Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MSDR > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

In patient history, what does CODIERS stand for?

A

CODIERS:

Course

Onset

Duration

Intensity

Exacerbating factors

Relieving factors

Symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

For the following nerves, indicate the 1. muscle innervated and its function and 2. the sensory area innervated:

  • axillary n.
  • musculocutaneous n.
  • median n.
  • ulnar n.
  • radial n.
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

For the following nerves, indicate the 1. muscle innervated and its function and 2. the sensory area innervated:

femoral n.

deep branch of fibular (peroneal) n.

superficial branch of fibular (peroneal) n.

tibial n.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is strength tested and what does each score indicate?

A

Strength Testing is scored out of 5:

  • 0/5: No muscle movement
  • 1/5: Visible muscle movment, but no movement at joint
  • 2/5: Movement at joint, but not against gravity
  • 3/5: Movement against gravity, but not added resistance
  • 4/5: Movement against resistance, but less than usual
  • 5/5: NORMAL strength
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How are nerve reflexes tested and what does each score indicate?

A
  • 0 = absent
  • 1+ = hypoactive
  • 2+ = normal
  • 3+ = hyperactive, no clonus
  • 4+ = hyperactive, with clonus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define gait and what is considered the normal horizantal length and what is considered the normal step length?

A
  • Gait
    1. Watching a patient walk
      • Normal horizontal distance between feet: 4 inches
      • Normal step length: 15 inches
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the different types of imaging used (5 types) and what are they each used for?

A
  1. Radiograph – used mainly for simple bone and joint imaging
    • IMPORTANT: If joint is weight bearing order weight bearing x-rays
    • order x-rays for joints above and below if visualizing long bone
    • obtain perpendicular images
  2. CT – great for bone visualization
    • ALWAYS order CT before MRI
  3. MRI – great for soft tissue, spine, and joints
  4. Ultrasound – good for real time assessment of dynamic movement
  5. Bone Scans – not used, can see deformities of the bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  • What type of orthopedic pathology is tendinopathy considered to be?
  • Define some symptoms of tendinopathy.
  • What are the two types of tendinopathy and what is each characterized by?
  • What is the histology of a normal tendon vs an abnromal tendon?
A
  1. Type of Pathology: Overuse injury
  2. Tendinopathy – pain, swelling, impaired performance
    • Tendinitis – inflammation
    • Tendinosis – degradation
      • Normal Tendon: tightly packed collagen fibers, few cells, little vascularization
      • Abnormal Tendon: spread out collagen fibers, many cells, more vascularization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  • What type of orthopedic pathology do shin splints fall under?
  • What is the medical term for shin splints?
  • What are they characterized by?
A
  1. Pathology: overuse injury
  2. Medial Tibia Stress Syndrome: Shin Splints
    • Periostitis caused by abnormal traction of deep flexor/soleus muscles with tibia
    • Generalized pain along the anterior tibia
    • Happens when there is sudden increase in exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  • What type of orthopedic pathology do stress fractures fall under?
  • What are they characterized by?
  • Treatment?
A
  1. Patholgy: overuse injury
  2. Stress Fractures
    • Focalized pain in a specific area of the body
    • Low risk vs. high risk based on where it happens
      • High risk: if risk of dealyed union or propensity for re-fracture
    • Treatment: Non-operative (4-8 weeks) and Operative
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What 5 tests are used to evaluate basic tendon and nerve function in the hand?

A
  • Make fist
  • Abduct and adduct fingers
  • Make okay sign
  • Cross fingers
  • Abduct thumb
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the pathogenesis of trigger finger?

A
  • Pathologic process: locking of flexor tendons due to size mismatch between the tendon and pulley/tunnel/sheath
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the three types of trigger finger and what are they associated with?

A
  • Types
    • Primary: idiopathic
    • Secondary: associated with systemic disease (i.e. diabetes and rheumatoid arthritis)
    • Infantile: early after birth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

For trigger finger, what are the treatments for children and what are the treatment for adults?

A
  • Treatments
    • Children: observation
    • Adults: steroid injections to reduce inflammation or surgical intervention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Define De Quervains tenosynovitis:

A
  • De Quervains tenosynovitis: tendonitis of thumb extensor as they pass through the thenar snuffbox
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What structures are involved in De Quevains tenosynovitis? Remember the pneumonic!

A

Pneumonic: SEX LAP of the 1st Dorsal Compartment

SEX: EXtensor Pollicis Brevis (S=short)

LAP: Abductor Pollicis Longus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the treatment for De Quervains tenosynovitis?

A
  • Treatment:
    • Non-operative
      • Brace
      • NSAIDS
      • Injection
    • Operative
      • Release of tunnel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Where does carpal tunnel occur? What are the motor and sensory changes in carpal tunnel?

A

Carpal Tunnel Syndrome: affects median nerve at wrist

  • Motor changes
    • Weakness
    • Thenar muscle wasting
  • Sensory changes
    • Dropping objects due to inability to feel
    • Numbness
    • Tingling of thumb, index, and middle finger
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where does cubital tunnel occur? What are the motor and sensory changes in cubital tunnel?

A

Cubital Tunnel Syndrome: affects ulnar nerve at elbow

  • Motor changes
    • Atrophy of first dorsal interosseous muscle (between thumb and index finger)
    • Clawing of ring and pinky finger
  • Sensory changes
    • Numbness and tingling of pinky and medial half of ring finger
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are two physical examination tests to diagnose carpal tunnel syndrome?

A
  • Tinel Sign at wrist
    • Produces electric shock
  • Phalen’s Test but doesn’t isolate the median nerve from radial nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are two physical exam findings with cubital tunnel syndrome?

A
  • Elbow flexion with Tinel
  • Elbow compression-flexion with Tinel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the 4 most common causes of decreased shoulder motion? Describe them in terms of passive/active motion.

A

Passive motion = active motion → physical barrier to motion

  1. Arthritis
  2. Adhesive capsulitis (frozen shoulder): scar tissue forms after stiffening of joint
  3. Locked dislocation

Passive motion > active motion → no physical barrier to motion

  1. Pain/weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the three phases of adhesive capulitis (frozen shoulder)? How does the pain and ROM progress in each phase? How long does each phase last?

A

Freezing

  • Progressive increase in pain
  • Worsening range of motion
  • Lasts 6 weeks to 9 months

Frozen

  • Pain goes away but unable to move shoulder
  • Lasts 4 to 6 months

Thawing

  • Range of motion returns slowly
  • Lasts 6 months to 2 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the 4 muscles of the rotator cuff and what are their functions?

A
  1. Supraspinatus: ABduct 0-15
  2. Infraspinatus: Externally rotate with arm at SIDE
  3. Teres minor: Externally rotate with arm abducted
  4. Subscapularis: Medially/internally rotate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How can you test the supraspinatus m?
Empty Can test
26
How can you test the infraspinatus m?
External rotation with arm at side
27
How can you test the teres minor m?
External rotation with arm ABducted
28
What is one of the two tests for the subscapularis m?
Lift Off Test
29
What is the second of the two tests for the subscapularis m?
Belly Press Test
30
What is rotator cuff impingement?
Pinching of rotator cuff muscles inferior to coracoacromial arch
31
What are the 4 tests for rotator cuff impingement?
1. Neer's Sign (shown in picture) 2. Hawkin's Sign (shown in picture) 3. Bicep Tendon Test 1. Yergason’s: Pushing against supination 2. Speed’s: Pushing against flexion
32
What are three potential causes of weakness of the rotator cuff?
1. Disuse (i.e. atrophy due to bed-bound) 2. Denervation (i.e. suprascapular nerve compression or lesion) 3. Tendon rupture (i.e. rotator cuff tear causing muscle to be detached with no action)
33
1. What is lateral epicondylitis? 2. What are the involved structures? 3. What are the treatement measures for lateral epiconylitis?
* Lateral epicondylitis: inflammation due to overuse or injury (aka Tennis Elbow) * Involved structures: extensor carpi radialis brevis * Non-operative treatments: stretching, anti-inflammatory medications, bracing, resting ECRB, injections with steroids
34
List the cervical nerve roots and describe how to evaluate them on physical examination (corresponding strength, sensation, and reflexes).
35
List the lumbar nerve roots and describe how to evaluate them on physical examination (corresponding strength, sensation, and reflexes).
36
Describe appropriate use of radiography in orthopedics.
* No imaging before six weeks unless there is presence of red flag symptoms
37
Describe and list the treatment for **cervical strain**.
* Cervical Strain * Description: whiplash injury – rapid flexion/extension of the neck (i.e. MVA) * Treatment: NSAIDS and moving muscles
38
Describe and list the treatment for **cervical radiculopathy**.
* Cervical Radiculopathy * Description: compression of cervical nerve root peripheral neurogenic symptoms * Young: disc related * Old: osteoporosis * Pain is relieved with affected arm above head * Treatment: NSAIDs and PT
39
Describe and list the treatment for **chronic low back pain**.
* Chronic Low Back Pain * Description: low back pain that lasts longer than 3 months * Treatment: narcotics
40
Describe and list the treatment for **lumbar spinal stenosis**.
* Description: narrowing of the spinal canal with pain that worsens with extension and gets better with flexion * Neurogenic claudication: leg pain/heaviness resulting from compression of lumbar spinal nerves (differentiate from peripheral vascular disease because PVD gets better after rest/laying down) * Occurs in individuals \>60yo
41
Describe spondylolysis.
* Description: defect in the pars interarticularis (near the facet joint) that results in stress fracture after repetitive hyperextension of lumbar region (super common in athletes)
42
Describe and list the treatmenet for **spondylolisthesis**.
* Spondylolisthesis * Description: forward slippage of vertebral body due to degeneration of facet joint/intervertebral disc (degenerative) or fracture of the pars interarticularis leading to forward slippage (isthmic) * Usually asymptomatic * Treatment: NSAIDs and activity modifications
43
Describe and list the treatment for **cauda equina syndrome.**
* Cauda equine Syndrome * Description: acute compression of cauda equina due to disc herniation (L2-S4 nerve roots) causes urinary/bowel incontinence/retention * **_Emergent condition_** because it can cause irreparable damage to nerves * Treatment: immediate surgery
44
Recognize red flags for lower back pain (theres a lot).
* Age greater than 50 * Fever * Trauma * Indications of Cancer * Unrelenting Night Pain * Weight Loss * History of Cancer or Family History * Progressive neurologic deficits * Failure to improve after 6 weeks of conservative therapy * Urinary or bowel incontinence or retention * Immunosuppression * Drug, oral, IV, steroid abuse
45
# Define the piezoelectric property of the bone and what process does it play a role in? * What are the two sides and on what side do the osteoblasts and what side do osteoclasts lie in?
* Piezoelectric property of bone – mechanical loading of bone via weight and force produce small electric currents that causes remodeling of bone (think bowed legs and how the body is trying to correct them) * Concave side – negative charge where osteoblasts form bone * Convex side – positive charge where osteoclasts remove/resorb bone
46
What are the stages of bone healing? There are 4. Provide the approximate range of days.
1. Inflammation (0-5 days) 2. Repair - Soft Callus (5 - 21 days) 3. Repair - Hard Callus (21 days - 4 months 4. Remodeling
47
What takes place in the inflammation phase of bone healing? What does the stage begin with and end with?
Inflammation (0-5 days) * Begins at impact and lasts until cartilage formation occurs * Correlates with pain and swelling * Events in Phase * Hematoma * Fibroblasts form granulation tissue replacing hematoma * Osteoclasts remove necrotic tissue
48
What takes place in the repair - soft callus phase of bone healing? What does the stage begin with and end with?
* Repair – Soft Callus (5 – 21 days) * Stage ends when fracture fragments are no longer clinically moveable * Events in Phase * Increased vascularity and cellularity * Recruitment of mesenchymal stem cells * Fibrocartilaginous callus bridges fracture site
49
What takes place in the repair - hard callus phase of bone healing? What does the stage begin with and end with?
* Repair – Hard Callus (21 days – 4 months) * Begins when soft callus is completed * Ends with clinical and radiographic union (bones look united with no air in between) * Events in Phase * Blood supply is fully returned * Endochondral ossification (creation of bone through cartilage replacement) * Calcification of cartilage
50
What takes place in the remodeling phase of bone healing?
* Conversion of woven bone to lamellar bone * Diameter of callus is reduced to normal
51
What is the sequence of tissue types that appear during bone healing?
* Fibroblasts make granulation tissue (can form with 100% strain) – collagen type 3 * Chrondroblasts make cartilage (requires less than 10% strain to form) – collagen type 2 * Osteoblasts make bone (requires less than 2% strain to form) – collagen type 1
52
Define strain in terms of bone healing.
* Strain = change in length per unit length * As you bring bone close together, any movement will cause strain
53
What are the requirements for bone healing?
* Mechanical environment to reduce strain * Rods and casts * Biological environment to promote healing * Bridging capillary network – blood flow * Presence of stem cells and signaling molecules like TGF-B
54
Differentiate between primary and secondary bone healing.
* Primary bone healing – direct bone healing without intermediate tissue * Requires surgical stabilization with plate fixation * Bone to bone contact under compression * Used in articular fractures and simple fracture patterns * Secondary bone healing – undergoes phases of healing using endochondral ossification
55
Define nonunion spectrum in terms of fractures.
* Nonunion spectrum (improper fracture healing/reunion) – lack of clinical and radiographic progression toward healing due to mechanical and/or biological responses
56
What are the three different types of strains and define what is the result of each type of strain.
* Hypertrophic strain – excessive strain causing abundant callus * Need to bring strain below 2% for bone formation * Oligotrophic strain * Atrophic strain – inadequate biological response causing minimal callus * Need to restart the healing cascade via osteoinduction (i.e. grafting)
57
What is the general timeline for compartment syndrome?
* Surgical emergency * After two hours, damage begins to accumulate * After 8 hours, the limb may not be salvageable
58
What is the pathophysiology for compartment syndrome?
* Pathophysiology * Muscle and other vital tissues are contained in fixed volume by enveloping fascia * Increase pressure in the compartment enclosed in fascia leads to ischemia * Decreased compartment size (tight dressing or cast) * Increased compartment content (bleeding, swelling, capillary permeability) * Ischemia leads to tissue death
59
What is the clinical presentation of comaprtment sydrome?
**Five P's** * Pain * Paresthesia – numbness, tingling, and burning sensation * Pallor – paleness * Paralysis * Pulseness – occurs when capillaries collapse (normal is 30 mmHg) * Can be determined by sticking A-line into compartment
60
What is the treatment and what are the complications for compartment syndrome?
* Treatment * Emergent fasciotomy – cutting of fascia * Complications * Muscle necrosis * Nerve damage * Amputation of limb
61
Define what an open fracture means and what problems do open fractures pose?
Open Fracture * Overview * Bone pierces through skin * Problems * Barrier is broken which allows bacteria and foreign debris to get in – **osteomyelitis (infection of the bone)**
62
What is the treatment for an open fracture?
* Treatment * Restore alignment (ASAP) * Stabilize join (ASAP) * Antibiotics (ASAP)
63
What are the typical mechanisms of pelvic injuries?
* Mechanism of pelvic injury * MVA * Fall from height * Significant compressive force * Strong external rotation at femur
64
Why is a pelvic fracture signficant (think pelvic volume)?
* Pelvic volume is important because it comprises 30% of your total blood volume and bleeding into pelvis is considered bleeding into free space and patients can bleed out * Human blood is 5L total * Pelvic volume is 1.5L
65
What is the treatment for pelvic fractures and what is the importance of mechanical stablilty?
* Treatment * Sheet/binder application for compression of pelvic region and to bring anatomy close together * Importance of mechanical stability * Posterior ligaments act as suspension bridge and allow weight transmission from spine and torso into lower extremities and provide stability
66
What are the two main types of ankle sprains and define each type? Which ligaments are "sprained" in each ankle sprain type?
* Lateral ankle sprain: typical inversion/plantar flexion injury in which anterior talofibular ligament (ATFL) is sprained * High ankle sprain: forced dorsiflexion and eversion of ankle in which the ligaments attaching the tibia to the fibula (syndesmotic ligaments) are torn
67
What are the diagnostic tests for the two types of the ankle sprains?
Lateral ankle sprain: * Ankle Drawer Test: if a ATFL is torn, talus dislocates anteriorly High ankle sprain * Squeeze test (compress mid calf): pain at ankle joint is positive for high ankle sprain * External rotation test: knee bent to 90 degrees with ankle in dorsiflexion with force applied to ankle; positive if pain
68
What is the treatment for the two types of ankle sprains?
* Lateral Ankle Sprain Treatment * “PRICE” – Protection, Rest, Ice, Compression, Elevation * Stirrup splint * Surgery is rare * High Ankle Sprain Treatment * If mild, can treat conservatively with walker boot * If severe, can be candidate for surgery
69
What are the Ottawa Ankle and Foot Rules of X-Rays of ankle/foot injuries? There are 6 rules.
* Ottawa Ankle and Foot Rules for X-Rays * Cannot take four steps at time of injury * Cannot take four steps in clinic * Pain at posterior medial malleolus * Pain at posterior lateral malleolus * Pain at navicular bone * Pain at base of 5th metatarsal
70
What is the achilles tendon made up of? What are the intrinsic and extinsic risk factors for achilles tendinopathy?
Achilles’ Tendinopathy * Achilles tendon is a combined tendon of the gastrocnemius and soleus muscles * Risk Factors * Intrinsic * Hypovascularity – blood supply decreases with age * Extrinsic * Exercise – overuse can lead to injury
71
What are the three types of achilles tendinopathies? Define what ocurs with each type.
* Tendinitis is acute inflammation of a tendon whereas tendinosis is chronic and degenerative * Pain over tendon, heel pain, stiffness * Bursitis (bursa are extra-articular synovial fluid-filled sacs that cushion muscles) * Pain at back of heel, worsens with activity, improves with rest, pain wearing shoes * Rupture * “Pop” * “Kicked in the back of the ankle”
72
What are the treatments for the three tendinopathies?
Tendinitis * Treatment: PRICE and NSAIDs and PT (NO STEROID INJECTIONS because increases likelihood of rupture) Bursitis * Treatment: NSAIDs, stretching, and surgery if no improvement Rupture * Treatment: surgery + immobilization OR surgery alone
73
What is medial heel pain known as? What occurs and what nerve is compressed? What is the treatment?
Medial Heel Pain: **Tarsal Tunnel Syndrome** * Compression by the flexor retinaculum ligament on the **posterior tibial nerve** * Tingling, burning and numbness of heel * Treatment: PT but can refer to specialist for surgery
74
What occurs in plantar fascitis and when is the pain worse? What is the treatment?
Plantar Fasciitis * Biomechanical overuse that is worse in the morning * Microtears in the thick fibrous bands of the plantar fascia * Treatment: PT/splint but can refer to specialist for surgery
75
What occurs in metatarsal stress fracture and what are three types?
Metatarsal Stress Fracture * Fracture along different points of the 5th metatarsal * Jones’s Fracture, diaphyseal stress fracture, and tuberosity avulsion fracture
76
What is morton's neuroma and where does the pain occur? What is the treatment?
Morton’s Neruoma * Pain in webspace between toes due to plantar digital nerve irritation * Treatment: get better shoes
77
What is Lisfranc Injuries and where does the pain occur? What is the treatment?
Lisfranc Injuries * Disruption of the TMT joint ligaments due to vertical force on the heel * Treatment: surgery
78
What are the two main type of halluxes and what occurs in each?
Halluxes * Hallux valgus = bunion * Lateral deviation of the 1st MTP joint * Hallux rigidis = osteoarthritis of 1st MTP joint
79
In toe fractures, what ocurs? What is the most common toe to be injured? What is the treatment?
Toe Fractures * Caused by direct trauma and usually the 5th toe * Treatment: tape toes together
80
Differentiate between corns (hard and soft) and calluses.
Corns and Calluses * Corns * Hard = occurs over bony prominences * Soft = between toes and webspace * Calluses * Hyperkeratonic lesion of skin due to pressure over bony prominences
81
List the 8 types of acute knee pain.
* ACL tear * Patellar dislocation * Tibial plateau fracture * Meniscal tear * Extensor mechanism disruption * Bucket-handle tear * Quadriceps tendon rupture * Patellar tendon rupture
82
What are the symptoms and treatment for an ACL tear?
* ACL tear * Symptoms: moderate effusion, lack terminal 5 degrees of extension, and asymmetric laxity with Lachman and anterior drawer test * Treatment: surgery
83
What are the symptoms and treatment for patellar dislocation?
* Patellar dislocation * Symptoms: + effusion, limited ROM, medial tenderness * Tear of medial patellofemoral ligament (MPFL) * Treatment: bracing versus surgery depending on severity
84
What are the symptoms for extensor mechanism disruption?
* Extensor mechanism disruption * Symptoms: unable to perform straight leg raise, full passive extension, palpable defect
85
What are the symptoms and treatment for bucket-handle meniscus tear?
* Bucket-handle meniscus tear * Symptoms: limited and painful ROM, unable to fully passively extend, no palpable defect, “locked knee”, occurs with ACL tear * Treatment: requires surgery
86
What are the symptoms for a quadriceps tendon rupture?
* Quadriceps tendon rupture * Symptoms: no active extension, defect superior patella
87
What are the symptoms for patellar tendon rupture?
* Patellar tendon rupture * Symptoms: no active extension, defect inferior patella
88
List the two main types of chronic knee pains?
* Meniscus tear * Osteoarthritis
89
For meniscus tear, what are the symptoms and how is it diagnosed?
* Meniscus tear * Symptoms: joint line tenderness * Diagnosis via MRI (soft tissue)
90
For osteoarthritis, what is the pathophysiology and how is it treated?
* Osteoarthritis * Pathophysiology: global loss of articular cartilage * Treatment: NSAIDs, injections, bracing, and total knee replacement
91
What are the two limb-threatening injuries?
* Knee dislocation * Tibial plateau fracture
92
Why is a knee dislocation so serious (what is at risk: nerve and artery)? Is it the same thing as a patellar dislocation?
* Knee dislocation (≠ patellar dislocation) * Popliteal artery and fibular nerve are at risk!
93
In terms of urgent surgical intervention, what are three knee injuries are there and what two hip injuries are there?
* Knees * Extensor mechanism disruptions * Displaced tibial plateau fractures * Bucket-handle meniscal tears * Hips * Femoral neck fractures * Hip dislocations * Increase risk of peroneal nerve palsy and avascular necrosis
94
What is the mortality rate within one year for hip fractures and why?
* Hip fractures * 12-37% die within 1 year because elderly have many comorbidities
95
What are the three type of hip fractures?
* Interotrochanteric * Subtrochanteric * Femoral neck fractures
96
Is there a compromise to blood supply for interotrochanteric hip fractures? What is the treatment?
* Intertrochanteric * No compromise to blood supply * Requires surgery
97
For femoral neck fractures, what is the treatment for younger and older patients respectively? What is there a risk for with this condition?
* Femoral neck fractures * Younger get screws and older gets replacement * Risk for avascular necrosis
98
What are the two differential diagnoses for lateral hip pain: trochanteric?
* Lateral hip pain: trochanteric * Bursitis * Abductor tendinopathy
99
What are the 5 differential diagnoses for chronic groin pain: hip pain?
* Hip osteoarthritis * Avascular necrosis of femoral head * Acetabular impingement→acetabular labral tear * Hernia * Nephrolithiasis
100
What is the pathophyisology and treatment of hip osteoarthritis?
* Hip osteoarthritis * Pathophysiology: global loss of articular cartilage * Treatment: NSAIDs, injections, and total hip replacement
101
What is avascular necrosis caused by and what can it lead to?
* Avascular necrosis of femoral head * Caused by disruption of blood flow to femoral head * Can lead to collapse of femoral head
102
When acetabular impingement leads to acetablar labral tear, what two things can it be caused by?
* Acetabular impingement → acetabular labral tear * Caused by deformity of femoral head (cam impingement) and/or acetabulum (pincer impingement)
103
What condition is this?
Clubfeet
104
* Do adults or children get clubfeet more? Male or female? * What are some of the clinical features of clubfeet? * What is the universal method of treatment for clubfeet?
* Children: Boys \>\> girls * Clinical features * Forefoot supination * Internal rotation (inverted) * Posterior crease (equinus = tight Achilles tendon) * Treatment * Serial Ponseti Casting – several stages of casting to correct bone growth
105
What are three characteristics of developmental dusplasia of the hip (DDH)?
* Developmental Dysplasia of the Hip * Dysplasia * Subluxation * Dislocation
106
What are the risk factors of Developmental Dysplasia of the Hip (DDH)? Treatment?
* Risk Factors * First-born * Female * Breech birth with other birthing defects * Treatment * Pavlik harness
107
What are the two tests/maneuvers for developmental dysplasia of the hip and how are they performed?
* Barlow Maneuver * Internal rotation followed by pushing gently backward * Ball of femur goes out of socket * Ortolani Maneuver * External rotation/abduction of hip * Ball of femur goes back into socket
108
For slipped capital femoral epiphysis (SCFE), what is the general clinical presentation, what occurs, and what is the treatment?
* Clinical presentation – obese teenage boy with knee pain * Femoral head slips off physis * Requires urgent surgical intervention
109
Where do Salter-Harris frctures occur? How many types are there?
* Salter-Harris fractures are fractures to proximal and distal ends of growing bones * 5 types
110
List the 5 types of Salter-Harris fractures.
**Pneumonic: SALTER** * Type I – through physis (S – same) * Type II – through physis and metaphysis (A – above) * Type III – through physis and epiphysis (L – lower) * Type IV – through metaphysis, physis, and epiphysis (TE – through everything) * Type V – crush injury to entire physis (R – rammed)
111
What is the general clinical presentation of non-accidental trauma (NAT)?
* NAT – non-accidental trauma * Clinical presentation * Fractured posterior rib * Fractured long bones (femur and humerus) before walking * Bruising, burns, scratches
112
Where does scoiliosis occur and what defines scoliosis?
* Scoliosis – severe curvature of thoracic and lumbar spine * Defined by curve size * Cobb angle must be greater than 10 degrees = draw perpendicular line from top bent vertebra and bottom bent vertebra and measure angle
113
What are the parameters for bracing scoliosis? What are the parameters for surgery on scoliosis?
* Parameters for bracing * 25-45 degree cobb angle * Still growing individual * Wear brace for 16-18 hours a day * Parameters for surgery * \>50 degree cobb angle
114
What is the general strategy for the work-up of orthopaedic infections?
* Infections involving joint or bone require prompt recognition and usually emergent irrigation and debridement to prevent long-term consequences * Routine work-up for any suspected infection: * Radiographs of affected region * Serum CBC, ESR, and CRP * +/- synovial fluid aspirate
115
What is septic arthritis and what treatment is generally used?
* Septic arthritis * Hematogenous spread to various joints * Treatment: surgical I&D and antibiotics
116
What are the common locations, organisms, and treatments involved in septic bursitis?
* Septic bursitis * Bursa are extra-articular synovial fluid-filled sacs that cushion tendons/muscles * Common locations: pre-patellar and olecranon bursa * Common organism: *S. aureus* * Treatment: antibiotics and operative excision
117
What is cellulitis, what are the symptoms, and what treatment is most often used?
* Cellulitis * Infection involving skin and subcutaneous tissue * Painful at rest and tender to palpation * Treatment: antibiotics
118
What is necrotizing fascitis and what is the general treatment?
* Necrotizing fasciitis * Infection involving fascia * Extremely aggressive infection that causes hemodynamic instability * Treatment: emergent and extensive debridement and IV antibiotics
119
What is osteomyelitis?
* Osteomyelitis * Infection of bone
120
What is lyme disease caused by, what is its appearance, and what is its treatment?
* Lyme disease * Caused by bacteria *Borrelia burgdorferi* * Characteristic “bull’s eye” rash * Treatment: doxycycline
121
What is aspiration in terms of joints?
* Aspiration = drawing of fluids in joint space
122
What diseases require aspiration and what diseases do not require aspiration? Think which ones swell and which ones do not swell.
* Acute atraumatic swelling differential * Effusion (intra-articular) requiring aspiration * Septic arthritis, gout, lyme disease, hemarthrosis, reactive arthritis, osteoarthritis * No effusion (extra-articular) requiring NO aspiration * Cellulitis, bursitis, and necrotizing fasciitis
123
What is flexor tenosynovitis? Where is it located and how is it diagnosed?
* Flexor tenosynovitis * At phalanges of hand * Kanavel’s Signs * Flexed posture, pain with extension, tender over flexor tendon, fusiform swelling (across joint space)
124
What is paronchia? What is it caused by? What is its treatment?
* Paronychia * Most common hand infection * Caused by *S. aureus* * At distal phalanx * Treatment: soaking
125
What is herpetic whitlow?
* Herpetic whitlow * Painful vesicles filled with clear fluid and erythema
126
What is a felon and what is it caused by?
* Felon * Abscess of distal finger pulp * Caused by *S. aureus*
127
What is a deep hand infection usually caused by?
* Deep hand infection * Caused by penetrating injury
128
What is Sporothrix schenckii and what is it generally caused by?
* Sporothrix schenckii * Subcutaneous fungal infection * Caused by penetrating injury while handling rose thorn
129
How is septic arthritis in children treated? Why is this condition more common in children?
* Septic arthritis * Requires I&D * More common in kids because bones are more vascularized
130
What is transient synovitis? What often follows after this condition? What is the general treatment?
* Transient synovitis * Inflammation of hip capsule * Often follows viral infection * Treatment: NSAIDs

MSDR (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions