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212 Cards in this Set
- Front
- Back
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Most common type of Glenohumeral Joint-Dislocation?
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Anterior
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Detachment of the anterior inferior labrum from the glenoid rim
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Bankart Lesion
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Defect to posterolateral humeral head when the humeral head is abraded by the anterior rim of the glenoid
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Hill-Sachs Lesion
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Radiographs needed for Glenohumeral Joint Dislocation? (3)
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AP
Y-view Axillary view |
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Injury is a result of a direct blow to the tip of the shoulder, or by and upward force exerted on the long axis on the humerus
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AC Joint Sprin
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Muscle for internal rotation of the shoulder?
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Subscapularis
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Muscles for external rotation and abduction of the shoulder? (3)
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Supraspinatus
Infraspinatus Teres Minor |
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Most comomon rotator cuff injury?
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Supraspinatus
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Pain originating from the compression of tissues between the humeral head and coracoacromial arch
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Impingement Syndrome
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Rotator cuff injuries in > 40 yo (2)
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Impingement
Tendonitis |
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Rotator cuff injury in < 40 yo
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Rotator Cuff Tears
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Inability to abduct arm above horizonatal plane
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Rotator Cuff Injury
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Positive Drop Arm Test
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Can't hold arm up
Rotator Cuff Injury |
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"Empty Can" Test
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Supraspinatus injury
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Neer Impingement Test
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Rotator Cuff Injury
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Gold standard for Rotator Cuff Injury Dx
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MRI
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Inflammation of the long head of the biceps tendon
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Biceps Tendonitits
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Tests for Biceps Tendonitis (2)
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Yergason's
MRI |
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What portion of the clavicle is most often fractured?
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Middle one third
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Can't lift wrist
Result of humeral fracture |
Radial Nerve Palsy
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Golfer's Elbow
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Medial Epicondylitis
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Overuse injury to the tendinous origin of the flexor pronator muscle group
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Medial Epicondylitis (MFP)
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Tennis Elbow
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Lateral Epicondylitis
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Overuse injury to the tendinous origin of the extensor supinator muscle group
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Lateral Epicondylitis (LES)
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Positive posterior fat pad or sail sign
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Radial Head Fx
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Fall on outstretched arm (3)
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Supracondylar Humerus Fx
Olecranon Fx Radial Head Fx |
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Fall on outstretched arm with decreased pronation/supination
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Radial Head Fx
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Splint options for Elbox Fracture (2)
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Long Arm Posterior
Sugar Tong |
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Gold Standard for CTS Dx
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Electrodiagnostic Studies
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Stenosing Tenosynovitis of the 1st dorsal compartment of the wrist
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deQuervain's Tenosynovitis
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2 tendons in deQuarvain's
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Extnsor Policis Brevis
Abductor Policis Longus |
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Fist made with thumb inside of fingers
Ulnar deviation of wrist reproduces pain |
Finkelstein's Test
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Method of immobilization for deQuarvain's
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Thumb spica cast
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DIP joint forced into extension
Inability to flex DIP joint No resistance to passive extension Injury most common to ring finger |
Jersey Finger
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Jersey finger time limit before tendon shrinks
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10-14 days
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Inability to actively extend DIP joint
Caused by axial compression load Ruptures thin extensor tendon |
Mallet Finger
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Splint for Mallet Finger
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STAX extension splint
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Inability to extend PIP joint
Ruptured central slip extensor tendon mechanism Secondary hyperextension at DIP |
Boutonniere Deformity
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Tx for Boutonniere Deformity
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Slint PIP joint in extension x6-8 weeks
Leave DIP joihnt free to flex |
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Hyperextension of PIP joint with flexion of DIP joint
Volar plate attenuation at PIP |
Swan Neck Deformity
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Swan Neck Deformity Tx
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Extension splinting of PIP joint
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Injury to the ulnar collateral ligament of the thumb at the MCP joint resulting in instability of the MCP joint and decreased thumb grip strength
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Gamekeeper's Thumb
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Skier's Thumb
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Gamekeeper's Thumb
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Splint for Gamekeeper's Thumb
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Thumb Spica
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Distal radius fracture through the metaphysis with dorsal angulation of the distal fragment
Commonly occurs with a fall on an outstretched hand |
Colle's Fracture
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Splint for Colle's Fx
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Sugar Tong
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Fx through the 5th Metacarpal neck
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Boxer's Fx
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How to assess rotational deformity of Boxer's Fx
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Fingers flexed in normal cascade
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Splint for Boxer's Fx
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Ulnar Gutter
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Most commonly fractured bone in the wrist
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Scaphoid Fx
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Pain in anatomic snuff box
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Scaphoid Fx
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Nondisplaced scaphoid fx cast
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Thumb Spica Long Arm Cast
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Connective tissue disorder affecting palmar fascia
Begins as painless lumps that form into cords |
Dupuytren's Contracture
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5 P's of Compartment Syndrome
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Pain
Pallor Paresthesias Pulselessness Paralysis |
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Unilateral contraction of sternocleidomastoid muscle with visible shortening
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Torticollis
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Dysfunction of cervical spine nerve root due to compression at foraminal level affecting upper extremity
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Cervical Radiculopathy
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Deltoid Myotome
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C5
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Arm abduction myotome
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C5
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Biceps Myotome
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C6
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Arm flexion myotome
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C6
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Triceps Myotome
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C7
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Arm extension myotome
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C7
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Interossei Myotome
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C8
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Palmar adduct myotome
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C8
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Dorsal abduct myotome
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C8
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Biceps DTR
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C5, part of C6
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Brachioradialis DTR
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C6
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Triceps DTR
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C7
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Radiculopathy Tests (3)
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Spurlings's
Axial compression Cervical distraction |
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Disruption of C1 Ring
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Jefferson Fx
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C2 vertebral body fx w anterior subluxation
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Hangman's Fx
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Pain, numbness, weakness of upper extremity
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Thoracic Outlet Syndrome
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Common at T10-T12
Occur in elderly patients with osteoporosis Pain with movement, relieved by rest |
Compression Fx
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Tx of Compression Fx
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Kyphoplasty
Vertebroplasty |
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Defect in pars interarticularis
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Spondylolysis
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Anterior displacement of vertebral segment
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Spondylolisthesis
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Lumbar Spine Tests (3)
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Lasegue's Straight Leg Raise
Bowstring Sitting Root Test |
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L4 Nerve Root Sensory
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Posterolateral thigh
Anterior knee Medial leg |
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L4 Nerve Root Motor
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Quads
Hip abductors |
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L5 Nerve Root Sensory
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Anterolateral leg
Dorsum foot Big toe |
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L5 Nerve Root Motor
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EHL
EDL EDB Gluteus medius |
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S1 Nerve Root Sensory
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Lateral malleolus
Lateral foot Heel |
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S1 Nerve Root Motor
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Peroneais
Gastroc soleus Gluteus maximus |
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Associated with HLA-B27
Uveitis |
Anklyosing spondylitis
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Closed fluid filled sac bn muscle/bone and muscle/muscle that occur where friction or impingement may occur
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Bursa
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Point tenderness where gluteus medius inserts and IT band passes over
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Trochanteric Bursitis
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Pain with walking or running, especially up an incline or up stairs
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Trochanteric Bursitis
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Breakdown and loss of articular cartilage within the joint surfaces
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OA
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Pain in groin region
Decreased ROM, especially abduction |
OA
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Inability to WB
Shortened leg, typically in external rotation |
Hip Fractures
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Types of Hip Fractures (5)
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Subcapital/Femoral Neck
Intertrochanteric Sub-trochanteric Femoral Shaft Pubic Rami |
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Pubic Rami Fracture Tx
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WB as tolerated with walker
Pain management |
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Occurs in tibia in ER and knee in valgus position
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ACL Injury
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ACL Tests (4)
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Anterior Drawer
Lachman's Pivot-Shift MRI |
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Occurs when knee flexed to 90 degress
Vulnerable to injury after ACL has been torn |
PCL Injury
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PCL Injury Tests (3)
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Posterior Drawer
Posterior Sag Test MRI |
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Occurs from direct blow from lateral side or from an outward twist
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MCL Injury
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MCL Injury Test
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Valgus Stress
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Rare
Occurs when tibia internally rotated with force directed laterally |
LCL Injury
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LCL Injury Test
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Varus Stress
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Bucket Handle Tear
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Meniscus Injury
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Decreased ROM
Pain in area of tear Locked knee with inability to flex/extend |
Meniscus Injury
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Meniscus Tests (3)
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McMurray's
Apley's MRI |
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Accumulation of joint flid in posterior aspect of knee
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Baker's Cyst
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Septic Arthritis Dx
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Gram Stain
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Septic Arthritis Tx
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Surgical urgency
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Lateral malleolus extends more distally
Medial malleolus acts as fulcrum Combo of plantar flexion and inversion |
Inversion Ankle Sprain
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Fracture/dislocation of 1st/2nd TMT joint
Midfoot pain and disability w WB |
Lisfranc Injury
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Lisfranc Injury Dx
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Weight bearing x-rays bilateral feet
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Pain and/or inability to do heel rise
Inability to otoe walk "Too Many Toes" sign |
Posterior Tibial Tendon Injury
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Most frequently ruptured tendon
Inability to toe walk Point tenderness along course of tendon Inability to do push-off |
Achilles Tendon Injuries
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Test for Achilles Tendon Injuries
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Thomson Test
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Most common fracture treated by orthopaedists
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Ankle Fracture
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Most common lower extremity fracture in sports
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Ankle Fracture
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Usually caused by verical and/or medial-lateral force when foot inverted with heel raised
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Fifth Metatarsal Fracture
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High heel fracture
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Fifth Metatarsal Fracture
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Fracture to base of fifth MT specifically occuring at the metaphyseal diaphyseal junction
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JonesFracture
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Salter Harris Classification
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SALTER:
Same Above Lower Through Everything R |
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Apophysitis of the tibial tubercle at the attachment of the patellar tendon
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Osgood-Schlatter Syndrome
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Osgood-Schlatter Syndrome Tx
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Cho-Pat Strap
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Reduction of Nursemaid's Elbow
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Firm supination and flexion of arm
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Temporary interruption of blood to the proximal femoral epiphysis
Gradual onset of groin, hip, or knee pain Trendelenberg gait |
Legg Calve-Perthes Syndrome
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"Ice cream scoop slipping off of cone"
Overweight males Presents as pain that may be referred to the thigh or knee |
Slipped Capital Femoral Epiphysis
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Tx of Slipped Capital Femoral Epiphysis
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Surgical fixation
Protected weightbearing |
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Viral v. antecendent infection
Typically unilateral pain Antalgic gait Hip pain w PROM Knee pain |
Pediatric Hip Synovitis
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Most common primary malignant tumor
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Osteosarcoma
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Cartilage based malignant tumor
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Chondrosarcoma
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Patient supine with knee flexed to 90 degrees
Examiner stabilizes foot by sitting on it Fingers in popliteal fossa with thumbs on lateral and medial joint line Pull tibia forward Positive test if tibia displaces forward |
Anterior Drawer Test
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Patient supine with knee flexed to 30 degrees
One hand is placed on distal femur and the other hand is placed on proximal tibia Tibia is gently pulled fwd while femur is pushed back Positive if tibia has soft endpoint |
Lachman's
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Pt is supine
One hand on knee with finger and thumb on joint line Other hand grasps the foot/ankle Flex knee fully, externally rotate tibia and apply valgus force, extend knee (medial meniscus) Repeat with internally rotating tibia and applying a varus force, extend the knee (lateral meniscus) |
McMurray's
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Pt lies in prone position with knee flexed 90 degrees
Foot is grasped, tibia is internally and externally rotated Compression = meniscal Distraction = ligamentous |
Appley's
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Predominant cause of Aspiration Pneumonia
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Streptococcal
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CXR shows cavitary lesions that may contain air-fluid levels
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Aspiration Pneumonia
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TB of the spine
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Pott's Disease
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Occurs when an individual becomes infected but does not become acutely ill
Pts asymptomatic and cannot spread the infection |
Latent TB Infection
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Progressive infection poorly contained by host defense mechanisms associated with symptoms determined by the site of disease
Usually occurs in lung parenchyma as a progressive infiltrative and cavitating process |
TB Disease
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Caseating Granulomas
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TB
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Classic CXR pattern of soft nodules involving all lung fields
Represents hematogenous dissemination of a poorly contained infection with small tuberculous abscesses |
Miliary TB
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Upper lobe infiltrates with cavitation
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TB
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Latent TB Tx
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Isoniazid x9 months
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Active TB Tx
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Isoniazid
Rifampin Pyrazinamide Ethambutol for 8 weeks INH and RIF for 16 weeks |
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Isoniazid SEs
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Hepatitis
Peripheral Neuopathy Coadminister Vit B6 |
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Rifampin SEs
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Hepatitis
Flu Syndrome Orange discoloration of body fluids |
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Ethambutol
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Optic neuritis (red/green vision loss
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Atypical Mycobacterial Infection
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M. avium complex
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Comprises a heterogeneous group of disorders that share a common reaction to lung injury
Alveolitis Leads to diminished lung compliance and restrictive lung disease |
Interstitial Lung Disease
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Patchy ground glass, reticular, or reticulnodular infiltrates on CXR
Multiple small, thick-walled cystic saces in the lung periphery ("honeycomb lung") |
Interstitial Lung Disease
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Honeycomb Lung
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Interstitial Lung Disease
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Dx of Interstitial Lung Disease
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Biopsy
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Most common diagnosis for patients with ILD
Progressive fibrosis on CXR |
Idiopathic Fibrosing Interstitial Pneumonia (Idiopathic Pulmonary Fibrosis)
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Granulomatous inflammation of the lung
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Sarcoidosis
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3 Extrapulmonary findings common in Sarcoidosis
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Erythema nodosum
Parotid gland enlargement HSM or lymphadenopathy |
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Bilateral adenopathy and right paratracheal adenopathy
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Sarcoidosis
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Dx of Sarcoidosis
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Biopsy
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Biopsy of Sarcoidosis
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Noncaseating granulomas
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Tx of Sarcoidosis
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Prednisone
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When to Tx Sarcoidosis (6)
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Constitutional symptoms
Hypercalcemia Iritis Arthritis CNS or cardiac involvement Granulomatous hepatitis |
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Wegner's Granulomatosis Symptoms (3)
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Glomerulonephritis
Necrotizing granulomatous vasculaitis of the upper/lower airways Small vessel vasculitis |
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c-ANCA and elevated ESR
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Wegner's
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Dx of Wegner's
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Biopsy of lung, skin, or kidney
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Tx of Wegner's
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Cyclophosphamide +/- prednisone
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Ideopathic multisystem vasculitis of small and medium-sized arteries that occurs in patiens with asthma
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Churg-Strauss Syndrome
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Marked peripheral eosinophilia
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Churg-Strauss Syndrome
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Churg-Strauss Syndrome Tx
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Cyclophosphamide and prednisone
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Chronic fibrotic lung diseases caused by inhalation of coal dust that is ingested by alveolar macrophages
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Coal Worker's Pneumoconiosis
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Seen as diffuse small opacities in the upper lung on CXR
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Coal Worker's Pneumoconiosis
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Prolonged inhalatio of silica causes formation of small rounded opacities throughout the lungs
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Silicosis
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A nodular interstitial fibrosis that leads to progressive dyspnea
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Asbestosis
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Pleural plaquing
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Asbestosis
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Tx of Pleuritis
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Anti-inflammatories or opiates
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Increased production of fluid due to abnormal capillary permeability or decreased lymphatic drainage from pleural space
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PE Exudates
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Increased production of fluid with normal capillaries due to increased hydrostatic pressure, decreased oncotic pressure, or greater negative intrapleuar preasure
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PE Transudates
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Suggests local pleural disease
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Exudates
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Indicates absence of local pleural diesease
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Transudates
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Protein >3g in transudates or exudates?
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Exudates
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Exudate examples (2)
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Pneumonia
Cancer |
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Transudate examples (3)
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CHF
Hypoalbuminemia Atelectasis |
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Exudative pleural effusion caused by direct infectionof the pleural space (appears purulent or turbid)
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Empyemas
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Gross blood inthe pleural space often from trauma
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Hemothorax
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Due to disruption of the thoracic duct where cholesterol complexes accumulate
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Chylothorax
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Often caused by TB, rheumatic pleural effusion, or other physical disruption of the thoracic duct (lymphoma or thoracic surgery)
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Chylothorax
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PE Dx Gold Standard
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Diagnostic thoracentesis
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PE Tx
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Treat underlying condition
Possible therapeutic thoracentesis for severe dyspnea |
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Accumulation of air in the pleural space
Occurs in the absence of an underlying lung disease Classically in tall, thin young men |
Spontaneous Pneumothorax
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Accumulation of air in the pleural space from penetrating or blunt trauma (including iatrogenic)
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Traumatic Pneumothorax
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Accumulation of air in the pleural space from penetrating trauma, CPR, or mechanical ventilation
Contralateral mediastinal shift |
Tension Pneumothorax
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If large, may present with decreased BS and tactile fremitus
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Pneumothorax
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Pneumothorax Dx
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CXR, especially expiratory film
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Occlusion of pulmonary arterial circulation from an embolized substance
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Pulmonary Thromboembolism
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Most common 2 symptoms of PE
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Dyspnea
Pain on inspiration |
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Most common sign of PE
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Tachypnea
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PE EKG
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S1Q3T3
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Prominent central pulmonary artery with local oligemia
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Westermark's sign
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Pleural-based areas of increased opacity that represent intraparenchymal hemorrhage
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Hampton's hump
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Standard of care for PE Dx
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Spiral CT
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Most commonly used to diagnose DVTs
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Venous US
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Gold standard DVT Dx
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Venography
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Gold standard to Dx PE
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Pulmonary angiography
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Tx of PE
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Anticoagulate for 3-12 months
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Indication for surgery for PE
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Saddle embolus
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Coagulation Tx that is contraindicated in pregnancy?
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Warfarin
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Pulmonary artery pressure rises to a level inappropriate for a given cardiac output
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Pulmonary HTN
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2 causes of Pulmonary HTN
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Decreased area of pulmonary arterial bed
Increased pulmonary venous pressure |
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Causes of decreased area of pulmonary arterial bed (3)
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Vasoconstriction
Loss of vessels Obstruction of vessels |
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Causes of increased pulmonary venous pressure (5)
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Constrictive pericarditis
LVF Mitral stenosis Myxoma Mediastinal disease compressing pulmonary veins |
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Tx of Pulmonary HTN
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Tx underlying cause
CCBs Diuretics Moderate Disease: Bosentan Severe Disease: Treprostinil, epoprostenol/prostacyclin |
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Enlargement of the right ventricle due to abnormalities of the lung, thorax, or pulmonary ventilation/circulation
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Cor Pulmonale
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Hypoventilation appears to result from a combo of blunted ventilatory drive and increased mechanical load imposed upon the chest by obesity
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Obesity-Hypoventilation Syndrome
AKA Pickwickian Syndrome |
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Acute hypoxemic respiratory failure following a systemic or pulmonary insult without heart failure
|
ARDS
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Most severe acute lung injury that typically presents with:
Bilateral, diffuse pulmonary infiltrates that spare the costophrenic angles Normal pulmonary capillary wedge pressure PaO2/FIO2 ratio <200 |
ARDS
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Rapid onset of dyspnea 12-48 hours after initiating even (sepsis, drowning, aspiration, trauma, etc)
Pink, fothy sputum |
ARDS
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Pink, frothy sputum
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ARDS
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