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EOR Exam - Emergency Medicine > Orthopedics and Rheumatology > Flashcards

Orthopedics and Rheumatology Flashcards

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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
Q

Define Monteggia fracture.

A

Proximal ulnar shaft fracture with radial head dislocation.

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26
Q

What is the common MOI and treatment for Monteggia fracture?

A

MOI: fall on outstretched hand
Tx: ORIF

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27
Q

Define Galeazzi fracture, state the most common MOI and the most common treatment.

A

Def: distal radial shaft fracture, dislocation of ulna
MOI: fall on outstretched hand
Tx: ORIF or long arm splint

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28
Q

Define Colles fracture, state the most common MOI and the most common treatment.

A

Def: dorsally angulated extra articular distal radius fracture –> dinner fork deformity.
MOI: fall on outstretched hand
Tx: sugar tong splint

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29
Q

Define Smith fracture, state the most common MOI and the most common treatment.

A

Def: extra-articular fracture of radius with anterior displacement - garden spade deformity
MOI: fall with palm closed or hand flexed
Tx: usually ORIF

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30
Q

What is a common complication of Smith fracture?

A

Median nerve injury - carpal tunnel over time

31
Q

What is the MOI, most common clinical finding, and treatment for a scaphoid fracture?

A

MOI: fall on outstretched hand
S/S: snuff box tenderness
Tx: thumb spica splint for 10-12 weeks

32
Q

What is a common potential complication of scaphoid fracture and what is the x-ray finding?

A

XR: may not be evident for 2 weeks after fracture
Comp: avascular necrosis

33
Q

Define Boxer’s fracture and state the treatment.

A

Def: Fracture of neck of 5th/4th metacarpal
Tx: ulnar gutter splint with joints flexed at 60 deg

34
Q

Describe Rolando and Bennet fractures and state the treatment.

A

Def: displaced fractures of the first metacarpal.
Tx: ORIF

35
Q

Differentiate anterior shoulder dislocation from posterior by MOI.

A

Ant: fall with arm abducted and externally rotated
Post: fall with arm adducted and internally rotated

36
Q

What is the most common MOI and most common site for a clavicular fracture?

A

MOI: fall or direct blow to lateral shoulder
Site: middle third of bone

37
Q

What is the most common complication of a femoral neck fracture what clinical S/S is associated with it?

A

Comp: avascular necrosis

S/S: log roll (ext and int rotation) elicits pain

38
Q

Define Jones fracture, state clinical S/S and treatment.

A

Def: proximal 5th metatarsal diaphysis fracture
S/S: pain over lateral border of foot
Tx: surgery or 6 weeks non-weight bearing

39
Q

What joint fluid analysis and lab findings are diagnostic of gout?

A

Joint: rod shaped negatively birefringent
Lab: uric acid > 8

40
Q

What is the drug of choice for an acute gout attack?

A

Indomethacin (NSAID)

41
Q

What drugs are indicated for gout between attacks?

A

Allopurinol and colchicine (bad GI AE)

42
Q

What medications should be avoided in patients with gout?

A

ASA and thiazide diuretics

43
Q

What joint fluid analysis is consistent with pseudogout?

A

Rhomboid shaped calcium crystals – positively birefringent

44
Q

Define osteomyelitis and describe the most common clinical S.S.

A

Def: infection and inflammation of bone and marrow

S/S: fever, restriction of movement of involved extremity or refusal to bear weight

45
Q

State and describe the most common causative agents associated with osteomyelitis.

A

Staph Aureus: most common
Pasteurella: cat or dog bites
Salmonella: SCD
Mycobacterium TB: Potts disease (vertebral)

46
Q

Describe the x-ray triad of osteomyelitis.

A

demineralization, periosteal reaction, bone destruction –> imaging changes lag S/S by 7-10 days, changes show on MRI before x-ray

47
Q

What lab findings are consistent with a diagnosis of osteomyelitis?

A

CRP elevated, WBC and ESR high in most cases Definitive Dx: blood culture or by needle aspiration or bone biopsy

48
Q

What is the recommended duration of antibiotic therapy for osteomyelitis?

A

Abx therapy = 4-6 weeks for acute and > 8 weeks for chronic or MRSA causative agent.

49
Q

What findings in a diabetic foot ulcer are likely to indicate osteomyelitis?

A

Ulcer is > 2cm x 2cm or if bone is palpable

50
Q

List clinical S/S associated with septic arthritis.

A

Swollen, warm, painful joint that is tender with constitutional sx – fever, sweats, myalgia, malaise.

51
Q

State and describe the most common causative agents associated with septic arthritis.

A

Staph aureus is most common
Gonorrhea in sexually active young adults
Pseudomonas in IVDU

52
Q

Describe joint fluid aspirate findings associated with septic arthritis.

A

WBC > 50,000 (primarily PMNs) or WBC > 1000 in patient with prosthetic joint

53
Q

State the common antibiotics used for septic arthritis.

A

Abx therapy for 2-4 weeks
Staph aureus = vanc/nafcillin
Gonorrhea = ceftriaxone
IVDU = cipro/Levaquin

54
Q

What are the common names for medial and lateral epicondylitis?

A

Med: pitcher’s or golfer’s elbow
Lat: tennis elbow

55
Q

Describe clinical findings consistent with cubital/ulnar tunnel syndrome.

A

Paresthesia over small finger and ulnar half of 4th finger and ulnar dorsum of hand

56
Q

Describe clinical findings consistent with carpal tunnel syndrome.

A

Pain or paresthesia in median nerve distribution (first 3 digits and radial half of 4th digit. Sx worse at night.

57
Q

Describe clinical S/S associated with De Quervain’s Tenosynovitis and state the name of the test that is diagnostic.

A

Pain and swelling at base of thumb that radiates into the radial aspect of forearm
Dx: Finkelstein

58
Q

Describe gamekeeper’s/skier’s thumb.

A

Ulnar collateral ligament injury from fall on abducted thumb

59
Q

What is the common name for Dupuytren Contracture and with what condition is it associated?

A

AKA claw hand

Associated with alcoholic cirrhosis

60
Q

Describe Mallet finger.

A

Tear at DIP joint, avulsion of extensor tendon from forced flexion.

61
Q

Describe Boutonniere deformity.

A

PIP flexion and DIP hyperextension; usually from jammed finger

62
Q

What is paronychia.

A

Infection next to fingernail

63
Q

List the four muscle included in the rotator cuff and state which is most commonly injured.

A

MC = supraspinatus

Others: infraspinatus, teres minor, subscapularis

64
Q

Describe adhesive capsulitis.

A

Gradual onset shoulder stiffness and pain at rest with decreased ROM. Diagnosed by Apley Scratch Test.

65
Q

What is the treatment for adhesive capsulitis?

A

NSAIDs, PT, steroid injection

66
Q

Describe the clinical S/S associated with subacromial impingement.

A

pain with reaching or lifting and pain with overhead motion.

67
Q

Name and describe three tests that aid in the diagnosis of subacromial impingement.

A

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
Q

List the tests used to identify ACL, PCL, and meniscus injuries.

A

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
Q

Describe the role of steroids in the treatment of patellar tendonitis.

A

Contraindicated s/p risk of tendon rupture

70
Q

What is the most common ligament injured in an ankle sprain?

A

Anterior talofibular (during inversion)

71
Q

Describe clinical S/S associated with plantar fasciitis.

A

Pain at calcaneal insertion of plantar fascia upon weight bearing, especially in the morning.

72
Q

Describe the clinical S/S associated with hallux valgus.

A

AKA bunion –> deformity of bursa over 1st metatarsal with pain worst at MTP joint. Usual patient history of poorly fitting shoes or RA.

73
Q

Describe the clinical S/S associated with Morton’s Neuroma.

A

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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