Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med semester 2 > Orthopedics- The ED side (Ross)- exam 2 > Flashcards

Orthopedics- The ED side (Ross)- exam 2 Flashcards

1
Q

What is a good ortho history?

OLD CARRTS

A
  • If chronic complaint–> then a focused hx & don’t forget to ask if there isnumbness/weakness !!!
  • How/when did it happen, the mechanism what is the complaint
  • Did they hear a snap/crackle or pop?
  • Right or left handed
  • Previous injury
  • ARE THEY UTD w/ TETANUS
  • Ask when their last meal was (if acute)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Neurovascular Intact

Vital Sign of Musculoskeletal

A
  • not just a word
  • base it on pulses and the color of extremities
  • base it on peripheral nerve function–sensory and motor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

85 yo has left arm pain for 3 days. Staff has found that pt is unable to use arm when he presents to ED.
Check radial pulse–> its ok, you test sensory and motor function and notice wrist drop and sensory loss. What is wrong?

A

Radial nerve damage and fx of humeral shaft = causes wrist drop!!

surgical neck fracture= axillary nerve damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

An acute ortho injury: what questions should you ask the Pt about their MOI?

A
  • Listen to mechanism that the patient describes
  • OPEN Ended Questions
  • Are they able to move affected area?
  • After ABC’s Immediately assess neurovascular status
  • **document before and after any manipulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Signs and symptoms of Bone Fracture

A
  • Deformity
  • Tenderness (TTP)
  • Splinting
  • Swelling
  • Bruising
  • Crepitus
  • False motion (they lift a body part and it goes the wrong way)
  • Exposed fragments
  • Pain
  • Locked joint (usually a fracture of the knee or elbow that inhibits movement of the joint)
  • *Document all of these on the chart!! A joint above and below!!!!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

say the Pt presents with an elbow injury. What do you HAVE to document?

A
  • document below and above that joint

- ie document how their shoulder joint and wrist joint functions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Red Flags
for HX and PE:
Blood on clothing–>

A

open fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pain out of proportion–>

A

compartment syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Elderly Pt with hip pain (neg film)–>

A

Occult hip fracture (may need Ct, MRI or bone scan)

**if elderly Pt has pain with ambulation–> its a hip fracture until proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Jumping from a height

–>

A

Calcaneous FX with vertebral body compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Eldery, hx of malignancy, mechanism doesn’t fit–>

A

Pathologic fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Grossly deformed extremity in field, now normal–>

A

Dislocation reduced in the field query vascular injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

13 yo boy running at gym has severe pain and stops.

A

Pathologic fx from lesion: osteocondroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

bones heal by _____ ______

A

callus formation & Remodeling of deposits of new bone along the fracture line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Fractures: clinical relevance

A

Some folks you don’t see initial fracture repeat films in 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

stage 1-6 fractures

A
  1. impact
  2. Induction
  3. Inflammation
  4. Soft callus
  5. Ossification
  6. Remodeling

3 stages of bone healing: Inflammatory, ossification and remodeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pearls ED ortho:

A
  • please examine first then order X-ray
  • may find unexpected findings such as jewelry or clothing causing tourniquet
  • may find incorrect side documented
  • **may find other injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How to describe a Fracture (steps)

A 
Closed vs Open
Location of injury
Orientation of fracture line
Displacement
Angulation
Shortening
-Dislocation or subluxation

ex: closed fracture of the —- that is ———with ——displacement, with no angulation or shortening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

_____ fracture is typically pediatric

A

greenstick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Physical Exam: In addition to the basics of ABC– what other steps should be taken?

A
  • Inspect deformity
  • Edema
  • Discoloration
  • Assess passive and active ROM
  • Palpation to detect deformity or tenderness
  • Check for pulse and neuro eval
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is included for neuro and vascular for the arm exam?

A

radial /ulnar and cap refill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is included for neuro and vascular for the leg exam?

A

popliteal, post tip, doraslis pedis

23
Q

Vascular and neuro exam:

  • how many hours until their limb is dead?
  • what sign is problematic?
A
  • 6 Hours until limb is DEAD
  • check pulse distal to fracture
  • *Skin tenting: problematic, needs to be addressed urgently.
24
Q

What are the peripheral nerves (branches) of the upper extremity?

A

musculocutaneus, axillary, radial, median and ulnar

25
Q

What are the peripheral nerves (branches) of the lower extremity?

A

genitofemoral, lat. cutaneous, obturator, femoral, and sciatic

26
Q

Orthopedic conditions commonly found with the radial nerve.

A
  • Wrist and finger extension
  • Wrist drop
  • Injury to shaft of humerus
  • Compression of nerve results in first drop
  • Saturday night or crutch palsy
27
Q

What muscles are involved with the flexion of the digits?

A

Flexor digitorum profundus

Flexor digitorum superficialis

28
Q

Describe the role of the flexor digitorum profundus

A
  • 2 motor nerve branches
  • Distal end of phalanges
  • Ulnar nerve innervates the 4th and 5th
  • Median nerve innervates the 2nd and 3rd
29
Q

Describe the flexor digitorum superficialis.

A

Innervated by median nerve

30
Q

Ulnar nerve

A
  • Provides motor innervation to: flexor digitorum profundus of 4th & 5th digit as well as flexor carpi ulnaris, adductor pollicis, all interosseous, lumbricals 3 and 4.
  • Injured in supra-condylar fractures (proximal)
31
Q

Ulnar nerve: PE

A
  • Examine in open hand position
  • Ask to close hand with ulnar n. injury
  • PROXIMAL injury takes out flexor digitorum profundus m.
    • 2nd & 3rd digits will flex to close
    • 4th & 5th stay extended at MCP
    • Weakened lumbricals no abduction of fingers
  • DISTAL n ijury (at wrist)
32
Q

Compression of ____ nerve results in wrist drop

A

radial

-Saturday night or crutch palsy: time +/- steroids

33
Q

The ulnar nerve is injured in ____ _____ fractures

A

medial. epicondyle

- when Pt asked to flex fingers, they are weakened on 4,5

34
Q

slide 27-60

A

dd

35
Q

Danger of a septic joint:

A

-PE is not specific

36
Q

***Gunmetal gray lesions on the palm=

A

Disseminated Gonorrhea

–Tx: Ceftriaxone

37
Q

***Gunmetal gray lesions on the palm=

A

Disseminated Gonorrhea

–Tx: Ceftriaxone and aythromycin

38
Q

Septic joint: MC sites

A
  • typically knee, wrist and ankles
  • S. aureus and streptococci MC organisms

ABx early!– tx gram + cocci with vanco IV or beta lactase cefazolin

39
Q

Tools for dx of septic joint

A
  • joint aspirate with LACTATE levels–> when high lactate, this is a septic joint
  • use IV steroids
40
Q

Gonococcal arthritis is the MC cause of _____ _____ in young sexually active young adults

A

septic arthritis

41
Q

Gonococcal arthritis: Sx

A
  • large joints: Knee wrist and ankle, tenosynovitis +/- skin lesions typically on fingers
  • disseminated gonococcemia: one or more joint
  • fevers and joint pain 1-4 days
  • NOT AS destructive as septic arthritis, can do daily aspiration and antibiotics IV then switch to po
42
Q

Bursitis=

A

=inflammation of thin walled sac lined with synovial tissue bursa, OVERUSE injury also traumatic

  • prepatellar, olecrenon, suprapatellar, subdeltoid, trochanteric
  • Not much pain at rest, can have pain with motion
  • rest, nsaid, steroid injections
  • Bursal aspiration can be diagnostic and therapeutic: careful as it can be infectious such as cellulitis
  • –If you think a cellulitis with a bursitis: Infectious are skin flora S. aureus
  • -14 day outpatient is ok unless septic, pus, surrounding cellulitis
43
Q

Gout= altered _____ _____

A

purine metabolism

44
Q

Gout Labs and Sx

A
  • increased body pool of urate with hyperuricemia
  • uric acid (monosodium rate MSU) =gout=negative biofringence=needle shape
  • calcium pyrophosphate=pseudogout=rhomboid
  • middle age men
  • serum uric acid levels not useful for acute attacks as can be high or low ( inflammatory cytokines are uricosuric) but at some point are elevated and can be used to follow therapy
45
Q

How to confirm dx of gout?

A

aspirate the joint and send to lab to look for crystals

mcc : initial attack in in great toe (podagra)

46
Q

Typically gout has occurred ____

A

before,

  • pain is constant at rest
  • WBC count can be elevated
47
Q

Algorithm for Gout: (not using joint fluid)

A
  • male 2 points
  • previous attack 2 points
  • onset within one day .5 points
  • Joint redness 1 point
  • first metatarsal 2.5 points
  • htn or cardiovascular dz 1.5
  • serum urate greater than 5.88 3.5 points

low risk <4
intermediate 4-8
high risk >8

48
Q

Gout tx 1st line

A
  • NSAID 5-7 days
  • 1st Line: indomethacin, naproxen
  • 2nd prednisone PO or IV

-or colchicine- 0.6mg tid, potent anti-inflammatory agent can help prevent and abort attacks

49
Q

Osteomyelitis: bone infection generally caused by ____

A

staph aureus

  • usually due to acute open fx
  • can be due to hematogenous spread of bacteria or contiguous
  • -think DM Pts with foot ulcers
50
Q

Osteomyelitis in sickle cell. Pt is caused by which organism

A

salmonella

51
Q

Osteomyelitis: dx/tx

A
  • CBC, CRP are initial labs
  • get several blood cultures
  • Xray
  • MRI or bone scan is easiest way to dx
  • BONE BX is GOLD STANDARD

tx: IV ABX, consult with ID, acute 6-8 weeks, chronic= 4-24 months

52
Q

Upper body:
shoulder–> ____ nerve

arm–> ____ nerve

Forearm–> ___ nerve

A

axillary nerve, C5 (shoulder abduction)

arm= musculocutaneous nerve, C6 (biceps cant flex elbow)

Forearm= radial nerve, C7 (wrist and finger extension)

Wrist–> median nerve (C6-C8)

Hand: Ulnar T1 , median nerve= flexion of fingers

Digits: Palmar digital

53
Q

PE: Ulnar nerve

A
  • examine in open hand position
  • Ask them to close hand with Ulnar n. injury
  • Proximal injury takes out flexor digitorum profundus muscle
  • –the 2nd and 3rd digits will flex to close
  • –4th and 5th stay extended at mcp
  • -weakened lumbricals no abduction of fingers

-Distal n injury (at wrist) the 4,5th digits have some flexion as FDP is ok but hyperextended due to force of extensors and paralyzed 3 4th lumbricals, ulnar claw hand

54
Q

“claw hand” slide 28-60

A

ulnar nerve damage

Clin Med semester 2 (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions