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Clin Med II - Exam 2 > Ross - General Ortho > Flashcards

Ross - General Ortho Flashcards

1
Q

name 7 components of ortho ER hx

A
  1. numbness/weakness
  2. MOI
  3. snap/crackle/pop?
  4. r or l handed
  5. previous injury
  6. tetanus
  7. last meal (if acute)
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2
Q

what 3 components should you base “neurovascular intact (NVI)” on

A
  1. pulses
  2. color of extremity
  3. sensory and motor peripheral nerve fxn
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3
Q

in acute ortho injury, what is the 2nd step after ABCs

A

assess neurovascular status

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4
Q

when should you document neurovascular status

A

before AND after any manipulation → ex even just a sling

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5
Q

what are 4 pe signs of bone fx

A
  1. crepitus
  2. false motion
  3. exposed fragments
  4. pain
  5. locked joints
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6
Q

what does blood on clothing suggest

A

open fx

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7
Q

what does pain out of proportion suggest

A

compartment syndrome

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8
Q

what does an elderly pt w. hip pain and a neg film suggest

A

occult hip fx

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9
Q

what imaging should you order for previous pt

A

MRI

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10
Q

what injury does a jump from a height suggest

A

calcaneous fx w. vertebral body compression

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11
Q

what does an elderly pt w. hx malignancy and mechanism that doesn’t fit suggest

A

pathologic fx

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12
Q

what does a grossly deformed extremity in field, now normal suggest

A

dislocation reduced in field

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13
Q

what is a do not miss in the previous pt

A

vascular injury!

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14
Q

what is a major concern in this fx

A

femoral fx → concern for severing of popliteal artery

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15
Q

bones heal by

A

callus formation

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16
Q

what are the 3 stages of callus formation

A
  1. inflammatory
  2. ossification
  3. remodeling
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17
Q

in acute ortho injury __ first

then order __

A

examine

xray

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18
Q

what is the second most common reason for medical law suit

A

missed fracture

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19
Q

tx for open fractures is always

A

operating room

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20
Q

what type of fx is this and what pt population does it affect

A

greenstick

peds

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21
Q

what type of fx

A

spiral

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22
Q

what type of fx

A

comminuted

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23
Q

what type of fx

A

transverse

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24
Q

what type of fx

A

compound

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25
Q

how many hours until a limb is dead in vascular injury

A

6 hours

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26
Q

where should you check the pulse for an acute fx

A

distal to fx

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27
Q

what are the peripheral nerves of upper extremity

A

MARMU → median, axillary, radial, musculocutaneous, ulnar

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28
Q

what are the peripheral nerves of the lower extremity

A

I2GOLF

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29
Q

what is the only nerve that goes to the distal end of the phalanges

A

flexor digitorum profundus

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30
Q

what type of fx

A

supracondylar

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31
Q

what nerve is damaged

A

median

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32
Q

what nerve is injured

A

ulnar n

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33
Q

signs of a median n injury (3)

A
  1. weak pronation of forearm
  2. weak flexion and radial deviation of wrist
  3. thenar atrophy and inability to oppose or flex thumb
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34
Q

is it ok to give narcotics to a fx pt?

A

yes

35
Q

what do you need to do before ordering xray in female

A

pregnancy test

36
Q

what does tdt stand for

A

tetanus diptheria

37
Q

does this need immediate ortho consult

A

yes! still an open fx

38
Q

what is abx of choice for open fx

A
  1. cefazolin 1-2 g IV q8 → wt based dosing
  2. pen allergy: clindamycin 600 mg IV
39
Q

where do splint in hand fx

A

one joint above fx

40
Q

closed and angulated fx needs

A

reduction

41
Q

you should splint a pt in what position

A

anatomical

42
Q

what are 4 post fx complications

A
  1. non-healing
  2. neurological dysfxn → sympathetic dysreflexia
  3. loss of fxn
  4. avascular necrosis
43
Q

what 2 bones are highest risk for avascular necrosis

A

scaphoid

femur

44
Q

what are 3 causes for compartment syndrome

A
  1. overuse w. edema
  2. crush
  3. fracture
45
Q

what is mc location for compartment syndrome

A

ant leg

46
Q

what part of leg is often missed in compartment syndrome

A

deep posterior

47
Q

where is flexor compartment syndrome

A

volar forearm

volkmann’s contracture

48
Q

what pediatric fx is prone to compartment syndrome

A

supracondylar

49
Q

for compartment syndrome raise extremity, but not

A

above the heart

50
Q

tx for compartment syndrome w. pressure btw 10-20

A

admit → watch

51
Q

tx for compartment syndrome btw 10-20

A

emergent fasciotomy

52
Q

painful joint, swelling + fever makes you think

A

septic joint until proven otherwise!

53
Q

what should you do if you see blood in joint aspirate

A

advanced imaging

54
Q

reactive arthritis

RA

SLE

are

A

monoarticular

55
Q

lyme dz and gonococcal dz are

A

migratory

56
Q

septic arthritis and crystal induced arthritis are

A

monoarticular

57
Q

usually w. septic joint there is a hx of

A

penetrating trauma (may be minor)

58
Q

what should you do BEFORE you tap a joint

A

xray! → then aspirate

59
Q

what is gold standard to r.o septic joint

A

arthrocentesis

60
Q

is a peripheral cbc helpful in a painful joint

A

no!

61
Q

what labs may helpful in painful joint

A

CRP

sed rate

→ but limitied → no parameters for values for septic joint

-

62
Q

what will arthrocentesis look like for OA

A

yellow

clear

WCC: 700

PMN: 15%

crystals: none
bacteria: none

63
Q

what does arthrocentesis report look like for traumatic arthritis

A

color: straw
clarity: cloudy

WCC: 100

PMN: 25%

crystals: none
bacteria: none

64
Q

septic joint clues (5)

A

pain out of proportion

pain w. passive/active ROM

limited ROM

pain at rest

elevated WBC in aspirate

65
Q

at risk for septic joint (4)

A
  1. elderly
  2. DM
  3. IVDU
  4. prosthetic joint
66
Q

mc locations for septic joint (3)

A

knee

wrist

ankles

67
Q

mc organisms in septic joint

A

s. aureus

streptococci

68
Q

early abx for septic joint

A

vancomycin

OR

cefazolin

69
Q

mc cause of septic arthritis in young sexually active adults

A

gonococcal arthritis

70
Q

mc locations for gonococcal arthritis

A

large joints:

knee

wrist

ankle

71
Q

what are these called

what condition

what tx

A

gun metal gray lesions

disseminated gonorrhea

ceftriaxone 250 mg im + single dose arythromycin 1 gm po

72
Q

when would you xray a pt w. bursitis

A

if trauma is involved

73
Q

no pain w. radiation means this is unlikely

A

septic joint

74
Q

are serum uric aid levels useful for ACUTE attacks of gout

A

no!

just for chronic

75
Q

how do you confirm dx of acute gout attack

A

joint aspiration

76
Q

what is podagra

A

mc location for acute gout attack → great toe

77
Q

what med is preventive and abortive for gout

A

colchicine

78
Q

does allopurinol help w. acute gout attack

A

no!

prophylactic only

79
Q

mc pathogen in osteomyelitis in pt w. scc

A

salmonella

80
Q

mc cause of osteomyelitis in ivdu pt

A

pseudomonas

81
Q

mc cause of osteomyelitis overall

A

s. aureus

82
Q

what is gs to diagnose osteomyelitis

A

MRI → said in lecture

bone bx → on slide

83
Q

initial abx tx for osteomyelitis

A

3rd gen cephalosporin

84
Q

the lower the number in a likelihood ratio,

A

the more helpful

Clin Med II - Exam 2 (14 decks)

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