FM > Week 1 > Flashcards
Week 1 Flashcards
Nerve root inpingment syndromes
Heel and toe walk nerve locations
Rubella vacination pregnancy
Influenza vacination schedual
Lung cancer screening
Surgery after Coronary artery re-vascularization
MSCT tests
Pre-op history of CAD
Alternative medicine
St Jhon wart MOA
Echinacea
Glucosamine
Fish Oil
Death rattle treatment
squamous cell carcinoma in gay men
Slipped capital femoral epiphysis (SCFE
Slipped capital femoral epiphysis (SCFE) occurs most commonly during the adolescent growth spurt
(11–13 years of age for girls, 13–15 years of age for boys). While the cause is unknown, associated factors
include anatomic variables such as femoral retroversion or steeper inclination of the proximal femoral
physis, in addition to being overweight. African-Americans are affected more commonly as well.
The patient may present with pain in the groin or anterior thigh, but also may present with pain referred
to the knee. That is also the case for Legg-Calvé-Perthes disease, also known as avascular or aseptic
necrosis of the femoral head. This condition most commonly occurs in boys 4–8 years of age. In addition
to hip (or knee) pain, limping is a prominent feature.
Upper thigh numbness in an adolescent female is a classic symptom of meralgia paresthetica, which is
attributed to impingement of the lateral femoral cutaneous nerve in the groin, often associated with obesity
or wearing clothing that is too tight in the waist or groin. Developmental dysplasia of the hip is identified
by a click during a provocative hip examination of the newborn, using both the Barlow and Ortolani
maneuvers to detect subluxation or dislocation.
hip labral tear
This patient has signs and symptoms of a hip labral tear. This causes dull or sharp groin pain, which in
some patients radiates to the lateral hip, anterior thigh, or buttock. The pain usually has an insidious onset,
but occasionally begins acutely after a traumatic event. Half of patients also have mechanical symptoms,
such as catching or painful clicking with activity. The FADIR and FABER tests are effective for detecting
intra-articular pathology (the sensitivity is 75%–96% for the FADIR test and 88% for the FABER test),
although neither test has high specificity. Magnetic resonance arthrography is considered the diagnostic
test of choice for labral tears, as it has a sensitivity of 90% and an accuracy of 91%. However, if a labral
tear is not suspected, less invasive imaging modalities such as plain radiography and conventional MRI
should be used first to assess for other causes of hip and groin pain.
This patient has no history of trauma or risk factors to suggest a fracture. A femoral hernia would typically
present as pain that is worse with straining or lifting, associated with a palpable bulge in the upper thigh.
Trochanteric bursitis typically causes lateral hip pain with point tenderness over the greater trochanter of
the femur.
Elbow injuries
This patient has injured his ulnar collateral ligament (UCL). The UCL is the primary restraint to valgus
stress on the elbow during overhead throwing. These injuries often occur in athletes participating in sports
that require overhead throwing, such as baseball, javelin, and volleyball. Patients often report a pop
followed by immediate pain and bruising around the medial elbow. The moving valgus stress test has 100%
sensitivity and 75% specificity for diagnosing UCL injuries.
Medial epicondylitis usually presents with an insidious onset of pain related to a recent increase in
occupational or recreational activities. Patients also often report weakened grip strength. The point of
maximal tenderness is 5–10 mm distal to and anterior to the medial epicondyle. It is most often a
tendinopathy of the flexor carpi radialis and the pronator teres.
Biceps tendinopathy usually presents with a history of vague anterior elbow pain and a history of repeated
elbow flexion with forearm supination and pronation, such as dumbbell curls. Resisted supination produces
pain deep in the antecubital fossa.
Cubital tunnel syndrome is a neuropathy of the ulnar nerve caused by compression or traction as it passes
through the cubital tunnel of the medial elbow. The onset of pain is more insidious than UCL injury,
occurring with repetitive activity, and is usually accompanied by numbness and tingling in the ulnar border
of the forearm and hand. If it has existed for some time, the intrinsic hand muscle may become weak.
Tendinopathy of the triceps insertion is more common in weight lifters or athletes who repetitively extend
their elbows against resistance. Pain occurs at the posterior elbow with resisted extension, and tenderness
is located over the triceps insertion.
reducing a lateral patellar dislocation
It is usually simple to reduce a lateral patellar dislocation, and these injuries rarely require acute surgical
management. The proper technique is to have the patient sit or lie with the leg in a flexed position and then
apply gentle medial pressure to the patella until the most lateral edge is over the femoral condyle. The leg
should then be gently extended and the knee brought into full extension. This should cause the patella to
slip back into place, and the knee should then be immobilized
Opioid-induced hyperalgesia
Opioid-induced hyperalgesia is characterized by a paradoxical increase in sensitivity to pain despite an
increase in the opioid dosage. It is seen in patients who are receiving high doses of parenteral opioids such
as morphine. Patients report the development of diffuse pain away from the site of the original pain.
Allodynia, a perception of pain in the absence of a painful stimulus, is also typical in opioid-induced
hyperalgesia. Strategies to manage this condition include reducing the current opioid dosage, and
occasionally eliminating the current opioid and starting another opioid. The addition of non-opioid pain
medications should also be considered. The addition of an anxiolytic is not likely to improve this patient’s
pain (SOR C).
Gilbert’s syndrome
Gilbert’s syndrome is a hereditary condition associated with unconjugated hyperbilirubinemia (usually with
a bilirubin level <5.0 mg/dL). The bilirubin level increases with infection, exertion, and fasting. Patients
are asymptomatic and have otherwise normal liver function studies. The differential diagnosis includes
hemolytic anemias, which cause a decrease in serum haptoglobin, an increase in lactate dehydrogenase,
and/or CBC abnormalities, particularly on the peripheral smear.
Asplenic patients
Asplenic patients who develop a fever should be given antibiotics immediately. Due to the increased risk
of pneumococcal sepsis in asplenic patients, vaccinations against these particular bacteria are specifically
recommended. Since pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine
(PPSV23) can interact with each other they should be given at least 8 weeks apart. Prophylactic penicillin
given orally twice a day is particularly important in children under 5 years of age who are asplenic, and
may be considered for 1–2 years post splenectomy in older patients. Lifelong daily antibiotics may be
considered following post-splenectomy sepsis. The risk for Haemophilus influenzae type b infection is not
increased in asplenic patients, so additional vaccine is not needed for those who have already been
vaccinated. Live attenuated influenza vaccine may be used in asplenic patients, unless they have sickle cell
disease.
de Quervain’s tenosynovitis
This patient has de Quervain’s tenosynovitis. Finkelstein’s test has good sensitivity and specificity (SOR
C) in patients with a negative grind test. A positive grind test would be more consistent with scaphoid
fracture. A hand radiograph with secondary thumb spica splinting would be appropriate for a suspected
scaphoid fracture, but the insidious onset as opposed to overt trauma makes this diagnosis unlikely in this
case. A short arm cast is not indicated in de Quervain’s tenosynovitis but may be appropriate for
forearm/wrist fractures.
