize with splint
Referral for orthopedic eval
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16
Q

What does an ACE wrap do?

A

Limits swelling and movement

Reminds patients to slow down and protect the joint

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17
Q

In what direction do you wrap an ACE wrap?

A

Distal to proximal (with minimal stretching of material)

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18
Q

Buddy taping is used for what type of fractures?

A

Stable non-displaced fractures not involving the joint surface

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19
Q

How long is buddy taping recommended for?

A

2-3 weeks

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20
Q

Splints and casts usually involve what joints?

A

Joints above and below the fracture or injured joint

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21
Q

Can splints be for both sprains and fractures?

A

Yes

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22
Q

Is pain relief immediate with splints and casts?

A

Yes

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23
Q

For which injuries can you use splints?

A 
Fractures
Dislocations
Injury of muscles, tendons, and ligaments
Protection of vascular/nerve repair
Wound protection postsurgically
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24
Q

Which ranges of motions are prevented in ankle stirrups?

A

Internal rotation

External rotation

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25
Q

Which splint is ideal for mild to moderate ankle sprains?

A

Ankle stirrup

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26
Q

What is a simple fracture?

A

Two fragment

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27
Q

What is a comminuted fracture?

A

More than two fragments

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28
Q

What is a torus fracture?

A

Buckle fracture

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29
Q

What is angulation?

A

Named for distal fragment

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30
Q

What is an avulsion?

A

Fracture at site of ligamentous origin or insertion

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31
Q

What is a compound fracture?

A

Opening of skin associated with fracture

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32
Q

What is a spiral fracture?

A

Twisting fracture caused by torque

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33
Q

What is an oblique fracture?

A

Caused by a force in the same direction as the long axis of bone

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34
Q

What is a transverse fracture?

A

Perpendicular to the long axis of the bone

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35
Q

Is a grade 3 ankle sprain with complete ligament disruption stable?

A

No

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36
Q

How do you treat a grade 3 ankle sprain?

A

Complete immobilization
Posterior splint
Ortho referral

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37
Q

For what injuries are a posterior leg splint appropriate?

A

Foot fractures
Ankle fractures
High grade ankle sprains

38
Q

When is a short-arm cast with thumb spica appropriate?

A

Fracture of scaphoid, trapezium, or 1st metacarpal (wrist and thumb immobilization)

39
Q

When is a sugar tong appropriate?

A

Fracture of distal radius and ulna

40
Q

When is a long arm cast appropriate?

A

Fracture of navicular
Radius and ulnar shaft fracture
Colles fracture

41
Q

When is an ulnar gutter appropriate?

A

Fracture of neck, shaft, and base of 4th/5th metacarpals

42
Q

How does septic arthritis appear?

A

Painful, warm, and distended joint capsule

43
Q

Are gonococcal arthritis or non-gonococcal arthritis more common?

A

Gonococcal arthritis

44
Q

Does gonococcal arthritis occur in women or men more?

A

Women

45
Q

Which joints are more commonly affected in gonococcal arthritis?

A

Large joints

46
Q

Is gonococcal arthritis more or less destructive than non-gonococcal infections?

A

Less

47
Q

How does non-gonococcal arthritis typically present?

A

Monoarticular in large joints

48
Q

Which organisms make up 80% of non-gonococcal arthritis?

A

Gram-positive

49
Q

Permanent joint destruction can occur in how many days if treatment is delayed in non-gonococcal arthritis?

A

3 days

50
Q

If there is a high index of suspicion for gonococcal arthritis which sources should be collected for culture?

A 
Blood
Cervical
Urethral
Rectal
Pharyngeal
51
Q

What are the therapeutic indications for joint arthrocentesis?

A

1) Relieve pain from effusion or hemarthroses
2) Improve accuracy of physical exam
3) Instill medications into joint capsule to treat inflammatory conditions

52
Q

Are intraarticular antibiotics recommended?

A

No

53
Q

What are the diagnotics indications for joint arthrocentesis?

A

1) Establish etiology of any joint effusion of uncertain cause
2) Distinguish infectious vs. noninfectious causes of effusion

54
Q

What are the contraindications for joint athrocentesis?

A

1) Overlying skin infections/lesions
2) Cutaneous infection (unless source of skin infection is thought to be from joint)
3) Skin lesions (such as psoriasis plaques)
4) Abnormal coagulopathy (maybe)
5) Bacteremia (relative contraindication)

55
Q

In what populations is gout seen in?

A

Middle-aged to elderly men

Postmenopausal women

56
Q

What is gout associated with?

A

Alcohol consumption
Obesity
High purine diet

57
Q

What are the symptoms of gout?

A 
Acute episodic arthritis (monoarticular)
Chronic arthritis (polyarticular)
58
Q

What tissues are affected in gout?

A

Deposition of monosodium urate (MSU) crystals in joints and connective tissue (tophi)

Acute attack begins at night; joint becomes red, warm and tender that often mimics cellulitis

59
Q

What are the joint aspirate findings in gout?

A

Needle shaped MSU crystals appear birefringement under polarized light

60
Q

What joints are affected in gout?

A

1st metatarsal, fingers, knees

61
Q

What are the x-ray findings with gout?

A

Chronic joint changes are cystic

Well-defined erosions w/sclerotic margins

62
Q

What is the population for pseudogout?

A

Elderly (increases with age)

63
Q

What are the symptoms with pseudogout?

A 
Intense pain
Redness
Warmth
Swelling
Joint disability
Subacute and chronic forms exist
64
Q

What are the affected tissues in pseudogout?

A

Calcium pyrophosphage deposition rarely associated with soft tissue tophi

Polyarticular synovitis superimposed on chronically involved joints

65
Q

What are the joint aspirate findings in pseudogout?

A

Small, polymorphic rhomboid, cuboid or rod crystals weakly birefreingement or non-birefringent

66
Q

What are the x-ray findings in pseudogout?

A

Punctate and/or linear radiodense deposits within meniscus or hyaline cartilage (chondrocalcinosis)

Does not cause joint damage

67
Q

What is the age for osteoarthritis?

A

> 50, increases with age

68
Q

What is the symptoms for osteoarthritis?

A

Worse with activity, stiffness less than 30 minutes

69
Q

What is the pathogenic abnormality with osteoarthritis?

A

Numerous abnormalities includes loss of articular cartilage, thickening of synovium, bone and soft tissue

70
Q

What is the role of inflammation in osteoarthritis?

A

May be secondary, inflammatory mediators exacerbate cartilage damage

71
Q

What is the path for osteoarthritis?

A

Cartilage degenerates and fragmentation, bone spurs, and subchondral cysts

72
Q

Are there serum antibodies seen with osteoarthritis?

A

No

73
Q

What is the age for RA?

A

50-75

74
Q

What are the symptoms of RA?

A

Pain/stiffness > 1 hour in morning, improves with activity
MCP, PIP, and wrists
Decreased associated grip strength

75
Q

What is the pathogenic abnormality with RA?

A

Autoimmune

76
Q

What is the role of inflammation in RA?

A

Primary: cartilage destruction caused by T cells and antibodies reactive with joint antigens

77
Q

What joints are impacted by RA?

A

Small joint of finger, toes then progresses

78
Q

Which joints are impacted by osteoarthritis?

A

Weight bearing (hips, knees) most common

79
Q

What is the path associated with RA?

A

Inflammatory pannus invading and destroying cartilage; severe inflammation; joint fusion (ankyloses)

80
Q

What are the serum antibodies associated with RA?

A

ACPA= anti-CCP, RA

81
Q

What other organs are affected by RA?

A

Heart

Lung

82
Q

Are swan neck deformities associated with RA or OA?

A

RA

83
Q

Is ulnar deviation associated with OA or RA?

A

RA

84
Q

What are the anatomic landmarks for shoulder arthrocentesis?

A

Needle is inserted inferior and lateral to the coracoid process, and directly posteriorly towards the joint space

85
Q

What are the anatomic landmarks for knee arthrocentesis?

A

Needle enters 1cm medial or lateral to the superior third of patella

86
Q

What does normal synovial fluid look like?

A

Colorless/amber

Transparent

87
Q

What does inflammatory fluid look like?

A

Amber/yellow/opaque

Grossly purulent if septic arthritis

88
Q

Regardless of appearance, what should synovial fluid be submitted for?

A

1) Cell count and differential
2) Crystal analysis
3) Gram stain with culture and sensitivity

89
Q

Do absolute cell counts have diagnostic value?

A

No

90
Q

What does cell count tell you?

A

Presence/absence of an inflammatory arthritis

91
Q

Should chemical analysis of synovial fluid be routinely ordered?

A

No

92
Q

Does evaluation of serum uric acid have a role in the diagnosis of acutely inflamed joints?

A

No

PCM Final (11 decks)

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