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246 Cards in this Set

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This complication of "supracondylar" humerus fracture is 2/2 radial nerve injury complicated by compartment syndrome.

Volkmann's contracture (flexion of wrist and fingers)
6 Ps of compartment syndrome
Pain
Pallor
Paresthesias
Poikilothermia
Paralysis (late finding)
Pulselessness (rare finding)
2 most common locations of compartment syndrome
forearm (most common) and anterior lower leg
Forearm pain increases with passive motion of fingers. Diagnosis?
compartment syndrome
Diagnostic test for compartment syndrome
measure compartment pressures compared to diastolic pressure
Treatment of compartment syndrome.
Immediate fasciotomy
Phalen's maneuver.
In Carpal Tunnel: flexion of wrists reproduces aching/numbness in under 60 seconds
Tinel's Sign
In carpal tunnel: tapping over median nerve elicits tingling in median n. distribution
Entrapment of the median nerve. Diagnosis?
Carpal Tunnel
Why are symptoms of Carpal Tunnel worse at night at times?
Wrist may be positioned inadvertently in extension or flexion
Patient acknowledges increased frequency of dropping things and difficulty opening jars. Most common diagnosis?
Carpal Tunnel
If Carpal Tunnel is a clinical diagnosis, why are some diagnosed by EMG?
work-up for atypical presentation or incindental finding
first line treatment for carpal tunnel (2).
Splinting into neutral position
NSAIDS
Carpal tunnel continues despite splinting and NSAIDS. 2 options for management
Corticosteroids or Surgery
When to do surgery for Carpal Tunnel.
indicated if fixed sensory loss or weakness, but you can do surgery if patient wants it basically
Most common bone to be fractured.
clavicle
Most common LOCATION of a fracture?
wrist (8 bones)
Most common bone to be fractured in adults (especially over 50 years); also very common in children.
distal radius
Most common shoulder dislocation.
Anterior (posterior is rare)
Anterior shoulder dislocation: worry about damage to this artery and to this nerve.
Axillary
Treatment for Shoulder Disloation
expedient reduction, then sling/swath
What is a sling and what is a swath?

sling holds forearm up (elbow flexed)
swath holds humerus in (shoulder adducted)

Dashboard injury
posterior hip dislocation
Treatment for Hip dislocation
closed reduction, then pillow bracing
F/U test after hip dislocation surgery
CT scan
Most common radius fracture.
colles fracture (distal radius)
Mechanism of injury causing colles fracure (distal radius)?
fall onto outstretched hand
Most common wrist bone fracture.
Scaphoid
Tenderness in anatomical snuff box. Diagnosis?
Scaphoid fracture
What is closed reduction?
push bones back in place with your hands (without opening the skin)
Treatment of colles fracture (distal radius)?
closed reduction, then cast
What cast for a scaphoid fracture?
thumb spica cast (thumb and wrist)
Where exactly is a boxer's fracture?
5th metacarpal neck
Punched a wall. What is the classic fracture?
boxer's fracture (5th metacarpal neck)
What bacteria is common hand infection after a patient punched someone in the mouth?
Eikenella
Treatment for boxer's fracture
closed reduction and ulnar gutter splint (ulna to pinky)
Radial nerve pasly. What classical fracture?
Humerus
Homeless man found in alley and brought to ER. He has an ulnar shaft fracture with bruises on both forearms and . Cause?
self defence from blunt trauma ("nightstick fracture")
A "nightstick" ulnar fracture WITH radial head deviation is called what?
monteggia's fracture
Treatment of monteggia's fracture
Open Reduction and Internal Fixation (ORIF)
Fracture of the radius and dislocation of the radioulnar joint is called what?
Galeazzi's fracture; remember "G-azz plays on the Radio (radius)"
Femoral fracture. What classic complication?
Fat emboli
Elderly (i.e. osteoporosis) patient presents after fall. What classic fractures (2)?
Hip fracture or Colles Fracture (distal radius)
These complications of a Hip Fracture are more common if there is displacement of the femoral neck. (2)
Avascular necrosis and DVT
This type of fracture is ALWAYS an O.R. emergency.
open fracture
Open fractures have subsantially increasing risk of infection after this many hours.
6 hours (get to OR)
While heading to the OR, what to give a patient with an open fracture?
Antibiotics and Tetanus booster
Hip fractures require Open Reduction and Internal Fixation. What treatment afterward?
anticoagulation to prevent DVTs
Treatment of Galeazzi's fracture of the radius.
Open reduction and Internal Fixation (ORIF) and then supinated arm cast
Treatmenf of a Hip Fracture
Open Reduction and Internal Fixation (ORIF)
Treatment of Femoral Fracture
Intramedullary nailing (aka intramedullary rod) +/- traction; early mobilization
Tibial Fracture. What is the feared complication?
Compartment Syndrome
Treatment of Tibially Fracture
Intramedullary nailing (aka intramedullary rod); casting
What is the Thompson Test?
Squeeze the gastrocnemius: if no plantar flexion, test is positive for Achilles Tendon Rupture
Which knee ligament tear almost always requires surgical correction.
ACL
When might surgery be done on an isolated PCL tear?
on a competitive athlete
Tibia moves forward too far on exam. Name the test and the ligament torn.
Positive Anterior Drawer = ACL tear
Tibia is displaced too far back on exam. Name the test and the ligament torn.
Positive Posterior Drawer = PCL tear
5 most common knee injuries.
ACL, PCL, MCL, LCL, meniscus
Clicking or locking on knee exam. Which of the 5 common knee injuries is most likely?
Meniscal tear
These 3 of the 5 common knee injuries almost never get surgery
MCL, LCL, meniscus
Valgus vs. Varus
ValGus: feet Go, knees together like Gum
VaRus: feet Return, knees like a bowlegged horse rider ("Vhere is my horse?")
McMurray's Test is positive. Suspect what?
Meniscal tear with click/pop on McMurrays (very specific)
McMurray's Test?
you trap the meniscus between tibia and femur and then rotate knee while feeling and listening for pop/click
Treatment of Bursitis (along with rest, heat&ice, elevation)
NSAIDS +/- corticosteroids
What is contrindicated treatment if bursitis is suspected to be septic?
corticosteroids
Treatment of septic bursitis.
7-10 days
Pain at lateral epicondyle worse on wrist extension. Diagnosis?
tendinitis: lateral epicondylitis (aka Tennis Elbow)
Rule about treatment of Achilles Tendonitis.
never inject the achilles tendon (risk of rupture)
3 levels of therapy for Tendonitis. Name them in the correct order.
1) NSAIDS and ice
2) splinting/immobilization
3) lidocaine or corticosteroid injection
Which reflex tests L4?
patellar (knee = down on all "4"s)
Which reflex tests S1?
Achilles
Dermatome of L4.
medial lower leg and foot
Dermatome of L5.
dorsum and plantar surfaces of foot
Dermatome of S1.
Lateral foot
Where is the herniated disc: absent foot dorsiflexion (tibialis anterior).
L4
Where is the herniated disc: absent big toe dorsiflextion
L5
Where is the herniated disc: absent plantar flexion
S1
Sudden electricity like lower back pain. Diagnosis.
Disc Herniation
Test for Disc Herniation.
Straight leg raise (passive and crossed)
When to order MRI if Disc Herniation symptoms.
if not resonding to conservative treatment NSAIDS and PT
80% of cases of Disc Herniation will resolve in this amount of time with just conservative treatment (NSAIDS).
4 weeks
Treatment to consider if NSAIDS fail.
Epidural or nerve block
Treatment for cauda equina or rapid neuro deficits due to disc herniation?
discectomy (surgical emergency)
cauda equINA symptoms (3).
Impotence
iNcontinence (bowel or bladder)
saddle-area Anesthesia
Bone cancer's classic pain description?
worse at rest or worse at night
Lower back pain relieved by rest. Most likely diagnosis?
lumbar strain
lower back pain in paitient with osteoporosis. Diagnosis?
vertebral decompression
Lower back pain worse with Lumber Extension; improves with hip and lumber flexion (bending forward). Diagnosis?
lumbar stenosis
PBKTL ("lead kettle") cancers which often metastasize to the bone.
Prostate
Breast
Kidney
Thyroid
Lung (most common)
Most common primary bone malignancy.
Multiple Myeloma
Cancer in the metaphyseal regions at distal femur and proximal tibia. Diagnosis?
Osteosarcoma
Most common benign tumor of the bone.
osteochondroma
Sunburst pattern on XR of leg. Diagnosis?
Osteosarcoma
Onion skinning on XR of leg. Diagnosis?
Ewing's Sarcoma
Morning stiffness under 30 min. Diagnosis?
Osteoarthritis
Osteoarthritis dilemma about resting.
pain decreases with rest
stiffness increases with rest
Joint space narrowing on XR in osteoarthritis. Mechanism of narrowing?
deterioration of articular cartilage
Why delay joint replacement in patients with osteoarthritis?
the artificial joint will likely fail before the patient dies (e.g. 15 years with knee replacement)
Biggest risk factor for osteoarthritis other than age.
obesity
Reduction in risk of osteoarthritis in the knee with the loss of 10 lbs.
50%
1st line therapy for osteoarthritis.
Tylenol
Why are NSAIDS 2nd line (after Tylenol) for treatment of osteoarthritis if they work so well.
GI symptoms (e.g. GIB)
Heberden's nodes on DIPs. Diagnosis?
Osteoarthritis
Bouchard's nodes on PIPs. Diagnosis.
Rheumatoid Arthritis
Swan Neck or Boutonniere deformities. Diagnosis?
Rheumatoid Arthritis
After limb trauma, some kind of neurofeedback creates this weird syndrome:
1) out-of-proportion chronic pain
2) loss of function of affected limb
3) sympathetic dysfunction
and increased skin and hair growth with edema and warmth
Diagnosis?
Complex Regional Pain Syndrome (reflex sympathetic dsystrophy); aka causalgia or sudecks atrophy
Chronic pain syndrome most common in women; no joint pain or inflammation. Diagnosis?
Fibromyalgia
Treatment of Fibromyalgia (2)
Antidepressants (e.g. SSRI/TCA combo)
Physical Therapy
less than 11 of 18 tender points on the fibromyalgia map. Called what?
myofascial pain syndrome
Undiagnosed monarticular joint pain. Test?
Joint aspiration (arthrocentesis)
Recurrent monarticular arthritis. Most likely Diagnosis?
Gout
3 D's as a part of Gout treatment.
Dehydration (drink water)
Diet (lose weight!; avoid EtOH and red meat)
Diuretics (avoid)
Advanced gout appearance on XR.
rat-bite erosions (punched out lesions)
Medical therapy options for gout maintenance.
Probenecid (1st line)
Allopurinol
Gout crystals
Needle shaped
Negative birefringence
Psuedogout crystals
"P" for psuedogout:
Positive birefringent
Polygon shaped crystals (rhomboid)
calcium Pyrophosphate
Treatment for acute attacks of Gout (3)
NSAIDS, Colchicine, Steroids
What is Tophi?
urate crystal deoposits in soft tissue (complicaiton of chronic gout)
What cell marker is associated with Ankylosing Spondylitis?
HLA-B27
Onset of symptoms (age) in Ankylosing Spondylitis?
late teens to early 20s
Pos HLA-B27, Elevated ESR, Negative RF. Diagnosis?
Ankylosing Spondylitis
What does Spondylo refer to?
Spine (greek for vertebra)
5 bacteria associated with Reactive Arthritis (aka Reiter's Syndrome).
Chlamydia
Campylobacter
Shigella
Salmonella
Ureoplasma
Sausage shaped digits (dactylitis). Diagnosis?
psoriatic arthritis
What gastrointestinal diagnosis is associated with Ankylosing Spondylitis?
IBD
Spine shape in Ankylosing Spondylititis.
loss of Lumbar Lordosis, decreased flexion
fused sacroiliac joints. Diagnosis?
Ankylosing Spondylitis
Morbidity (besides arthritic pain) in Ankylosing Spondylititis.
decreased chest expansion
medical treatment for Ankylosing Spondylitis symptoms (2)
1) NSAIDS for pain control
2) TNF inhibitors for refractory cases
polymyositis: describe the weakness
Symmetric progressive proximal muscles
heliotrope rash and rash on shoulders, upper chest, and back ("shawl sign"). Diagnosis?
Dermatomyositis
New proximal weakness and rash. Diagnosis?
Dermatomyositis
10% of Dermatomyositis is associated with this (classic association).
neoplasm
Gottron's papules (papular rash over nuckles). Diagnosis?
Dermatomyositis
elevated CK and presence of anti-Jo-1. Diagnosis?
Polymyositis or Dermatomyositis
Confirmatory test for polymyositis.
muscle bx
Treatment for polymyositis
high dose corticosteroid then taper to maintenance does
SLE: associated antibody test (3)
ANA (sensitive), Anti-Smith (specific), and Anti-dsDNA (specific)
Rheumatoid Arthritis: associated antibody test (2)
Rheumatoid factor (classic) and Anti-CCP (more specific)
CREST syndreom: associated antibody test
Anticentromere
Drug-Induced SLE: associated antibody test
Antihistone (100% sensitive; not specific)
Primary Biliary Cirrhosis: associated antibody test.
Antimitochondrial
Scleroderma: associated antibody test
AntiScl70
Grave's disease: associated antibody test
Anti-TSHR
Wegener's Vascultis: associated antibody test
c-ANCA
Microscopic Polyangiitis: associated antibody test
p-ANCA
Dermatitis Herpetiformis (extra-intestinal IBD): associated antibody test.
Anti-endomesial
Common ocular manifestation of Rheumatoid arthritis.
Sjogren's syndrome (keratoconjuctivitis sicca)
HLA-DR4 positive. Diagnosis?
Rheumatoid Arthritis
Morning stiffness for over an hour. Diagnosis?
Rheumatoid Arthritis
Symmetric polyarthritis with swelling and warmth. Diagnosis?
Rheumatoid Arthritis
When gout crystals line up with the condensor, what color are they?
yeLLow when paraLLel
mechanism of colchicine
inhibits neutophil chemotaxis
2 limiting factors in treatment of acute gout with Colchicine.
1) efficacious if used early in acute attack
2) narrow therapeutic window
Rheumatoid Arthritis, Splenomegaly, and Neutropenia. What syndrome?
Fetty's Syndrome
Ulnar deviation of the fingers bilaterally. Diagnosis?
Rheumatoid Arthritis
Common anemia in Rheumatoid Arthritis.
Anemia of Chronic Disease
When to reduce or discontinue NSAIDS in treatment of Rheumatoid Arthritis.
once DMARDs effective
2 popular DMARDs for Rheumatoid Arthritis
Methotrexate or Sulfasalazine
CREST syndrome
Calcinosis
Raynauds
Esophageal dysmotility
Sclerodactyly
Telangiectasias
AntiScl70 antibodies indicate what about Scleroderma?
poor prognosis
Common cause of death in Scleroderma
pulmonary hypertension
Excessive collegen I and III deposition. What is the disease?
Scleroderma
Treatment for acute flares of Scleroderma.
Corticosteroids
Treatment for skin changes in Scleroderma.
Penicillamine
Treatment of Raynaud's Phenomenon.
Calcium Channel Blockers
Prevention of renal crisis in Scleroderma.
ACEI
What medicine often used in Scleroderma can cause a lupus like syndrome?
Penicillamine
DOPAMINERASH criteria for SLE.
Discoid Rash
Oral ulcers
Photosensitivity
Arthritis
Malar rash
Immunologic stuff
Neuro sx
ESR elevated
Renal disease
ANA
Serositis
Hematologic abnls
Malar rash. What is the disease?
Systemic Lupus Erythematosus (SLE)
Libman Sacks endocarditis: associated conditions (2)
SLE and antiphospholipid syndrome
Treatment of joint pain in SLE
NSAIDS
Treatment for acute exacerbations of Lupus
Corticosteroids
Vasodilating Hypertension med known to cause lupus like syndrome.
Hydralazine
Another name for Temporal Arteritis.
Giant Cell Arteritis
Most feared manifestation of Temporal Arteritis.
Blindness (usually monocular)
Half of temporal arteritis patients also have this joint disease.
Polymyalgia Rheumatica
Trigeminal Neuralgia and Temporal Arteritis can appear similar on Step 2 questions. What are the differences in pain characteristics?
Trigem: episodes of recurrent attacks of severe dermatomal skin pain that lasts seconds to minutes
TA: new temporal headache that is constant
How high of ESR is criteria for Temporal Arteritis and how high does it usually get?
higher than most rheumatologic diseases: over 50 for criteria; usually over 100
Treatment for Temporal Arteritis
High dose prednisone immediately
Confirmatory test for Temporal Arteritis?
Temporal Artery biopsy
Why get serial CXRs after an episode of Temporal Arteritis?
TA is associated with aortic aneurisms
3 areas of pain in Polymyalgia Rheumatica.
Neck, Shoulders, Hips
2 labs associated with polymyalgia rheumatica.
increased ESR and anemia
Treatment for Polymyalgia Rheumatica.
daily low dose prednisone
Usual age of onset of Polymyalgia Rheumatica
50
Usual age of onset of Temporal Arteritis?
50
Usual age of onset of Scleroderma?
35
Usual age of onset in Rheumatoid Arthritis.
35
Most common age and gender in SLE
child-bearing age (women)
dystrophin mutation. Diagnosis?
Muscular Dystrophy (DMD or BMD)
Whats the difference between Becker's (BMD) and Duchenne Muscular Dystrophy (DMD)?
BMD has more mild phenotype because the mutation still creates a partially functional protein
inheritance pattern in Duchenne Muscular Dystrophy (DMD)
x-linked recessive
Gowers' maneuver: what is it and what is the diagnosis?
walks hands up body to help stand up = Duchenne Muscular Dystrophy (DMD)
psuedohypertrophy of the gastrocnemius. Diagnosis?
Duchenne Muscular Dystrophy (DMD)
Waddling gait (hip drop) in a child. Diagnosis?
Duchenne Muscular Dystrophy (DMD)
Diagnosing Duchenne Muscular Dystrophy (DMD).
DNA sequencing
Old diagnostic test for Duchenne Muscular Dystrophy (DMD) now only used as a second option.
muscle biopsy +/- immunostaining
What medication will prolong time to wheel chair in Duchenne Muscular Dystrophy?
prednisone
Prognosis of DMD.
death by 20
Why use Physical Therapy to ambulate DMD patient if they will never be able to regain self-ambulatory function?
prevent contractures
What causes death in most DMD patients?
pulmonary congestion due to cardiac failure
Common bone fractured during birth.
clavicle
What is a greenstick fracture?
incomplete fracture involving only cortex (only one side of bone)
Treatment for nursemaid's elbow?
manual reduction:
1) extend elbow with gentle distal traction
2) supinate hand while flexing elbow
What joint is effected in nursemaid's elbow?
radial head (subluxation)
Young child with arm pain after being lifted by one arm. Diagnosis?
Nursemaid's Elbow
Describe arm position at presentation of nursemaid's elbow.
elbow flexed to near 90; refuses to move arm
Treatment of a partial fracture (greenstick).
cast
Buckling of the cortex of a long bone secondary to trauma. Fracture?
Torus Fracture
Most common age of Suracondylar humerus fracture (risk of volkmann's contracture secondary to compartment syndrome)?
5-8 y/o
Treatment for Supracondylar humerus fracture?
cast usually all that is needed; closed reduction if needed
Treatment of torus fracture (a long bone fracture).
cast
12 year old boy hits growth spurt and develops knee pain worse with resisted flexion (active extension). Diagnosis?
Osgood-Schlatter Disease (aka traction apophysitis)
What is a Salter Harris fracture?
fracture in the growth plate
Rule for conservative vs surgical repair of Growth Plate fracture (Salter Harris fracture).
if it involves the epiphysis, do surgery
Hip abnormality that can be seen in babies who spent a long time in the breech position?
Developmental Dysplasia of the Hip (aka Congenital Hip Dislocation)
Prognosis of BMD.
Death by 40
Describe Barlow and Ortolani procedures in evaluation of the newborn hip.
Barlow: posterior pressure with knees together (femoral head may CLUNK out)
Ortolani: medial pressure on hip as thighs are abducted (femoral head may CLICK in)
Asymetric skin folds (fat creases) in newborn groin. Diagnosis?
Developmental Dysplasia of the Hip (aka Congenital Hip Dislocation)
First line treatment of Developmental Dysplasia of the Hip.
Pavlik Harness (maintains hip flexed and abducted)
Most common gender for Developmental Dysplasia of the Hip
female
Developmental Dysplasia of the Hip not caught until after 6 months of age. What is treatment?
Spica Cast (maintains hip flexed and abducted)
Developmental Dysplasia of the Hip not caught until after 15 months of age. What is treatment?
open reduction followed by Spica Cast
Idiopathic Avascular Necrosis (AVN) of the femoral head. What is the disease?
Legg-Calve-Perthes Disease
Painless unilateral limp in child under 10. Diagnosis?
Legg-Calve-Perthes Disease
Treatment for Legg-Calve-Perthes Disease
observation usually sufficient
Painful bilateral (50%) limp in and obese 12 year old child. Diagnosis?
Slipped Capital Femoral Epiphysis (SCFE)
Treatment for Slipped Capital Femoral Epiphysis.
Open reduction and pinning
Is Slipped Capital Femoral Epiphysis acute or chronic.
Chronic
What lab to order in child with Slipped Capital Femoral Epiphysis? Ruling out what?
TSH (r/o hypothyroidism)
Insidious thigh, knee, groin pain, and limp in 12 year old. What test to order to dx Slipped Capital Femoral Epiphysis?
XR sufficient (AP and frog-leg lateral)
Separation of the femoral epiphysis from the growth plate in child. What is the disease called?
Slipped Capital Femoral Epiphysis (SCFE)
STARTSS HOTT differential for a child with a limp.
Septic joint
Tumor
Avascular necrosis (L-C-Perthes)
Rheumatoid arthritis (JIA)
Tuberculosis
Sickle Cell disease
SCFE
Henoch-Schonlein prupura
Osteomyelitis
Trauma
Toxic synovitis
Degree of curvature for criteria of scoliosis.
more than 10 degrees
Clinically significant scoliosis is most common in males or females?
females (7:1)
Diagnostic test for scoliosis (as well as exam).
XR spine
Degree of curvature of scoliosis that is threshold for at least bracing.
over 20 degrees
Degree of curvature of scoliosis that is threshold for surgery?
over 50 degrees
Most common complication of scoliosis (besides back pain).
restrictive lung disease
Prognosis in Juvenile Idiopathic Arthritis?
90% resolve by puberty
Treatment for Juvenile Idiopathic Arthritis (JIA) (3).
1. NSAIDS
2. Corticosteroids
3. Immunosuppression (Methotrexate)
Usual RF and ANA results in Juvenile Arthritis.
RF negative, ANA positive
Morning Stiffness for over six weeks in patient under 16 years old. Meets criteria for this diagnosis?
Juvenile Idiopathic Arthritis (JIA) - formerly JRA
Child with recurrent high fever, hepatosplenomegaly, rash, and Morning Stiffness in joints. Diagnosis?
Still's Disease (Systemic Onset Arthritis)