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Emergency EOR > Orthopedics > Flashcards

Orthopedics Flashcards

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1
Q

Transverse fracture

A

Right angle to the axis of the bone

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2
Q

Spiral fracture

A

Has twisted appearance, also called otrsion

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3
Q

Oblique fracture

A

Fracture line between horizontal and vertical direction

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4
Q

Comminuted fracture

A

Splintered or crushed

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5
Q

Segmental fracture

A

Double

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6
Q

Study of choice to diagnose an occult hip fracture

A

MRI

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7
Q

Intra-articular fracture

A

Fracture line enters a joint cavity

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8
Q

Salter-Harris Classification of fractures

A 
Growth (epiphyseal) plate fractures 
Same
Above
Lower
Through
Rammed
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9
Q

Buckle fractures (torus)

A

When one side of the cortex buckles as a result of compression injury (FOOSH)

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10
Q

Treatment for buckle fracture

A

4-6 weeks in cast

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11
Q

Greenstick fractures

A

Occurs in long bones when bowing causes a break in one side of the cortex

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12
Q

Most common sites of dislocation

A

Anterior shoulder
Posterior elbow
Posterior hip

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13
Q

Treatment for dislocations

A

Closed reduction, immobilization for 24 weeks

If associated fractures, needs ORIF

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14
Q

Worrisome r/o injury with anterior glenohumeral shoulder dislocation

A

Axillary nerve injury - pinprick sensation over deltoid

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15
Q

Posterior glenohumeral shoulder dislocations are most commonly associated with:

A

Seizures, electric shock, trauma

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16
Q

Worrisome r/o injury with humeral shaft gracture

A

Radial nerve injury

May cause wrist drop

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17
Q

Most commonly fractured bone in children, adolescents and newborns during birth

A

Clavicle fracture

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18
Q

Complications of clavicle fractures

A

Pneumothorax, coracoclavicular ligament disruption, hemothorax, brachial plexus injuries

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19
Q

Complications of supracondylar humerus fracture

A

Median nerve and brachial artery injury - volkmann ischemic contracture (claw-like deformity) from ischemia

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20
Q

+ fat pad sign

A

Posterior fat pad or displaced anterior fat pad

Radial head fracture

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21
Q

Complications of olecranon fractures

A

Ulnar nerve dysfunction

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22
Q

Monteggia fracture

A

Proximal ulnar shaft fracture with anterior radial head dislocation

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23
Q

Management of monteggia fracture

A

Unstable - ORIF

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24
Q

Galeazzi fracture

A

Mid-distal radial shaft fracture with dislocation of distal radioulnar joint

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25
Q

Management of Galeazzi fracture

A

Unstable - ORIF

Sugar tong splint temporarily

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26
Q

Caused from lifting/swinging/pulling a child while forearm is pronated and extended - radial head wedges into the stretched annular ligament

A

Radial head subluxation (nursemaid’s elbow)

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27
Q

Management of radial head subluxation (nursemaid’s elbow)

A

Reduction - pressure on radial head with supination and flexion

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28
Q

Management of elbow dislocation

A

Urgent reduction!

Posterior splint at 90 degrees x 7-10 days

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29
Q

Colle’s Fracture

A

Distal radius fracture with dorsal/posterior angulation

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30
Q

60% with colle’s fracture also have __________ fracture

A

Ulnar styloid

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31
Q

Need a ______________ to diagnose colle’s from smiths fracture

A

Lateral view xr

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32
Q

Smith fracture

A

Reverse colle’s fracture

Ventral/anterior angulation

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33
Q

Boxer’s fracture

A

Fracture at neck of 5th metacarpal

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34
Q

Management of boxer’s fracture

A

Ulnar gutter splint

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35
Q

Management of bite wounds

A

Augmentin

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36
Q

Diagnosis of patellar frx

A

Sunrise view

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37
Q

Worrisome r/o injury with tibial-femoral dislocations

A

Popliteal artery rupture

38
Q

Insidious onset of localized aching pain, swelling and tenderness at the end of activities. Located in 3rd metatarsal most commonly

A

Stress (march) fracture

39
Q

Disruption between the articulation of the medial cuneiform and the base of the 2nd metatarsal

A

Lisfranc injury

40
Q

Management of lisfranc injury

A

ORIF followed by non-weight bearing cast for 12 weeks

41
Q

Red flags for low back pain (5)

A
  1. Weight loss
  2. Over the age of 50
  3. History of CA
  4. Night time pain
  5. Fever
42
Q

What to do if red flags present with low back pain?

A

Order XR

If no red flags, treat with NSAID

43
Q

Three major medical conditions to look for with lower back pain

A

Cauda equina syndrome
CA
Spinal infection (osteomyelitis and spinal epidural abscess)

44
Q

Radiculopathy may be present with __________ (which most commonly affects _____ or _____ root), which will present as pain or numbness radiating to the leg (below leg)

A

Disk herniation

L5 or S1 root

45
Q

A ___________ is done to assess herniation (sciatica)

A

Straight leg raise test

With pt lying flat, lift leg: a positive test will cause this maneuver to reproduce symptoms

46
Q

Most commonly a result of a metastatic tumor and is actually the initial presentation of cancer in up to 20% of patients

A

Cauda equina

47
Q

Symptoms of cauda equina

A

Saddle numbness, weakness, paresthesias, and motor deficits not localized to a single unilateral nerve root. Bladder/bowel dysfunction is a late finding.

48
Q

The ______ is the most common site of metastasis. Therefore, anyone with a history of _________ and __________ should be worked up for metastsis and pathological fracture

A

Bone

CA and new onset back pain

49
Q

Epidural abscess will present with _________ and _________

A

Back pain

Fever

50
Q

There should be suspicion of an abscess in pts who are (3)

A

Immunocompromised
Injection drug users
Recent spinal injection or epidural catheter placement

51
Q

Presents as a gradual worsening of low back pain over days. May or may not have any other symptoms

A

Osteomyelitis

52
Q

Risk factors for back compression fracture

A 
History of glucocorticoid use
Over 70 y/o
Trauma
Osteoporosis
Noticeable contusion
53
Q

Pts will describe severe back pain and sudden onset of pain with focal tenderness

A

Compression fracture

54
Q

Diagnostic testing for low back pain

A

If suspicion for one of the major three medical conditions exists, immediate MRI and referral
Otherwise, NSAIDs

55
Q

Tx for low back pain

A 
NSAIDs
PT should be offered
XR if not improved after 4-6 weeks
If no pathology found on MRI, trial of epidural glucocorticoids may be given
Final step is surgery
56
Q

Infection in the joint cavity (usually bacterial) - most dangerous form of acute arthritis

A

septic arthritis

57
Q

Most common organism in septic arthritis

A

S. aureus MC
N gonorrhoeae
Streptococci, staph epidermidis

58
Q

Signs/symptoms of septic arthritis

A
  1. Joint involvement - single, swollen, warm, painful joint (decreased ROM), tender to palpation
  2. Constitutional symptoms: fever, chills, diaphoresis, myalgia, malaise, pain
59
Q

Most common sites of septic arthritis

A

Knee most common

Hip > elbow > ankle > wrists

60
Q

Diagnosis of septic arthritis

A
  1. Arthrocentesis - definitive - WBC > 50,000 (PMNs)

2. MRI/CT

61
Q

Arthrocentesis WBC Counts:
> 20,000 =
> 2,000 =
< 500 =

A

Infection
Inflammation
Normal

62
Q

Management of septic arthritis

A

Arthrotomy with joint drainage
Prompt abx guided by gram stain (2-4 week course)
Gram Positive - Nafcillin, Vanc
Gram Negative - Ceftriaxone, aminoglycosides

63
Q

Acute inflammation of the costochondral, costosternal, or sternoclavicular joints

A

Costchondritis

64
Q

Pleuritic chest pain, described as an intermittent sharp, stabbing pain that is worse with inspiration, worse with coughing or certain movements of the upper limbs or torso. May radiate to the shoulder

A

Costochondritis

65
Q

Physical exam with costochondritis

A

Localized pain and tenderness on palpation

No palpable edema

66
Q

Causes of bursitis

A

Direct trauma (can be repetitive motion)
Infectious
Gout
Inflammation

67
Q

Abrupt “goose egg” swelling (boggy, redness)
+/- tender or painless. Limited ROM with flexion
Evaluate for skin breaks to r/o septic

A

Bursitis (olecranon)

68
Q

Management of olecranon bursitis

A 
Rest
NSAIDs
Local steroid injection
Padding
Avoid repetitive motions
69
Q

Idiopathic inflammatory condition causing synovitis, bursitis and tenosynovitis, causing pain/stiffness of the proximal joints in pts > 50 y/o

A

Polymyalgia Rheumatica

70
Q

Most common joints affected by polymyalgia rheumatica

A

Shoulder
Hip
Neck

71
Q

Polymyalgia rheumatica is closely related to:

A

Giant cell arteritis

72
Q

Bilateral proximal joint aching/stiffness
Morning stiffness > 30 minutes of the pelvic, neck and shoulder girdle
Creates difficulty combing hair, putting on coat, getting out of chair

A

Polymyalgia Rheumatica

73
Q

A pt with polymyalgia rheumatica will have ______________ muscle weakness

A

No severe

74
Q

Diagnosis of polymyalgia rheumatica

A

Clinical diagnosis
Increased ESR
Anemia (normocytic)

75
Q

Management of polymyalgia rheumatica

A

Low dose corticosteroids
NSAIDs
Methotrexate

76
Q

Uric acid deposition in the soft tissue, joints and bone

A

Gout

77
Q

Most commonly due to underexcretion of uric acid

A

Gout

78
Q

Purine-rich foods that cause rapid changes in uric acid concentrations and therefore gout

A

Alcohol
Liver
Seafood
Yeasts

79
Q

Medications that are known to cause gout

A 
Diuretics (thiazides, loop)
ACEI/ARBs
Pyrazinamide
Ethambutol
Aspirin
80
Q

Severe joint pain, erythema, swelling and stiffness

A

Acute gouty arthritis

81
Q

Collection of solid uric acid in soft tissues (helix of ear, eyelids, achilles tendon). Usually occurs after 10-20 years of chronic hyperuricemia

A

Tophic deposition

82
Q

Diagnosis of gout

A
  1. Arthrocentesis - negative birefringent needle-shaped urate crystals
  2. Radiographs - mouse/rat bite, punched out erosions, +/- tophi
  3. Clinical diagnosis
  4. Increased ESR and WBC during acute attacks
83
Q

Management of acute gout

A

NSAIDs drug of choice - indomethacin, naprosyn
Avoid aspirin
Colchicine second line

84
Q

Management of chronic gout (prophylaxis)

A

Allopurinol

Febuxostat - safer in pts with renal disease

85
Q

S/E of allopurinol

A

Taken with meals to prevent gastric irritation

SJS/TEN

86
Q

Injury to a ligament

A

Sprain

87
Q

Injury to a tendon

A

Strain

88
Q

Most common ankle sprain

A

Inversion of the ankle - causes damage to lateral ligaments

89
Q

Most common ligament affected in ankle sprain

A

Anterior talofibular ligament

90
Q

Diagnosis of strain/sprain

A

Clinical diagnosis

May need to get XR if severe presentation

91
Q

Treatment of strain/sprain

A

Rest, ice, compression, elevation
NSAIDs used for swelling and pain relief
Range of motion should be started as early as possible

Emergency EOR (12 decks)

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