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

Ross - General Ortho Flashcards

1
Q

what are h&p and pe red flags for acute ortho injury (6)

A

blood on clothing

pain out of proportion

elderly pt w. hip pain

jumping from height

elderly, hx of malignancy,

grossly deformed extremity

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2
Q

what might blood on clothing suggest

A

open fx

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3
Q

what might pain out of proportion suggest

A

compartment syndrome

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4
Q

what might an elderly pt w. hip pain and a negative film suggest

A

occult hip fx → needs CT, MRI, or DEXA

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5
Q

what might hx of jumping from a height suggest

A

calcaneous fx w. vertebral body compression

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6
Q

what might an elderly pt w. hx of malignancy/mechanism doesn’t fit suggest

A

pathologic fx

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7
Q

what might a grossly deformed extremity in the field that is now normal suggest

A

dislocation reduced in field → think vascular injury

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8
Q

you must always check and document vascular and neuro assessment for all injuries __

A

before AND after splint is placed

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9
Q

what does SLIPPS stand for

A

nerves of sacral plexus

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10
Q

what are the nerve roots of the sacral plexus

A

S1 - S4

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11
Q

what are the nerves of the sacral plexus

A

superior gluteal n

lumbosarcral trunk

inferior gluteal n

posterior femoral cutaneous n

pudendal n

sciatic n

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12
Q

how do you manage open fx (5)

A
  1. first gen cephalo
  2. splint
  3. ortho consult
  4. remove any gross contamination
  5. xrays
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13
Q

what should you avoid in open fx

A

probing open wound

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14
Q

why don’t we place casts in ER

A

swelling in first 24 hr of injury

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15
Q

how do you describe a fx (7)

A

closed vs open

location

orientation fx line

displacement

angulation

shortening

dislocation/subluxation

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16
Q

example of fx description

A

closed fx of the distal tibia

that is __

with __ displacement

with no angulation or shortening

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17
Q

how do you manage angulated and/or dislocations

A

reduction

spint

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18
Q

any vascular or neuro compromise and you must

A

consult ortho ASAP

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19
Q

name 4 complications of fx’s

A

non-healing bones

necrosis

loss of fxn

pain

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20
Q

what are the 3 stages of bone healing

A

inflammation

reparative

remodeling

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21
Q

what is sympathetic dysreflexia

A

rare complication of fx → chronic intense pain, pallor, dysfxn of extremity

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22
Q

what bones are high risk for sympathetic dysreflexia

A

scaphoid

femoral head

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23
Q

what is the cardinal symptom of compartment syndrome

A

pain

pain

pain

pain

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24
Q

pain is worse w. __ in compartment syndrome

A

passive movement

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25
Q

what injuries are prone to compartment syndrome

A

fx

crush

burns

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26
Q

2 mc locations for compartment syndrome

A

anterior compartment

forear,

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27
Q

what peds fx is at risk for compartment syndrome

A

supracondylar fx

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28
Q

how do you dx compartment syndrome

A

stryker device

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29
Q

what is nl for stryker test

A

< 20 mmHg

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30
Q

if stryker shows > 20 mmHg, you need to consider

A

fasciotomy

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31
Q

when evaluating joint pain, consider

A

infectious cause

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32
Q

what might be on your differential for joint pain

A

other inflammatory → ex gout

fx

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33
Q

what are rf for septic joint

A

DM

age > 80

recent joint surgery

prosthetics

prior joint infxn

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34
Q

pe of septic joints will show pain with __

and __

and __

A

passive movement

AND

active motion

AND

pain at rest

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35
Q

mc pathogens in septic joints

A

staph aureus

streptococci

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36
Q

what pt population is a concern for septic arthritis dt neisseria gonococcus

A

young, sexually active

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37
Q

what is a sign of a gonococcal septic joint

A

gunmetal gray lesions on hands

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38
Q

work up for first presentation of joint pain

A
  1. xray
  2. joint fluid aspiration
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39
Q

what labs do you order for joint aspiration

A

cbc

gram stain

lactate

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40
Q

total wbc count in septic joint

A

60,000

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41
Q

will wbc be high in infectious AND inflammatory joint conditions

A

yes

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42
Q

if wbc is around 60k in joint aspiration what must you do

A

order same day ortho consult

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43
Q

gout is often __

and ___,

gonorrhea is __

A

gout: monoarticular, recurrent
gonorrhea: ologoartigular (migratory)

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44
Q

lyme dz involves a __ arthritis

A

migratory

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45
Q

what are the 2 types of compounds that form in synovial fluid of joint or bursae

A

uric acid

calcium pyrophosphate

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46
Q

uric acid gout is also called

A

MSU (monosodium urate)

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47
Q

MSU gout has a __ appearance on aspiration

A

negatively birefringent needle shaped uric acid crystals

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48
Q

what lab value is unhelpful in acute gout attacks

A

serum uric acid levels

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49
Q

algorithm for gout - not using joint fluid

A

male

previous attack

onset w.in one day

joint redness

first metatarsal involvement

htn or cvd

serum urate > 5.88

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50
Q

what is low risk for the gout algorithm

A

< 4

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51
Q

what is intermediate risk for the gout algorithm

A

4-8

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52
Q

what is high risk for the gout algorithm

A

>8

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53
Q

tx for acute gout attack

A
  1. anti-inflammatories
  2. allopurinol, probenecid
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54
Q

how does allopurinol work

A

inhibits formation of uric acid

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55
Q

how does probenecid work

A

eliminates uric acid in urine

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56
Q

when is allopurinol used

A

when uric acid levels are high

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57
Q

when is probenecid used

A

when uric acid levels are normal

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58
Q

bursitis is an __ cause of joint pain

A

inflammatory

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59
Q

what are pe findings of bursitis

A

distinct area of erythema

minimal pain

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60
Q

when does a clavicle fx need an asap ortho consult

A

depressed fx

skin tenting

proximal

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61
Q

in a clavicle fx, make sure to test

A

terminal branches of brachial plexus → esp axillary motor and sensory

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62
Q

for shoulder dislocations, evaluate the position of

A

humeral head in glenoid fossa

63
Q

pt w. clavicle fx may have hand held in

A

adduction and internal rotation

64
Q

what xray view shows you location of the humeral head

A

y view

65
Q

what is a hill-sachs fx

A

compression fx or “dent” of posterosuperolateral humeal head after anterior dislocation

66
Q

what tests evaluate rotator cuff tear

A

neer

empty can

67
Q

what injury do you think when a pt c.o pain that wakes them up at night and pain w. abduction

A

supraspinatus tear

68
Q

tx for supraspinatus tear

A
  1. PT
  2. +/- surgery
69
Q

what injury causes anterior shoulder pain similar to rotator cuff tear

A

bicipital tendonitis

70
Q

what might a positive yeargason test suggest

A

bicipital tendonitis

71
Q

what test involves arm at the side, then flexion of elbow to 90 degrees, then flexion of forearm against resistant

A

yeargason

72
Q

what injury involves radial head subluxation

A

nursemaid’s elbow

73
Q

tx for nursemaid’s elbow

A

no xray

arm held in slight flexion and pronation → reduce

74
Q

humeral shaft fx is concerning for what n damage

A

radial

75
Q

supracondylar fx is concern for what n injury

A

ulnar

76
Q

what is a monteggia fx

A

midshaft ulna fx and radial head dislocation

77
Q

what fx is this

A

monteggia → midshaft ulna fx and radial head dislocation

78
Q

what is a galeazzi fx

A

radius fx w. ulnar dislocation at wrist

79
Q

what fx is this

A

galeazzi

80
Q

supracondylar/medial condyle fx are concerning for injury to what nerves

A

ulnar

median

81
Q

what is tenodesis

A

surgical procedure to tx injuries to biceps tendon in the shoulder

82
Q

what is the allen test used for

A

vascular/motor and sensory testing of median, ulnar, radial nerves

83
Q

what is fds testing

A

flexor digitorum profundus testing

84
Q

fds testing needs to be used in

A

any potential flexor tendon injury

85
Q

tx for flexor tendon injury

A

urgent repair

possible hand surgeon

86
Q

which are more vital to hand fxn, flexor or extensor

A

flexor

87
Q

in any trauma to the wrist, you need to evaluate the

A

anatomic snuff box

88
Q

tender anatomic snuff box should make you consider

A

scaphoid fx

89
Q

tx for wrist injury

A

spica splint

90
Q

flexor tenosynovitis is a __ injury

A

do not miss

91
Q

when would you use kanaval’s signs

A

to evaluate flexor tenosynovitis

92
Q

what injury is jersey finger

A

hyperextension → rupture of fdp

93
Q

what is skier’s thumb

A

ulnar collateral ligament tear → radial deviation of thumb

94
Q

what is a boxer’s fx

A

fx of 4th and 5th metacarpals

95
Q

what is a “fight bite”

A

human bite wound

96
Q

what must be considered in bite wounds

A

hidden tendon tears

97
Q

abx tx for bite wounds

A

augmentin if no pcn allergy

98
Q

abx tx for bite wounds

A

augmentin if no pcn allergy

99
Q

aseptic necrosis most commonly affects __ aged populations,

they often complain of __ pain

A

middle aged

dull, throbbing

100
Q

rf for aseptic necrosis include (3)

A

chronic steroids

etoh

SSA

101
Q

tx for aseptic necrosis

A
  1. ct or xray
  2. non weight bearing
  3. ortho
102
Q

tx for pelvic fx

A
  1. exsanguinate (drain) for small vessel bleeding
  2. traction splint to compress pelvis
103
Q

hip fractures may present w. __ pain

A

groin

104
Q

pe for hip fx will show

A

short, abducted and externally rotated leg

105
Q

what should you do for an elderly pt who c.o of hip pain but has negative xray

A

keep imaging till you find something

106
Q

what is shenton’s line and when should it be evaluated

A

obturator foramen to underneath femoral head

hip fx

107
Q

hip dislocations are high risk for __

and should be __ early

A

avascular necrosis

reduced

108
Q

mc hip dislocation

A

posterior

109
Q

ottowa criteria is used to decide

A

who does NOT need imaging

110
Q

if a pt meets none of the ottawa criteria,

A

fx risk is low → you do NOT need to xray

111
Q

if pt does not meet ottawa criteria you should

A

evaluate pt

then make final decision

112
Q

acl injury is caused by

A

direct blow to the knee → person changing direction

113
Q

what test is used to evaluate acl

A

anterior drawer

114
Q

in acl injury, a pt might say they heard a __

and pe will show __

A

pop

immediate pain/swelling

115
Q

pcl injuries are caused by

A

hyperextension

116
Q

test to evaluate pcl

A

posterior drawer

117
Q

in a pcl injury, a pt might say they heard a __

and pe will show __

A

pop

immediate pain/swelling

118
Q

mcl injury is caused by

A

direct blow to the lateral knee

119
Q

what test evaluates mcl

A

valgus → laxity

120
Q

lcl injuries are concerning for damage to what n

A

peroneal

121
Q

peroneal n damage will manifest as

A

foot weakness w. dorsiflexion and eversion

122
Q

pt w. an mcl injury can probably __ after injury

because it takes __ days for swelling to occur

A

ambulate

2-3

123
Q

pe of mcl injury will show __

and __ of the joint

A

clicking and locking

124
Q

what tests are used to evaluate mcl injury

A

mcmurry’s

apley’s

125
Q

what are the ottawa criteria for ankle pain

A
  1. pain at medial malleolus radiating 6cm → xray
  2. pain at lateral malleolus radiating 6cm → xray
  3. inability to walk → xray
126
Q

what is the ottawa foot criteria

A

pain at navicular → xray

pain at base of 5th metatarsal → xray

127
Q

how many xray views do you need to evaluate ankle/foot fx

A

3

128
Q

what are the 3 views for foot/ankle fx

A

AP

lateral

mortisse

129
Q

what view is this

A

mortisse

130
Q

what is the mnemonic for SALTR fx

A

slipped →

above

lower

131
Q

the rest of SALTR mnemonic

A

through

ruined

132
Q

ankle sprains are graded __

through __

A

1-4

133
Q

grade 1 ankle fx

A

no ligament tear

no limitation

134
Q

grade 2 ankle fx

A

some torn ligaments

some functional limits

135
Q

grade 3 ankle fx

A

significant swelling/pain

laxity of joint

136
Q

which grade fx should be non wt bearing

A

3 and 4

137
Q

unstable ankle fx’s have wide __ involvement and

need __ emergently

A

mortisse

ortho consult

138
Q

for tx of amputations, you should clean amputated part w.

A

normal saline!

139
Q

after ns rinse, place amputated part in sterile container and

A

float on ice

140
Q

4 indications for re-implantation

A

multiple fingers

thumb

single finger in kids

clean amputation at wrist, distal forearm, hand

141
Q

contraindications for re-implantation

A

crushed, avulsed, dirty wounds

single finger in adults

multilevel injury

142
Q

what fx’s are unique to peds

A

buckle

greenstick

143
Q

what is nursemaid’s elbow

A

radius dislocation

annular ligament

144
Q

what are you thinking if a child aged 2-12 is limping

A

transient synovitis

145
Q

what are you thinking if a male child aged 5-9 is limping

A

idiopathic avascular necrosis

146
Q

what are you thinking if an overweight, male child aged 10-16 is limping and complaining of groin pain

A

SCFE

147
Q

what is a SCFE injury

A

slipped capital femoral epiphysis → assymetry of femoral neck

148
Q

what are scfe injuries concerning for

A

damage to growth plate

149
Q

what does the iced cream sign make you think of

A

scfe

150
Q

how do you diagnose septic arthritis

A

us

151
Q

how do you dx idiopathic avascular necrosis

A

mri

152
Q

what is the ice cream sign

A
153
Q

what is this xray showing and what condition does it suggest

A

ice cream sign

scfe

Clin Med II - Exam 2 (14 decks)

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