Orthopedic Procedures

Question 1

what is the most important thing to obtain before an Xray?

Answer 1

A complete history and physical

Question 2

Describe a Sprain

Answer 2

ligamentous stretching causing tearing, bruising, and possibly a “pop”

Question 3

Describe a Strain

Answer 3

Occurs when a muscle is stretched and contracted at the same time. Immediate pain and “grabbing” sensation

Ex: sprinter’s hamstring in late swing phase as decelerating leg in prepartion for foot strike,

Question 4

What are four aspects of the physical exam for an orthopedic complaint?

Answer 4

Palpation

ROM (watch for signs of pain or impairment)

Neurological assessment

Vascular assessment

Question 5

What should be compared to the injured area when examining an orthopedic complaint?

Answer 5

Compare the injured side to the uninjured side

Question 6

What are the Ottawa Ankle Rules?

Answer 6

bone tenderness along posterior tibia or tip of medial malleolus

Bone tenderness along posterior fibula or tip of lateral malleolus

inability to bear weight for four steps both immediately after injury and in ER/office

Question 7

When should a foot series xray be ordered?

Answer 7

bone tenderess at base of fifth metatarsal

bone tenderness at navicular bone

inability to bear weight both four steps after injury and in ER/office

Question 8

What is the treatment for sprains?

Answer 8

RICE

possibly spint, aircast, brace

Question 9

What type of sprain requires surgical intervention?

Answer 9

Third Degree

stabilize with splint

ICE and pain control

refer to ortho

Question 10

What joints are involved in splints/casts?

Answer 10

Generally includes the joints above and below the fracture or injury

can be used for temporary immobilization

Question 11

Describe the findings with gonococcal arthiritis?

Answer 11

2x more frequent in women

large joints commonly affected

less destructive than nongonococcal

hx of high risk sexual behavior

consider culture from blood/cervix/urethra

Question 12

Describe the findings of nongonococcal septic arthritis

Answer 12

monoarticular in large joints

gram +

permanent joint destruction can occur in as little as three days

Question 13

What are the indications for knee and shoulder arthrocentesis?

Answer 13

relieve pain

inject medications (injected ABX not recommended)

estabilish etiology of effusion (infectious/noninfectious)

Question 14

What are the contraindications for knee and shoulder arthrocentesis?

Answer 14

overlying infections

skin lesions

abnormal coagulation

bacteremia (relative CI)

Question 15

What are some findings in an arthrocentesis that would indicate the cause as gout?

Answer 15

older men with high purine diet

acute episodic or chronic arthritis

MSU crystals and tophi

worse at night, looks like cellulitis

needle shaped MSU crystals w/ neg. birefringence under polarized light

fingers/toes often affected

well defined erosions with sclerotic margins on xr

Question 16

Describe the findings of pseudogout

Answer 16

elderly people

pain, redness, warmth, may be asymptomatic

CPPD rarely associated with soft tophi

polyarticular acute sunovitis superimposed on chronically involved joints

small rhomboid/cuboid crystals weakly birifringent

knee most often affected

chondrocalcinosis on xray, no joint damage

Question 17

Describe the findings of OA?

Answer 17

>50 y/o and increases with age

worse with activity

inflammatory mediators worsen process

weight bearing joints affected

cartialge degenerates

no ab

no other organs affected

Question 18

Describe the findings of RA?

Answer 18

all ages, peaks in middle-elderly age

pain stiffness in morning, better with activity

autoimmune

cartilage destruction by immune system

small joints

pannus

ACPA, anti CCP, RA ab

affects heat, lungs, etc.

Question 19

What are the landmarks of a shoulder arthrocentesis?

Answer 19

inferior and lateral to coracoid process and directed posteriorly towards joint space

Question 20

what are the landmarks for a knee arthrocentesis

Answer 20

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

Question 21

Regardless of appearance, synovial fluid should be sent to lab for what tests?

Answer 21

Cell count and diff.

crystal analysis

gram stain with culture and sens.

Question 22

Does the cell count of synovial fluid help differentiate between septic arthritis/crystal arthirits/rheumatic disorders?

Answer 22

No

Cell count and diff, is only an indication of the presence or absence of an inflammatory arthritis

Question 23

Chem analysis of synovial fluid is/is not routinely ordered?

Answer 23

IS NOT

Question 24

Does serum uric acid levels help diagnose gouty arthritis?

Answer 24

No

Serum urice acid may actually be low in gout patients