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Orthopedics Flashcards

1
Q

Snuffbox pain

A

navicular fracture

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2
Q

Navicular fracture is high risk for

A

avascular necrosis and nonunion

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3
Q

Navicular fracture requires…

A

referral to hand surgeon

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4
Q

Colles fracture

A

fracture of the distal radius of the forearm along the dorsal displacement of wrist
-falling forward with outstretched hand

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5
Q

Severe hip fracture may present with

A

-severe hip pain with external rotation and leg shortening

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6
Q

Pelvic fracture may present with

A

ecchymosis and swelling in lower abdomen, hips, groin, scrotum
may have urine and/or fecal incontinence

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7
Q

Most common cause of cauda equina syndrome

A

-bulging disk on sacral nerve root

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8
Q

Low-back pain from dissecting abdominal aneurysm

A
  • acute and sudden onset of “tearing” severe low-back/abdominal pain
  • abdominal bruit with pulsation
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9
Q

Genu recurvtaum

A

hyperextention or backward curvature of legs

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10
Q

Genu valgum

A

knock-knees

“gum” knees stuck with gum

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11
Q

Genu varum

A

bowlegs

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12
Q

Acutely inflamed joints should NOT

A
  • in 48 hours
  • not be exercised
  • no heating applications
  • no ROM exercises
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13
Q

Isometric exercises

A

-non-weight bearing

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14
Q

Drawer sign

A
  • knee stability
  • dx of torn or rupture ligament
  • (+) anterior: torn ACL
  • (+) posterior: torn PCL
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15
Q

FInkelstein’s test

A

-De Quervain’s tenosynovitis

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16
Q

McMurray’s test

A
  • knee pain and click with maniuplation is positive

- suggests injury to medial meniscus

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17
Q

Gold standard test for meniscal tear

A

MRI

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18
Q

Lachman’s sign

A
  • knee joint laxity
  • Suggestive of ACL damage
  • More sensitive than anterior drawer test
  • Pull femur and lower leg apart
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19
Q

Valgus stress test

A

-MCL damage

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20
Q

Varus tress test

A

-LCL stress test

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21
Q

MRI is gold standard for which body parts

A
  • cartilage
  • menisci
  • tendons
  • ligaments
  • other joints
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22
Q

Medial tibial stress syndrome

A
  • aka shin splints

- common in runners and flat feet

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23
Q

Medial tibial stress syndrome presentation

A
  • recurrent shin pain in one or both legs
  • located along inner border of tibia and comes during and after exercise
  • mild swelling with focal tenderness
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24
Q

Medial tibial stress syndrome treatment

A
  • RICE for several weeks
  • cold packs
  • low impact exercise
  • bone scan or MRI, if no stress fracture, refer to orthopedic specialist
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25
Q

Plantar fasciitis patho

A
  • acute or recurrent pain on bottom of feet with walking

- microtears in plantar fascia due to tight Achilles tendon

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26
Q

People at risk for plantar fasciitis

A
  • obese
  • diabetic
  • aerobic exercise
  • flat feet
  • prolonged standing
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27
Q

Plantar fasciitis treatment

A
  • NSAIDS, topical or oral
  • orthotic foot appliance at night for a few weeks
  • ice pack
  • stretching and massaging
  • roll a golf ball with sole of foot several times a day
  • weight loss
  • consider X-ray
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28
Q

Morton’s neuroma patho

A
  • inflammation of digital nerve of foot between third and fourth metatarsals
  • increased risk with tight shoes, high heels, dancers, runners
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29
Q

Mulder test

A

test for Morton’s neuroma

  • grasp first and fifth metatarsals and squeeze forefoot
  • (+) click along with report of pain, pain relieved with release
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30
Q

Morton’s neuroma treatment

A
  • avoid tight fitting shoes
  • use forefoot pad
  • refer to podiatrist
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31
Q

Osteoarthritis presentation

A
  • gradual
  • early morning stiffness with inactivity
  • shorter duration of join stiffness compared to RA
  • absence of systemic symptoms
  • Heberden’s and Bouchard nodes
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32
Q

Heberden’s nodes location

A

DIP

-den = D

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33
Q

Bouchard nodes location

A

PIP

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34
Q

First line pharm treatment for OA

A
  • NSAID’s

- acetaminophen has little effect on pain

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35
Q

SLE is more common in men or women

A

women

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36
Q

SLE presentation

A
  • child bearing age
  • maculopapular butterfly-shaped rash on middle of face
  • nonpruritic thick scaly red rashes on sun-exposed areas
  • UA positive for proteinuria
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37
Q

SLE treatment

A

-refer to rheumatology

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38
Q

SLE patient education

A
  • avoid sun between 10am-4pm
  • use sunblock
  • use sun-protective clothing
  • use nonfluorescent light bulbs
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39
Q

RA patho

A
  • more common in women
  • inflammation of multiple joints, leading to joint damage
  • higher risk for other autoimmune disorders
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40
Q

RA presentation

A
  • adult women
  • gradual onset of fatigue, low-grade fever
  • generalized body aches
  • myalgia
  • generalized joint pains (fingers, hands, elbows, wrists, feet)
  • early morning stiffness/pain and warm, tender, and swollen fingers
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41
Q

RA objective findings

A
  • symmetrical joint involvement
  • Sausage joints
  • morning stiffness >1 hour
  • rheumatoid nodules
  • swan neck deformity
  • Boutonniere deformity
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42
Q

Swan neck deformity

A
  • flexion of DIP joint with hyperextension of PIP

- RA

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43
Q

Boutonniere deformity

A

Hyperextension of DIP with flexion of PIP

-RA

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44
Q

RA labs

A
  • ESR elevated
  • CBC mild microcytic or normocytic anemia common
  • Rheumatoid factor positive in ~80%
  • xray: bony erosions, joint space narrowing, subluxations
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45
Q

RA treatment

A

-rheumatology referral

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46
Q

RA complications

A
  • uveitis
  • scleritis
  • vasculitis
  • pericarditis
  • certain malignancies
  • Plaquenil: need eye exam prior to starting with frequent eye exam every 6 months
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47
Q

Which nodes present with both OA and RA

A

Bouchard

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48
Q

Which node is only present with OA

A

Heberden

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49
Q

COX-1

A

mucosal protective effect

50
Q

Gout patho

A

-deposits of uric acid crystals inside joints and tendons due to genetic excess production or low excretion of purine crystals

51
Q

Gold standard for gout diagnosis

A

-aspiration of synovial fluid of joint

52
Q

Chronic gout presents as

A

tophi

small white nodules full of urates on ears and joints

53
Q

Uric acid level and gout

A

> 7

  • during acute phase: uric acid levels are normal
  • test uric acid 2 weeks after acute attack
54
Q

Acute gout treatment

A
  • Indomethacin and naproxen
  • if no relief, combine NSAID with colchicine 1.2 mg (two tabs) at onset of attack
  • may repeat colchicine 0.6 mg in 1 hour
  • continue colchicine 0.6 mg one-two times daily until symptoms resolve
  • stop when symptom free for 2-3 days
  • wait until 4-6 weeks before maintenance treatment
  • patients taking allopurinol should stop during acute phase and restart 4-6 weeks after resolution of symptoms
55
Q

Gout maintenance treatment

A
  • allopurinol daily for years to life
  • Check CBC
  • Colchicine can be used during acute phase with NSAIDs
56
Q

Ankylosing spondylitis is most common in

A

males with HLA-B27 positive

57
Q

Ankylosing spondylitis patho

A

chronic inflammation of axial skeleton and sacroiliac joints
pain improved with exercise and not relieved by rest

58
Q

Ankylosing spondylitis presenation

A
  • loss of ROM of spine
  • decreased respiratory excursion
  • uveitis
59
Q

Ankylosing spondylitis labs

A
  • ESR and CRP elevated

- Spinal xray: classic “bamboo spine”

60
Q

Ankylosing spondylitis treatment

A
  • refer to rheumatologist
  • postural training
  • buy a mattress with good back support
  • NSAID’s first line treatment
  • Prescribe PPI or COX-2 inhibitor if high risk of bleed
  • severe: DMARDs, biologics, spinal fusion
61
Q

Ankylosing spondylitis complications

A

-anterior uveitis
-aortitis
fusing of spine, spinal stenosis

62
Q

Patient >50 with new onset back pain, need to rule out what

A

cancer

63
Q

Common site of herniated disk with symptoms

A

L5 to S1

64
Q

Best method for diagnosing herniated disk

A

MRI

65
Q

NSAID with fewest CVD effects

A

Naproxen

66
Q

Supraspinatus tendinitis

A

aka cuff tendinitis

67
Q

Movement that aggravates supraspinatus tendinitis

A
  • arm elevation and abduction (reaching to back pocket)

- local point tenderness over tendon on anterior area of shoulder

68
Q

Lateral epicondylitis

A

Tennis elbow

  • gradual onset of pain outside elbow
  • sometimes radiates to forearms
  • pain worse with twisting or grasping movements
69
Q

Medial epicondylitis

A
  • golfers elbow
  • gradual onset of pain along medial elbow
  • higher risk in baseball, bowlers, golfers
  • occurs around funny bone
70
Q

Impingement syndrome

A

-compression of rotator cuff tendons and subacromial bursa

71
Q

Rotator cuff tendinopathy complaint

A

shoulder pain with overhead activity

72
Q

Trigger finger grade I

A

pain/history of catching

73
Q

Trigger finger grade 2

A

demonstrable catching, but can actively extend the digit

74
Q

Trigger finger grade 3

A

demonstrable catching

require passive extension

75
Q

Trigger finger grade 4

A

fixed flexion contracture

76
Q

If positive snuffbox tenderness with - xray, what to do

A

repeat xray in 5-7 days
consider CT, MRI if patient cannot wait
provide spica cast

77
Q

Straight leg raise positive when

A

-pain reproduced between 10-60 degrees of affected leg

78
Q

Waddell’s sign

A
  • c/o physical pain with poss psych component
  • Physical exam is not representative of patients complaint of pain
  • press down on head and ask if back hurts
79
Q

Ottawa rules of ankle

A
  • rules to determine if radiographs are needed

- mild to mod –> use RICE and elastic bandage wrap

80
Q

Grade I sprain

A

mild

  • able to bear weight and ambulate
  • slight stretching and some damage to ligament fibers
81
Q

Grade II sprain

A
  • moderate
  • partial tearing of ligament
  • ecchymosis, moderate swelling and pain.
  • ambulation and weight bearing painful
  • consider x-ray
  • referral
82
Q

Grade III sprain

A
  • complete rupture
  • referral to ED
  • inability to bear weight immediately after injury
  • inability to ambulate at least 4 steps
  • tenderness over posterior edge of lateral or mdeial malleolus
83
Q

Which ligmanet sprain has high chance of avulsion fracture

A

medial ligament

eversion sprain

84
Q

Meniscus tear presentation

A
  • clicking, locking, or buckling of knees
  • some unable to fully extend knee
  • may limp
  • some have joint line pain
  • decreased ROM
85
Q

Meniscus tear treatment

A
  • MRI

- refer to orthopedics for repair

86
Q

Baker’s cyst

A

-bursitis located behind knee

87
Q

Rupture baker’s cyst presentation

A
  • active patient
  • ball-like mass behind knee
  • soft and smooth
  • can cause pressure pain or asymptomatic
  • when ruptured, causes inflammation, similar to cellulitis
88
Q

Ruptured Baker’s cyst treatment

A
  • RICE
  • Compression!!
  • NSAIDs
  • large bursa can be drained with 18 gauge needle of causing pain
  • if cloudy fluid, C&S to rule out infection
89
Q

Apley scratch test

A

Attempt to touch opposite scapula to test ROM

-rotator cuff problem

90
Q

Neer’s sign

A
  • arm in full flexion with arm internally rotated and raise up
  • (+) subacromial impingement
91
Q

Hawkin’s test

A
  • Forward flexion of shoulder to 90 degrees, passive internal rotation
  • (+) supraspinatus tendon impingement
92
Q

Drop-arm test

A
  • arm lowered slowly to waist, lower arm slowly with pain
  • (+) pain with lowering or sudden dropping of arm
  • (+) rotator cuff tear (supraspinatus)
93
Q

Pain with wrist flexion and pronation

A

medial epicondylitis

94
Q

Pain with wrist extension

A

Lateral epicondylitis

95
Q

Dietary causes of gout

A

high-purine diet

  • seafood (scallops, mussels0
  • organ meat
  • beans
  • spinach
  • asparagus
  • oatmeal
  • baker’s and brewer’s yeast
96
Q

Pseudogout is caused by

A

-calcium pryophosphate deposition

97
Q

What is pseudogout associated with

A

hypothyroidism or hyperparathyroidism

98
Q

Glucosamine

A

no improvement in arthritis symptoms, some may report reduction in pain, increased joint flexion, increased articular function
-must be used consistently for 2 weeks, benefits may not be seen until 3 months
-

99
Q

Why should glucosamine be used with caution

A

possible bronchospasm

100
Q

Chondroitin and glucosamine mechanism

A

not well understood

101
Q

NSAIDs cause gastric injury primarily by

A

thinning of the protective GI mucosa

102
Q

COX-2 function

A
  • inflammatory response
  • pain transmission
  • renal arteriole constriction

no role in GI

103
Q

Sjogren syndrome

A

autoimmune disease that usually occurs with other chronic inflammatory disorders

  • decreased oral and ocular secretions
  • mouth ulcers and dental caries
  • salivary gland biopsy is useful
104
Q

Most common cause of meniscal tear

A

twisting of knee

105
Q

Apley grinding test

A

patient supine, press down on foot with knee at 90 degrees

indicative of meniscal tear

106
Q

Nerve conduction test in person with CTS would show

A

-slowing of nerve impulses at carpal tunnel

107
Q

Primary osteoporosis Type 1

A

common in women 55-70
due to loss of estrogen
-decrease osteoblast activity in setting of increased osteoclast activity

108
Q

Primary osteoporosis Type 2

A
  • senile osteoporosis
  • 70-90
  • decreased osteoblast activity with normal osteoclast activity
109
Q

Empty can test

A

aka Jobe test

  • full extension and internal rotation and pronation of arm
  • (+) if unable to push against resistance
110
Q

What is often found with rotator cuff tendonitis

A

bursitis

111
Q

Form of vitamin D measured in labs to determine vitamin D status

A

25-hydroxyvitamin D

112
Q

Treatment of vitamin D deficiency

A

-50,000 IU of vitamin D3 by mouth once per week for at least 8 weeks

113
Q

Osteoclast

A

absorbs bone tissue during growth and healing

114
Q

Osteoblast

A

synthesize bone

115
Q

Chvostek’s sign

A

contraction of facial muscles when facial nerve is tapped briskly
-due to hypocalcemia

116
Q

Colchicine dosing

A
  • take one tab every 1-2 hours until relief or adverse GI side effects like abdominal pain, nausea, diarrhea
  • only prescribe 10 tabs at a time during a flare-up
  • many patients develop adverse GI effects before pain relief
  • can be taken daily in small amounts for prophylaxis
117
Q

Baseline exam prior to starting hydroxychloroquine

A
  • comprehensive eye exam

- can cause retinal toxicity

118
Q

Fibromyalgia criteria

A
  • widespread pain index
  • symptoms present at a similar level for at least 3 months
  • presence of pain or tenderness at certain body sites
  • neck, jaw, shoulder girdle, upper and lower arm, chest, abdomen, upper and lower back, upper and lower leg, hip
  • fatigue, sleep problems, cognitive problems
  • cause unknown
  • symptomatic treatment
119
Q

Which population are medial tibial stress fractures common in

A

sports involving running and/or jumping
females
exacerbated by increase in training or overuse

120
Q

Difference between medial tibial stress fracture and syndrome

A
  • pain is more persistent and worsens until it also occurs at rest
  • focal area of tenderness on anterior medial aspect of tibia
121
Q

Imaging choice for MDSS

A

MRI

  • xray will not show a stress fracture
  • RICE
  • refer to ortho
122
Q

Cast type for navicular/scaphoid fracture

A

thumb spica cast

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