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EOR Exam - Emergency Medicine > Orthopedics and Rheumatology > Flashcards

Orthopedics and Rheumatology Flashcards

1
Q

State the common name for a cervical neck sprain and state the common S/S.

A

AKA whiplash

S/S: neck stiffness/pain, paraspinal tenderness and spasm, positive Spurling test

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2
Q

Describe the treatment for cervical sprain.

A

soft collar 2-3 days, ice/heat, analgesics, gentle active ROM soon after injury.

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3
Q

What is the most common cause of back pain?

A

Thoracic or lumbar strain due to lifting or strenuous activity.

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4
Q

What is the common treatment of back strain?

A

If no radicular (neuro) S/S - NSAIDs, rest, ice, PT, re-evaluate after 4 weeks.

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5
Q

What is the most common pharmacological therapy for back strain?

A

Flexeril (cyclobenzaprine)

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6
Q

Other than back strain, what is the most common cause of low back pain?

A

prolapsed intervertebral disk

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7
Q

What are the common clinical features associated with prolapsed/herniated disk?

A

Point tenderness, sciatica, pain radiating down butt or leg, pain worsens with standing.

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8
Q

What clinical features are most associated with spinal stenosis in the elderly?

A

Pain increased by walking and relieved by leaning forward.

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9
Q

What S/S associated with low back pain are considered “red flags”.

A

fever, weight loss, morning stiffness, IVDU, steroid history, trauma, cancer, saddle anesthesia, loss of anal sphincter tone, motor weakness.

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10
Q

What imaging tests are used when red flag S/S are present with low back pain?

A

Emergent X-ray, CT to ID bony stenosis and lateral nerve root entrapment, MRI to ID cord pathology, neural tumors, herniated disks, and infections.

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11
Q

What is the treatment for herniated disk?

A

Rest up to 2 days, progressive walking to normal activity, PT, CT/MRI if 6 weeks of conservative therapy fails, surgery considered if conservative therapy fails.

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12
Q

What are clinical features associated with tendonitis?

A

Pain with movement, swelling, impaired function. Typically resolves over several weeks but recurrence is common.

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13
Q

What is the best pharmacological therapy for tendonitis or other joint injury?

A

NSAIDs help but don’t penetrate tendon circulation. Steroid injection + anesthesia may be beneficial.

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14
Q

Define cauda equina syndrome.

A

Midline disk herniation that compresses several nerve roots, usually at L4-L5 level.

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15
Q

What are the common S/S associated with cauda equina syndrome?

A

Incontinence, decreased lower extremity sensation and strength, leg pain, saddle anesthesia, paralysis.

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16
Q

How is the diagnosis of cauda equina made and what is the treatment?

A

Dx: MRI
Tx: surgical emergency

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17
Q

Define costochondritis and state common associated S/S.

A

Def: inflammation of cartilage in the rib cage.

S/S: pain to touch, radiating pain down limbs, chest pain worse with inspiration.

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18
Q

What is the most common cause of radial nerve injury?

A

Humerus fracture

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19
Q

What x-ray finding is associated with a distal humerus fracture?

A

Posterior fat pad or sail sign.

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20
Q

What is the treatment for a humerus fracture?

A 
Sugar tong splint (distal) 
Coaptation splint (shaft)
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21
Q

What is the most common pediatric elbow fracture? What is the most common MOI and what is the x-ray finding?

A

Supracondylar fracture
MOI: fall to outstretched hand
XR: anterior fat pad (dark area on either side of bone)

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22
Q

What is the treatment for a supracondylar fracture?

A

Posterior long arm splint

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23
Q

What is the most common MOI of a radial head fracture and what is the treatment?

A

MOI: fall on outstretched hand
Tx: sling or long arm splint at 90 degrees

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24
Q

What is the common name for radial head subluxation and what is the treatment?

A

AKA nursemaid’s elbow. Tx –> simultaneous flexion and supination

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25
Define Monteggia fracture.
Proximal ulnar shaft fracture with radial head dislocation.
26
What is the common MOI and treatment for Monteggia fracture?
MOI: fall on outstretched hand Tx: ORIF
27
Define Galeazzi fracture, state the most common MOI and the most common treatment.
Def: distal radial shaft fracture, dislocation of ulna MOI: fall on outstretched hand Tx: ORIF or long arm splint
28
Define Colles fracture, state the most common MOI and the most common treatment.
Def: dorsally angulated extra articular distal radius fracture --> dinner fork deformity. MOI: fall on outstretched hand Tx: sugar tong splint
29
Define Smith fracture, state the most common MOI and the most common treatment.
Def: extra-articular fracture of radius with anterior displacement - garden spade deformity MOI: fall with palm closed or hand flexed Tx: usually ORIF
30
What is a common complication of Smith fracture?
Median nerve injury - carpal tunnel over time
31
What is the MOI, most common clinical finding, and treatment for a scaphoid fracture?
MOI: fall on outstretched hand S/S: snuff box tenderness Tx: thumb spica splint for 10-12 weeks
32
What is a common potential complication of scaphoid fracture and what is the x-ray finding?
XR: may not be evident for 2 weeks after fracture Comp: avascular necrosis
33
Define Boxer's fracture and state the treatment.
Def: Fracture of neck of 5th/4th metacarpal Tx: ulnar gutter splint with joints flexed at 60 deg
34
Describe Rolando and Bennet fractures and state the treatment.
Def: displaced fractures of the first metacarpal. Tx: ORIF
35
Differentiate anterior shoulder dislocation from posterior by MOI.
Ant: fall with arm abducted and externally rotated Post: fall with arm adducted and internally rotated
36
What is the most common MOI and most common site for a clavicular fracture?
MOI: fall or direct blow to lateral shoulder Site: middle third of bone
37
What is the most common complication of a femoral neck fracture what clinical S/S is associated with it?
Comp: avascular necrosis | S/S: log roll (ext and int rotation) elicits pain
38
Define Jones fracture, state clinical S/S and treatment.
Def: proximal 5th metatarsal diaphysis fracture S/S: pain over lateral border of foot Tx: surgery or 6 weeks non-weight bearing
39
What joint fluid analysis and lab findings are diagnostic of gout?
Joint: rod shaped negatively birefringent Lab: uric acid > 8
40
What is the drug of choice for an acute gout attack?
Indomethacin (NSAID)
41
What drugs are indicated for gout between attacks?
Allopurinol and colchicine (bad GI AE)
42
What medications should be avoided in patients with gout?
ASA and thiazide diuretics
43
What joint fluid analysis is consistent with pseudogout?
Rhomboid shaped calcium crystals – positively birefringent
44
Define osteomyelitis and describe the most common clinical S.S.
Def: infection and inflammation of bone and marrow | S/S: fever, restriction of movement of involved extremity or refusal to bear weight
45
State and describe the most common causative agents associated with osteomyelitis.
Staph Aureus: most common Pasteurella: cat or dog bites Salmonella: SCD Mycobacterium TB: Potts disease (vertebral)
46
Describe the x-ray triad of osteomyelitis.
demineralization, periosteal reaction, bone destruction --> imaging changes lag S/S by 7-10 days, changes show on MRI before x-ray
47
What lab findings are consistent with a diagnosis of osteomyelitis?
CRP elevated, WBC and ESR high in most cases Definitive Dx: blood culture or by needle aspiration or bone biopsy
48
What is the recommended duration of antibiotic therapy for osteomyelitis?
Abx therapy = 4-6 weeks for acute and > 8 weeks for chronic or MRSA causative agent.
49
What findings in a diabetic foot ulcer are likely to indicate osteomyelitis?
Ulcer is > 2cm x 2cm or if bone is palpable
50
List clinical S/S associated with septic arthritis.
Swollen, warm, painful joint that is tender with constitutional sx – fever, sweats, myalgia, malaise.
51
State and describe the most common causative agents associated with septic arthritis.
Staph aureus is most common Gonorrhea in sexually active young adults Pseudomonas in IVDU
52
Describe joint fluid aspirate findings associated with septic arthritis.
WBC > 50,000 (primarily PMNs) or WBC > 1000 in patient with prosthetic joint
53
State the common antibiotics used for septic arthritis.
Abx therapy for 2-4 weeks Staph aureus = vanc/nafcillin Gonorrhea = ceftriaxone IVDU = cipro/Levaquin
54
What are the common names for medial and lateral epicondylitis?
Med: pitcher's or golfer's elbow Lat: tennis elbow
55
Describe clinical findings consistent with cubital/ulnar tunnel syndrome.
Paresthesia over small finger and ulnar half of 4th finger and ulnar dorsum of hand
56
Describe clinical findings consistent with carpal tunnel syndrome.
Pain or paresthesia in median nerve distribution (first 3 digits and radial half of 4th digit. Sx worse at night.
57
Describe clinical S/S associated with De Quervain's Tenosynovitis and state the name of the test that is diagnostic.
Pain and swelling at base of thumb that radiates into the radial aspect of forearm Dx: Finkelstein
58
Describe gamekeeper's/skier's thumb.
Ulnar collateral ligament injury from fall on abducted thumb
59
What is the common name for Dupuytren Contracture and with what condition is it associated?
AKA claw hand | Associated with alcoholic cirrhosis
60
Describe Mallet finger.
Tear at DIP joint, avulsion of extensor tendon from forced flexion.
61
Describe Boutonniere deformity.
PIP flexion and DIP hyperextension; usually from jammed finger
62
What is paronychia.
Infection next to fingernail
63
List the four muscle included in the rotator cuff and state which is most commonly injured.
MC = supraspinatus | Others: infraspinatus, teres minor, subscapularis
64
Describe adhesive capsulitis.
Gradual onset shoulder stiffness and pain at rest with decreased ROM. Diagnosed by Apley Scratch Test.
65
What is the treatment for adhesive capsulitis?
NSAIDs, PT, steroid injection
66
Describe the clinical S/S associated with subacromial impingement.
pain with reaching or lifting and pain with overhead motion.
67
Name and describe three tests that aid in the diagnosis of subacromial impingement.
Neer test: arm fully pronated with pain during forward flexion while shoulder held Hawkins: elbow/shoulder flexed at 90 with sharp anterior should pain with internal rotation Drop arm: pain with inability to lift arm above shoulder or hold it
68
List the tests used to identify ACL, PCL, and meniscus injuries.
ACL: anterior drawer, Lachman (ant drawer done at 20-30 degrees knee flexion) PCL: posterior drawer, sag sign (tibia sags by gravity with hips flexed at 45 and knees flexed at 90) Meniscus: McMurray
69
Describe the role of steroids in the treatment of patellar tendonitis.
Contraindicated s/p risk of tendon rupture
70
What is the most common ligament injured in an ankle sprain?
Anterior talofibular (during inversion)
71
Describe clinical S/S associated with plantar fasciitis.
Pain at calcaneal insertion of plantar fascia upon weight bearing, especially in the morning.
72
Describe the clinical S/S associated with hallux valgus.
AKA bunion --> deformity of bursa over 1st metatarsal with pain worst at MTP joint. Usual patient history of poorly fitting shoes or RA.
73
Describe the clinical S/S associated with Morton's Neuroma.
painful mass near tarsal heads and pain with | ambulation at 3rd metatarsal head. Typical history of high heels or tight shoes.

EOR Exam - Emergency Medicine (2 decks)

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