Walden Flashcards
Wrist pain palpation Hx of falling, 2nd x-ray will show fx, hi risk necrosis and nonunion, - TX splint wrist refer to hand surgeon
Navicular fracture
Cast for wrist fractures (scaphoid bone in wrist),
Thumb Spica cast
Fracture of distal radius of the forearm, DINNER FORK fracture, most common type wrist fracture
Colles fracture
high energy trauma, ecchymosis and swelling, lower abdomen, hips, groin, scrotum, may have bladder or bowel incontinence, hematuria, may cause internal hemorrhage life threatening - TX check ABC’s
Pelvic fracture
Sudden onset of one side pain, elderly have one-year mortality rate,
Hip fracture
Tennis/golfers elbow, pharm TX =nsaids, anti-inflammatory cream, intraarticular corticosteroid injection, nonpharm TX= rest, ice, brace, physical therapy, referral- ortho, PT/OT
Lateral epicondylitis
Used to determine when a patient needs radiographs of injured ankle in ED, 1,2,3, Grades, 2 needs x-ray, 3 referrals to ER for ankle fracture
Ottawa rule (ankle)
Injury of overuse of the muscles tendons and bone tissue of the tibia, shin splints, pain of overuse of the large front bone in lower leg, - Dx bone scan or MRI, - TX RICE, stretching, massage, nsaids,
Medial tibial stress syndrome/fracture
Acute or recurrent pain, bottom of foot, aggravated by walking, caused by micro tears in the plantar fascia due to tightness of the Achilles tendon, elevated risk factors BMI>30, diabetes, aerobic exercise, pes planus (flat feet), prolonged standing – TX Nasid, orthotic foot appliance, ice pack, stretching with golf ball sole of feet, x-ray to rule out fracture
Plantar fasciitis
- TX brace, stretching arch support
Pes planus (flat feet)
crystal deposits in joints, elevated uric acid, caused by excess dietary purines (beef, pork, lamb, seafood, beer, bread, gravy, alcohol) - Dx gold standard is joint aspiration of synovial fluid Labs- uric acid level, CBC, ESR - TXNSAIDs Indocin), colchicine for flare up, corticosteroids Podagra means gout of the foot
Gout exacerbations
Occurs during growth spurt and affects superior tibia, when quadriceps exert stress on the patellar tendon (tibial tubercle), anterior knee pain increases over time
Osgood-Schlatter
Small round projection on bone or surface
Tubercle
Typical in osteoarthritis, enlargement of proximal interphalangeal joint
Bouchards node
inflammatory arthritis affecting spine and large joints, pain improves with exercise not rest, low grade fever, fatigue, marked loss of ROM, humpback, uveitis, - Dx labs sed rate, C reactive protein, spinal radiograph bamboo spine, - TX refer to rheumatologist, first line is NSAIDS, postural training
Ankylosing spondylitis (Bechterews disease)
medical emergency, spinal cord compression, B/B dysfunction, - TX refer to ED, needs decompression
Cauda equina syndrome
painful condition hurts the ball of your foot, between third and fourth toe, involves thickening of tissue around nerves leading to your toe, toe may sting, burn or feel numb, DX with clinical presentation and history, small nodule between third and fourth toe, linked to tight fitting shoes and high heels, - TX with corticosteroid or surgery, avoid tight shoes,
Morton’s neuroma
TX- Tylenol first line, nsaids- Celebrex, topical nsaids
Arthritis
cartilage covering surface of joints becomes damage from overuse, obesity, affects distal interphalangeal joints, early morning stiffness<15 minutes, swollen tender joints, ASYMMETRIC symptoms, Bouchards nodes (Proximal) and Heberden’s nodes (Distal) - DX physical exam or radiographs, - TX first line treatment is Tylenol, nsaids, steroidal injections only, no oral steroids, glucosamine sulfate supplement
Degenerative joint disease/OSTEOARTHRITIS
autoimmune disorder inflammation of multiple joints plan is to prevent the joint damage, presents with bilateral pain and swelling of proximal interphalangeal joinst, SYMMETRICAL DISTRUBUTION, signs of fatigue, low grade fever, body aches, myalgia, GENERALIZED joint pain, early morning stiffness >1 hour, weight loss, anorexia, neurophathic pain in the extremities or eyes, chest pain upon inspiration, warm and tender swollen fingers “sausage joints” - Dx intital test is sed rate, Creactive protein, CBC, rheumatoid factor, - TX refer to rheumatologist, surgery, NSAIDS, steroids, Humira Anti TNF biologics, antimalarial- Plaquenil, can cause uveitis
Rheumatoid arthritis Severe RA go swimming
Deterioration of bone tissue caused by hormonal changes, calcium vitamin d deficiency, risk factors- patients on PPI, patients with anorexia/bulimia females, family history, age; estrogen and testosterone deficiency, kyphosis, Caucasians and Orientals, small frame people, cigarette, alcohol, caffeine, medication- steroids anticonvulsants, thyroid supplements, eating disorder, sedentary life, - Dx bone mineral density >-2.5 osteoporosis - TX first line is bisphosphonates alendronate, Fosamax, calcium500 mg, vitamin d thru food and supplementation, testosterone, wt bearing exercise
Osteoporosis
increase calcium dark green vegetables, salmon, sardines, soy and OJ
Osteopenia
slippage of the overlying end of the femur (epiphysis).SCFE happen to teens who have specific stuff going on with their health, such as: obesity (carrying extra weight puts increased pressure on the growth plate) endocrine disorders like diabetes, thyroid disease, or growth hormone problems. kidney disease. - TX in situ fixation. This is the procedure used most often for patients with stable or mild SCFE. The doctor makes a small incision near the hip, then inserts a metal screw across the growth plate to maintain the position of the femoral head and prevent any further slippage. Non- wt bearing, referral to ortho for pinning
Slipped capital femoral epiphysis
Also known as metatarsus varus, is a common foot deformity noted at birth that causes the front half of the foot, or forefoot, to turn inward. TX teach parent to perform passive stretching into straighten position several times a day, serial casting every 1-2 weeks or surgery for correction
Metatarsus adductus- (pigeon toe)
Involve lower extremity and foot, TX brace, stretching, casting, surgery
Club foot- talipes equinovarus
Injury in 1-4-year-old, - TX reduction to put back in place, or device wearing splint
Nursemaids elbow
Inflammatory disorder causing muscle and joint pain and stiffness (shoulders/hips), aching stiffness about the upper arms, neck, lower back and thighs, symptoms develop quickly, and worse in the morning, - DX elevated sed rate, Creactive protein, 1st line - TX oral prednisone
Polymyalgia rheumatic
depression, dysrhythmias or anxiety disorders, malaise fatigue, multiple joint pain, headaches, impaired memory, and concentration, sore throat, restless sleep, muscular pain for 3 months, - DX - TX cognitive based therapy CBT.
Fibromyalgia/chronic fatigue syndrome
Arthritis that causes inflammation, pain, and stiffness, mainly in the spinal joints.
Ankylosing spondylitis (AS)
Involves joints and arteries. It is associated with a high risk of giant cell arteritis (GCA) or temporal arteritis (15%-30%). New onset of vision loss and the location of the pain (neck, both shoulders/hips)
Polymyalgia rheumatica (PMR)
Enlargement of the middle joint of a finger
Bouchard’s node
(bony overgrowths) are classic signs of OA
Heberden’s nodes
A diagnostic test for carpal tunnel syndrome
Phalen test
