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Clin Med II - Exam 2 > Witwer > Flashcards

Witwer Flashcards

1
Q

what is the hard outer shell of the bone made of

A

cortical (compact) bone

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2
Q

what is the interior of bone made of

A

cancellous (spongy) bone

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3
Q

which portion of the bone contains nocireceptors, and is highly pain sensitive

A

periosteum

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4
Q

does the bone marrow also have pain receptors?

A

yes

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5
Q

how is pain from fx and OA characterized

A

deep somatic, dull, aching, poorly localized

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6
Q

ossification centers are divided into

A

primary
secondary

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7
Q

where is the primary ossification center located

A

diaphysis

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8
Q

where is the secondary ossification center located

A

epiphysis

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9
Q

name 4 things to look for in a bone xray

A
  1. bone destruction
  2. associated soft tissue changes
  3. alignment change
  4. bone deposition/proliferation
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10
Q

how do you classify and describe fx’s? (8)

A
  1. age
  2. location
  3. number and nature of fragments
  4. open or closed
  5. direct, pattern, and type of fracture line
  6. relationship of fragments to one another
  7. subluxation or dislocation
  8. articular involvement
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11
Q

what does distraction mean

A

increased length of bone (pulled apart)

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12
Q

what does displacement mean

A

a gap forms where the bone breaks

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13
Q

what does angulation mean

A

the ends of bone bone fragments are at an angle to each other

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14
Q

how is angulation described (3)

A
  1. direction of distal fragment is angled in relation to proximal fragment
  2. varus/vagus
  3. direction apex is pointing relative to long axis of bone
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15
Q

what is the most common type of angulation

A

direction of the distal fragment is angled in relation to the proximal fragment

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16
Q

describe varus

A

inward angulation

(apex lateral)

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17
Q

describe valgus

A

angled outward

(apex medial)

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18
Q

what is an open (compound) fx

A

bone pokes thru the skin

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19
Q

what is a closed fx

A

skin intact

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20
Q

what is a major concern in a compound fx

A

osteomyelitis

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21
Q

what 3 terms are used to describe fx location

A
  1. proximal
  2. mid-shaft
  3. distal
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22
Q

what is this type of fx called

A

transverse fx

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23
Q

what is this type of fx called

A

open/compound

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24
Q

what is this type of fx called

A

oblique fx

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25
Q

what is this type of fx called

A

oblique, displaced

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26
Q

what is this type of fx called

A

comminuted

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27
Q

what is this type of fx called

A

segmental

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28
Q

what is this type of fx called

A

avulsion

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29
Q

what is this type of fx called

A

spiral

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30
Q

what is this type of fx called

A

greenstick

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31
Q

how do you describe the distal fragment of a fx in relation to the proximal fragment (4)

A
  1. displacement
  2. angulation
  3. shortening
  4. distraction
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32
Q

how do you describe this fx

A

distraction without displacement

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33
Q

how do you describe this fracture

A

lateral displacement without angulation

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34
Q

how do you describe this fx

A

complete lateral displacement with shortening and without angulation

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35
Q

how do you describe this fx

A

lateral angulation (30degrees) without displacement

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36
Q

how do you describe this fx

A

lateral displacement (~50%) and lateral angulation (about 45 degrees)

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37
Q

how do you describe this fx

A

complete medial displacement with shortening and lateral angulation (~45 degrees)

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38
Q

when you see a fracture in one part of a ring, what should you be looking for

A

a fracture in another part of the ring

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39
Q

how do you evaluate symmetry

A

compare it to the normal side

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40
Q

pediatric fractures at the end of long bones often involve

A

growth plates

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41
Q

what classification system is used to evaluate pediatric fractures

A

Salter-Harris

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42
Q

Salter-Harris - Normal

A
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43
Q

which type of Salter Harris fx is this

A

type I: complete physeal fx with or without displacement

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44
Q

which type of Salter Harris fx is this

A

type II - physeal fx that extends thru the metaphysis, producing a chip fx of the metaphysis, which may be very small

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45
Q

which type of Salter Harris fx is this

A

type III - physeal fx that extends thru the epiphysis

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46
Q

what type of salter harris fx is this

A

type IV - physeal fx PLUS epiphyseal and metaphyseal fx’s

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47
Q

what type of salter-harris fx is this

A

type V - compression fx of the growth plate

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48
Q

a type II salter-harris fx extends thru the __

and produces a __

A

metaphysis

chip

49
Q

a type III salter-harris fx extends thru the __

A

epiphysis

50
Q

a type IV salter-harris fx is a physeal fx that also involves fractures of the __

and the __

A

epiphysis

metaphysis

51
Q

a type V salter-harris fx is a __ fx of the growth plate

A

compression

52
Q

what type of fx is this

A

salter-harris type I

53
Q

which class of salter-harris fx is this

A

salter harris type II

54
Q

which class of salter-harris fx is this

A

salter-harris type 3

55
Q

which class of salter-harris fx is this

A

type 4

56
Q

which type of salter-harris fx is this

A

type V

57
Q

why do salter-harris 5 fractures have a poor prognosis

A

they usually cause stunted growth

58
Q

what does CRITOE refer to

A

ossification centers of the elbow

59
Q

what does CRITOE stand for

A

capitellum → 2 years

radial head → 4 years

internal (medial) → 6 years

trochea → 8 years

olecranon → 10 years

external → 12 years

60
Q

what type of pediatric fx is characterized by no discernable fx

A

bowing (bending) fx

61
Q

what type of fx is this

A

greenstick → incomplete break in shaft

62
Q

in what pt population do greenstick fx’s usually occur

A

pediatrics → bones are more pliable

63
Q

what type of fx ‘s are these

A

salter harris type 1

64
Q

where do stress fx’s usually occur

A

weight bearing bones →

tibia

metatarsals

femur

65
Q

what type of pain do stress/fatigue fx’s usually present with

A

nagging pain and tenderness

focal or generalized

66
Q

stress/fatigue fx’s may present with no

A

radiologic findings

67
Q

stress/fatigue fx’s may mimic

A

shin splints

68
Q

what imaging might you order if you suspect a stress/fatigue fx, but xrays are normal

A

radionuclide bone scan

CT

MRI

69
Q

name 3 common pediatric fx’s

A

bowing (bending)

greenstick

buckle

70
Q

toddler fx are __ tibial

2/2 to __

A

spiral

twisting

71
Q

when you are given a minimal or no hx of trauma, but find fx’s in a child, what should you think about

A

child abuse

72
Q

in pt’s with child abuse fractures, what other injuries should you consider

A

subdural hematomas

subarachnoid hemorrhage

intracranial injury

brain injury

liver/spleen damage

73
Q

what are 2 fx’s characteristic of child abuse

A
  1. bucket handle fx
  2. corner fx
74
Q

what is the mechanism of injury in child abuse fx’s

A

direct blows and/or shearing injuries (twisting, pulling, shaking)

75
Q

child abuse fx’s are most commonly seen in what 2 age groups

A
  1. infants → <1 year
  2. toddler → 1-3 years
76
Q

multiple fx’s separated by time and space, rib fx’s, and skull fx’s in pediatrics should make you consider

A

child abuse

77
Q

what type of fx is this

A

bucket handle/corner fx

classic metaphyseal injury

78
Q

what is the first step in evaluating spine films, especially c spine films

A

make sure the area of concern has been adequately imaged (the entire c-spine)

79
Q

what pathology might wide interspinous spaces indicate

A

torn interspinous ligaments

80
Q

fx’s involving joints could lead to

A

arthritis

81
Q

when assessing a fx, what surrounding structures should you document that you have evaluated

A

motor and sensory nerves distal to the fx

82
Q

list 3 complications that could arise from fx if adjacent structures are damaged

A

compartment syndrome

DVT

pulmonary embolism

83
Q

name 3 things to look for when evaluating joint xrays

A

joints involved

mineralization

joint space integrity

84
Q

is there cartilage in the joints separating bone

A

no!

85
Q

what do radiographic findings suggest

A

the underlying dx

86
Q

arthritis is divided into what 2 classifications

A

clinical

radiographic

87
Q

clinical dx of arthritis involves

A

evaluation of systemic dz w. joint manifestations

88
Q

radiographic classification of arthritis invovles

A

dx of underlying dz

89
Q

xrays in arthritis help determine

A

nature and extent of change after clinical evaluation

90
Q

what types of arthritis involve clinical and systemic manifestations

A

non-tuberculosis pyogenic (septic) arthritis

advanced RA

psoriatic arthritis

hemophiliac joint dz

gout

neutrophic arthropathy

91
Q

what types of arthritis involve xray as suggestive of the underlying dx

A

OA

early RA

chondrocalcinosis (pseudo gout)

ankylosing spondylitis

reactive arthritis

ochronosis

TB arthritis

aspetic

92
Q

components of a synovial joint

A

synovial membrane

synovial fluid

articular cartilage

articular cortex

fibrous capsule

subchondral bone

associated ligamentous structure

→ arthritis can involve all

93
Q

psoriatic arthritis is found in __% of patients with

__

A

23%

psoriasis

94
Q

psoriatic arthritis is similar to

A

RA

95
Q

5 presentations of psoriatic arthritis

A

small joints (fingers/toes)

asymmetrical

symmetrical polyarthritis → RA-like

arthritis mutilans → aggressive

psoriatic spondylitis → sacroiliac joints and spine

96
Q

what is the most aggressive form of psoriatic arthritis

A

arthritis mutilans

97
Q

leading cause of disability in elderly

A

OA of knee

98
Q

what do you think when you see degenerative d.o → breakdown of articular cartilage in synovial joints, joint space narrowing, osteophytes, and loose bodies in joint space

A

OA

99
Q

primary OA is

A

idiopathic

100
Q

secondary OA is

A

2/2 to previously disturbed joint

101
Q

__ and

__ joints are mc affected in OA

A

knee

distal interphalangeal

102
Q

are women or men more affected by OA

A

women

103
Q

septic arthritis is also called

A

pyogenic arthritis

104
Q

septic arthritis (pyogenic) involves

A

rapid and severe joint destruction

105
Q

septic (pyogenic) arthritis in adults mc affects

A

knee

106
Q

septic (pyogenic) arthritis in kids mc affects

A

knee

hip

107
Q

most common pathogen in spetic arthritis

A

s. aureus

108
Q

what pathogens are more indolent and less destructive in → non pyogenic arthritis

A

TB

fungi

spirochaetes

109
Q

what does this make you think of

A

septic arthritis

110
Q

what is this showing

A

joint space loss

subchondral erosions

osteonecrosis

collapse of femoral head

→ septic arthritis

111
Q

what are ensethiopathies

A

boney insertion sites of tendons and ligaments

112
Q

what is chondrocalcinosis

A

calcification of soft tissue

build up of calcium compound crystals

113
Q

mc affected sites in chondrocalcinosis

A

cartilage

menisci

cruciate ligaments

synovium

114
Q

chondrocalcinosis is associated w. what diseases

A

lots! →

pseudogout

tophaceous gout

OA

familial CPPDDD

gout

hyperparathyroidism

hemochromatosis

and more!

115
Q

what is this showing

A

chondrocalcinosis

116
Q

what is this showing

A

chondrocalcinosis

117
Q

what type of joint is the atlantoaxial joint

A

synovial

118
Q

systemic manifestations of arthritis are diagnosed

A

clinically

Clin Med II - Exam 2 (14 decks)

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