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ICM II > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

What is arthrodesis?

A

Fusion

Adjacent joint surfaces are excised to promote bone healing

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2
Q

What is myelopathy?

A

abnormal condition of spinal cord

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3
Q

What is varus? Valgus?

A
  • Varus
    • adduction of distal bone in relation to proximal partner
    • Bowleg deformity
  • Valgus
    • abduction of distal bone
    • Knock-knee deformity
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4
Q

What is spondylolithesis?

A

Slippage of one vertebra on the one below it

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5
Q

What is Kienboch’s Disease?

A

vascular necrosis of the lunate

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6
Q

Acute Compartment Syndrome

  • Cause
  • Result
  • Common locations
A
  • Cause
    • Trauma
      • fracture
    • Acute increase in exercise
  • Result:
    • Increased Intercompartmental pressure
      • obstructs blood flow
      • Can damage nerves and muscles
  • Common locations:
    • Volar aspect of forearm
    • Anterior compartment of leg
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7
Q

Acute Compartment Syndrome

  • Signs and Symptoms
  • Diagnosis
A
  • Signs and Symptoms
    • Three P’s
      • Pain
      • Paresthesia
      • Paralysis
    • Tightness of compartment
    • Pain with passive stretching of mm
    • Inability to contract muscles of compartment
  • Diagnosis
    • PE
    • Pressure measurement of compartment
      • diastolic P - compartment P < 20 mmHg
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8
Q

What does pulselessness in a patient with suspected acute compartment syndrome indicate?

A

That it is NOT compartment syndrome!

It is an arterial injury

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9
Q

What is the most common bone tumor in patients over 40 y/o?

A

Metastatic!

  • Lung
  • Breast
  • Prostate
  • Thyroid
  • Renal
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10
Q

Cumulative Trauma Disorder

  • Cause
  • Symptoms
A
  • Cause
    • Etiology unknown
    • aggravated by repetitive motion or sustained exertion
  • Symptoms
    • Pain
    • Fatigue
    • Numbness
    • Tenosynovitis
    • Epicondylitis
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11
Q

Fibromyalgia

  • Cause
  • Symptoms
  • Diagnosis
A
  • Cause
    • etiology unknown
  • Symptoms
    • Muscular pain
    • Fatigue
    • Stiffness
    • Multiple tender points
  • Diagnosis
    • Widespread pain
      • longer than 3 mo
    • Multiple trigger points
    • Normal joints and x-ray
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12
Q

Torus fracture

  • Damage
  • Population
A
  • Damage
    • one side of cortex only
    • “buckle” or “wrinkle” frcture
  • Population
    • Young
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13
Q

Greenstick fracture

  • Damage
  • Population
A
  • Damage
    • Break one side of cortex
    • Bend the other
  • Population
    • Young
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14
Q

What does the Salter Harris Classification scale measure?

A

Severity of epithyseal fractures

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15
Q

What is a cominuted fracture?

A

Bone is in more than one piece

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16
Q

What is a segmental fracture?

A

Segment broken off of a bone

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17
Q

What bone abnormalities are common in Osteoporosis?

A
  • Fractures
    • Hip
    • Wrist
    • Compression
  • Kyphosis
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18
Q

What bone process is abnormal in Osteomalacia? What is the result?

A
  • Abnormal Osteoblastic process
  • Soft bone
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19
Q

Reflex Sympathetic Dystrophy

  • Symptoms
  • Common location
  • Stage at which it is irreversible
A
  • Symptoms
    • Severe pain
    • Swelling
    • Discoloration
    • Excessive perspiration
  • Common location
    • Upper extremity
  • Stage at which it is irreversible
    • 8-9 mo (stage 3)
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20
Q

Falling on the tip of the shoulder results in what type of injury?

A

Acromioclavicular

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21
Q

What complication should be concidered when fracture of the scapula occurs?

A

Pulmonary Contusion

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22
Q

What are the characteristics of Adhesive Capsulitis (Frozen Shoulder)? How long does it take to heal?

A
  • Characteristics
    • Insidious onset
    • Decreased range of motion
    • Pain
  • Time to heal
    • 2 years
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23
Q

What is the therapy for a shoulder dislocation?

A
  • Strengthening of subscapularis and infraspinatus
  • Immobilize for 2-3 weeks
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24
Q

What can present with subacromial pain that radiates into the brachium with weakness and catching with elevation?

A
  • Bursitis
  • Impingement
  • Rotator Cuff Tear
    • may need more aggressive therapy than the rest
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25
Q

What injury is pictured below?

A

Rupture of the long head of the Biceps

aka “Popeye muscle”

May occur spontaneously after 40 years

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26
Q

What is the anatomy of cubital tunnel syndrome? What symptoms are present?

A
  • Anatomy
    • entrapment of ulnar nerve
  • Symptoms
    • Pain
    • Numbness
      • pinky and half of ring finger
    • Muscle weakness
      • intrinsic mm of the hand
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27
Q

What causes acute olecranon bursitis?

A

Trauma

Infection

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28
Q

What causes chronic olecranon bursitis?

A

Gout

Rheumatoid

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29
Q

What is tennis elbow?

A

Lateral epicondylitis

(elbow)

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30
Q

What is golfer’s elbow?

A

Medial epicondylitis

(elbow)

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31
Q

What disease process is pictured below?

A

Rheumatoid arthritis

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32
Q

What disease process is pictured below?

A

Degenerative Arthritis

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33
Q

Patient has a flexion deformity of PIP with hyperextension of DIP. What is the condition? What is the cause?

A

Boutonniere Deformity

Cause: disruption of central slip of PIP

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34
Q

Patient has flexion of the DIP joint on full extention of the finger. What is the condition? What is the cause?

A

Mallet / Baseball finger

Cause: disruption of terminal extensor tendon

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35
Q

What is the anatomy of Carpal Tunnel Syndrome? What are the symptoms? Diagnosis?

A
  • Anatomy:
    • Compression of the median nerve
  • Symptoms
    • Pain
    • Numbness
    • Nocturnal Paresthesia
    • Thenar weakness
  • Diagnosis
    • Loss of 2 point discrimination
    • Phalen’s test
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36
Q

What is Dupuytren’s contracture?

A

Idiopathic thickening of Palmar Fascia

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37
Q

Patient fell on his outstretched hand and now has tenderness over the snuff box. What injury does he have? What severe complication can result?

A

Fracture of the Scaphoid

Complication: avascular necrosis of the proximal pole

38
Q

What is deQuervain’s? How can you test for it?

A
  • Tenosynovitis of the Wrist
    • first dorsal extensor compartment
    • APL and EPB tendons
    • THUMB
  • Test
    • Finkelstein’s Test
39
Q

What condition is pictured below? What symptoms are present? What causes this?

A

Trigger finger

  • Symptoms
    • Locking
    • Pain at A1 Pulley
  • Cause
    • Repetitive actions
    • Rheumatoid arthritis
40
Q

Where does ulnar nerve entrapment of the wrist occur?

A

Guyon’s canal

41
Q

Patient presents with one leg flexed, adducted, and internally rotated. In which direction was his hip dislocation? Function of what structure needs to be assessed?

A

Posterior dyslocation

Assess Sciatic Nerve function

42
Q

Patient presents with one leg flexed, abducted, and externally rotated. In which direction was his hip dislocation? Function of what structure needs to be assessed?

A

Anterior hip dislocation

Assess Femoral Nerve function

43
Q

The patient fell on their hip. The leg is now shortened and externally rotated. Where is the fracture?

A

Intertrochanteric

or

Femoral Neck Fracture

44
Q

Patient presents with pain in the buttock and lateral thigh. They limp and have a positive trendelenburg sign. There is loss of internal rotation. What is the diagnosis?

A

Osteoarthritis of the hip

45
Q

Patient has pain over the trochanter and lateral thigh with point tenderness over the trochanter. What is the diagnosis?

A

Trochanteric Bursitis

46
Q

Patient had a twisting injury of the knee, causing it to “pop.” There is now pain and an effusion around the knee. What is the next step in testing? What is the injury?

A

Test: Anterior Drawer sign

ACL tear

47
Q

What is a fluid filled sac from the medial hamstring tendons?

A

Baker’s cyst

aka Popliteal cyst

48
Q

Pes Anserine Bursitis

  • Anatomy
  • Symptoms
A
  • Anatomy
    • Inflammation of the bursa beneath the tendons of
      • Sartorius
      • Gracilis
      • Semitendonosis
  • Symptoms
    • Pain
    • Point tenderness ***
49
Q

Where is the pain located in a meniscal tear?

A

Along the joint line

50
Q

Patient presents with sudden severe calf pain, described as feeling like a “gunshot.” The calf is swollen. When squeezing the calf muscle, no plantar flexion is present. What is the injury? What is the test of squeezing the calf called?

A

Achilles Tendon Rupture

Test: Thompson test (negative here)

51
Q

Patient presents with lateral deviation of the great toe at the MTP joint and pain secondary to wearing shoes. What is the diagnosis?

A

Bunion

52
Q

What three major clinical problems of the foot can result from diabetes?

A
  1. Diabetic Ulceration
  2. Deep Infections
  3. Charcot Joints
53
Q

Patient presents with pain centralized between the 3rd and 4th MTP joint of the foot. He says says he feels like he is walking on a marble. What is the diagnosis?

A

Morton’s Neuroma

54
Q

Patient presents with heel pain that is more severe on waking up and the morning and with the first few steps. The pain becomes less severe with some movement. What is the diagnosis?

A

Plantar fasciitis

Inflammation of bone and fascia

55
Q

What injury is usually associated with increased activity?

A

Stress Fracture

56
Q

Spondylolithesis

  • Anatomy
  • Defect
A
  • Anatomy
    • Foreward slippage of vertebra on another
    • Most common: L5-S1
  • Defect
    • in Pars Interarticularis
57
Q

Does surgery reverse the damage that has already occured in lumbar disc herniation?

A

No! This is a degenerative process

58
Q

What symptoms are associated with spinal stenosis? In which age group is it most common?

A
  • Symptoms
    • Back and leg pain
    • Weakness
    • Pseudoclaudication
      • nerve pain w/ walking that causes them to need to stop and rest
  • Pop
    • 60s
59
Q

What is the ddx if a child presents with acute, severe bone pain?

A

Fracture

Dislocation

60
Q

What is the ddx if a child presents with bone pain that has progressed over several days?

A

Osteomyelitis

Septic Arthritis

61
Q

What is the ddx if a child presents with bone pain with a slow (indolent) onset?

A

Inflammatory arthritis

Rheumatoid arthritis

62
Q

What is the ddx if a child presents with bone pain at night?

A
  • Bone tumors
    • Osteosarcoma
    • Osteoid Osteoma
  • Marrow problems
    • Leukemia
63
Q

What is the most common site of disease is peds orthopedics?

A

Metaphyseal Region

64
Q

What is the diagnosis for the condition pictured below?

A

Club foot

  • Plantar flexion of ankle
  • Inversion of heel
  • High arch of foot
  • Adduction of forefoot
65
Q

What can result from untreated Congenital Dysplasia of the Hip in an older child?

A

Leg shortening

Limp

66
Q

What are the Barlow and Ortolani tests used to diagnose?

A

Diagnosis: Congenital Hip Dysplasia

Barlow: Dislocation test

Ortolani: Relocation test

67
Q

What is the treatment for Congenital Dysplasia of the Hip?

A

Contain head of femur in acetabulum

Stimulated growth / deepening of acetabulum

68
Q

What is the ddx for a child whose limp is worse in the morning?

A

Transient synovitis

Rheumatoid Arthritis

69
Q

What is the ddx for a child whose limp is worse in the afternoon, after activity?

A

Musculoskeletal conditions

70
Q

What is the ddx for a child whose limp is worse at night?

A

Neoplasm

(ex: leukemia)

71
Q

Legg-Calve-Perthes Disease

  • Pathology
  • Age group
  • Symptoms
  • Complications
A
  • Pathology
    • Osteonecrosis of the femoral head
  • Age group
    • 4-8 y/o
  • Symptoms
    • limping
    • Restriction of abduction of hip
  • Complications
    • Degenerative arthritis
    • Head may collapse
72
Q

Student athlete presents with pain and an enlargement of the anterior tibial tubercle. The radiology is shown below. What is the diagnosis? What is the pathology?

A

Osgood Schlatter Disease

  • Path
    • Apophysitis
      • Normal developmental outgrowth of a bone which arises from a separate ossification centre, and fuses to the bone later in development.
      • Forms an insertion for a tendon
    • Involved tendon
      • Infrapatellar
73
Q

Scoliosis

  • Definition
  • Most common location
  • Testing
A
  • Definition
    • Lateral curvature of the spine
    • > 10 degrees
  • Most common location
    • Thoracic and Lumbar
  • Testing
    • Forward bend test
    • Look for elevation of ribs on one side and depression on the other
74
Q

When is surgery necessary to treat scoliosis?

A

over 40 degree curvature

75
Q

Child presents with fever and pain and swelling of the knee. Joint Aspirate shows WBC > 50,000, Low sugar, Increased protein, and a culture is performed What is the diagnosis? What are the most common pathogenic causes?

A

Septic arthritis

  • Pathogens
    • Staph aureus (most common)
    • Group B Strep (< 1)
    • H. influenzae (6 mo - 4 yrs)
    • N. gonorrhea (12-18 yrs)
76
Q

Patient presents with pain of the groin and anterolateral thigh with a limp. Radiography is shown below. What is the diagnosis?

A

Slipped capital femoral epiphysis

77
Q

Toward what bony structure should all fingers point when at rest?

A

Distal pole of the scaphoid

78
Q

Where does the tendon flexor profundus insert?

A

Distal Phalanx

79
Q

Where does the tendon flexor sublimis insert?

A

Middle phalanx

80
Q

While supporting the middle phalanx, the patient is unable to bend the distal phalanx. What structure has most likely been damage?

A

Tendon flexor Profundus

81
Q

Patient is only able to flex the finger at the PIP joint. The other IP joints remain extended. What structure is probably damaged?

A

Flexor tendon Sublimis

82
Q

Sensation is provided to which parts of the hand by these nerves?

  • Median
  • Ulnar
  • Radial
A
  • Median (green)
    • Palm: part of thumb, fingers 2, 3, half of 4
    • Dorsum: Tips of fingers 2, 3, half of 4
  • Ulnar (blue)
    • Both sides: pinky and half of finger 4
  • Radial (red)
    • Palm: half of thumb
    • Dorsum: thumb, fingers 2, 3, half of 4 to the IPJ
83
Q

Which nerve allows thenar opposition?

A

Median

84
Q

What nerve provides motor function to the intrinsic mm of the hand?

A

Ulnar

85
Q

Which nerve allows wrist and thumb extension?

A

Radial

86
Q

What should be used to dress an injured hand?

A
  • First layer
    • Fine Mesh Gauze
  • Second layer
    • Bulky absorbent material
  • Third layer
    • Splint
87
Q

What are Ultrasounds most useful in detecting?

A
  1. Ganglia & abscesses
  2. Foreign body
  3. Ligament tear
  4. Tendonitis
  5. Ultrasound guided aspiration
88
Q

CT is useful in evaluation of what type of injury?

A

Fracture

89
Q

Which imaging tool provides the most information?

A

MRI

90
Q

Bone scan

  • Measures what factors?
  • Indications
A
  • Measures
    • blood flow
    • metabolic activity
    • Bone turnover
  • Indications
    • Osteomyelitis
    • Kienboch’s disease

ICM II (12 decks)

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