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EOR - Emergency Medicine > Orthopedics/Rheumatology > Flashcards

Orthopedics/Rheumatology Flashcards

1
Q

a sprain involves _
a strain involves _ (2)

A

sprain: ligaments
strain: muscles/tendons

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2
Q

stiff neck
paraspinal muscle tenderness and spasm
positive spurling test

A

cervical sprain

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3
Q

cervical sprain can last _ months

A

18

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4
Q

what does the spurling test evaluate

A

cervical radiculopathy

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5
Q

tx for cervical strain

A

soft cervical collar x 2-3 days
ice/heat
analgesics
gentle active ROM asap

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6
Q

mc cause of back pain

A

thoracic/lumbar strain

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7
Q

2 mc cause of thoracic/lumbar strain

A

BLT
strenuous activity

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8
Q

sx of thoracic/lumbar strain

A

stiff
difficulty bending
axial back pain
no radicular sx
NO neuro changes (pain below knees)

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9
Q

tx for thoracic/lumbar strain

A

r.o red flags
NSAIDs
heat/ice
PT
home exercises
bed rest < 2 days
+/- muscle relaxants

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10
Q

when should you re-eval back strain after conservative tx

A

4 weeks

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11
Q

what is this

A

olecranon bursitis (scholar’s elbow)

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12
Q

2 causes of bursitis

A

overuse
trauma

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13
Q

tx for bursitis

A

rest
brace/support
NSAIDs
steroid injxn

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14
Q

what is this

A

prepatellar bursitis

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15
Q

septic prepatellar bursitis is common in what pt pop

A

wrestlers

aspirate and culture

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16
Q

what is this

A

subacromial bursitis

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17
Q

describe the pain associated w. subacromial bursitis

A

painful w. motion AND at rest

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18
Q

indications for aspiration of subacromial bursitis

A

fever
DM
immunocompromised

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19
Q

sx of tendonitis

A

pain w. movement
swelling
impaired fxn

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20
Q

tx for tendonitis

A

ice
rest
stretching

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21
Q

t/f: NSAIDs don’t penetrate tendon circulation

A

t!

they still help tho

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22
Q

indications for surgery for tendonitis

A

excision of scar tissue
necrotic debris

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23
Q

activity-related anterior knee pain
jumper’s knee

A

patellar tendinitis

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24
Q

what is basset’s sign

A

ttp of distal patella in full extension
no ttp of distal patella in full flexion

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25
Q

what is this showing

A

inferior traction spur (enthesophyte) -> chronic patellar tendonitis

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26
Q

US finding of tendonitis

A

thickening -> hypoechoic

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27
Q

what is this showing

A

tendon thickening -> patellar tendonitis

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28
Q

what tx is contraindicated for patellar tendonitis

A

cortisone injxns -> due to risk of tendon rupture

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29
Q

pain at biceps groove
anterior shoulder pain

A

biceps tendonitis

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30
Q

PE finding of biceps tendonitis

A

pain w. resisted supination of elbow

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31
Q

what is this showing

A

increased T2 signal around biceps tendon -> biceps tendonitis

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32
Q

what is this

A

popeye deformity -> biceps tendon rupture

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33
Q

tx for biceps tendonitis

A

NSAIDs
PT
steroid injxns
surgical release for refractory

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34
Q

2 special test used for biceps tendonitis

A

speed
yergason’s

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35
Q

pain elicited in bicipital groove when pt forward elevates shoulder against resistance with elbow extended and forearm supinated

A

speed test

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36
Q

speed’s test may be positive in what 2 injuries

A

biceps
SLAP lesions

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37
Q

elbow flexed 90 degrees, pain w. wrist supination against resistance

A

yergason’s test ->

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38
Q

cauda equina usually affects what nerve roots

A

L4/L5

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39
Q

sx of cauda equina

A

leg pain/numbness
saddle anesthesia
bowel/bladder dysfxn and/or paralysis

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40
Q

indications for MRI emergent MRI w. back pain (2)

A

saddle anesthesia
bowel/bladder dysfxn and/or paralysis

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41
Q

inflammation of the cartilage that connects a rib to the breastbone

A

costochondritis

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42
Q

describe costochondritis pain (3)

A

pain/tenderness on breastbone
pain in more than one rib
gets worse w. deep breaths or coughing

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43
Q

rf for costochondritis (7)

A

> 40 yo
high impact sports
manual labor
allergies
rheumatoid arthritis
ankylosing spondylitis
RA

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44
Q

2 profession clues for costochondritis

A

painter
gardener

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45
Q

2 HPI clues for costochondritis

A

recent URI w. coughing
strenuous exercise

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46
Q

5 characteristics of costochondritis pain

A

sharp
aching
pressure like
unilateral
reproduced w. palpation

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47
Q

costochondritis pain is exacerbated by (2)

A

body movement
deep breathing

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48
Q

dx of costochondritis should be reconsidered if there is no

A

ttp

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49
Q

tx for costochondritis

A

NSADs/APAP
heat
steroids
PT

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50
Q

patients > _ yo w. sx of costochondritis must be worked up for CAD

A

35

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51
Q

_ can often mimic costochondritis

A

PE

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52
Q

inflammatory process causing visible enlargement of the costochondral area - aka “slipping rib syndrome”

A

tietze syndrome

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53
Q

any extremity injury w. ecchymosis is a _ until proven otherwise

A

fracture

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54
Q

acute, immune-mediated condition characterized by the appearance of distinctive erythema-like target-like lesions on the skin

A

erythema multiforme

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55
Q

upper extremity fx’s to know

A

humerus
supracondylar
radial head
radial head subluxation
nightstick fx
monteggia
galeazzi
colles
smith
scaphoid
boxer’s
bennett/rolando

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56
Q

mc site of radial nerve injury

A

humerus fx

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57
Q

what signs are associated w. humerus fx

A

fat pad
sail sign

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58
Q

splints for humerus fx:
distal:
shaft:

A

distal: sugar tong splint
shaft: coaptation splint

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59
Q

mc pediatric elbow fx

A

supracondylar

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60
Q

mc moi for supracondylar fx

A

foosh

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61
Q

XR finding of supracondylar fx

A

anterior fat pad

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62
Q

nerve/artery injuries associated w. supracondylar fax

A

median nerve
brachial artery

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63
Q

tx for supracondylar fx

A

long arm posterior splint followed by long arm casting

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64
Q

pain/tenderness along lateral aspect of elbow, limited forearm ROM

A

radial head fx

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65
Q

ROM most affected w. radial head fx

A

pronation/supination

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66
Q

mc moi for radial head fx

A

foosh

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67
Q

tx for radial head fx

A

sling
long arm splint @ 90 degrees
ORIF

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68
Q

what is a nursemaid fx

A

radial head subluxation

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69
Q

what ligament is associated w. radial head subluxation

A

annular

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70
Q

how will the pt present w. nursemaid elbow

A

lateral elbow pain
arm held in slight flexion, forearm pronated

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71
Q

tx for nursemaid elbow

A

supination-flexion technique

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72
Q

what fx is this

A

night stick -> fx of the ulnar shaft

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73
Q

mc moi for nightstick fx

A

blow to the arm

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74
Q

tx for nightstick fx

A

functional brace vs ORIF

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75
Q

what fx is this

A

monteggia -> proximal ulnar shaft w. radial head dislocation

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76
Q

mc moi for monteggia fx:
tx:

A

FOOSH
ORIF

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77
Q

what fx is this

A

galeazzi -> distal radial shaft w. dislocation of ulna

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78
Q

mc moi for galeazzi fx

A

pronated foosh

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79
Q

what fx is this

A

colle’s -> dorsally angulated extra-articular distal radius fx

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80
Q

what deformit is associated w. colle’s fx

A

dinner fork

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81
Q

what XR view is needed for dx of colle’s fx

A

lateral

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82
Q

tx for colle’s fx

A

sugar tong splint

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83
Q

what fx is this

A

smith -> extra-articular metaphysis of radius w. volar angulation/displacement

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84
Q

what deformity is associated w. smith fx

A

garden spade

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85
Q

moi’s associated w. smith fx

A

fall w. palm closed, hands flexed
blow to back of wrist

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86
Q

nerve mc injured w. smith fx

A

median -> CTS over time

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87
Q

what fx is associated w. snuffbox tenderness

A

scaphoid

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88
Q

major complication of scaphoid fx

A

avascular necrosis

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89
Q

t/f: scaphoid fx may not be evident for up to 2 weeks following injury

A

t!

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90
Q

tx for scaphoid fx

A

10-12 weeks thumb spica splint

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91
Q

what fx is this

A

boxer’s -> fx of neck of 5th/4th metacarpal

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92
Q

tx for boxer’s fx

A

ulnar gutter splint w. joints at 60 degree flexion

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93
Q

what fx’s are these

A

left: bennett -> simple/oblique
right: rolando -> comminuted

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94
Q

tx for bennett/rolando fx’s

A

ORIF

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95
Q

complication of shoulder fx

A

adhesive capsulitis
rotator cuff tear

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96
Q

_ fx is commonly missed after MVA

A

scapula

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97
Q

tx for shoulder fx

A

immobilze 2-3 weeks ->
passive ROM ->
light strengthening after 6 weeks

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98
Q

shoulder dislocation is mc in what pt pops

A

sports
elderly

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99
Q

mc type of shoulder dislocation

A

anterior

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100
Q

w. anterior shoulder dislocation, arm is _ and _ roatated

A

abducted
externally rotated

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101
Q

w. posterior shoulder dislocation, arm is _ and _ rotated

A

abducted
externally

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102
Q

3 XR views for shoulder dislocation

A

AP
axillary
sacpular

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103
Q

tx for shoulder dislocation

A

pre/post films
reduce
sling/swath
PT

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104
Q

4 conditions associated w. shoulder dislocation

A

bankart lesion
hill-sachs lesion
axillary nerve injury
rotator cuff tear/labral tear

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105
Q

what is this showing

A

bankart lesion -> fx of anterior inferior glenoid

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106
Q

what is this showing

A

hill sachs lesion -> dent in humeral head

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107
Q

what do you think when you see transient neurapraxia and numbness/tingling of lateral shoulder following shoulder dislocation

A

axillary nerve injury -> C5/C6 fibers

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108
Q

what is this showing

A

rotator cuff tear

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109
Q

moi for clavicular fx (3)

A

direct fall/blow to lateral shoulder
birth trauma

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110
Q

mc type of clavicular fx

A

middle third

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111
Q

PE finding of clavicular fx

A

tending of overlying skin

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112
Q

muscle mc injured w. clavicular fx

A

supraspinatus

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113
Q

2 XR views for clavicular fx

A

AP
clavicle

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114
Q

tx for clavicular fx

A

simple arm sling vs figure 8 x 4-6 weeks
PT after 4 weeks

ortho consult if proximal 1/3

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115
Q

main blood supply to femoral head

A

medial circumflex femoral artery

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116
Q

what is the log roll maneuver

A

internal and external rotation of leg elicits pain -> hip fx

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117
Q

major complication of hip fx

A

avascular necrosis of femoral head

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118
Q

tx for hip fx

A

ORIF
hip arthroplasty
DVT prophylaxis til ambulatory

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119
Q

patient presentation for anterior hip dislocation vs posterior

A

anterior: abducted, flexed, externally rotated
posterior: adducted, flexed. internally rotated

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120
Q

mc moi for hip dislocation

A

trauma

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121
Q

mc type of hip dislocation

A

posterior

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122
Q

nerve mc injured w. hip dislocation

A

sciatic

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123
Q

XR findings of anterior vs posterior hip dislocation

A

anterior: femoral head superior to acetabulum
posterior: femoral head inferior to acetabulum

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124
Q

2 criteria used to determine need for knee radiographs

A

ottawa
pittsburgh

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125
Q

ottawa criteria

A

-age > 55
-tenderness to head of fibula
-isolated tenderness to patella
-inability to flex knee 90 degrees
-inability to bear weight for 4 steps immediately and in exam room (regardless of limp)

126
Q

pittsburgh criteria

A

recent fall/blunt trauma
age < 12 OR > 50
unable to take 4 unaided steps

127
Q

mc moi for knee dislocation

A

high impact trauma

128
Q

injury associated w. kids after MVA

A

tibial plateau

129
Q

nerve to test w. knee injury

A

peroneal -> foot drop

130
Q

what is this showing

A

patella alta -> pulled quad muscles cause superior patella displacement

131
Q

3 XR findings of osteoarthritis

A

joint narrowing
osteophytes
subchondral sclerosis

132
Q

first and second line tx for OA

A
  1. APAP
  2. NSAIDs
133
Q

ottawa ankle criteria

A

pain along lateral/medial malleolus
midfoot/5th metatarsal/navicular pain
unable to walk more than 4 unaided steps during exam

134
Q

ankle fx to know

A

jones
stress
talus
fibular

135
Q

what fx is this

A

jones -> 5th metatarsal diaphysis fx

136
Q

tx for jones fx

A

walking boot/cast
RICE
surgery if displaced
6 weeks non weight bearing

137
Q

ankle stress fx is mc in which location

A

3rd metatarsal

138
Q

t/f: XR is 50% negative with stress fx

A

t!

bone scan/MRI more reliable

139
Q

common moi for talus fx

A

snowboarding -> high impact

140
Q

what is this showing

141
Q

weber ankle fx classification

A

a. fibular fx below mortise, tibiofibular syndemosis intact, unstable
b. fibular fx at level of mortise, tibiofibular syndemosis intact or mild tear, deltoid ligament intact or torn, stable vs unstable
c. fibular fx above mortise, tibiofibular syndemosis torn w. widening of talofibular joint, deltoid ligament damage or medial malleolar fx, unstable

142
Q

gout involves altered _ metabolism

143
Q

mc type of gout attack

A

podagra -> great toe

144
Q

PE finding of chronic gout

145
Q

workup for gout

A

arthrocentesis
serum uric acid > 8 (not diagnostic)
XR

146
Q

arthrocentesis finding of gout

A

negatively birefringent rod shaped crystals

147
Q

XR findings of gout

A

small, punched out lesions

148
Q

1st line tx for acute gout

A

indomethacin tid

149
Q

2 meds to avoid w. gout

A

diuretics
ASA

150
Q

management of chronic gout

A

colchicine
allopurinol

151
Q

ages associated w. gout vs pseudogout

A

gout: > 30
pseudogout: > 60

152
Q

3 characteristics of pseudogout vs gout

A

pseudogout:
> 60
large joints
no tophi

153
Q

arthrocentesis findings of pseudogout

A

positively birefringent rhomboid shaped Ca pyrophosphate crystals

154
Q

XR finings of pseudogout

A

fine, linear calcifications in cartilage

155
Q

tx for pseudogout

A

acute: indomethacin
chronic: colchicine

156
Q

mc location of cervical disc herniation

A

C5/C6
C6/C7

157
Q

what differentiates rotator cuff tear from disc herniation

A

no pain at rest w. rotator cuff tear

158
Q

weakness in shoulder elevation

159
Q

weakness of shoulder abduction and external rotation

bicep flexion weakness

160
Q

pain at shoulder tip w. radiation to anterior upper arm, radial forearm, thumb

weakness w. elbow flexion or shoulder external rotation

161
Q

pain at shoulder blade, pectoral area, medial axilla, posterolateral upper arm, dorsal elbow, forearm, index, and medial digits or all of fingers

diminished triceps reflex

162
Q

weakness of opponens pollicis and hand intrinsic muscles

weakness of finger abductors and grip strength

163
Q

pain in a dermatomal pattern that increases w. coughing/straining/bending/sitting

A

L5-S1 (sciatica)

164
Q

PE tests for sciatica

A

SLR
crossover SLR

165
Q

red flag sx w. LBP

A

fecal/urinary incontinence
saddle anesthesia
urinary retention
immunosuppression
IVDU
fever
chronic steroids
focal neuro deficits
fx/infxn
trauma
> 50 yo w. mild trauma
hx ca
unexplained wt loss
no improvement x 6 weeks of conservative tx

166
Q

inguinal pain

167
Q

spinal stenosis
pain at anterior aspect of thigh

168
Q

mc radiculopathy

169
Q

pain down lateral aspect of leg into the foot

reduced dorsiflexion/toe extension/foot inversion/eversion

170
Q

pain down posterior leg into foot
reduced plantar flexion/ankle reflex

171
Q

sacral/buttock pain radiating down posterior leg into perineum

urinary/fecal incontinence and sexual dysfxn

172
Q

2 mc cause of lbp

A

prolapsed intervertebral disc
low back strain

173
Q

where is sciatica felt

A

buttock ->
posterior thigh ->
posterolateral aspect f leg ->
lateral malleolus ->
lateral dorsum of foot

174
Q

unilateral lbp and butt pain taht gets worse w. standing

A

SI joint involvement

175
Q

pain in elderly increased by walking and relieved by leaning forward

A

spinal stenosis

176
Q

red flags for lbp

A

fever/wt loss
morning stiffness
IVDU
steroid hx
trauma
ca
saddle anesthesia
loss of anal sphincter tone
motor weakness

177
Q

usefulness of CT in evaluation of lbp

A

bony stenosis
lateral nerve root entrapment

178
Q

MRI usefulness in lbp evaluation

A

spinal cord pathology
neural tumors
stenosis
herniated disc
infxn

179
Q

max amt of time to recommend rest for lbp

A

2 days

w. support under knees/neck

180
Q

when to consider imaging if lbp isn’t improved w. conservative tx

181
Q

chronic infxn/inflammation of bone and bone marrow

A

osteomyelitis

182
Q

3 sources of osteomyelitis

A

hematogenous seeding
contiguous spread of infxn
direct inoculation into bone (trauma/surgery)

183
Q

3 PE findings of osteomyelitis

A

fever
restricted movement
refusal to bear weight

184
Q

mc pathogen associated w. osteomyelitis

185
Q

pathogen associated w. osteomyelitis caused by dog/cat bites

A

pasteurella

186
Q

pathogen associated w. osteomyelitis in SSA pt

A

salmonella

187
Q

pathogen assocaited w. osteomyelitis w. vertebral involvement (Potts Dz)

A

myobacterium TB

188
Q

pathogen associated w. osteomyelitis in prosthetic joints

A

staph epidermidis

189
Q

gs dx for osteomyelitis

A

bone aspiration w. culture

190
Q

xray triad for osteomyelitis

A

demineralization
periosteal rxn
bone destruction

191
Q

gs imaging for osteomyelitis

A

MRI

XR lags behind symptoms 7-10 days

192
Q

what 3 labs are elevated in most osteomyelitis cases

A

CRP x 4-6 weeks
WBC
ESR

193
Q

tx for osteomyelitis

A

-empiric abx -> tailored based on culture
-remove all hardware

194
Q

duration of abx for osteomyelitis: acute vs chronic vs MRSA

A

acute: 4-6 weeks
chronic and MRSA: > 8 weeks

195
Q

suspsect osteomyelitis if a diabetic foot ulcer is (2)

A

> 2 cm x 2 cm
OR
bone is palpable

196
Q

first step in pain management

A

differentiate acute vs chronic

197
Q

2 types of acute pain

A

nociceptive
neuropathic

198
Q

t/f: NSAIDs/APAP are just as effective as opioids for nociceptive pain

199
Q

NSAID ceiling effect

A

naproxen: 500 mg (1,000 mg/day)
ibuprofen: 400 mg (1200/day)
diclofenac: 50 mg (150 mg/day)

200
Q

nonpharm tx for pain

A

PT
heat/cold
OMT
acupuncture
masssage

201
Q

non opioid pharm management of pain

A

topical analgesics
cymbalta
COX 2’s: celebrex, mobic
muscle relaxants
gabapentin
TCAs

202
Q

name 3 muscle relaxants

A

baclofen
cyclobenzaprine (flexeril)
tizanidine (zanaflex)

203
Q

pharm for neuropathic pain (2)

A

gabapentin
TCAs

204
Q

use NSAIDs w. caution in what pt pops (3)

A

ckd
hepatobiliary/GI dz
CVD

205
Q

rf for NSAID GI toxicity

A

hx previously complicated ulcer
> 65 yo
high doses
concurrent use of ASA/steroids/anticoagulants

low = no rf
mod = 1-2 rf
high = > 2 rf or hx complicated ulcer

206
Q

management of NSAIDs in pt’s at high risk for GI toxicity

207
Q

pt pop to avoid NSAIDs in
why?

A

-decompensated cirrhosis
-risk of PG mediated renal perfusion and bleeding

208
Q

how to safely prescribe opioids

A

lowest dose for lowest amt of time
oral
short acting

209
Q

direct bacterial invasion of joint space
medical emergency

A

septic arthritis

210
Q

sx of septic arthritis

A

-single, swollen, warm painful joint that is ttp
-fever, sweats, myalgia, malaise, pain

211
Q

2 mc locations for septic arthritis

212
Q

3 causes of septic arthritis

A

hematogenous spread
direct inoculation
contigous spread

213
Q

mc pathogen associated w. septic arthritis

214
Q

pathogen associated w. septic arthritis in sexually active young adults

A

n. gonorrhea

215
Q

2 pathogens associated w. septic arthritis in IVDU

A

streptococci
pseudomonas

216
Q

definitive dx for septic arthritis

A

arthrocentesis w. gram stain

217
Q

arthrocentesis findings indicative of septic arthritis: non prosthetic joints vs prosthetic joints

A

non prosthetic joints: WBC > 50,000, primarily PMNs

prosthetic joints: WBC > 1,000

218
Q

tx for septic arthritis

A

abx x 2-4 weeks
arthrotomy w. joint drainage

219
Q

abx for septic arthritis based on pathogen

A

-s. aureus: vanco/nafcillin
pcn allergy: vanco vs clinda
-gonorrhea: ceftriaxone
-IVDU: cipro/levaquin

220
Q

pain w. resisted wrist flexion and pronation
pain at medial elbow
overuse syndrome

A

medial epicondylitis (golfers elbow/pitcer’s elbow)

221
Q

pain w. wrist extension and forearm supination
overuse syndrome

A

lateral epicondylitis (tennis elbow)

222
Q

-ulnar n compression at wrist
-paresthesia’s over small finger/ulnar half of 4th finger/ulnar dorsum of hand
-worse w. cell phone use
-caused by sleeping w. arm in flexion

A

cubital/ulnar tunnel syndrome

223
Q

tx for cubital/ulnar tunnel syndrome

A

NSAIDs
nighttime bracing
ulnar n decompression

224
Q

-pain/paresthesia in first 3 digits/radial half of 4th digit
-sx worse at night

A

carpal tunnel syndrome

225
Q

what n is involved with carpal tunnel syndrome

226
Q

PE tests for CTS

A

phalen
tinel

227
Q

PT test for cubital tunnel syndrome

228
Q

tx for CTS

A

night splint
steroid injxn
surgical decompression

229
Q

pain and sweling at base of thumb that radiates into radial aspect of forearm

A

de quervain’s tenosynovitis

230
Q

PE test for de quervain’s tenosynovitis

A

finkelstein

231
Q

tx for de quervain’s tenosynovitis

A

thumb spica splint x 3 weeks
NSAIDs
steroid injxn
PT

232
Q

injury from fall on an abducted thumb
laxity/pain w. valgus stretch

A

thumb collateral ligament injury (gamekeeper/skier injury):
gamekeeper = chronic
skier = acute

233
Q

tx for thumb collateral ligament injury

A

XR to evaluate for avulsion injury
thumb spica x 4-6 weeks

234
Q

-benign fibroproliferative disorder chracterized by contracture of palms and palmar nodules mc in 4th and 5th digit
-painless nodules on palms

A

duputyren contracture

235
Q

what disease is associated w. dupuytren contracture associated w.

A

alcoholic cirrhosis

236
Q

PE test for duputyren contracture

237
Q

tx for duputyren contracture

A

injected collagenase or steroid
fasciotomy vs fasciectomy

238
Q

tear at DIP joint
avulsion of extensor tendon -> can’t straighten distal finger

A

mallet finger

239
Q

what is this showing

A

bony avulsion of distal phalanx -> mallet finger

240
Q

tx for mallet finger

A

splint DIP -> uninterrupted extension x 6 weeks
surgical pinning

241
Q

tear at PIP joint - jammed finger
PIP flexion and DIP hyperextension

A

boutonniere deformity

242
Q

PE test for boutonniere deformity

243
Q

tx for boutonniere deformity

A

splint PIP in extension x 4-6 weeks

244
Q

soft tissue infxns to know

A

cellulitis
paronychia
felon
herpetic whitlow

245
Q

2 pathogens associated w. cellulitis

A

staph
strep

246
Q

what is this showing

A

paronychia -> infxn next to fingernail

247
Q

causes of paronychia: acute vs chronic

A

acute: bacterial
chronic: fungal

248
Q

what is this showing

A

felon -> abscess in the tip of the finger

249
Q

what is this showing

A

herpetic whitlow -> herpes infxn around the fingernail (thumb sucking)

250
Q

benign, asymptomatic, mucin filled synovial cyst mc on dorsal aspect of wrist

A

ganglion cyst

251
Q

PE test to perform for ganglion cyst

A

allen’s test
to ensure radial and ulnar artery flow

252
Q

shoulder injuries to know

A

AC separation
biceps tendonitis
rotator cuff tear/tendinopathy
adhesive capsulitis
subacromial impingement
subacromial bursitis
glenohumeral joint OA

253
Q

what is this showing

A

step off deformity -> AC separation

254
Q

PE test for AC separation

A

cross chest testing

255
Q

imaging for AC separation

A

XR w. pt holding a weight

assess level of injury to joint

256
Q

anterior shoulder pain
pain w. resisted supination of elbow

A

biceps tendonitis

257
Q

what is this showing

A

pop eye deformit -> biceps tendon rupture

258
Q

MRI finding of biceps tendonitis

A

increased T2 signal around biceps tendon

259
Q

PE tests for biceps tendonitis

A

speed’s
yergason’s

260
Q

elbow flexed at 90 degrees, wrist supination against resistance

A

yergason’s test

261
Q

muscle mc injured w. rotator cuff tear/tendinopathy

A

supraspinatus

262
Q

pain associated w. rotator cuff injury

A

pain w. overhead activity
pain w. lying down at night

263
Q

what is this showing

A

loss of subacromial space -> rotator cuff injury

due to upward migration of humeral head

264
Q

when is surgery indicated for rotator cuff tear

A

failure of 3-6 months of conservative tx

265
Q

what are the SITS muscles

A

supraspinatus
infraspinatus
teres minor
subscapularis

266
Q

3 PE tests suggestive of supraspinatus injury

A

empty can
full can
arm drop

267
Q

PE test associated w. subscapularis injury

268
Q

PE test associated w. teres minor/infraspinatus injury

A

elbow at 90 degrees -> rotate laterally against resistance

269
Q

-insidious onset shoulder stiffness/pain at rest
-decreased active and passive ROM
-may mimic rotator cuff injury

A

adhesive capsulitis

270
Q

PE test for adhesive capsulitis

A

scratch test

271
Q

pain w. reaching/lifting and w. overhead motion

A

subacromial impingement

272
Q

PE tests for subacromial impingement

A

neer
hawkins
drop arm

273
Q

knee injuries to know

A

prepatellar bursitis
patellar tendinitis
ACL
MCL
LCL
PCL
meniscal

274
Q

pain w. direct pressure on knee
swelling over patella
wrestlers

A

prepatellar bursitis

275
Q

swelling over tendon
tenderness at inferior border of patella

A

patellar tendinitis

276
Q

what tx is contraindicated for patellar tendinitis
why?

A

steroid injxn
due to risk for tendon rupture

277
Q

popping/swelling w. instability and feeling of knee giving out after plant and twist injury

278
Q

PE tests for ACL tear

A

anterior drawer
lachman’s

279
Q

most sensitive test. forACL tear

A

lachman’s

280
Q

indications for surgery for ACL tear

A

young
active

281
Q

valgus stress injury - football
“pop”

282
Q

PE test for MCL tear

283
Q

indiacation for surgery for MCL tear

A

chronic instability

284
Q

rare knee injury associated w. trauma to the medial knee

285
Q

indication for surgery w. LCL tear

286
Q

PE test for LCL tear

287
Q

blow to the knee while flexed or bent
landing hard during sports fall
dashboard injury

288
Q

PE test for PCL tear

A

posterior drawer

289
Q

what is. this showing

A

sag sign -> PCL tear

290
Q

indications for surgery for PCL tear

A

PCL + ACL
PCL + grade III MCL or LCL

291
Q

twist injury w. locking
feeling of knee giving out
effusion 6-24 hr after injury

A

meniscal tear

292
Q

triad of meniscal tear

A

joint line pain
effusion
locking

293
Q

PE tests for meniscal tear

A

mcmurray
apley

294
Q

ankle/foot injuries to know

A

ankle sprain
achilles tendon rupture
plantar fasciitis
tarsal tunnel
bunion (hallux valgus)
morton’s neuroma

295
Q

and 85% of ankle sprains are. in which ligament and via what moi

A

atfl
inversion

296
Q

which ankle ligament is injured with ankle eversion

297
Q

PE tests for ankle injury

A

anterior drawer
talar tilt

298
Q

ottawa ankle rules for xray

A

malleolar zone pain
bone tenderness at lateral or medial malleolus
can’t bear weight/take a few steps

299
Q

“pop” with weakness
palpable gap w. increased resting ankle dorsiflexion in prone position w. knees bent

A

achilles tendon rupture

300
Q

PE test for achilles tendon rupture

301
Q

-pain on plantar surface of foot at calcaneal insertion of plantar fascia upon wt bearing
-worse in AM
-dancers, runners

A

plantar fasciitis

302
Q

posterior tibial n compression from overuse
restrictive footear

A

tarasl tunnel syndrome

303
Q

deformity of bursa over 1st metatarsal
hx poorly fitted shoes/flat feet (pes planus) or RA
pain over prominence at MTP joint

A

bunion (hallux valgus)

304
Q

painful mass near tarsal heads
hx tight fitting shoes/high heels
sharp pain w. ambulation at 3rd metatarsal head
numbness/paresthesia

A

morton’s neuroma

305
Q

mc location of sprain

A
  1. ankle
  2. wrist
306
Q

sprain classifications

A
  1. first degree/mild: fibers and ligaments are stretched but intact
  2. second degree/moderate: tear of ligament from a third to almost all it’s fibers
  3. third degree/severe: complete rupture of ligament, sometimes avulsing a piece of bone
307
Q

tx for sprain

A

RICE
clinical dx vs xray vs MRI

308
Q

mc location for strains

A

hamstring
lower back

309
Q

classification of strains

A
  1. first degree/mild: little tissue tearing, mild tenderness, pain w. full ROM
  2. second degree/moderate: torn tissue, painful limited ROM, +/- swelling
  3. third degree/severe: limited or no ROM, severe acute pain
310
Q

tx for strains

A

RICE
PT after 7 days of rest

311
Q

swelling and deformity in. theemergency setting indicate (2)

A

fracture
dislocation

312
Q

management of fracture/dislocation

A
  1. check vascular area distal to swelling/deformity
  2. immediate reduction

EOR - Emergency Medicine (13 decks)

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