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PANCE study guide > Orthopedics/Rheumatology > Flashcards

Orthopedics/Rheumatology Flashcards

1
Q

Forced arm abducted externally rotated with “squared off shoulder” indicates

A

Anterior glenohumeral shoulder dislocation

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2
Q

What x-ray is needed in a glenohumeral dislocation

A

AP plus Y view

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3
Q

What is most common glenohumeral joint dislocation?

A

Anterior

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4
Q

Tx for glenohumeral joint dislocation

A

Immediate reduction, sling imobilize for 2-4wks

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5
Q

Describe

Diagnose

A

Hill Sach Lesion : Humeral head groove

Occurs with Anterior glenohumeral dislocation

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6
Q

Describe

Diagnose

A

Bankart Fx of inferior glenoid rim

Occurs with Anterior glenohumeral dislocation

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7
Q

MOI AC joint separation

A

Direct blow to tip of shoulder

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8
Q

Describe

Diagnose

TX

A

Type 1 AC dislocation

AC joint intact

Point tenderness at AC joint

Brief Sling imobilization Ice, analgesia

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9
Q

Describe

Diagnose

Tx

A

Grade 2 AC separation

Slight widening AC ligament Ruptured, caraclavicular ligament sprain

Point tenderness, less ROM , instability w/ stress test

Sur. intervention may be needed but less likely

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10
Q

Describe

Diagnose

Tx

A

Grade 3 AC separation

Significant widening, both ligaments ruptured

Severe pain, deformity Loss of ROM

Surgical intervention most likely necessary

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11
Q

What structures make up the rotator cuff

A

SITS

Supraspinatus

Infraspinatus

Teres MINOR

Subscapulars

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12
Q

Pt’s with rotator cuff abnormalities <40yo usually tend to have what etiology?

A

Impingement, tendonitis

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13
Q

Pt’s with rotator cuff abnormalities <40yo usually tend to have what etiology

A

Cuff tears

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14
Q

What structure in the rotator cuff is most commonly injured?

A

Supraspinatus

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15
Q

The “empty can” test is testing the strength of which muscle?

A

Supraspinatous

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16
Q

MC complication of Humeral shaft fx

A

Radial nerve injury

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17
Q

Where do most clavicular fx occur?

A

Middle one third of the clavicle

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18
Q

MOI in Humeral shaft fx

A

FOOSH

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19
Q

Management for Mid 1/3rd clavicular fx

A

Arm sling 4-6wks in adults

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20
Q

Management for proximal 1/3rd clavicular fx

A

Ortho consult

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21
Q

What is the most common fx in children?

A

Clavicle

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22
Q

+ adson on physical exam indicates what?

A

Thoracic outlet syndrome

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23
Q

Adson test

A

Loss of radial pulse w/ head rotated to affected side

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24
Q

Pt presents w/ FOOSH w/ hyperexteded elbow, swelling and tenderness at the elbow. Diagnose?

A

Elbow (supracondular fx)

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25
Q

Describe

Dx

A

posterior fat pad indicative of fx. (anterior fat pad also present but these are sometimes a normal variant).

Supracondylar (elbow) FX

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26
Q

Managment of displaced supracondylar fx

A

Immediate ortho consult, possible ORIF

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27
Q

MOI of Radial head fx

A

FOOSH

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28
Q

Sx indicative of radial head fx.

A

Hx consistent w/ FOOSH

Decreased pronation/supination

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29
Q

Describe

Diagnose

A

Radial head fx.

This photo does not have it - but a posterior fat pad would help to dx this - These are notoriously hard to see

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30
Q

MOI olecranon fx

A

Direct blow (fall on flexed elbow)

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31
Q

complication of olecranon fx.

A

Ulnar nerve dysfunction

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32
Q

Describe

Diagnose

Tx

A

Olecranon fx

All olecranon fx are considered intraarticular and need reduction

Non-displaced split (90deg); when displaced ORIF

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33
Q

Describe a “nightstick” fx

A

Isolated unlar shaft fx

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34
Q

Describe

Dx

Tx

A

Proximal ulnar shaft fx w/ radial head dislocation

Monteggia fx

ORIF

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35
Q

What nerve can be injured in monteggia fx

A

Radial nerve

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36
Q

Describe

Dx

Tx

A

Distal radioulnar disloation with distal radial shaft fx

Galeazzi Fx

VERY UNSTABLE - Immediate ORIF

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37
Q

Child presents w/ arm slightly flexed, refusing to use it. No swelling, and tenderness to palpation of radial head. TX?

A

Reduction-Pressure on the radial head w/ supination and flexion. If the child cannot almost immediately use the arm after get x-ray to r/o fx.

Nursemaids elbow

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38
Q

What action increases the sx/pain of lateral epidondylitis?

A

Gripping, forearm pronation and wrist extension against resistance (radiates down the forearm).

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39
Q

What action increases pain of Medial epicondylitis?

A

Pulling activities, forceful extension of elbow against resistance w/ forearm supinated and wrist flexion against resistance

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40
Q

Describe

Dx.

Tx

A

posterior Elbow dislocation - MC type

Emergent reduction

Posterior splint at 90deg. x 7-10d

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41
Q

What nerve is compressed in carpal dunnes syndrome?

A

Median nerve

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42
Q

Describe Tinel sign

A

percussion of median nerve produces symptoms

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43
Q

Phalen’s sign

A

Flex both wrists for 30-60 seconds reproduces sings

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44
Q

Tx of Carpal Tunnel

A

No tx if pregnant

Volar Splint

NSAIDS

Corticosteroids

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45
Q

What part of the hand is effected by Carpal Tunnel Syndrome

A

1st 3 and 1/2 of 4th digit esp at night

Thenar muscle wasting if advanced

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46
Q

Pain along radial aspect of wrist radiating to forearm indicatie of?

A

Dequervain’s tenosynovitis

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47
Q

Describe Finkelstein’s test, and what does it indicate?

A

Pain w/ ulnar deviation or thumb extension

Dequervain’s tenosynovitis

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48
Q

Tx for Dequervain’s

A

Thumb spica splint

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49
Q

Gamekeeper’s thumb is also known as?

A

Skier’s thumb

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50
Q

MOI of Scaphoid (Navicular Fx)

A

FOOSH

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51
Q

What is the most common carpal fx?

A

Scaphoid (navicular) fx.

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52
Q

Describe

Diagnose

A

Posterior angulation d/t FOOSH

Colles Fx

“Hand is Oustretched = cOlles”

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53
Q

Describe

Diagnose

A

Ventral angulation on lateral view

FOOSH w/ wrist in flexion

Hand is “Inside” when they fell = smIth

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54
Q

Dinner fork deformity describes

A

Colle’s Fx

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55
Q

Garden spade deformity describes

A

Smith fx

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56
Q

What is considered the most serious carpal fx

A

Lunate fx

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57
Q

Describe

Dx

Tx

A

Fx at neck of 5th metacarpal

Boxer’s Fx

Ulnar gutter splint

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58
Q

If pt has snuffbox pain and no fx evident what do you do?

A

Tx as a scaphoid fx and imobilize

repeat xray in 2 weeks

Maintain high suspicion for fx

59
Q

hallmark pain in anatomic snuffbox?

A

Scaphoid fx

60
Q

5p’s of compartment syndrome

A

Pain

Pallor

Parasthesias

Pulselessness

Paralysis

61
Q

Xray show’s “bamboo spine” What does this make you think of?

A

Ankylosing spondylitis

62
Q

T for Ankylosing Spondylitis

63
Q

If NSAIDS and PT aren’t successful what is the next step in pharm. tx for Ankylosing spondylitis?

A

TNF a inhibitor (Infliximib)

64
Q

Management of lumbosacral sprain/strain?

A

Brief bed rest <2d NSAIDS/Anagesics +/- muscle relaxers

65
Q

MC site of herniated Nuecleus pulposis

66
Q

What are the physical exam findings of pt with herniated disk?

A

+ slr

+crossover test

Strength, reflex and sensibility defects

67
Q

Pt presents w/ new onset of urinary/bowel retention/incontinence w/ saddle anesthesia, uni/bilateral leg radiation. Decreased anal sphincter tone on rectal exam. What is our dx/Tx

A

Cauda equina syndrome

Emergent Neurosurgery consult

68
Q

Back pain in spinal steonsis is relieved with _____ and worsened with _____.

A

Relieved wtih flexion (sitting/walking uphill) and worsened with extension (walking/standing)

69
Q

Lateral curvature of the spine greater than ___ deg is indicative of scoliosis

70
Q

Pt’s with 20-40deg of scoliosis require what tx?

A

bracing observation

71
Q

Pt’s with scoliosis >40deg require what tx?

72
Q

Most common upper C-spine fx?

A

Odontoid fx

73
Q

What are NEXUS criteria

A

No midline tendernss

No focal neuro defect

Normal alertness

No intoxication

No painful, distracting injury

74
Q

Legg-Calve’-Perthes disease is also known as

A

Avascular oseteonecrosis of the femoral head in children

75
Q

Clinical description of pt/ with LCP

A

Painless liming x weeks. Worse w/ activity. Hip pain radiating to thigh, knee or groin. Loss of abduction and internal rotation

76
Q

Tx for pt with Legg-Calve’-Perthes

A

Observation, NSAIDS, Rest, bracing in children >5yo or signficicant loss of abduction

77
Q

Define SCFE

A

Femoral head (epiphysis) sleeps posterior and inferior at the growth plate.

78
Q

Clinical picture of SCFE

A

Obsese, male pt during groth spurt c/o hip, thigh, or knee pain w/ limp.

79
Q

Tx of SCFE

A

ORIF (inc risk of AVN)

80
Q

Pain with limp in a kid. Think

81
Q

Painless limp in a kid think

A

Legg-Calve’-Perthes

82
Q

Tx of Hip dislocation

A

TRUE ortho emergency!!

Risk of avascular necrosis

83
Q

MC hip dislocation

84
Q

Pt presents w/ leg shortening and internal rotaiton with adduction and hip/knee slightly flexed. Think ____.

A

Hip dislocation

85
Q

Hip pain with leg shortened and externally rotated, abducted think _____.

A

Hip Fracture

86
Q

MOI MCL

A

vaLgus stress

So injury comes from outside of the knee

87
Q

MOI LC tear

A

vaRus stress

So the injury comes from the inside of the leg

88
Q

ACL injury MOI

A

Noncontact pivoting injury

89
Q

MC injured knee ligament

90
Q

PCL injury MOI

A

“Dashboard injury”

91
Q

Lachman’s test when positive indicates what?

A

ACL laxity

92
Q

Anterior drawer test indicates what?

A

ACL laxity

93
Q

Most common meniscal tear

94
Q

PE sign indicatve of Meniscal tear

A

McMurray’s sign

95
Q

MOI Patellar dislocation

A

Valgus stress

96
Q

MOI knee (tib fem) dislocation

A

High velocity trauma

97
Q

With tib-fem dislocations what is concerning?

A

Popliteal artery injury! These pt’s need arteriography immediately ortho consult

98
Q

MC cause of chronic knee pain in young active adolesents?

A

Osgood-Schlatter dz

99
Q

Tx for osgood-schlatter

A

RICE, Nsaids, stretching

100
Q

Ottawa ankle rules

A

Ankle films if :

pain along lateral malleolus

Paul along medial malleolus

Foot Films if:

Midfoot pain

5th metatarsal or navicular pain

If unable to walk >4steps at time of injury and in ER

101
Q

Pt describe sudden heel pain w/ pushoff movement, a pop, and sudden sharp calf pain. You think ____

A

Achilles rupture

102
Q

Pt has a spiral prox fib fx and distal medial malleolar fx w/ deltoid ligament rupture. What is this called?

A

Maisonneuve fx.

103
Q

Salter harris type I fx

A

Through the physis - best outcome

104
Q

Salter harris type 2 fx/

A

Metaphysis and physis

105
Q

Salter harris type 3

A

physis and epiphysis

106
Q

Salter harris type 4

A

fx of metaphysis, physis, and epiphysis

107
Q

Salter harris type 5

A

Complete erasure of physeal plate

108
Q

Osteomyelitis

A

inflammation/infection of bone by pyogenic organism

109
Q

MC pathogen of osteomyelitis

110
Q

Labs for osteomyelitis

A

Inc. WBC

Inc ESR

111
Q

Most sensitive test in early dz for Osteomyelitis

112
Q

Gold standard for Osteo testing

A

Bone aspiration

113
Q

Management of chronic osteomyelitis

A
  1. debride
  2. culutre and tx
114
Q

Acute osteo tx. in Newborn

A

MC patho is GBS: - Nafcillin or oxacillin + 3rd gen cephalo

115
Q

Acute osteo tx in >4mo

A

Staph aureus most likely - MRSA/MSSA: Tx w/ nafcillin or oxacillin or cefazolin

116
Q

Septic arthritis

A

infection in joint cavity

117
Q

MC pathogen of septic arthritis

118
Q

Tx for septic arthritis w/ gram pos coccli

A

Nafcillin, Vanco if MRSA

119
Q

Tx for septic arthritis w/ Gram neg cocci, unknown, or gonoccocal suspect

A

Ceftriaxone

120
Q

MC bone malignancy

A

Osteosarcoma

121
Q

MC mets of Osteosarcoma

122
Q

Onion peel appearance on Xray

A

Ewing’s sarcoma

123
Q

Primary joint affected in RA

A

Wrist, MCP, PIP

124
Q

Primary joint affected in OA

A

DIP, Thumb

125
Q

Morning stiffness indicates?

126
Q

Evening stiffness indicates

127
Q

Joints in RA are

A

Boggy and tender

128
Q

Joints in OA are

A

hard and bony

129
Q

When is DEXA scan indicated in Female?

130
Q

When is first DEXA scan indicated for males?

131
Q

DEXA scan for osteopenia

132
Q

DEXA score for osteoporosis

133
Q

What fx is the primary cause of Compartment syndrome?

A

Tibial shaft fx

134
Q

Tx for RA

A

DMARDS Methotrexate

135
Q

TX for OA

A

Acetaminophen

NSAIDS

136
Q

Test for SLE

A

ANA

Antismith antibodies

137
Q

Management of SLE

A

Hydroxychloroquin for skin lesions, NSAID, Acetaminophen for arthritis

138
Q

Fibromyalgia diagnosis requirements

A

diffuse pain in 11 out of 18 trigger points>3mo

139
Q

Crystals seen in synovial fluid in GOUT

A

Negatively birefringent; needle shaped

140
Q

Synovial fluid crystals in Pseudogout

A

WEakly positive; rhomboid shaped

141
Q

Inflammatory causes of polyarthritis include what?

A

SLE and RA

142
Q

Scheuermann kyphosis

A

Kyphotic curve w/ anterior wedge of more than 5 degrees in three successive vertebrae

143
Q

Ankylosing spondylitis results in what?

A

straightening and fusion of involved spinal segment

PANCE study guide (14 decks)

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