Review For Ortho Test

Front 1

One circumstance in which prehospital reduction of obvious fracture to the shaft of a long bone may be justified is the absence of what?

Back 1

The absence of a distal pulse

Front 2

Name the 7 most common fracture line orientation terms

Back 2

1. Transverse 2. Oblique 3. Spiral 4. Comminuted 5. Segmental 6. Torus 7. greenstick

Front 3

For an adult a plaster splint should be at least how many layers thick?

Back 3

At least 12 layers thick and more layers should be used for children.

Front 4

Which tendons of the hands are more likely 2 have a deep space infection? The extensor tendons or the flexor tendons? Why?

Back 4

Unlike the extensor tendons, the flexor tendons are enclosed in synovial sheaths, making them prone to deep space infections

Front 5

Which nerve innervates the dorsal and radial aspect of the hand?

Back 5

The radial nerve

Front 6

Which of the three primary nerves of the hand has no motor innervation of any of the intrinsic muscles of hand?

Back 6

The radial nerve

Front 7

Have the patient tightly grasp the piece of paper between the thumb and index finger. Weakness suggest s what two possible problems?

Back 7

Weakness suggest median nerve or ulnar collateral ligament disruption, depending on the mechanism of injury being evaluated

Front 8

Having the patient spread the fingers apart against resistance and then push them together again against resistance assesses the integrity of what nerve?

Back 8

The ulnar nerve

Front 9

Having the patient flex the distal phalanx of the thumb against resistance is a way of assessing which nerve?

Back 9

The median nerve

Front 10

Why is it important to test resistance when doing range of motion testing when assessing tendons?

Back 10

Because up to 90% of a tendon can be lacerated with preservation of range of motion without resistance.

Front 11

True or false. A hand surgeon should repair all flexor tendon lacerations and primary repair should occur within 12 hours.

Back 11

Both are true.

Front 12

What is the most common tendon injury in athletes?

Back 12

Mallet finger.

Front 13

Chronic untreated mallet finger may result in what kind of a deformity?

Back 13

A swan neck deformity

Front 14

As a general rule lacerations of a tendon that involve less than what % do not require repair?

Back 14

Less than 25% do not require repair

Front 15

Tendon lacerations from what to what need simple suture repair only?

Back 15

25% to 50%

Front 16

More than how many degrees of radial angulation indicates complete rupture of the ulnar collateral ligament of the thumb?

Back 16

More than 40 degrees of radial angulation indicates complete rupture and requires surgical consultation

Front 17

Describe the maximum number of degrees of angulation that is allowable in the second, third, fourth and 5th metacarpals in the setting of a metacarpal neck fracture.

Back 17

Second and third metacarpals can be angulated up to 15 degrees. The fourth metacarpal can be angulated up to 20 degrees and the fifth metacarpal does not need reduction unless it is angulated more than 40 degrees

Front 18

What is the name of a fracture that is intra-articular with associated subluxation or dislocation at the thumb CMC joint?

Back 18

A Bennett fracture

Front 19

What is the name of a thumb CMC fracture that is intra-articular and comminuted at the base of the metacarpal?

Back 19

Rolando fracture

Front 20

What is the most common fracture in the wrist?

Back 20

Fracture of the distal radius is the most common fracture in the wrist.

Front 21

What is the most commonly injured ligament of the wrist?

Back 21

The scapholunate ligament has a marked propensity for injury and is the most commonly injured ligament of the wrist.

Front 22

Scapholunate dissociation is a widening of the scapholunate joint space of more than how many millimeters on the PA view?

Back 22

More than 3 millimeters

Front 23

What is the disposition of all patients with perilunate or lunate dislocations?

Back 23

All patients with perilunate or lunate dislocations require emergency orthopedic consultation

Front 24

What imaging modality is considered the gold standard for definitive diagnosis of scaphoid fracture?

Back 24

MRI is considered the gold standard for definitive diagnosis

Front 25

What carpal bones are at increased risk of avascular necrosis because of their distal to proximal blood supply?

Back 25

The scaphoid, the lunate and the capitate

Front 26

If an unscrupulous test question refers to an injury that creates a "dinner fork"deformity, what fracture is it trying to describe?

Back 26

A colles fracture, which is a distal radial fracture with dorsal displacement of the distal fragment

Front 27

Which distal radius fracture is sometimes referred to as a garden spade deformity?

Back 27

A Smith fracture or a distal radius fracture with volar displacement of the distal fragment.

Front 28

Dorsal or volar rim fractures of the distal radius are known as what?

Back 28

Barton fracture

Front 29

Asking the patient to extend both the wrist and the fingers against resistance is the single best test of which nerve's motor function?

Back 29

The radial nerve.

Front 30

The ability to abduct the index finger against resistance and two-point discrimination over the tip of the fifth digit are two easy tests of what nerve?

Back 30

The ulnar nerve

Front 31

Making a circle or okay sign with the thumb and index finger and demonstrating intact two-point discrimination over the tip of the index finger complete the evaluation of which nerve?

Back 31

The median nerve

Front 32

Approximately 90% of all elbow dislocations are dislocated in what direction?

Back 32

Posterolateral

Front 33

When confronted with an elbow dislocation what is the first priority of care?

Back 33

The first priority of care is to assess the neurovascular status of structures most vulnerable to entrapment, namely the brachial artery, and the ulnar, radial and median nerves.

Front 34

If no fracture is detected in the elbow but a positive fat pad sign is noted how should the injury be treated?

Back 34

Treatment is initiated as though a fracture were identified, with splint immobilization and orthopedic consultation

Front 35

Posteromedial displacement of a supracondylar fracture may involve which nerve?

Back 35

Posteromedial displacement may involve the radial nerve

Front 36

Supracondylar fracture with posterolateral displacement usually affects which nerve?

Back 36

The median nerve

Front 37

Which nerve is commonly injured with an olecranon fracture?

Back 37

The ulnar nerve

Front 38

What are the most common fractures of the elbow?

Back 38

Radial head fractures are the most common fractures of the elbow.

Front 39

A fracture of the proximal third of the ulna with a radial head dislocation is often referred to as what?

Back 39

Monteggia fracture dislocation

Front 40

As a rule the radial head normally points to which bone in all radiographic views of the elbow?

Back 40

the capitellum

Front 41

Which are more common, posterior or anterior sternoclavicular joint dislocations?

Back 41

Anterior sternoclavicular joint dislocations are more common

Front 42

What is the most commonly injured nerve associated with anterior shoulder dislocations?

Back 42

The axillary nerve

Front 43

Although the AP radiograph will reveal the dislocation, what view will indicate whether the dislocation is anterior or posterior?

Back 43

The scapular Y view

Front 44

True or false. First-time shoulder dislocations should be referred for orthopaedic evaluation.

Back 44

True

Front 45

In patients with isolated ulna fracture also known as night stick fracture, with more than what percentage of displacement, more than what percentage of angulation or those that involve what portion of the ulna are considered unstable?

Back 45

Fractures with more than 50% displacement, more than 10% angulation, or those that involve the proximal third of the ulna are considered unstable and require orthopedic consultation

Front 46

Describe the similarities and differences between a nightstick fracture and a Monteggia fracture.

Back 46

Both involve a fracture of the ulna. A Monteggia fracture dislocation is a fracture of the proximal third of the ulna with an associated radial head dislocation

Front 47

What is the treatment for types 1 & II acromioclavicular joint injuries?

Back 47

Treatment of type 1 & II injuries consists of rest, ice, analgesics, and immobilization, followed by early range of motion exercises in 7 to 14 days.

Front 48

What are treatment options for type III AC joint injuries?

Back 48

Treatment of type III injuries is controversial with proponents for conservative or operative philosophies. A trend, however, reveals a shift to conservative treatment with sling immobilization.

Front 49

What treatment should type IV, 5 and VI AC joint injuries receive?

Back 49

Most experts recommend surgical repair.

Front 50

What percentage of patients over 40 years old with an anterior shoulder dislocation will have an associated rotator cuff tear?

Back 50

As many as 86% of patients over 40 years old with an anterior shoulder dislocation have an associated rotator cuff tear.

Front 51

True or false. Neuro vascular and rotator cuff tears are more common in posterior shoulder dislocations then they are in anterior shoulder dislocations.

Back 51

False. Neurovascular and rotator cuff tears are more common in anterior shoulder dislocations

Front 52

In the setting of a proximal humerus fracture or an anterior shoulder dislocation what is the most commonly injured nerve and how might you assess it?

Back 52

The most commonly injured nerve is the axillary nerve, and sensation over the deltoid muscle should be tested.

Front 53

Describe the treatment of a 1 part proximal humerus fracture.

Back 53

Treatment of a 1 part proximal humerus fracture generally consists of immobilization with a sling and swathe, ice, analgesics, and orthopedic referral.

Front 54

Describe the bimodal age distribution of fractures of the humeral shaft.

Back 54

Fractures of the humeral shaft occur in a bimodal age distribution, with peaks in the 3rd and 7th decades of life, representing active young men and osteoporotic elderly women, respectively.

Front 55

What two anatomic areas are brachial plexus injuries divided into?

Back 55

Injuries can be divided into supraclavicular (roots and branches) or infraclavicular (cords and terminal nerves)

Front 56

In brachial plexus injuries adduction and internal rotation of the shoulder indicates weakness of the deltoid and infraspinatus muscles indicating an injury to which nerve root?

Back 56

C5

Front 57

In brachial plexus injuries, elbow extension is due to weakness of the biceps indicating injury to which nerve root?

Back 57

C6

Front 58

Persons with hip and femur injuries who have been immobile for a prolonged period due to their inability to send for help should also be evaluated for what?

Back 58

Dehydration and/or rhabdomyolisis

Front 59

Describe the incidence and demographics of femoral neck fractures.

Back 59

Common in older patients with osteoporosis; rarely seen in younger patients

Front 60

Pathologic fractures of the femoral shaft are uncommon but can occur secondary to metastasis most commonly from what types of cancer?

Back 60

Breast, lung and prostate

Front 61

What type of patellar fractures are more likely to be displaced and to be associated with a disrupted extensor mechanism?

Back 61

Transverse fractures of the patella are more likely to be displaced and to be associated with a disrupted extensor mechanism

Front 62

Is the medial or the lateral tibial plateau more likely to be fractured?

Back 62

The lateral plateau is more often fractured.

Front 63

What ligaments of the knee are most commonly injured with lateral plateau fractures of the tibia?

Back 63

The anterior cruciate ligament and the medial collateral ligament

Front 64

What ligaments of the knee are more commonly injured with medial plateau fracture of the tibia?

Back 64

The posterior cruciate ligament in the lateral collateral ligament

Front 65

Approximately 75% of all hemarthrosis are caused by disruption of what knee ligament?

Back 65

The anterior cruciate ligament

Front 66

What is the most common type of knee dislocation?

Back 66

An anterior dislocation is most common in the knee. It occurs about 40% of the time.

Front 67

What is the most common type of dislocation in the ankle

Back 67

A posterior dislocation of the ankle is most common

Front 68

What drug, commonly used in procedural sedation provides analgesia, sedation, anxiolysis and amnesia?

Back 68

Ketamine.

Front 69

At what dosing threshold does the characteristic dissociative state abruptly appear in the use of ketamine?

Back 69

About 1 to 1.5 milligrams per kilogram IV or 3 to 4 milligrams per kilogram IM is when the characteristic dissociative state abruptly appears

Front 70

Young infants who are less than 3 months old, patients with significant upper respiratory tract infection symptoms, and patients who will undergo intra oral procedures should not receive what drug due to a possible increased risk of laryngeal spasm.

Back 70

Ketamine

Front 71

What medication is commonly given along with ketamine to blunt the occurrence of emergence reactions?

Back 71

Midazolam aka versed

Front 72

What is the recommended dose for emergency department procedural sedation using propofol?

Back 72

1 milligram per kilogram IV, followed by 0.5 milligrams per kilogram IV every 3 minutes if needed.

Front 73

Propofol is contraindicated in patients who are allergic to what?

Back 73

Propofol is contraindicated in patients who are allergic to eggs or soy protein.

Front 74

What induction agent can cause myoclonic jerking in up to 20% of patients, which can interfere with the procedure for which the patient was sedated?

Back 74

Etomidate

Front 75

On a 100 mm visual analogue scale a decrease in pain of how many millimeters is the minimal clinically significant change noticeable by patients?

Back 75

13 millimeters

Front 76

On a 100 mm visual analogue scale a decrease in pain of how many millimeters is the minimally acceptable change?

Back 76

An average decrease of 30 millimeters on the visual analog scale is the minimally acceptable change

Front 77

When there are language difficulties or cross cultural differences, which pain rating scale is preferred because it is the least affected by these factors?

Back 77

The visual analogue scale is the preferred pain assessment modality in such circumstances.

Front 78

What are the five components to effective pharmacologic pain management in the emergency department?

Back 78

1. Selection of an agent appropriate for the intensity of the pain.
2. Prompt onset of analgesic activity. 3. Ease of administration.
4. Safety.
5. Efficacy.

Front 79

Up to 10 percent of the US population is deficient in the necessary enzymes for the conversion of this drug to its active metabolites and therefore this drug does not work. Which drug is this?

Back 79

Codeine

Front 80

Name the four cyclic antidepressants and anticonvulsants used to treat neuropathic pain.

Back 80

CAGP
Carbamazepine, amitriptyline, gabapentin, pregabalin

Front 81

In order to become dependent on a pain medication how long does the drug have to be used?

Back 81

Dependence requires daily usage for 4 to 6 weeks

Front 82

True or false. The presence of addiction does not infer the presence of dependence

Back 82

True

Front 83

True or false. The presence of drug dependence does not infer the presence of drug addiction.

Back 83

True

Front 84

What percentage of patients in pain are at risk for prescription medication abuse?

Back 84

Only 10 percent of patients are at risk for prescription medication abuse and so by implication 90 percent are in pain and their pain is poorly controlled.

Front 85

What opioid pain medications are preferred in the setting of renal failure?

Back 85

If a patient has renal failure, use hydromorphone or fentanyl

Front 86

In the setting of trauma what is the opioid of choice?

Back 86

Fentanyl

Front 87

If sedation is being used for an emergent procedure, when should anelgesia therapy begin?

Back 87

Begin analgesia therapy after sedation recovery