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Emergency medicine EOR > orthopedics/rheumatology > Flashcards

orthopedics/rheumatology Flashcards

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1
Q

A sprain involves ______ whereas a strain involves ________?

A
  1. ligaments

2. Tendons and muscles

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2
Q

What physical exam/test can you do that is very specific for cervical sprain?

A

Spurling test

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3
Q

How do you tx a cervical sprain?

A

Treat with soft cervical collar (2-3 days), application of ice /heat, analgesics, gentle active ROM soon after injury

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4
Q

What is the tx for a back strain in the absence of “red flags”?

A

Bed red restricted to less than 2 days, + NSAIDs+ Muscle relaxants

Re-eval if no improvement in 4 weeks

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5
Q

What is a bursa?

A

This is a thin walled sac lined with synovial fluid (they are caused by trauma or overuse)

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6
Q

What are three common places to have bursitis?

A
  1. olecranon
  2. Patellar
  3. subacromial
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7
Q

If someone has pain and a fever with an olecranon bursitis what should you do to r/o septic bursitis?

A

Aspirate

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8
Q

tx for non-septic olecranon bursitis?

A

Treat with PT, rest and ice, systemic antibiotics based on culture if septic, NSAIDS, injected corticosteroids and joint, operative bursectomy.

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9
Q

If a wrestler presents with a prepatellar bursitis what should you be worried about?

A

septic bursitis- they are high risk for this. You should culture with gram stain

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10
Q

Tx for prepatellar bursitis?

A

compression wrap, NSAIDs, +/- aspiration

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11
Q

When do you think youd ant to aspirate a subacromial bursitis?

A
  1. Fever
  2. Diabetic
  3. immunocompromised
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12
Q

Tx for subacromial bursitis?

A

Treatment includes prevention of the precipitating factors, rest, and NSAIDs. Cortisone injections can be helpful.

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13
Q

What are two common places to have tendonitis?

A
  1. Patellar

2. Biceps

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14
Q

Tenderness to palpation of the distal patella at full extension and non-tender to palpation at the distal pole of the patella in flexion is know as what sign?

A

basset sign

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15
Q

Should you give patellar tendonitis a corticosteroid injection?

A

nope, these are contraindicated due to risk of patellar rupture

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16
Q

If someone has pain in the shoulder with resisted supination of the elbow what do suspect?

A

bicep tendonitis

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17
Q

Increased T2 signal around the biceps tendon on MRI indicates what?

A

biceps tendonitis

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18
Q

Tx for biceps tendonitis?

A

NSAIDS, PT strengthening, and steroid injections

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19
Q

What are the two special tests to check for biceps tendonitis?

A
  1. Speeds

2. Yergasons test- elbow flexed at 90, wrist supinated add resistance

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20
Q

Someone has newonset urinary symptoms and lower back pain. What imaging do you want?

A

MRI

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21
Q

Cauda equina usually occurs at what lumbar level?

A

L4-L5

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22
Q

Where do you do a lumbar puncture for adults? how bout kids?

A

L3-L4 adults

L4-L5 kids

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23
Q

42 yom has pain in multiple ribs and chest that is sharp and aching. Pain gets worse with deep breaths and coughing. What physical exam do you want to confirm your suspected diagnoses?

A

Try and see if you can produce the pain by applying pressure to the chest wall area.

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24
Q

42 yom has pain in multiple ribs and chest that is sharp and aching. Pain gets worse with deep breaths and coughing. What do you think they have

A

costochondritis

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25
Q

Tx for costochondritis?

A
  1. NSAIDs

2. Steroid injections

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26
Q

Erythema with increase temperature to the skin should make you want to rule out what?

A

infection

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27
Q

MCC of radial nerve injury?

A

Humerus fracture

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28
Q

What two fractures of the upper extremity do you treat with sugar tongue splint?

A
  1. Distal humerus

2. Colles fx

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29
Q

You have an x-ray on a child who just fell on an out stretched hand and it show an anterior fat pad and the child is holding there elbow. What type of fracture? what two other injuries are you worried about?

A
  1. supracondylar fx

2. Median nerve and brachial artery

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30
Q

Pain and tenderness along the lateral aspect of the elbow, decreased rom particularly pronation and supination. What is the likely fracture?

A

radial head

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31
Q

How do you treat a radial head fx?

A

sling and long arm splint at 90 degrees

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32
Q

How do you fix a nursemaids elbow?

A

supination and flexion technique

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33
Q

Proximal ulnar shaft fracture with dislocation of radial head is what?

A

Monteggia fracture

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34
Q

How do you treat a monteggia fracture?

A

ORIF

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35
Q

distal radial head fracture with dislocation of ulna is what kind of fracture?

A

Galeazzi fx

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36
Q

dorsally angulated extra-articular distal radius fracture. Has the appearance of a dinner fork deformity is what?

A

Colles fx, tx with sugar tong splint

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37
Q

Pain in the area created by the extensor pollicies brevis and longus is suspicious for what fracture?

A

scaphoid fx

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38
Q

complication of scaphoid fx?

A

AVN

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39
Q

tx for scaphoid fx?

A

thumb spica splint for 10-12 weeks

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40
Q

tx for boxers fx?

A

ulnar gutter splint with joints at 60 degree flexion

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41
Q

Someone comes into the office saying they cant move their arm. You find out they fOOSH with arm abducted an externally rotated. What is the most likely Dx?

A

anterior dislocation

42
Q

Someone comes into the office saying they cant move their arm. You find out they fOOSH with arm adducted and internally rotated? what is the likely Dx?

A

posterior dislocation

43
Q

What three view do you wan on x-ray for either anterior or posterior shoulder dislocation?

A

axillary, scapula and AP view

44
Q

fracture of anterior inferior glenoid following impaction of the humeral head against glenoid is what?

A

bankart fx

45
Q

compression chondral injury of the posterior superior humeral head following impaction against the glenoid is what?

A

Hill sachs lesion

46
Q

transient neurapraxia present in 5% shoulder dislocations. Numbness/tingling of lateral shoulder after injury is what?

A

axillary nerve injury C5-C6

47
Q

What is the main blood supply to the femoral head?

A

medial circumflex femoral artery

48
Q

Pain with internal and external rotation of the leg which elicits hip pain (log roll manuever) is suspicious for what?

A

femoral neck fx

49
Q

If you suspicious of hip fx what should you do Diagnostic wise?

A

get an AP xray to make sure there is no AVN of femoral head

50
Q

Should someone receive DVT prophylaxis after a hip fx?

A

you betcha

51
Q

hip pain with leg shortened and internally rotated/adducted after trauma. What is Dx?

A

Hip dislocation

52
Q

What kind of hip dislocation occurs 90% of the time?

A

posterior

53
Q

Tx for hip dislocation?

A

closed reduction under conscious sedation; open reduction if failure of closed reduction; repeat XR and neurovascular exam after reduction

54
Q

What are the ottawa knee rules for X-ray?

A
  1. Age >55
  2. tenderness to the head of the fibula
  3. inability to flex the knee past 90 degrees
  4. Inability to bear weight for 4 steps both immediately and in examination room regardless of limp
55
Q

injury to what can occur with a knee dislocation?

A

Popliteal artery injury

56
Q

What imaging should you get to check for popliteal artery injury secondary to knee dislocation?

A

CT-A pre and post reduction

57
Q

What kind of imaging should you get for tibial plateau fx?

A

AP lateral oblique X-ray

58
Q

What can be injured secondary to a tibial plateau fx?

A

The peroneal nerve which would cause foot drop

59
Q

Smarty pances first line tx for knee osteoarthritis?

A

acetaminophen? NSAIDs are second line

60
Q

ottowa ankle rules?

A
  1. Pain on the medial or lateral malleolus or 6 cm up
  2. Mid-foot pain with pain on base of 5th meta tarsal or navicular pain
  3. unable to bear weight for 4 steps in ER or exam room
61
Q

Tx for jones fracture?

A

walking boot/cast

62
Q

foot stress fracture is most common in what area of the foot?

A

3rd metatarsal

63
Q

Causes of talus fx?

A

high impact shit, they say snowboarding?

64
Q

Imaging for talus fx?

A

X-ray

65
Q

An xray of a joint with gout will show what?

A

small punched out lesions

66
Q

Tx for gout flare up?

A

NSAIDs- indomethacin drug of choice

67
Q

True or false, you should give someone allopurinol during a gout attack?

A

false, this will make things much much worse

68
Q

An x-ray of a joint affected by pseudogout will show what?

A

linear calcifications of cartilage

69
Q

prophylaxis for pseudogout?

A

colchicine

70
Q

what imaging to confirm herniated cervical disc?

A

MRI

71
Q

Difference between rotator cuff injury and cervical herniated disc injury when i comes to numbness and tingling and pain.

A

There is numbness and tingling and pain at rest with cervical herniated disc

72
Q

Weakness in shoulder elevation is injury to what part of the cervical spine?

A

C4

73
Q

pt was in a MVA and now has weakness with shoulder abduction and external rotation bicep flex is also minimally diminished. What part of the cervical spine is injured?

A

C5 guess some musculotaneous nerve shit

74
Q

A pt walks in after quickly turning their head. They felt a weird sting and now have pain at shoulder tip with radiation to anterior upper portion of the arm, radial forearm, thumb and weakness with elbow flexion. What nerve roots are injured.

A

C5-C6 pick up sticks

75
Q

Another cervical injury walks in to the office. This pt is complaining of pain at the shoulder blade, pectoral area, medial axilla, posterolateral upper arm, dorsal elbow and forearm, index, and medial digits or all of the fingers; diminished triceps reflex. Which nerve roots are affected?

A

C6-C7 primarily C7

76
Q

Someone who has weakness with finger abductors and grip strength most likely have injury to what nerve roots

A

C8-T1

77
Q

Injury to L5 has what affect on the foot. What is difficult for the foot to do?

A

foot dorsiflexion, toe extension, foot inversion, and foot eversion.

78
Q

injury to S1 travels from where to where and causes what kinds of weakness?

A

down the posterior aspect of the leg into the bottom of the foot from the back.

Causes weakness with foot plantar flexion and ankle reflex

79
Q

Red flags to back pain?

A 
Truma 
Unintentional weight loss 
Neurological symptoms 
Age >50
Fever
IVDU
Steroid use 
History of cancer
80
Q

MC organism of osteomyelitis?

A

Staph aureus 80%

81
Q

imaging of choice to diagnose osteomyelitis?

A

MRI

82
Q

gold standard or best option to diagnose osteomyelitis?

A

bone aspiration

83
Q

definitive dx of osteomyelitis

A

blood culture or by needle aspiration/bone biopsy

84
Q

empiric antibiotic therapy for osteomyelitis?

A

vanco plus a third or fourth cephalosporin

85
Q

a pt presents with A single, swollen, warm, painful joint that is tender to palpation + constitutional symptoms (fever, sweats, myalgia, malaise, pain). what is the likely diagnoses?

A

septic arthritis

86
Q

MC organism for septic arthritis?

A

S. aureus

87
Q

a 22 sexually active human presents with warm, swollen tender knee joint and has a fever. You do a joint aspiration. What will you see (WBC) wise that makes you think septic arthritis

A

WBCs > 50,000 predominately PMNs

88
Q

what is the most likely causative organism for a sexually active adult who has septic arthritis?

A

N. gonorrhea

89
Q

Tx for IVDU with septic arthritis?

A

Cipro/levo

90
Q

tx for s. aureus septic arthritis?

A

Vanco/nafcillin (Vanco or Clindamycin if PCN allergic)

91
Q

Tx for septic arthritis caused by N. gonorrhea?

A

ceftriaxone

92
Q

You suspect someone to have an AC joint seperation and you want to xray them. What should you have them do?

A

have the patient holding a weight in the affected arm

93
Q

MOI for AC joint injury?

A

fall directly on shoulder or FOOSH

94
Q

if a patient complains of shoulder pain with overhead activity or at night when lying on arm/weakness and immobility after acute injury. What are you thinking they have?

A

rotator cuff tear or tendinopathy

95
Q

What is your initial choice of imaging for rotator cuff tear or tendenopathy? what is the most accurate imaging for it?

A

X-ray is first

MRI is most accurate

96
Q

What test can you perform to see if the supraspinatus tendon is inflammed or causing pain?

A
  1. Empty can
  2. Full can
  3. arm drop
97
Q

How to test to see if the subscapularis muscle is injured?

A

Lift off test

98
Q

insidious onset shoulder stiffness and pain at rest, decreased active and passive ROM makes you think what Dx?

A

adhesive capsulitis

99
Q

Patient comes in complaining of pain with reaching/lifting and over head activities. What could be going on?

A

subacromial ligament impingement

100
Q

What test can you perform to Dx subacromial impingement?

A
  1. Neers test
  2. Hawkins
  3. Drop arm
101
Q

Tx for subacromial impingement?

A

RICE/NSAIDs

Emergency medicine EOR (5 decks)

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