Clin Med Exam 8-Ortho

Front 1

Tinel’s sign

Back 1

Examiner taps the volar aspect of the wrist over the median nerve or medial elbow over the ulnar nerve. This reproduces paresthesias over the tested nerve distributions.

Front 2

Finkelstein’s test

Back 2

patient grasps the thumb in the palm of the hand and the examiner ulnar deviates the thumb and hand. Look for sharp pain produced along the extensor pollicis and abductor pollicis.

Front 3

Phalen’s sign

Back 3

involves flexing the wrist maximally and holding it in this position for at least one minute. This will reproduce numbness and tingling along the median nerve distribution. (More sensitive test for carpal tunnel than Tinel’s sign.)

Front 4

most sensitive test for carpal tunnel

Back 4

Phalen's sign

Front 5

finkelstein's test is used to diagnose what?

Back 5

deQuervain's tendinitis

Front 6

usually surgical process that promotes bone growth across joints

Back 6

arthrodesis

Front 7

fracture of a bone in which the surrounding skin remains intact

Back 7

closed fracture

Front 8

normal bone/joint relationship is restored without necessity of an incision

Back 8

closed reduction

Front 9

fracture of a bone that communicates with the air through a disruption in the skin

Back 9

open fracture

Front 10

normal bone/joint relationship is restored through the use of a surgical approach

Back 10

open reduction

Front 11

definition of acute compartment syndrome

Back 11

-bleeding into a closed muscle compartment to the extent that perfusion of muscle and nerve tissue decreases to a level inadequate to sustain the viability of these tissues
-surgical emergency!!

Front 12

most commonly affected areas of acute compartment syndrome

Back 12

volar aspect of the forearm and the anterior compartment of the leg

Front 13

what can develop if acute compartment syndrome is left untreated?

Back 13

tissue necrosis, secondary muscle paralysis, muscle contracture and sensory impairment can occur (Volkmann’s ischemic contracture – claw hand or foot)

Front 14

symptoms of compartment syndrome

Back 14

-the three "P's"
Pain
Paresthesia
Paralysis

Front 15

Pulselessness indicates __ NOT compartment syndrome

Back 15

arterial injury

Front 16

__indicates arterial injury NOT compartment syndrome

Back 16

Pulselessness

Front 17

when diagnosing acute compartment syndrome, The most important physical sign is __. what else can be used to diagnose it?

Back 17

-extreme pain on stretching the long muscles passing through a compartment
-Manometric measurement of intra-compartmental pressure: diastolic pressure minus the intra-compartmental pressure should be less than or equal to 20mm/Hg.

Front 18

tx of acute compartment syndrome

Back 18

-Surgical fasciotomy of the affected compartment is essential
-The wound is left open with delayed closure or skin grafting after the edema subsides
-Elevation of the extremity is helpful in reducing edema, but excessive elevation should be avoided since it can reduce the hydrostatic pressure and may lower arterial pressure enough to decrease compartment perfusion

Front 19

best way to diagnose bone tumors

Back 19

CT scan

Front 20

cummulative trauma disorders (CTD)

Back 20

an umbrella term that encompasses specific terms such as carpal tunnel syndrome, epicondylitis, flexor tendinitis, and generalized myofascial pain

Front 21

physical exam findings and testings for cummulative trauma disorders (CTD)

Back 21

-Phalen’s test positive and weakness in the opponens muscle = carpal tunnel syndrome
-Positive Finkelstein’s test, local tenderness and swelling = de Quervain’s tenosynovitis
-Tinel’s sign at the medial elbow and numbness at the ulnar side of the fingers = Ulnar nerve entrapment

Front 22

definition of fracture

Back 22

disruption in the continuity of a bone

Front 23

microscopic fracture often not initially detected by x-ray

Back 23

stress fracture

Front 24

occurs mostly in young bone and shows a buckling of the affected bone cortex but no visible fracture

Back 24

torus fracture

Front 25

shows a break in one bone and a bending of the other

Back 25

green stick fracture

Front 26

more than one piece at a single fracture sight

Back 26

comminuted fracture

Front 27

straight line fracture along the axis of the bone

Back 27

linear fracture

Front 28

two or more fractures of a single bone

Back 28

segmental fracture

Front 29

fracture at an angle across a bone

Back 29

oblique fracture

Front 30

fracture straight across a bone

Back 30

linear fracture

Front 31

fracture twisting down the axis of a bone

Back 31

spiral fracture

Front 32

symptoms of fractures

Back 32

-Swelling, tenderness, pain, deformity
-With non-displaced fracture there will be no angulation, but pain and swelling
-Stress fractures will cause pain on weight bearing and mild swelling

Front 33

X-rays – indicate presence of an acute fracture most times. __ are the exception. In some cases bone scan can be helpful.

Back 33

Stress fractures

Front 34

The principle goal of fracture treatment is to __. Preservation of function of joints adjacent to the fracture, restoring alignment, and preserving bone length are also important.

Back 34

achieve union, especially in weight bearing bones

Front 35

first step in treating fractures

Back 35

reduction (closed or open)

Front 36

Infection – typically in __fractures. Osteomyelitis (infection of the bone) can be a very difficult complication to treat.

Back 36

comminuted

Front 37

if after a fracture, you get non-union, consider __

Back 37

patients with other disease processes or poor reduction technique

Front 38

most common injected joints are __

Back 38

knees and shoulders

Front 39

intra-articular corticosteroids are typically used in tx of __

Back 39

chronic inflammatory diseases

Front 40

intra-articular corticosteroids:
-the __ appear to have the greatest potency and longest duration of action

Back 40

triamcinolone compounds

Front 41

if someone comes in with pain in the knee, be concerned that it is __

Back 41

really hip pain that is referred

Front 42

where do you experience hip pain?

Back 42

in the groin

Front 43

most frequently broken bone in the body

Back 43

clavicle

Front 44

are intra-articular injections more effective for RA or OA?

Back 44

RA (50% relief)

Front 45

intra-articular injections should NOT be given in what areas?

Back 45

achilles and patellar tendons (since pain in these can indicate tears)

Front 46

improper uses of intra-articular injections

Back 46

-Acute trauma
-Injection directly into a tendon or nerve
-Injection onto an infected joint, tendon, or bursa
-Multiple injections in conditions other than rheumatoid arthritis

Front 47

Splints are often applied as an initial measure following trauma to the upper or lower (or both) extremities. A well applied splint can do the following: (4)

Back 47

-Reduce pain, bleeding and swelling
-Prevent further damage to muscles, nerves or blood vessels by sharp ends of fracture bones
-Prevent laceration of the skin by sharp fracture ends (converts a closed fracture to an open fracture)
-Prevent constriction of vascular structures by malaligned bone ends

Front 48

bone density=

Back 48

grams of mineral/area (volume)

Front 49

osteoporosis definition

Back 49

Skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture.

Front 50

what does dense bone look like on xray?

Back 50

bright white (less dense bone looks not as white)

Front 51

__ is a determinate of bone strength

Back 51

Bone density

Front 52

Osteopenia is defined as a __

Back 52

lower than normal bone density (BMD), but not low enough to be diagnosed as osteoporosis

Front 53

Standard devise and preferred diagnostic test for determining bone mineral density is the __. Measures the bone density at the __ or __ and gives very precise results. Emits VERY low radiation.

Back 53

Dual energy X-ray absorptiometry or DEXA scan

hip or spine

Front 54

-• Osteopenia: Bone density __ below the YAM
-Osteoporosis: Bone density __ or more below the YAM

Back 54

1 to 2.5 SDs

2.5 SDs

Front 55

severe osteoporosis

Back 55

Bone density is more than 2.5 SDs below the YAM and one or more broken bones (osteoporotic fractures) has occurred.

Front 56

Normal: Bone density within __of the young adult mean (YAM).

Back 56

1 SD (+1 or -1)

Front 57

what lab do you order for men suspected of having osteoporosis?

Back 57

testosterone

Front 58

medications that are risk factors for osteoporosis

Back 58

Heparin, Dilantin, Phenobarbital, corticosteroids

Front 59

The ultimate goal of osteoporosis treatment is __

Back 59

prevention of bone fractures by increasing or maintaining bone density and strength

**prevention**

Front 60

instructions for taking biphosphonates

Back 60

To reduce side effects and enhance absorption all oral bisphosphonates should be taken in the AM on an empty stomach 30 minutes before breakfast with at least 8 oz. of water, NOT juice.

Front 61

approved for post menopausal women with osteoporosis

Back 61

Raloxifene – (Evista)
((a SERM))

Front 62

__ is a synthetic version of human parathyroid hormone which helps regulate calcium metabolism. Is administered subcutaneously.

Back 62

Teriparatide (Forteo)

Front 63

__ an intravenous infusible antibody that blocks a chemical messenger that plays a role in promoting bone thinning.

Back 63

Denosumab (Prolia)

Front 64

Paget’s disease is also known as __. It affects mostly __ (age group and gender)

Back 64

osteitis deformans

adults – 40 years of age and older; MEN

Front 65

Paget's disease

Back 65

-chronic condition of bone characterized by disorder of the normal bone remodeling process.
-because of the asynchronous bone remodeling, the bone that is formed is abnormally enlarged, not as dense, brittle, and prone to fractures.

Front 66

cause of Paget's disease

Back 66

unknown

Front 67

if someone is diagnosed with paget’s disease of the skull, make sure to __

Back 67

test for loss of vision and hearing loss!! And ask if they have headache

Front 68

__ is frequently elevated in persons with Paget’s and becomes a marker used to monitor the effectiveness of treatment once the disease is diagnosed.

Back 68

serum alkaline phosphatase SAP (enzyme that comes from bone metabolism)

Front 69

mainstay of tx for Paget's disease

Back 69

oral (first line) or the injectable bisphosphonate class of drugs:

Front 70

what do you want to think about with a spiral fracture?

Back 70

abuse

Front 71

best imaging technique for a rotator cuff injury

Back 71

MRI

Front 72

Stress fractures/degenerative hip disorders will complain of?

Back 72

groin pain

Front 73

first line tx of osteoporosis

Back 73

PREVENTION

Front 74

pathologic fractures

Back 74

One that occurs without trauma and generally indicates a disease process is present- seen in elderly

Front 75

Which type of fracture is especially susceptible to infection/ osteomyelitis?

Back 75

comminuted

Front 76

most commonly injected joint

Back 76

knee

Front 77

How do you inject patients with tenosynovitis and bursitis?

Back 77

into the tendon sheath (not the tendon itself)

Front 78

Always remember to keep the extremity in the position of () when splinting.

Back 78

function

Front 79

The () score compares your bone density with that of healthy young women.

Back 79

T

Front 80

What are the signs and symptoms of osteoporosis?

Back 80

Usually they aren’t any until a fracture occurs, but they may complain of joint pain

Front 81

How does exercise relate to osteoporosis?

Back 81

Weight-bearing exercise will add BMD to uninjured bone, but once bones are weakened, you should avoid exercise that would injure them

Front 82

Is it more important monitor patients on osteoporosis therapy for medication side effects or for improvement in BMD?

Back 82

side effects

Front 83

very widespread Paget's may lead to __

Back 83

CHF

Front 84

What imaging test is best to show the extent of Paget's?

Back 84

bone scan

Front 85

most common neonatal foot disorder? what is it?

Back 85

calcaneovalgus

excessive eversion and dorsiflexion of the foot (so that the toes can touch the tibia)

Front 86

necrosis of the navicular bone secondary to ischemia

Back 86

Kohler's disease

Front 87

what is Kohlner's disease? when and how does it present?

Back 87

necrosis of the navicular bone secondary to ischemia

Painful limp around age 5, often with pain, tenderness and swelling over navicular

Front 88

most common injuries in all of sports

Back 88

ankle sprains

Front 89

85% of ankle sprains involve the __ complex

Back 89

lateral ligament

Front 90

ankle sprains:
Which is more common, and which is more severe – anterior talofibular or calcaneofibular injury?

Back 90

-Anterior talofibular – more common
-Calcaneofibular – more severe

Front 91

Which stability test is the most reliable and least painful for ankle sprains?

Back 91

anterior drawer

Front 92

what is tarsal tunnel syndrome?

Back 92

This is a nerve entrapment by compression of the posterior tibial nerve under the flexor retinaculum

Front 93

primary symptom of talar dome fracture? how do dx it? tx?

Back 93

restricted ankle motion

xray

prolonged non-weight bearing status

Front 94

what causes plantar fasciits and how does it present?

Back 94

overuse

usually bilateral; pain beneath the calcaneous that is worse in the morning or after inactivity

Front 95

tx of achiles tendonitis? what should you avoid and why?

Back 95

-Rest, heat, gentle stretching
-NSAIDs – questionable benefit
-Small heel lift

**AVOID steroid injections or quinolones bc they can cause rupture!!

Front 96

Calcaneal apophysitis aka?

Back 96

Sever's disease

Front 97

Sever's disease aka? What is it? In what gender and age is it more common?

Back 97

Calcaneal apophysitis

Low grade inflammatory reaction at the insertion of the Achilles tendon with sclerosis of calcaneal growth plate

In males 8 to 14 years old (adolescence)

Front 98

after an achilles tendon rupture, the patient will walk __ and is unable to __

Back 98

-flatfooted
-stand on the ball of the foot (most, but not all, plantar flexion is lost)

Front 99

what test should you ues to help you diagnose an achilles tendon rupture? describe the test.

Back 99

Thompson’s Squeeze test – squeezing the calf should yield plantar flexion in an un-ruptured Achilles tendon

Front 100

a sudden sharp pain in the calf with no associated loss of calf strength (plantar flexion) is characteristic of?

Back 100

plantaris tendon rupture

Front 101

MTP synovitis...most commonly affected toe?

Back 101

2nd

Front 102

Lateral deviation of great toe at MTP joint

Back 102

hallux valgus

Front 103

Medial deviation of great toe at MTP

Back 103

hallux varus

Front 104

best imaging technique for meniscal tears

Back 104

MRI

Front 105

the "hinge" of the knee is the __

Back 105

ACL

Front 106

an ACL injury is typically what type?

Back 106

noncontact deceleration injury

Front 107

how do you test for PCL injury?

Back 107

posterior drawer test

Front 108

a rupture of the terminal tendon of a finger results in a __

Back 108

mallet finger

Front 109

Muscle and tendon assessment is graded from 0-5. What is normal?

Back 109

5

Front 110

What does Froment’s sign indicate? What is a positive sign?

Back 110

Ulnar nerve lesion – can’t make a pincher grip between thumb and forefinger

Front 111

What is Wartenberg’s sign? What does it look like?

Back 111

In ulnar paralysis, the little finger is abducted

Front 112

What is the prune test? What does it test?

Back 112

Hold a finger in warm water for 10 minutes. Fingers without sensory innervation will not wrinkle. It tests sensory nerve function in fingers

Front 113

What does the Allen test evaluate?

Back 113

Collateral blood flow to the hand via the ulnar and radial arteries

Front 114

what is Osteochondritis Dissecans?

Back 114

a portion of subchondral bone undergoes avascular necrosis

Front 115

Osteochondritis Dissecans is most commonly seen in the () joint, but can also be seen in the (), especially with Little Leaguers.

Back 115

knee; elbow

Front 116

joint swelling is __ until proven otherwise

Back 116

sepsis

Front 117

Which fractures tend to occur at birth?

Back 117

humeral shaft fractures

Front 118

What is the most common elbow fracture? How does it happen?

Back 118

supracondylar humerus fractures

hyperextension

Front 119

What do you call a fracture of the ulna and a dislocation of the radial head?

What do you call a fracture of the radius and a dislocation of the distal radioulnar joint?

Back 119

Monteggia

Galeazzi

Front 120

Which fractures need to be fixated under anesthesia? What is the concern?

Back 120

-Distal femur (after the kid weighs > 30 lbs, a cast-only approach is not enough to heal it)
-Fractures of the distal femur growth plate are very likely to not grow afterwards

Front 121

Children ages 3-6 who limp probably have ().

Back 121

septic arthritis

Front 122

Which condition has a positive trendelenburg sign?

Back 122

Legg-Calve-Perthes disease (common in ages 6-10)

Front 123

What is the most common adolescent hip disorder?

Back 123

SCFE (slipped capital femoral epiphysis)

Front 124

low back pain..what is the definitive test for nerve pain?

Back 124

straight leg raise

Front 125

What is a subluxation of one vertebral body over another?

Back 125

Spondylolisthesis

Front 126

What is a hypertrophy of spinal architecture resulting in compression of thecal sac or nerve roots and leading to chronic problems like arthritis, scoliosis and hypermobility?

Back 126

spinal stenosis

Front 127

Spondylolysis/ spondylolisthesis are due to repetitive () of the spine.

Back 127

hyperextension

Front 128

what is Osgood-Schlatter caused by? tx?

Back 128

repetitive trauma to the tibial tuberosity

rest, stretch, ice

Front 129

pain in the hip is often referred from the __

Back 129

knee

Front 130

Acute posterior dislocation of the shoulder is common in () patients.

Back 130

seizure

Front 131

Avascular necrosis is a common side occurrence in () hip dislocation and () fracture.

Back 131

posterior

femoral neck

Front 132

what color aspirate from ACL?

Back 132

bloody

Front 133

gamekeeper's thumb

Back 133

Tear in the ulnar collateral ligament; common in skiers; Stenar’s lesion is when the thumb opens or abducts more than 30˚; Surgery is required to fix it

Front 134

PIP hyperflexion and DIP hyperextension caused usually by inflammatory process (RA); Wear splint ALL the time for 8 wks

Back 134

Boutonniere deformity

Front 135

most common site of ulnar nerve entrapment? second most common?

Back 135

elbow

Guillan channel

Front 136

o Traumatically produced lesion that occurs at the attachment of the patellar tendon to the tibial tuberosity

Back 136

Osgood Schlatter Disease

Front 137

salter harris classifciation type I

Back 137

-Type I: Transverse fx through the entire growth plate; Localized swelling and tenderness; X-ray appears negative (if non-displaced); Usually has an excellent prognosis

Front 138

salter harris type 2

Back 138

Fracture line passes through a portion of the growth plate and exits through metaphysis; fractures of distal radius rarely cause growth arrest; fractures of distal femur cause growth arrest in 50% of patients.

Front 139

salter harris type 3

Back 139

Fracture line passes through physis and extends to articular surface; Prognosis for growth is more guarded; Must restore congruity of articular surface

Front 140

salter harris type 4

Back 140

Fracture line crosses all zones of the physis vertically (includes metaphysic); Small proportion of physis is affected however, high risk of growth arrest; Anatomic reduction needed to restore articular surface.

Front 141

salter harris type 5

Back 141

Injury results from crushing force applied to the growth plate (axial load); May not be apparent on x-ray; Growth arrest is common

Front 142

most common cause of compartment syndrome

Back 142

tibial fracture