Orthopedics/Rheumatology Flashcards

Question

How is ecchymosis diagnosed and exam?

Answer 1

- bruising and discoloration of the skin - can be from a dark purple color to a light tan color - ecchymoses also have a more diffuse border

Answer 2

ice packs and NSAIDS

Answer 3

- eccymosis is commonly seen in the ER after fractures because the bone is bleeding and the surrounding tissue - any extremity injury with ecchymosis is a fracture until proven otherwise

Answer 4

- characterized by the reddening of the skin, the appearance of the rash - erythema is caused due to injury or irritation is caused blood capillaries - It occurs with any skin injury, infection, or inflammation

Answer 5

inflammation, sunburn, allergic reactions to drugs (for example Erythema multiforme is an acute, immune-mediated condition characterized by the appearance of distinctive erythema-like target-like lesions on the skin

Answer 6

- must identify the underlying cause for treatment | - In other words, erythema is smoke, not fire

Answer 7

in the ER with orthopedic cases, erythema with increase temperature to the skin should alarm you to the fact that infection needs to be ruled out

Answer 8

MC site of radial nerve injury; posterior fat pad/sail sign, treat with sugar tong splint (distal) and computation splint (shaft) with ortho follows up in 24-48 hours

Answer 9

MC pediatric elbow fracture; usually from fall to outstretched hand; XR shows anterior fat pad (dark area on either side of the bone), check neurologic/vascular involvement (median nerve/brachial artery injury), long arm posterior splint followed by long arm casting (ORIF for displaced)

Answer 10

pain and tenderness along the lateral aspect of the elbow, limited elbow/forearm ROM, particularly pronation/supination; MC cause is falling on an outstretched arm; treat with a sling, long arm splint at 90 degrees, ORIF

Answer 11

lateral elbow pain, hold the elbow in slight flexion and forearm pronated; pain and tenderness localized to the lateral aspect of the elbow; usually from pulling upward motion; the supination-flexion technique is classically used

Answer 12

usually from a blow; functional brace with good interosseous mold for isolated nondisplaced or distal 2/3 ulna shaft fx; ORIF if displaced

Answer 13

(proximal ulnar shaft fracture with radial head dislocation) -elbow pain and swelling, tenderness to palpation along the elbow, decreased elbow ROM, the radial head may be palpable if dislocated, FOOSH, radial nerve injury, treat with ORIF

Answer 14

(distal radial shaft fracture, dislocation of ulna) -wrist pain, swelling, pain wit flexion/extension; FOOSH, falling on pronated hand, unstable fracture = ORIF, long arm splint

Answer 15

dorsally angulated extra-articular distal radius fracture; "fragility fracture "; FOOSH; causes dinner fork deformity; need lateral XR to make the diagnosis; treat with sugar tong splint/cast

Answer 16

extra-articular metaphysic fracture of the radius with solar angulation and displacement - garden space deformity; from fall with palm closed, hands flexed, blow to the back of the wrist; median nerve injury = common (can develop carpal tunnel over time); reduction/surgery or casting, PT for ROM and strengthening

Answer 17

FOOSH, snuffbox tenderness = treat as a fracture; pain on radial surface of the wrist at anatomical snuffbox, fracture may not be evident for up to 2 weeks; complication = avracular necrosis; treat with 10-12 weeks casting with a thumb spica splint

Answer 18

fracture of the neck of the 5th/4th metacarpal; usually from a punch with a clenched fist, treat with ulnar gutter splint with joints at 60-degree flexion

Answer 19

require ORIF

Answer 20

mode of injury = FOOSH (abduction and extension) - usually sports-related/in elderly - anterior: MC (arm = anterior) = arm is abducted and externally rotated (FOOSH) - posterior: the arm is adducted and internally rotated - In both: get x-ray (AP, axillary, and scapular view) - Tx: reduce, post reduction films, sling, and swath, PT - rotator cuff tear/labral tar also possible

Answer 21

fracture of anterior inferior glenoid following impaction of the humeral head against glenoid

Answer 22

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

Answer 23

transient neurpraxia present in 5% shoulder dislocations, numbness/tingling of lateral shoulder

Answer 24

usually from direct fall on the shoulder - a direct blow to the lateral aspect of shoulder/birth trauma in newborn - Middle third = MC - PE: swelling, erythema, tenderness to palpation, tenting of overlying skin, MC injured rotator cuff muscle = supraspinatus - X-ray: anteroposterior and clavicle view - tx: simple arm sling or figure of eight sling: 4-6 weeks adults, ortho consult if proximal 1.3; begin PT after 4 weeks with light strengthening after 6 weeks

Answer 25

sever hip, groin, thigh pain often with a history of recent trauma/fall; hip tender with pain on active and passive ROM - femoral neck = main blood supply to femoral head = medical circumflex femoral artery - log roll maneuver (internal and external rotation of leg elicits hip pain) which suggests femoral neck fracture - get AP x-ray of the pelvis; high incidence of avracular necrosis with femoral neck fractures - Tx: manage with ORIF; hip arthroplasty, DVT, prophylaxis until ambulatory

Answer 26

hip pain with leg shortened and internally rotated/adducted after trauma = MC cause (fall from height, MVA) - posterior dislocation in 90% = adducted, flexed, internally rotates; anterior dislocation = abducted, flexed, externally rotated - R/O sciatic nerve injury, prevent DVT - X-ray: posterior - femoral head superior to acetabulum; anterior - femoral head inferior to the acetabulum - tx: closed reduction under conscious sediation, open reduction if failure of closed reduction; repeat XR and neuromuscular exam after reduction

Answer 27

sensitive - age > 55 - tenderness to the head of the fibular - Isolated tenderness to the patella - Inability to flex the knee to 90 degrees - Inability to bear weight for 4 steps both immediately and in examination room regardless of limp

Answer 28

greater specificity - recent fall or blunt trauma - age < 12 y/o or > 50 y/o - unable to take 4 steps unaided steps

Answer 29

usually after high impact trauma and pt can't extend knee; worry about popliteal artery injury - diagnose with CT angiogram, get pre and post-reduction reduction X-ray; MRI required to eval soft tissue injury for surgical planning; orthopedic emergency à early reduction essential (check distal pulses and perineal nerve function)

Answer 30

usually in children in MVA, get ap lateral oblique XR, if displace check perineal nerve (foot drop) - may need to confirm with CT/MRI, tx: non displace = cast 6-8 weeks; displaced= ORIF

Answer 31

patella Alta (pulled quad muscles cause fracture displacement; tx = 6-8 weeks immobilization, may bear partial weight; displaced need ORIF

Answer 32

degenerative disease of synovial joints that cause progressive loss of articular cartilage; pain worse with activities, swelling, stiffness, palpable crepitus on exam; XR shows joint space narrowing, osteophytes, subchondral sclerosis; tx = weight reduction, moderate activity, NSAIDs, intra-articular steroid injection, bracing, canes, muscle strengthening, PT; acetaminophen = first line, NSAIDs = second lines; total joint replacement indicated in advanced cases

Answer 33

- pain long lateral malleolus, medial malleolus - midfoot pain, 5'th metatarsal or navicular pain - unable to walk more than four steps in the ER or exam room

Answer 34

proximal 5'th metatarsal diaphysis fracture; pain over the lateral border of foot; not benign (poor blood supply to that area); radiographs: AP later, oblique; tx: walking boot/cast, RICE, surgery for displaced, 6 weeks non-weight bearing

Answer 35

common in athletes, military (overuse), most common in 3'rd metatarsal; dx: XR 50% negative, bone scan/MRI may show, tx: rest, splint, post-op shoe

Answer 36

high force impact (falling/snowboarding), x-ray demonstrates talus fracture, non-weight bearing cast for non-displaced, surgery for displaced

Answer 37

level of fibular fracture relative to the syndesmosis - fibular fracture below mortise, tibiofibular syndesmosis intact or mild tear, deltoid ligament intact or may be torn, stable or unstable - fibular fx above Mortise, tibiofibular syndesmosis torn with a widening of talofibular joint, deltoid ligament damage or medial malleolar fracture, unstable = ORIF

Answer 38

usually from fall, MVA, sports injury; can be damage to blood vessels/nerves/skin; tx = reduction +/- ORIF

Answer 39

involves the accumulation of uric acid in the soft tissue of joints and bone - altered purine metabolism and sodium urate crystal precipitation into the synovial fluid, M>W (9:1) until menopause (1:1) - usually young, > 30 yo, asymmetric, great toe; tophi

Answer 40

MC = podagra (attack of MTP of the great toe) (70% of cases); pain, swelling, redness, exquisite tenderness, in chronic gout = tophi

Answer 41

arthrocentesis - rod-shape negatively birefringent - serum uric acid level > 8 (not diagnostic) - Imaging: small, punched out lesions on XR = high likelihood diagnosis

Answer 42

lifestyle: elevation, rest, decrease purines (meats, beer, seafood, alcohol), weight loss, increase protein, limit alcohol - pharm: NSAIDs = drug of choice (indomethacin tid); colchicine = effective but bad GI s/e; steroid injections for those who can't take NSAIDs, oral pred if other meds not tolerated - thiazide diuretics and aspirin should be avoided - the management between acute attacks: colchicine, allopurinol - don't start someone on allopurinol in an acute attack

Answer 43

usually > 60 yo; large joints, lower extremity; no tophi | -similar gout symptoms

Answer 44

rhomboid-shaped calcium pyrophosphate crystals - positively birefringent -XR shows fine, linear calcification in cartilage

Answer 45

NSAIDs, colchicine, intra-articular steroid injections | -colchicine = prophylaxis, NSAIDs = acute attacks

Answer 46

usually posterolateral at C5-C6/C6-C7; pain into arm/shoulder, numbness/tinging pain into the arm with pain at rest until there's movement; confirmed with MRI

Answer 47

weakness in shoulder elevation

Answer 48

weakness of shoulder abduction and external rotation; bicep reflex may be diminished

Answer 49

pain at shoulder tip with radiation to the anterior upper arm, radial forearm, thumb; weakness with elbow flexion or shoulder external rotation

Answer 50

affects C7 nerve root - 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

Answer 51

cause T8 radiculopathy - opponens pollicis and hand intrinsic muscles; weakness of finger abductors and grip strength

Answer 52

pain in a dermatomal pattern - increases with coughing, straining, bending, and sitting (L5-S1 is most common)

Answer 53

back pain radiating through thigh/buttocks (lower leg below the knee down L5-S1) - do straight leg raise, crossover test; dx = noncon MRI; tx: NSAIDs, rest, steroids, PT, epidural steroid injection, surgery if warranted

Answer 54

fecal/urinary incontinence, saddle anesthesia, urinary retention, immunosuppresion, IVDU, fevers, chronic steroid use, focal neurological deficit, fracture/infection, trauma, >50 with mild trauma, neoplasm or fracture, history of CA, unexplained weight loss, no improvement after 6 weeks of conservative management

Answer 55

inguinal region (rare)

Answer 56

spinal stenosis; anterior aspect of the thigh

Answer 57

Mc radiculopathy: lateral aspect of the leg into the foot; strength can be reduced in foot dorsilfexion, toe extension, foot inversion, and foot eversion

Answer 58

pain down the posterior aspect of the leg into the foot from the back; reduced strength with plantar flexion, ankle reflex loss

Answer 59

sacral/buttock pain that radiates down the posterior aspect of the leg into perineum = urinary/fecal incontinence and sexual dysfunction

Answer 60

the most common causes of low back pain = prolapsed intervertebral disk and low back strain -usually occurs within 24 hours of injury/overuse

Answer 61

- pain originating in the back and radiating down the leg = nerve irritation - musculoskeletal usually located to one region/point tenderness - sciatica felt in buttock, posterior thigh, posterolateral aspect of leg around lateral malleolus to the lateral dorsum of the foot - unilateral low back and butt pain that gets worse with standing = SI joint involvement - pain in the elderly increased by walking and relieved by leaning forward = spinal stenosis

Answer 62

x-ray usually not required if history and physical is benign/normal neuro exam - red flags: fever, weight loss, morning stiffness, IVDu/steroid history, trauma, cancer, saddles anesthesia, loss of anal sphincter tone, motor weakness = emergent x-ray - CT helpful in demonstrating bony stenosis and identifying lateral nerve root entrapment - MRI helpful for cord pathology, neural tumors, stenosis, herniated disks, and infections - get x-ray if pain persists

Answer 63

short term rest (max 2 days), with support under knees and neck + NSAIDs - progressive walking to normal activities if pain subsides - postural exercises/back rehab - no improvement in 6 weeks = imaging to r/o spinal tumor/infection (if normal = rehab) - surgery if conservative tx fails (-5%)

Answer 64

acute or chronic infection and inflammation of bone and bone marrow - can occur as a result of hematogenous seeding, the contiguous spread of infection or direct inoculation into intact bone (trauma/surgery) - fever, restriction of movement of involved extremity or refusal to bear weight - S. aureus is the most common organism (80%) - pasteurella seen in case caused by cat/dog bites; salmonella in sickle cell; mycobacterium TB seen in vertebral involvement (Potts DZ); Staph epidermidis in prosthetic joints

Answer 65

with bone aspiration = gold standard - x-ray triad: demineralization, periosteal reaction, bone destruction (lags behind symptoms 7-10 days); MRI shows changes before XR - labs: CRP elevated for 4-6 weeks, WBC and ESR high in most cases - definitive diagnosis = blood cultures or by needle aspiration/bone biopsy

Answer 66

empiric therapy directed toward most probable organism and tailored once culture results are available - all hardware removed - IV antibiotics = 4-6 weeks for acute OM and > 8 weeks for chronic or MRSA - if diabetic foot ulcer is > 2 cm x 2 cm or bone is palpable osteomyelitis is likely

Answer 67

- before treating, first, differentiate acute pain from chronic pain (or acute flare of chronic pain) - if chronic pain - escalations in pain medication should be made with discussion with outpatient providers - if acute pain - determine nociceptive or neuropathic pain - discuss expectations upfront including function-related goals over the absence of pain - NSAIDs +/- acetaminophen are 1st line meds for most acute nociceptive pain and are just as effective as opioids - NSAID ceiling effect for analgesia: - naproxen: 500 mg (1000 mg/day) - ibuprofen: 400 mg (1200 mg/day) - diclofenac: 50 mg (150 mg/day) - scheduling NSAIDs and acetaminophen provide continuous pain control that avoids many of the challenges of PRN medications - Nonpharmacologic treatments include mobility with PT and heat/cold packs, OMT, acupuncture, massage, and others - consider topical analgesic patches (lidocaine 5%) - consider cymbalta for a combination of pain and depression - consider COX 2 inhibitors such as celebrex or mobic - consider muscle relaxants such as baclofen, cyclobenzaprine (flexeril), tizanidine (Zanaflex), etc. - consider gabapentin or TCAs (nortripytline) for neuropathic pain - consider referral to pain management

Answer 68

- in general, NSAIDs are not absolutely contraindicated in patients with chronic kidney disease, hepatobiliary/gastrointestinal disease, and cardiovascular disease - however - they should be used with caution and, in many cases, with oversight and assistance from subspecialists - to reduce risk of harm use less potent NSAIDs like naproxen and ibuprofen - Using NSAIDs at low doses and for short duration helps mitigate risk for kidney, cardiovascular, and GI disease - risk factors for GI toxicity: - history of a previously complicated ulcer - age > 65 - high doe NSAID therapy - concurrent use of aspirin/corticosteroids/anticoagulants - low risk for GI toxicity = no risk factors, moderate risk = 1-2 risk factors, high risk > 2 or h/o previously complicated ulcer - consider a PPI while on NSAID therapy for moderate and high-risk patients - due to the risks of impairing prostaglandin-mediated renal perfusion, NSAIDs should be avoided in decompensated cirrhosis, bleeding risk is also significant in this population

Answer 69

- it starts with a discussion of treatment goals and duration upfront - use low dose, oral, short-acting opioids for the shortest duration possible - combining opioids with non-opioid adjuvants like acetaminophen and NSAIDs creates an opioid-sparing and synergistic effect - it helps improve pain control at lower opioid doses - lower doses and shorter courses of opioids expose the patient to less risk of opioid related adverse effects - oral preferred over IV because there are less extreme peaks and troughs - immediate release preferred over controlled release formulations for better titration

Answer 70

direct bacterial invasion of joint space - most dangerous form of acute arthritis = medical emergency

Answer 71

- a single, swollen, warm, painful joint that is tender to palpation + constitutional symptoms (fever, sweats, myalgia, malaise, pain) - MC = knee and hip - caused by: hematogenous spread, direct inoculation, contiguous spread - S. aureus is most common (40-50%); N. gonorrhea in sexually active young adults, streptococci; psudodomonas in IVDU - diagnose with arthrocentesis: joint fluid aspirate for definitive diagnosis (WBC > 50,000 primarily PMNs)

Answer 72

based on gram stain - 2-4 week course of antibiotics + arthrotomy with joint drainage - staph aureus = vanco/nafcillin (Vanco or clindamycin if PCN allergic) - gonorrhea = ceftriaxone - IVDU = cipro/levaquin

Answer 73

(golfer's/pitchers elbow): overuse syndrome, pain with resisted wrist flexion and pronation, pain at the medial elbow may radiate to the wrist -tx: activity modification, PT, steroid injection, surgery for a patient who failed PT for 4-6 mo

Answer 74

(tennis elbow): overuse syndrome; pain with wrist extension and forearm supination -tx: activity modifcation, counterforce bracing, PT, steroid injection, surgery for failed PT 4-6 mo

Answer 75

(scholar's elbow) elbow swelling - nonseptic = acute trauma/repetitive trauma; septic = pain/fever (r/o septic/gout with aspirate) -tx: PT, rest, ice, systemic antibiotic based on culture if septic, NSAIDs, injected steroids, operative

Answer 76

caused by ulnar nerve compression at wrist - sx = paresthesias over small finger and ulnar half of 4th finger and ulnar dorsum of hand; worse with cell phone use, nigh sx caused by sleeping with arm in flexion , tinnel sign positive - tx: NSAIDs, activity medication, nighttime bracing, operative = ulnar nerve decompression

Answer 77

pain/paresthesia in median nerve distribution (first 3 digits and radial half of 4th digit; sx worse at night); Phalen (pushing backs of hands together) and + Tinel test (tapping over nerve); clinical dx; confirmed by nerve conduction studies -tx = splint at night, steroid injection/oral, surgical decompression for severe

Answer 78

pain and swelling at base of thumb that radiates into the radial aspect of forearm + Finkelstein -tx = thumb spica splint x 3 weeks, NSAIDs 10-14 days, steroid injections, PT

Answer 79

(gamekeeper/skier): ulnar collateral ligament injury from fall on an abducted thumb - gamekeeper = chronic; skier = acute - laxity and pain with valgus stretch; XR to evaluate for avulsion injury - tx: thumb spica splint 4-6 weeks

Answer 80

AKA claw hand (MC 4th and 5th digit): benign fibroproliferative disorder characterized by contracture of palms and palmar nodules - associated with alcoholic cirrhosis - painless nodules on palms, may limit function; tabletop test positive (lie flat on tabletop) - diagnosis = clinical - tx: injected collagenase or steroid, faciotomy or fasciectomy if patient is refractory to 1st line therapy

Answer 81

(baseball - tear at DIP joint): avulsion of extensor tendon = forced flexion; can't straighten distal finger - XR = bony avulsion of the distal phalanx - tx: splint DIP uninterrupted extension x 6 weeks or surgical pinning

Answer 82

(tear at PIP joint - jammed finger): PIP flexion and DIP hyperextension; usually from jammed finger, Elson test = bend PIP 90 degrees over edge of table and extend middle phalanx against resistance = weak PIP extension and DIP will be rigid; XR not required -tx: splint PIP in extension x 4-6 weeks

Answer 83

usually staph/strep

Answer 84

infection next to fingernail; acute = bacterial; chronic = fungal

Answer 85

abscess in the tip of the finger

Answer 86

herpes virus infection around the fingernail (thumb sucking)

Answer 87

noncancerous mucin - filled synovial cyst caused by trauma, mucoid degeneration, synovial herniation usually on the dorsal aspect of the wrist; usually asymptomatic, do Allen's test to ensure radial and ulnar artery flow; U/S can differentiate a cyst from a vascular aneurysm; most ganglia don't require treatment - observe -aspirate (avoid on the volar aspect of wrist d/t radial artery - effective on only 50% of pt. Excision (severe sx or neurovascular manifestations)

Answer 88

fall directly on shoulder or FOOSH, may have an elevation of clavicle (step off deformit) and point tenderness and pain with cross-chest testing; XR taken with pt holding weight to assess the level of injury to joint -tx: conservative management can be sling/analgesia; more severe = operative repair

Answer 89

pain at biceps groove, anterior shoulder pain, pain with resisted supination of elbow - dx: XR to r/o fx, U/S can show thickened tendon within bicipital groove; MRI shows increased T2 signal around biceps tendon; "popeye deformity" a rupture - tx: NSAIDs, PT, steroid injection; surgical release for refractory cases - speed's: pt attempts to forward elevate shoulder against examiner resistance while the elbow extended and forearm supinated; positive with pain (SLAP lesion) - Yergason's elbow flexed at 90, wrist supination against resistance

Answer 90

supraspinatus = MC injury; shoulder pain with overhead activity or at night when lying on arm/weakness and immobility after acute injury; shoulder pain with overhead activity or at night when lying o arm/weakness and immobility after acute injury; XR= initial imaging (loss of subacromial space due to upward migration of humeral head) - MRI = most accurate - tx = NSAIDs, steroid injection and surgical repair if you fail 3- mo of conservative - supraspinatus: empty can test, full can test, arm drop - subscapularis: lift-off test (elbow at 90, rotate medially against resistance) - teres minor/infraspinatus: elbow at 90, rotate laterally against resistance

Answer 91

insidious onset shoulder stiffness and pain at rest, decreased active and passive ROM, post-fracture looks like rotator cuff injury, apley scratch test -tx = NSAIDs, PT, steroid injection

Answer 92

pain with reaching/lifting and pain with overhead motion - Neer test: arm fully protonated with pain during forward flexion while shoulder held - Hawkins: elbow/shoulder flexed at 90 with sharp anterior shoulder pain with internal rotation - Drop arm: pain with inability to lift the arm above shoulder or hold it - XR may show a subacromial spur - Tx: rest, ice, activity modification, NSAIDs, steroid injection, arthroscopic surgery if refractory to conservative

Answer 93

inflammation of bursa from trauma/overuse; pain on motion and at rest a fluid accumulation; aspirate if fever, diabetic, immunocompromised -tx: prevention of precipitation factors, rest, NSAIDs, steroid injections sometimes

Answer 94

more common in elderly; pain with activities - XR = subchondral clerosis and osteophytes at the inferior aspect of humeral head - MRI indicated to evaluate rotator cuff tendon - tx = NSAIDs, PT, steroid injections, total shoulder arthroplasty if unresponsive to conservative tx

Answer 95

pain with direct pressure on the knee, swelling over the patella, concern for septic bursitis in wrestlers -tx: compressive wrap, NSAIDs, +/- aspiration and immobilization for 1 week; steroid use = controversial

Answer 96

activity-related, "jumper's knee", swelling over tendon and tenderness at inferior border of patella; XR may show inferior traction spur in chronic cases (enthesophyte) - U/S = thickening tendon and hypoechoic areas - MRI shows tendon thickening - tx = ice, rest, activity modification, PT; surgical excision and suture repair as needed; steriod injection = CI d/t risk or tendon rupture

Answer 97

pop and swelling along with instability or "giving out" the knee after plant and twist injury; quickly stopping movement and changing direction while running/landing jump = rotation or valgus stress = ACL injury; anterior drawer test, Lachman's = most sensitive, MRI confirms diagnosis; PT and lifestyle modification for low demand pt; surgery for young/active

Answer 98

valgus stress injury (hit in football); "pop" along with medial joint line pain, MRI = definitive, conservative tx with bracing and therapy = effective, surgery for grade III injury; Valgus stress test

Answer 99

trauma to the inside of the knee; rare; MRI = definitive study; conservative treatment with bracing and therapy usually effective, surgery for grade III injury; Varus stress test

Answer 100

blow to the knee while flexed or bend like landing hard during sports fall; test = posterior drawer sing, sag sign, MRI = confirms; protected weight-bearing and rehab for isolated grade I and II; surgical repair for PCL + ACL or PCL and PCL + grade III MCL or LCL

Answer 101

after twist injury with locking, feeling of knee giving away, a triad of joint line pain, effusion, locking; effusion usually 6-24 hours after injury; McMurray test/apley test

Answer 102

85% are in collateral ligaments a anterior talofibular ligament during inversion; deltoid affected by eversion - anterior drawer test, talar tilt test - Xray depends on Ottawa ankle rules: malleolar zone pain and bone tenderness at lateral or medial malleolus; can't bear weight/take a few steps - Tx: rest, ice, NSAIDs, crutches , bracing, splinting, f/u with ortho based on Xray and dx

Answer 103

"pop" then weakness, palpable gap + increased resting ankle dorsiflexion in a prone position with knees bend, + thompson test - MRI shows acute rupture with retracted tendon edges - tx: surgical repair for early ROM, splint with the ankle in some plantar flexion

Answer 104

pain on the plantar surface usually at calcaneal insertion of plantar fascia upon weight bearing especially in morning/initiation of walking after prolonged rest (dancers, runners) -tx: stretching, ice, calf strengthening, shoe inserts, NSAIDs

Answer 105

posterior tibial nerve compression from overuse, restrictive footwear, +tinel's sign - dx: nerve conduction test/electromyography - tx: avoid exacerbating activities, NSAIDs, steroid injection if no improvement, surgery

Answer 106

deformity of the bursa over 1st metatarsal; hx of poorly fitted shoes/flate feet (pes planus) or RA; pain over prominence at MTP joint/pain with shoes - dx = XR - tx = comfortable wide toed shoes; surgical when sx present despite shoe modification

Answer 107

painful mass near tarsal heads, MC in women with tight-fitting shoes, high heels; sharp pain with ambulation at 3rd metatarsal head; associated with numbess/paresthesia - MRI may be needed for diagnosis - tx = wide shoes, steroid injections, surgical resection if conservative management fails

Answer 108

involves ligaments and a strain involves muscles and tendons - the symptoms of a sprain and a strain are very similar, that's because the injuries themselves are very similar - remember a strain has the letter "t" for tendon

Answer 109

a joint sprain is the overstretching or tearing of ligaments -ligaments connect two bones together

Answer 110

- symptoms include pain, bruising, swelling, limited flexibility, decreased ROM - the most common location for a sprain is the ankle joint - caused by trauma or the joint being taken beyond its functional range of motion - ranges from a minor injury resolve in a few days - major rupture of one or more ligaments requiring surgical fixation - can occur at any joint but are most common in wrist and ankle

Answer 111

- first degree sprain (ild) the fibers of the ligament are stretched but intact - second-degree sprain (moderate) is a tear of a ligament, from a third to almost all its fibers - third-degree sprain (severe) is a complete rupture of the ligament, sometimes avulsing a piece of bone

Answer 112

often clinical = X-ray or MRI

Answer 113

RICE include - Rest: the sprain should be rested, no additional force should be applied on the site of the sprain - Ice: ice should be applied immediately to the sprain to reduce swelling and pain, it can be applied for 10-15 minutes at a time, 3-4 times a day, ice can be combined with wrapping to minimize swelling and provide support - Compression: dressings, bandages, or ace-wraps should be used to immobilize the sprain and provide support - Elevation: keeping the sprained joint elevated

Answer 114

in the ER with orthopedic cases sprains deal with ligament and RICE and anti-inflammatories are 1st line therapy

Answer 115

a joint strain is the overstretching or tearing of muscles or tendons -tendons connect bones to muscles

Answer 116

- muscles or tendon fiber tear as a result of an acute or chronic injury - the muscle fibers tear as a result of chronic overstretching or an acute injury - the most common locations for a muscle strain are the hamstring muscle and the lower back - symptoms include pain, muscles spasms, swelling, limited flexibility, decreased ROM - acute strains are more closely associated with recent mechanical trauma or injury - chronic strains typically result from repetitive movement of the muscles and tendons over a long period of time

Answer 117

Degrees of injury (as classified by the American College of Sports Medicine) - first degree (mildest) - little tissue tearing; mild tenderness; pain with a full range of motion - second degree - torn muscle or tendon tissues; painful, limited motion; possibly some swelling or depression at the spot of the injury - third-degree (most severe) - limited or no movement; severe acute pain, though sometimes painless straight after the initial injury

Answer 118

RICE include: - Rest: The strain area should be rested, no additional force should be applied on the site of the strain - Ice: ice should be applied immediately to the strain to reduce swelling and pain, it can be applied for 10-15 minutes at a time, 3-4 times a day, ice can be combined with wrapping to minimize swelling and provide support - Compression: dressings, bandages, or ace-wraps should be used to immobilize the strain area and provide support - Elevation: Keeping the strained muscle elevated - Physical therapy for the strained muscle or tendon can be schedules after at least 7 days of rest

Answer 119

strains deal with injuries to muscles and tendons while sprains deal with ligaments

Answer 120

- in the emergency room swelling and deformity after an acute injury can be either be a fracture and/or dislocation of a specific joint or area - it is imperative to make sure that the vascular area distal to the swelling and/or the deformity is intact - any type of vascular compromise distal to a deformity must be treated immediately - for example, in an elbow supracondylar fracture, the median nerve can be compromised distal to the fracture - another example is during a knee dislocation the popliteal artery can be compromised and the knee dislocation needs to be reduced immediately afterward usually a CT angiogram of the knee is done to rule out any type of vessel injury

Answer 121

- x-ray imaging and sometimes a CT scan of the area of deformity and swelling area needs to be done to rule out a fracture and/or dislocation - if dislocation is present reduction is next management - if a fracture is present reduction is the next in management or possible surgery depending on the severity of the fracture

Answer 122

Any type of ER orthopedic injury with swelling or deformity needs to be immediately evaluated for neurovascular compromise if it is present the deformity whether it be a fracture or dislocation needs to be reduced immediately

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Orthopedics/Rheumatology Flashcards

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