Subspecialty Flashcards
Avulsion
flap of skin
abrasion
superficial loss of dermis with lower components intact
What imaging is done for a fracture?
two X-rays perpendicular to each other
What are treatment options for fracture?
- Open reduction internal fixation: if fracture is open, angular, or comminuted
- casting if fracture is closed and approximated
- Open fracture means emergency washout
What can cause anteiror dislocation of shoulder?
any trauma (FOOSH, anteiror trauma)
What is the appearance of an anterior shoulder dislocation?
Abduction externally “shaking hands”
What nerve damage can occur in anterior shoulder dislocation?
- axillary artery and axillary nerve (C5,C6)(37%) results in a weakened or paralyzed deltoid muscle and as the deltoid atrophies unilaterally, the normal rounded contour of the shoulder is lost. difficulty abducting greater than 15 degrees.
- suprascapular nerve (29%)
- radial nerve (22%)
What can cause a posterior shoulder dislocation?
Massive trauma: seizures, lightning, electric shock
what is the appearance of a posterior shoulder dislocation?
Adducted and internally rotated, like arm is hurt. anterior shoulder is flattened with prominent coracoid process.
Imaging for dislocated shoulder?
X-ray
Treatment for anterior/posterior shoulder dislocaitons?
Relocate, sling. X-ray can confirm reduction
What is a Colle’s fracture?
-a fracture of the distal radius in the forearm with dorsal (posterior) and radial displacement of the wrist and hand
Who typically gets Colle’s fractures?
Old woman with osetoporosis who falls
Management for Colle’s?
X-ray, treat
What is a Monetggia fracture?
- fracture of the proximal third of the ulna with dislocation of the head of the radius.
- Caused by fall on outstretch arm or a blow to outer arm (upward block)
- open reduction internal fixation is typically performed
What is a Galeazzi fracture?
- a fracture of the radius with dislocation of the distal radioulnar joint.
- “downward block”
susepcted scaphoid fracture management
X-ray, cast regardless, x-ray again in 7-10 days
Boxer’s fx
Punch against wall, fourth, fifth digits break
If the knee hurts and is not swollen, it’s probably the _____
hip (referred pain)
Hip fracture characteristics
- Lots of trauma
- Leg is shortened an externally rotated
Hip fracture management for varying locations
-Femoral head = prosthesis (poor vascular supply)
-Intratrochanteric fx = plates
-shaft = rods
open = emergency washout with traction to stop bones form sliding against each other
posterior knee trauma
ACL tear with anteiror drawer sign
Anterior knee trauma
PCL with posteiror drawer sign
Cruciate ligamaent tear management
MRI
Surgery (athletes)
Casting (everybody else)
Valgus stress causes what tear?
vaLgus - Lateral - MCL tear
Vargus stress causes
medial - LCL tear
MCL/LCL management
MRI
Surgery (athletes)
Hinge cast
Meniscus signs
Knee pain and a click on extension
Meniscus management
MRI, arthroscopic surgery to remove torn portion.
Stress fx managmeent
Weekend warriors
X-ray:
Normal: cast anyway, redo in a few days. Crutches.
An ankle patient in ortho doesnt need n x-ray if ________
they can walk on it
Who gets carpal tunnel most often?
Those with hypothyroidism and diabetes
What is the pathology of Carpel tunnel syndrome?
Compression of median nerve, inflammatory
What is the progression of Carpel tunnel?
Pain ->parasthesias->paralysis of first three digits
Phalen test
Carpel tunnel: flexion of both hands
Tinel’s test
Carpel tunnel: tap median nerve
What is a high yeild physical exam finding for carpel tunnel?
Thenar atrophy
Diagnosis of Carpel tunnel
EMG: decreased conduction through the median nerve.
An electromyograph detects the electric potential generated by muscle cellswhen these cells are electrically or neurologically activated.
Carpel Tunnel Treatment
- Splinting _ NSAIDs
- Steroids
- Surgery
f/u: RA assessment
Jersey finger
- Tearing of flexor tendon when grabbing jersey
- patient cannot flex digit
- Clinical diagnosis
- Standard treatment
Mallet finger
Tearing of extensor tendon
- Cannot extend digit
- Clinical diagnosis
- Standard treatment
Trigger finger
- Stenosing tensynovitus of extensor
- cannot extend, when they do there is a pop
- treatment: standard
Dequervains tensynovitis
- Path: tendonitis of the tendons of extensor pollicis brevis and abductor pollicis longus muscles. CHRNOIC DEGENERATIVE, not inflammation.
- Seen in mother holding a baby or man doing overhead lifts.
- diagnosis: you know
- Tx: NSAIDs, splinting, No surgery
Who does Dupuytren’s occur in typcially?
Alcoholics and scandinavian men
What are the characteristics of Dupuytren’s
Fascia balls up in hand, causes inability to extend fingers, they are clawed.
findings:
-cannot extend fingers
-fascial nodules
Treatment: surgical, no NSAIDs (not inflammatory)
Felon
- Abscess of pulp of finger
- Pain, penetrating injury, fever, leukocytosis
- Dx: clinical
- Tx: I+D
In what age does developmental dysplasia of the hip occur?
Newborn
What is the PE finding of Developmental dysplasia of the hip?
Clicky hip
What is Tx for Developmental dysplasia of the hip?
Harness
In what age does Legg-Calve-Perthe disease occur?
6
What are the H&P/PE findings of Legg-Calve-Perthe disease?
- Insidious onset
- antalagic gait
What is Dx for Legg-Calve-Perthe disease?
X-ray
What is Tx for Legg-Calve-Perthe disease?
Cast
What is age of slipped-capital femoral epiphysis?
13
What are findings for slipped-capital femoral epiphysis??
Fat kid
Growth spurt
nontraumatic
knee pain
What is Dx for slipped-capital femoral epiphysis?
Frog-leg X-ray
What is Tx for slipped-capital femoral epiphysis?
Surgery
What age does septic hip occur in?
any age
What are findings for septic hip
Fever+joint pain
What is diagnosis for spetic hip?
Arthrocentesis
What is treatment for septic hip?
I&D
What is the typcial presentation of Osgood-schlatter disease?
Teenage athlete
Knee pain+swelling
What is the diagnosis of Osgood-schlatter disease?
clinical
What is the Tx of Osgood-schlatter disease?
- Work through it which could result in palpable nodule that does not go away
- Cast + rest, which is curative
Scoliosis is usually on the _______ side
right
What is scoliosis?
Deformity of spine
What patient is scoliosis seen in?
Teenage girl
moderate: cosmetic
Severe: SOB
What is the Diagnosis for scoliosis?
- Adam’s (she bends forward, look at back)
- X-ray
What is Tx for scoliosis?
Brace
Ewing sarcoma is translocation of ______
11,22 (11+22 was patrick ewings jersey)
Ewing sarcoma locaiton
midshaft
Appearance of Ewing’s on X-ray?
-onion skinning
Osteosarcoma is associated with what gene?
retinoblastoma gene (people who had an eye taken out as a child)
Osteosarcoma x-ray appearance?
sunburst
Presentation of bone tumors
Bone pain, atraumatic focal pain with no other symptoms
Diagnosis of bone tumors
- X-ray
- MRI
- Biopsy
Tx of bone tumors
Resection
what do you do for a fracture in kids that involves the growth plate?
Open reduction with internal fixation (no involvement is standard care)
Aortic stenosis murmur
- Systolic crescendo-decrescendo murmur
- left sternal border
Mitral regurgitation murmur
- holosystolic
- occludes S1 and S2
- cardiac apex radiate to axilla
Aortic insufficiency murmur
- High pitched, blowing
- decrescendo
- diastole at 4th intervostal space left sternal border
Mitral stenosis murmur
rumbling diastolic murmur with OPENING SNAP
Atrial myxoma murmur
-An atrial myxoma may create an extra heart sound, audible to auscultation just after S2 It is most seen on echocardiography
Elderly, dehydrated post-op patient with fever, leukocytosis, and parotid inflammation has….
- acute bacterial parotitis
- Staph aureus most ocmmon cause
- prevented by adequate hydration and oral hygiene
What is suggested by terminal hematuria?
- prostate bleeding
- with clots, suggests urothelial cancer
urothelial cancer risk factors
- Age >40
- Smoke!
- Male sex
What do you evaluate urothelial cancer with?
Cystoscopy
Old Asian with bleeding from nose and EBV history
Nasopharyngeal carcinoma (NPC)
Nasopharyngeal carcinoma
- recurrent otitis media, epistaxis, nasal obstruction, asian, old, smoking, nitrosamine consumption (fish) EBV
- Track with EBV titer levels
Whistling in nose after rhinoplasty
nasal septal perforation
Causative organism of prosthetic joint infection
Staph aureus or pseudmonas in first 3 months (late is propionibacterium or coagulase negative staph like epididermis after 3 months)
PEEP is used for what?
Increase oxygenation
What do you do to a bleeding lung after stabilization?
CT +/- bronchoscopy
Cusingoid features + hypotension
Adrenal insufficiency from chronic cortisol suppresion
Treatment for adrenal crisis
hydrocortosone or dexamethasone with aggressive fluid support
diaphragmatic rupture after trauma management
X-ray -> CT+/- bronchoscopy
most effective postop pneumonia prophylaxis
incentive spirometry
What do you suspect in patient with reperfusion surgery?
Compartment syndrome (reperfusion syndrome) -Pain out of proportion to injury -PAIN INCREASE ON PASSIVE STRETCH -Rapidly increasing and tense swelling Parasthesia (early)
Difference between arterial embolus and arterial thrombosis
embolus is sudden, thrombosis is slow
Bilateral lower extremity edema and stasis dermatitis
Venous hypertension
AAA repair colonic complication?
Ischemia of the bowel
Fast MVA trauma increases risk for
aortic injury
