Term
| :Condition typically resulting from degenerative changes in the lumbar spine. |
|
Definition
| Spondylosis (Osteoarthritis) |
|
|
Term
| :a term referring to degenerative osteoarthritis of the pars interarticularis in which the vertebrae are held in place only by ligaments and the intervertebral disk |
|
Definition
|
|
Term
| :a term referring to degenerative osteoarthritis of the pars interarticularis with associated slippage of the upper part of the spine anteriorly |
|
Definition
|
|
Term
|
Definition
| Pain originating in the spine that radiates distally. |
|
|
Term
| Describe the difference between an antalgic gait and a trendelenburg gait. |
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Definition
Antalgic gait is characterized by a shortened stance phase on the affected side.
Trendelenburg gait is caused by abductor weakness that causes the contralateral side to drop while on the stance phase of the affected side. |
|
|
Term
| How long does fracture consolidation of large bones usually take in adults? |
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Definition
|
|
Term
| What are the 3 main orthopedic emergencies? |
|
Definition
Compartment syndrome
Open fractures
Neurovascular injuries |
|
|
Term
| Describe the classic clinical findings of compartment syndrome. |
|
Definition
The 6 P's:
Pain out of proportion
Paresthesia
Palpation (hard and dense)
Paralysis (muscles in the compartment cannot move)
Pallor
Pulselessness |
|
|
Term
| A compartment pressure of what level is virtually diagnostic of compartment syndrome? What pressure difference must be present to maintain adequate tissue perfusion? |
|
Definition
| 30mmHg, a pressure difference of 15mmHG must be present between the diastolic pressure and the patients compartment pressure to maintain adequate perfusion. |
|
|
Term
| What is a potential complication of a prolonged compartment syndrome? |
|
Definition
| Volkmann's ischemic contracture (fibrous scarring of the tissue) |
|
|
Term
| What antibiotic is used for small open fractures? What is added for larger ones? What else should be given? |
|
Definition
Ancef and then Gentamycin.
Give a tetanus shot as well. |
|
|
Term
| What is shoulder impingement syndrome? Describe the 3 main maneuvers to test for impingement syndrome. |
|
Definition
Repetitive impingement of the supraspinatus between the humoral head and the acromion resulting in chronic tendinitis and potentially a rotator cuff tear.
Neer - at maximal passive forward flexion the examiner applies a light pressure to further flex the shoulder and push the acromion and the humoral head together.
Hawkins - shoulder is at 90 degrees of flexion and the elbow is at 90 degrees of flexion and the examiner internally rotates the arm.
Empty beer can test - shoulder is held at 90 degrees forward flexion and 30 degrees adduction and internal rotation and resists downward pressure by the examiner. |
|
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Term
| What must be ruled out with a proximal humerus fracture? How will this present? |
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Definition
| Axillary nerve damage which will present with numbness to the lateral side of teh shoulder and possibly Deltoid weakness. |
|
|
Term
| What is the most frequent location for a clavicle fracture? |
|
Definition
|
|
Term
| Describe the 3 grades of AC joint separations. |
|
Definition
I: no instability on stressed x-ray
II: there is instability on stressed x-ray
III: there is a classic piano key deformity on physical exam |
|
|
Term
| Which muscles are the primary elbow flexors? Which nerve innervates these muscles? |
|
Definition
| Biceps and brachioradialis, innervated by the musculocutaneous nerve |
|
|
Term
| Which muscle is the primary extensor of the elbow? Which nerve innervates this muscle? |
|
Definition
| Triceps, innervated by the radial nerve |
|
|
Term
| What nerve is at risk of injury in a humeral shaft fracture? How will this present? |
|
Definition
| Radial nerve, the patient will not be able to extend their wrist or fingers (wrist drop). |
|
|
Term
| Describe the differences between golfer's and tennis elbow. |
|
Definition
Golfer's elbow involves the wrist flexors so they will have medial elbow pain.
Tennis elbow involves the wrist extensors so they will have lateral elbow pain. |
|
|
Term
| What is a sailboat sign on x-ray indicative of? |
|
Definition
| A subtle non-displaced radial head fracture |
|
|
Term
| Describe which hand muscles are innervated by the radial, ulnar and median nerves. |
|
Definition
Radial = extensor muscles of all the fingers.
Ulnar = flexor muscles of the 5th, 4th and half of the 3rd digit.
Median = flexor muscles of the thumb, 2nd and half of the 3rd digit. |
|
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Term
| Describe the differences between a Monteggia and Galeazzi fracture and their treatments. |
|
Definition
Monteggia involves a fracture of the proximal ulna and a dislocation of the radial head.
Galleazzi involves a fracture of the distal radius and dislocation of the distal radio-ulnar joint.
A Monteggia is usually treated with ORIF and a Galeazzi can usually be manual reduction. |
|
|
Term
| Describe the differences between a Colles' fracture, Smith's fracture and Barton's fracture. |
|
Definition
Colles = Distal radius fracture (and 50% of the type a ulnar styloid process fracture) with dorsal (posterior) displacement of the distal fragment.
Smith's = intraarticular fracture of the palmar (volar or anterior) lip of the distal radius.
Barton's = intraarticular fracture of the dorsal (posterior) lip of the distal radius. |
|
|
Term
| Which nerve can be damaged with distal radial/ulnar fractures? How does this present? |
|
Definition
| The median nerve can be damaged which will present as paresthesia to the thumb, index and middle fingers. |
|
|
Term
| Which nerve and fingers are typically involved with carpal tunnel syndrome? |
|
Definition
| Median nerve, 1st, 2nd, and 3rd digits will have numbness and tingling. |
|
|
Term
| What is Kienbock's disease? |
|
Definition
| AVN of the lunate due most commonly to a hyperextension injury. |
|
|
Term
| Which tendons are involved with De Quervain's tenosynovitis? |
|
Definition
| abductor pollicis longus and extensor pollicis brevis |
|
|
Term
| What splint should be used for a De Quervain's? |
|
Definition
|
|
Term
| What is the initial treatment for a trigger finger? |
|
Definition
| Steroid injection into the tendon sheath |
|
|
Term
| What is the treatment for a non-displaced scaphoid fracture? |
|
Definition
|
|
Term
| Describe the difference between a Bennett's and a Rolando's fracture. |
|
Definition
Bennett's is a single intra-articular fracture at the base of the 1st metacarpal.
Rolando's is a comminuted intaarticular fracture at the base of the first metacarpal. |
|
|
Term
| Describe the mechanism of injury for a skiers thumb. |
|
Definition
| Forced abduction of the thumb injuring the ulnar collateral ligament with possible avulsion fracture of the 1st proximal phalanx. |
|
|
Term
| Describe the differences between a mallet/baseball finger and a jersey finger. Which one definitely requires surgery? |
|
Definition
Mallet/baseball = the DIP joint will bend but it will not straighten due to rupture of the extensor tendon.
jersey = the DIP joint will extend but it will not flex due to rupture or avulsion of the flexor digitorum profundus.
A Jersey finger always requires surgery to reattach the FDP tendon. |
|
|
Term
| What should be suspected with localized lateral hip pain just over the greater trochanter? |
|
Definition
|
|
Term
| Which nerve supplies the hamstring and quadriceps muscles? |
|
Definition
Hamstrings = sciatic nerve.
Quads = femoral nerve. |
|
|
Term
| Describe the difference between an anterior drawer and lachman test. |
|
Definition
Anterior drawer = knee is at 90 degrees with the examiner sitting on the patients foot and pulling forward with 2 hands.
Lachman = performed at 20 degrees of flexion with one hand pushing posteriorly on the femur and one pulling anteriorly on the tibia. |
|
|
Term
| What are the graft options for an ACL reconstruction? |
|
Definition
| Hamstring tendon, patellar tendon, quadriceps tendon or cadaver tissue. |
|
|
Term
| Damage to which nerve results in a foot drop? |
|
Definition
|
|
Term
|
Definition
| The great toe is deviated laterally with a large bunion forming. |
|
|
Term
| Describe the sensory, motor and reflex responsible C5-C7 and L3-S2/3. |
|
Definition
C5: Deltoid sensation, deltoid motor, biceps reflex.
C6: thumb sensation, elbow/wrist flexion, brachioradialis reflex.
C7: middle fingers sensation, elbow/wrist extension, triceps reflex.
L3: medial upper thigh sensation, knee extension, patellar tendon reflex.
L4: below the knee across to the medial foot sensation, ankle dorsiflexion, patellar tendon reflex.
L5: big toe sensation, big toe extension, no reflex.
S1: lateral foot sensation, ankle plantarflexion, achilles tendon reflex.
S2-3: anus sensation, anal sphincter, no reflex. |
|
|
Term
| Describe grade 0-5 muscle strength. |
|
Definition
0: no contraction
1: trace of contraction
2: movement with gravity eliminated
3: movement against gravity
4: movement against resistance
5: normal strength |
|
|
Term
| How will spondylolysis appear on oblique x-ray? |
|
Definition
| A break in the neck for the scotty dog |
|
|
Term
| Describe the differences between a Hangman's, Burst, and Jefferson's fracture. |
|
Definition
Hangman: extension injury resulting in anterior diplacement of C2 and fracture through the pars interarticularis or pedicle.
Burst: axial compression resulting in loss of anterior and posterior vertebral body height.
Jefferson: C1 fracture due to axial loading in which the right and left aspects fracture and slip down over C2. |
|
|
Term
| Which antibiotic is used empirically to treat suspected septic arthritis while you are waiting on culture results? |
|
Definition
|
|
Term
| Which hands joints are typically involved with RA? |
|
Definition
| Wrist, MCP and PIP joints |
|
|
Term
| Describe the maneuver to reduce a nursemaids elbow. |
|
Definition
| Supinate the hand while flexing the elbow while applying gently pressure over the radial head. |
|
|
Term
| Describe Ortolani and Barlow signs for congenital hip dislocations. |
|
Definition
Ortolani: exert an upwards force with external rotation to reduce a dislocated hip.
Barlow: exert a downward force with internal rotation to try and dislocate the hip. |
|
|
Term
|
Definition
| It is basically Osgood-Schlatter of the achilles tendon insertion on the calcaneous. |
|
|
Term
| What is Legg-Calve-Perthes Disease? |
|
Definition
| AVN of the femoral head occurring most commonly in males between the age of 3-11. |
|
|
Term
| *Which level of vertebra and which direction does scoliosis usually affect? |
|
Definition
| Thoracic and to the right |
|
|
Term
| *MC organism with osteomyelitis? |
|
Definition
|
|
Term
| *What should be suspected if synovial fluid analysis shows monosodium urate crystals? |
|
Definition
|
|
Term
| *What medication class is a predisposing risk for Gout? |
|
Definition
|
|
Term
| *What is the best treatment for plantar fascitis? |
|
Definition
|
|
Term
| *What would be a concerning symptom of back issues? |
|
Definition
|
|
Term
| *Little league elbow is AKA? |
|
Definition
|
|
Term
| *MC primary bone cancer is? |
|
Definition
|
|
Term
| *MC location of an osteosarcoma? |
|
Definition
|
|
Term
| *MC location for a Ewing's sarcoma? |
|
Definition
| Diaphysis of bones around the knee |
|
|
Term
| *Initial treatment for RA? |
|
Definition
|
|
Term
| *MCC for a tibial plateau fracture? |
|
Definition
| Fall from height/axial load |
|
|
Term
| *Know what a Jones fracture is. |
|
Definition
| Stress fracture to the 5th metatarsal base. |
|
|
Term
| :anterior surface of the hand |
|
Definition
|
|
Term
| Describe the differences between Ankylosis, Spondylolysis, Spondylolisthesis, Spondylitis, and Spondylosis. |
|
Definition
Ankylosis: restriction of motion in a joint.
Spondylolysis: dissolution or loosening of a vertebra.
Spondylolisthesis: slipping of the vertebra.
Spondylitis: inflammation involving the spinal column.
Spondylosis: disease, degenerative of a vertebrae. |
|
|
Term
| :hollow, abnormally high arch |
|
Definition
|
|
Term
| :flat, abnormally low arch |
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Definition
|
|
Term
| :loose jointedness – “double jointed” |
|
Definition
|
|
Term
| :rotational or angular position of a fracture |
|
Definition
|
|
Term
| :amount of end-to-end contact of a fracture |
|
Definition
|
|
Term
| :fracture that heals in an unsatisfactory position |
|
Definition
|
|
Term
| How long does it take for type 1 (contusion), type 2(crush) and type 3(transection) nerve injuyries to recover? |
|
Definition
Type 1 = 2-3 months.
Type 2 = 95% by 6 months (2cm/month).
Type 3 = may not ever recover. |
|
|
Term
| What degree is the ankle casted? Knee? |
|
Definition
Ankle is casted at 90 degrees.
Knee is casted at 30 degrees. |
|
|
Term
| What is the most common site of acute Osteomyelitis? |
|
Definition
| Metaphyseal end of a long bone near the knee joint. |
|
|
Term
| How long does it take for acute osteomyelitis to show up on x-ray? What test can detect it earlier? |
|
Definition
Can take up to 2-4 weeks in adults for x-ray.
Bone scan can detect it earlier. |
|
|
Term
| What is the typical first Sx seen with acute osteomyelitis? |
|
Definition
| Decrease in joint mobility. |
|
|
Term
| Describe grades 0-5 of diabetic foot ulcers. |
|
Definition
0 = No open lesion.
1 = Superficial ulcer affecting only the skin.
2 = Deep ulcer that involves the underlying tendons, bones or ligaments.
3 = Abscess that reaches the bone.
4 = Gangrene present in the toes and forefoot.
5 = Gangrene of the entire foot. |
|
|
Term
| What is the most common cause of chronic osteomyelitis? What are the cellular changes and how does it appear on x-ray? |
|
Definition
MCC = an open fracture.
It has dead bone that is surrounded by a shell of new bone, appears on x-ray as sclerotic bone with several areas of radiolucentcy. |
|
|
Term
| What are the major differences between regular septic arthritis and Gonococcal (N. gonorrhoeae) Septic Arthritis? |
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Definition
| Regular septic arthritis is usually monoarticular and Gonococcal septic arthritis is usually polyarticular and has symptoms of tenosynovitis (inflammation of the lining of the sheath that surrounds a tendon) and dermatitis. |
|
|
Term
| What is the most common benign bone tumor? What are the most common sites of this tumor? |
|
Definition
Osteochondroma.
MC site = metaphysis of the distal femur or proximal tibia. |
|
|
Term
| :benign tumor that is the most common tumor of the hand and usually affects the small bones of the hands or feet. |
|
Definition
|
|
Term
| :malignant tumor that most commonly originate in the metaphysis around the knee in 10-20 year olds and may be associated with Paget's disease. |
|
Definition
|
|
Term
| :Bone disorder w/ repeated episodes of bone destruction and excessive bone repair most commonly affecting the hips, pelvis and spine and is characterized by pain, bowing of the long bones, pathologic fractures and skull enlargement. |
|
Definition
|
|
Term
| :malignant bone cancer of the midshaft of a long bone most commonly affecting the diaphyseal region of 10-15 year olds and characterized by painful soft tissue mass, weight loss, fever and lethargy |
|
Definition
|
|
Term
| What are the nerve roots that make up the Brachial Plexus? |
|
Definition
|
|
Term
| Describe the distraction test in examination of the spine. |
|
Definition
| Decompression of vertebrae to see if symptoms are resolved. |
|
|
Term
| Describe the compression test of spinal examination. |
|
Definition
| Push straight down on the head and see if symptoms are increased. |
|
|
Term
| Describe Spurling's test of spinal examination. What does this indicate? |
|
Definition
| Head is tilted towards the effected side and you push down to see if the symptoms are increased. Indicates cervical disc herniation. |
|
|
Term
|
Definition
| Used to test the vascular system. Find the radial pulse and then abduct and move the arm posterior, then rotate the head towards the affected side. If they pulse disappears, that is a positive test. |
|
|
Term
| What are some causes of atraumatic C-spine dislocation? |
|
Definition
| Atraumatic causes = RA and Down's syndrome. |
|
|
Term
| What is Brown-Sequard's Syndrome? S&S? |
|
Definition
Emergency spinal cord compression characterized by an injury to half of the spinal cord.
S&S = low back pain, loss of motor function and sensation on the affected side and loss of sharp touch and temperature on the opposite side. |
|
|
Term
| What is the normal kyphotic curve range for thoracic vertebrae? What are some characteristics of kyphosis on x-ray? What are the treatments of kyphosis based on the angle? |
|
Definition
Nl = 20-49 degrees.
Characteristics = flattened discs, thickened anterior longitudinal ligament, wedged vertebral bodies and Risser's sign (calcification of the iliac crest).
Tx for 50-70 degrees = exercise and stretching with use of a back brace.
Tx for over 70 degrees = surgery. |
|
|
Term
| What are the treatments for scoliosis based on the degree of rotation? |
|
Definition
10-25 degrees = PT and monitor.
25-45 degrees = Brace and PT.
Over 45 degrees = Surgery and PT. |
|
|
Term
| Describe grades O-V for Spondylolisthesis. |
|
Definition
Grade 0 = 0% slipped.
Grade I = <25% slipped.
Grade II = 25-50% slipped.
Grade III = 51-75% slipped.
Grade IV = 76-99% slipped.
Grade V = complete displacement. |
|
|
Term
| What is the action of the Rotator Cuff muscles? |
|
Definition
Supraspinatus = Abduction.
Infraspinatus = External rotation.
Teres minor = External rotation.
Subscapular = Internal rotation. |
|
|
Term
| Which muscle is tested in the Empty Can (Jobe) test? |
|
Definition
|
|
Term
| What is the Neer Impingment Test? |
|
Definition
| The examiner performs maximal passive forward flexion with internal rotation while stabilizing the scapula. A positive test elicits pain on the acromion process or sub-acromial space. |
|
|
Term
| What is the Hawkins-Kennedy Impingement Test? |
|
Definition
| The patient is examined in sitting with their arm at 90° and their elbow flexed to 90°, supported by the examiner to ensure maximal relaxation. The examiner then stabilises proximal to the elbow with their outside hand and with the other holds just proximal to the patient's wrist. They then quickly move the arm into internal rotation. Positive test is when there is pain elicited in the sub-acromial space. |
|
|
Term
|
Definition
| a diagnostic test for a tear in the supraspinatus tendon. The result is positive if the patient is unable to lower the affected arm slowly and smoothly from a position of 90 degrees of abduction. |
|
|
Term
| Describe grade I-IV AC separation. |
|
Definition
I - Strain to ligament, but no displacement.
II - Torn AC ligament but intact coracoclavicular ligament (clavicle is mildly displaced upward).
III - disruption of all ligaments w/ full dislocation.
IV - disruption to all ligaments w/ full dislocation w/ deltoid & trapezius disruption. |
|
|
Term
| What tests can be used to detect thoracic outlet syndrome? Describe them. |
|
Definition
Adson test - turn your head toward the symptomatic shoulder while you extend your arm, neck and shoulder slightly away from your body. While you inhale, your doctor will check for a pulse on the wrist of your extended arm. If your pulse is diminished or if your symptoms are reproduced during the maneuver, your doctor considers this a positive test result, which may indicate thoracic outlet syndrome.
Roos test - hold both elbows at shoulder height while pushing your shoulders back. You will then repeatedly open and close your hands for several minutes. If your symptoms are present after the test, or if you feel heaviness and fatigue in your shoulders, this can indicate the presence of thoracic outlet syndrome. Halstead test - In a seated position, palpate the radial pulse, and then pull traction on the patient’s arm downward while the patient extends their head backwards. A positive test is the reproduction of symptoms such as paresthesias which indicates thoracic outlet syndrome. |
|
|
Term
What is the etiology of Nursemaid's elbow?
How do you treat it? |
|
Definition
between the radial head and the humerus.
Tx = the way the arm has to be situated for x-ray usually reduces it (supinate hand & then flex it to the shoulder). |
|
|
Term
| What does a fat pad/sail sign usually indicate in adults? Children? |
|
Definition
| It will hide fractures on x-ray but it is usually indicative of a subtle radial head fracture in adults and a supracondylar fracture of the humerus in children. |
|
|
Term
| What is a Monteggia fracture? What is the treatment in children? Adults? |
|
Definition
It is a fracture to the proximal 1/3 of the ulna and dislocation of the radial head.
Tx in children = closed reduction.
Tx in adults = open reduction w/ internal fixation. |
|
|
Term
| Which muscles are part of the hip flexor group? |
|
Definition
Iliopsoas m.
Sartorius m.
Rectus femoris m. |
|
|
Term
| Which muscles are part of the hip adductor group? |
|
Definition
Gracilis m.
Pectineus m.
Adductor longus m.
Adductor brevis m.
Adductor magnus m. |
|
|
Term
| Which muscles are part of the hip abductor group? |
|
Definition
Gluteus medius m.
Gluteus minimus m. |
|
|
Term
| Which muscles are part of the hip extensor group? |
|
Definition
Gluteus maximus m.
Hamstring muscles (Bisceps femoris m., Semitendinous m., Semimembranous m.) |
|
|
Term
| What are the Thomas and Ober tests? What does a positive test mean? |
|
Definition
Thomas test – lay supine and flex the non-problematic leg, the opposite leg that is laying flat should stay flat. If the knee bends on the leg that is supposed to stay flat then that is a positive Thomas test indicating ITB contracture of the side that was supposed to flat on the table.
Ober test – pt on side, affected side up, examiner abducts the leg as far as possible, flex knee to 90 degrees, examiner releases leg it should adduct; if it does not + ober test = iliotibial band (ITB) contracture |
|
|
Term
| What is an Ortolani click? What is the name of the harness used for those with a positive click? |
|
Definition
Ortolani click – congenital, flex thigh, abduct and externally rotate femoral head, + click means congenital dislocated hip on the side that clicked (must put in a sling after you relocate the hip)
A Pavlik harness is used in babies with an Ortolani click. |
|
|
Term
| What nerves and nerve roots make up the Sciatic nerve? |
|
Definition
| The tibial and common fibular nerve (L4-S3). |
|
|
Term
| How will SCFE's look on x-ray in the chronic stages of the disease? |
|
Definition
|
|
Term
| What is the Q angle? What are the average Q angles for men and women? |
|
Definition
The Q-angle is formed from a line drawn from the ASIS to the center of the kneecap and another line from the center of the kneecap to the tibial tubercle. Look at the intersection of these lines and the most inferior quadrant made by the lines is used to measure the Q angle.
Average for men is 14 degrees and women is 17 degrees. |
|
|
Term
| Which ankle ligament common tears with inversion injuries? Which is most commonly injured? |
|
Definition
Most commonly torn = Calcaneofibular ligament.
Most commonly injured = anterior talofibular ligament. |
|
|
Term
| Describe Thompson's Test. |
|
Definition
| Patient lies prone or kneels on a chair with feet hanging over the edge while relaxing. The examiner squeezes the calf muscle and there should be plantar flexion of the foot. If there is not then it is indicative of an Achilles tendon rupture. |
|
|
Term
| What is Morton's sign and what does it indicate? |
|
Definition
| Examiner grabs around the pts metatarsal heads and squeezes them together, pain between the 3rd and 4th metatarsal head is indicative of a Morton's neuroma. |
|
|
Term
| What does the Deltoid ligament of the ankle connect? |
|
Definition
| Connects the medial malleolus with the talus, navicular and calcaneous. |
|
|
Term
|
Definition
| Pt is prine and the examiner bends the ipsilateral leg. If there is ipsilateral flexion of the patients hip then they have a rectus femoris contracture. |
|
|
Term
| What is osteochondritis dessicans? How is it managed? |
|
Definition
| A joint condition in which a piece of cartilage, along with a thin layer of bone beneath it, comes loose from the end of a bone. It can heal by itself but may require surgery if the loose segments gets caught between moving parts of the joint. |
|
|
Term
| Describe Gamekeeper's and Skier's thumb. |
|
Definition
| Both are injuries to the ulnar collateral ligament (UCL) of the thumb but gamekeeper's is due to more of a chronic injury and skier's is due to an acute injury. |
|
|
Term
| What foot deformity can lead to shin splints? |
|
Definition
| Overpronation or flat feet (pes planus) |
|
|
Term
| What is the most common side for a patellar dislocation? |
|
Definition
|
|
Term
| Which PE test is the most sensitive for diagnosing an ACL tear? |
|
Definition
|
|
Term
| Which ankle ligament is injured with an eversion ankle injury? |
|
Definition
|
|
Term
| :Painful condition affecting the MTP joint of the great toe and is characterized by restriction of motion. It is secondary to traumatic osteoarthritis. Because it affects the MTP joint of the great toe, it is sometimes confused with gout (podagra). |
|
Definition
|
|
Term
| :a discrete, focused callus, usually about 1 cm, on the plantar aspect of the forefoot. Typically, occurs beneath one or more lateral metatarsal heads or under another area of pressure. It is a focused, painful lesion directly beneath a weight-bearing portion of the foot. This pain can limit ambulation and also cause compensatory changes in gait. |
|
Definition
| Intractable plantar keratosis (Calluses) |
|
|
Term
| Describe how a Technetium Bone Scan works and what it is useful at detecting. |
|
Definition
| Phosphorus compounds are metabolized in bone at a rapid rate, and this assimilation can be rapidly detected by a scintillation camera when the substances tagged with a radiotracer. Areas of very rapid bone turnover such as those seen in healing fractures, aggressive tumors, and infections can be readily detected by bone scan. |
|
|
Term
| Describe what is so unique about SPECT- single photon emission computerized tomography. |
|
Definition
| Nuclear imaging test that uses radioactive substance and special camera to take pictures of organs. The scan produces 3-D images to show how things work. For instance, a SPECT scan and show how blood flows through the heart or white areas of the brain are more active or less active |
|
|
Term
| What is the hallmark PE finding for adhesive capsulitis? |
|
Definition
| Loss of internal rotation |
|
|
Term
| Since sub-deltoid/acromial bursitis presents with deltoid insertion site tenderness just like a rotator cuff tear, how can they be differentiated? |
|
Definition
| If a local anesthetic injection relieves pain and the examination after injection reveals normal strength and improved range of shoulder motion, subacromial bursitis and/or rotator cuff tendinitis are a likely cause of shoulder pain. In contrast, pain relief but with persistent supraspinatus muscle weakness suggests a clinically significant rotator cuff tear. |
|
|
Term
| With spinal stenosis, which positions typically aggravate and improve the symptoms? |
|
Definition
Lumbar extension usually aggravates.
Lumbar flexion usually improves. |
|
|
Term
| How do you treat AVN of the femoral head with and without head collapse? |
|
Definition
With = hip replacement.
Without = non-weight bearing to see if the avascular segment will regenerate. |
|
|
Term
| Is an elbow dislocation usually anterior or posterior? |
|
Definition
|
|
Term
| What should be suspected if an x-ray reports a central lytic nidus with a reactive sclerosis surrounding it near the proximal femur? |
|
Definition
|
|
Term
| What is the most common site for an osteosarcoma? |
|
Definition
| metaphyseal area of the knee joint |
|
|
Term
| How will an osteosarcoma present on x-ray? |
|
Definition
| Sunburst pattern of periosteal reaction |
|
|
Term
| What is the treatment for an osteosarcoma? |
|
Definition
| Combo of chemo and then surgery |
|
|
Term
| Describe the 5 year survival rate for osteosarcoma. |
|
Definition
|
|
Term
| How will a soft tissue osteosarcoma appear different than a myositis ossificans on x-ray? |
|
Definition
ST osteosarcoma — heavy mineralization in central area
MO — zonal pattern of ossification, w/ mature dense ossification at periphery of lesion |
|
|
Term
| What is the most common benign tumor of the bone? Most common locations? |
|
Definition
| Osteochondroma, most commonly located on the metaphyseal side of bones with a growth plate. |
|
|
Term
| Describe a Giant Cell bone tumor. |
|
Definition
| Usually benign, most commonly occur around the knee and may cause pathologic fractures. |
|
|
Term
| What is the most common location and x-ray appearance for a Ewing's sarcoma? |
|
Definition
| Most common location is the diaphysis of the long bones around the knee and it appears on x-ray as an onion-skin appearance. |
|
|
Term
| Describe the cause of Multiple Myeloma, x-ray appearance, UA findings and SPEP findings. |
|
Definition
| Malignancy of monoclonal plasma cells which attack bone making it appear on x-ray as multiple punched-out lesions. UA findings include Bence-Jones proteins. SPEP findings include an M spike. |
|
|
Term
| What are the 5 most common cancers to METS to the bone? |
|
Definition
| Breast, prostate, kidney, thyroid and lung. |
|
|
Term
| What is the most common bone for cancer to METS to? |
|
Definition
|
|
Term
| What is the most common complaint of bone METS? Do most bone METS from breast cancer cause pain? |
|
Definition
Pain is the most common complaint.
Breast cancer METS does not typically cause pain because it causes a blastic METS instead of a lytic METS. Lytic METS is more associated with pain. |
|
|
Term
| Name and describe the most common foot deformity in the newborn infant. Treatment? |
|
Definition
| Metatarsus Adductus (metatarsus varus), it is a sharp, inward angle of the front half of the foot. It is usually self-correcting by 12-18 months without treatment. |
|
|
Term
| What is Scheurmann's kyphosis? What is the treatment in a patient that is still skeletally immature? |
|
Definition
It is kyphosis that develops at puberty with unknown cause.
Tx = Milwaukee brace and exercises. |
|
|
Term
| Describe the typical patient with Femoral or Tibial Torsion. Treatment? |
|
Definition
Usually under 5yo and they walk with a pigeon toed gait.
Tx = it will usually correct spontaneously over time. |
|
|
Term
| What is a Jones dressing? |
|
Definition
| thick, well-padded bandage often used after trauma and elective operations to provide firm, evenly distributed pressure and help immobilize the joint. |
|
|
Term
| What are the 2 main indications for a posterior elbow splint? |
|
Definition
Fractures or soft tissue injuries of the elbow
Fractures or soft tissue injuries of the proximal radius/ulna that require immobilization of the wrist and elbow. |
|
|
Term
| Which organisms are patients with sickle cell or IVD abuse at risk for with osteomyelitis? |
|
Definition
SS = Salmonella.
IVD = pseudomonas. |
|
|
Term
| How will an acute osteomyelitis appear on x-ray after 1-2 weeks? |
|
Definition
| Radiolucent lesion with periosteal elevation of the cortex. |
|
|
Term
| How does chronic osteomyelitis appear on x-ray? |
|
Definition
| Involucrum - dead bone surrounded by shell of new bone |
|
|
Term
| What is the most common cause of septic arthritis in adults? What about sexually active young adults? |
|
Definition
Adults = Staph aureus.
Sex active = N. gonorrhea |
|
|
Term
| Describe the typical patient and organism with acute discitis (vertebral osteomyelitis). |
|
Definition
| Typically affects kids and affects the mid-lumbar spine. The most common organism is S. aureus. |
|
|
Term
| Describe what Pott's disease is. Treatment? |
|
Definition
Tuberculosis infection of the spine.
Tx is the same as regular TB. |
|
|
Term
| What is a paronychia? Most common organisms? |
|
Definition
Infection of the nail fold due to any cause.
MC organisms are Staph and strep species |
|
|
Term
| What is a felon? MC organism? Tx? |
|
Definition
It is a distal localized soft tissue finger infection.
MC organism is S. aureus.
Tx = I&D |
|
|
Term
| Describe the 7 ACR criteria for RA. |
|
Definition
1. Morning stiffness >1 hour
2. Arthritis in 3 or more joints w/ swelling
o. Arthritis of hand joints w/ swelling
4. Symmetric arthritis
5. Rheumatoid nodules
6. X-ray changes of typical RA
7. Positive Rheumatoid factor of serum |
|
|
Term
| What is the only area of the spine affected by RA? |
|
Definition
|
|
Term
| How does RA appear on joint fluid analysis? |
|
Definition
| Turbid, poor mucin clot, elevated WBC count, increased PMN leukocytes, neutrophils forming 75-85% of cells in fluid |
|
|
Term
| How will the joint cartilage appear when doing a joint replacement in a patient with RA? |
|
Definition
| Infiltrating granulation tissue from synovium (pannus) spread over joint cartilage. |
|
|
Term
| Which antibody is 99% specific for SLE? |
|
Definition
|
|
Term
| How do you treat lupus arthritis? |
|
Definition
| Hydroxychloroquine, NSAIDs and low-dose steroids. |
|
|
Term
| What is the main difference as far as hand involvement in regards to Psoriatic arthritis vs RA? |
|
Definition
| Psoriatic involves the DIP joints and has nail pitting/grooves. |
|
|
Term
| What is the classic triad of Reiter's syndrome? What is the most common cause? |
|
Definition
Conjunctivitis, urethritis and peripheral arthritis.
MCC is chlamydia. |
|
|
Term
| What are the 3 main causes of neuropathic arthritis? Where do each of them typically affect? |
|
Definition
Diabetic neuropathy - most commonly affects the feet.
Tabes dorsalis - neurosyphilis, commonly affects the LE and vertebrae.
Syringomyelia - damage to the spinal cord due to the formation of a fluid-filled area within the cord, affects the UE first. |
|
|
Term
| :a progressive degenerative condition that affects the metatarsal, tarsometatarsal and tarsal joints in the feet. It is associated with nerve damage (neuropathy) that decreases the ability to sense stimuli, including pain, and decreases muscular reflexes that control movement. As a result, the joints in the feet are subjected to repeated trauma and injury, causing progressive damage to the ligaments, cartilage, and bones. |
|
Definition
|
|
Term
How do you treat an acute gouty attack?
Prophylaxis? |
|
Definition
Acute = NSAIDs, corticosteroids or colchicine.
Prophylaxis = allopurinol (overproducers) or probenecid (underexcreters). |
|
|
Term
| Describe the pathophysiology behind pseudogout or chondrocalcinosis. How is this typically differentiated from gout? Most commonly affected joint? Tx for an acute attack? |
|
Definition
Calcium pyrophosphate dehydrate crystals are deposited in joint hyaline and fibrocartilage.
It resembles gout but large joints are typically involved rather than small joints.
Knee is the most commonly affected joint.
Tx = NSAIDs or colchicine for acute but no preventative treatments. |
|
|
Term
| What is the typical treatment for a clavicle fracture in kids and adults? |
|
Definition
Kids = closed reduction in a figure 8 sling for 3-4 weeks.
Adults = closed reduction in a figure 8 sling for 6-8 weeks. |
|
|
Term
| Describe the Allman classification for clavicle fractures (I-III). |
|
Definition
I = middle third.
II = distal third.
III = proximal third. |
|
|
Term
| Describe type I-IV C2 fractures. |
|
Definition
I = tip of odontoid.
II = base of odontoid.
III = body of axis.
IV = hangman's neural arch. |
|
|
Term
| How do you treat a scaphoid fracture? |
|
Definition
| Thumb spica splint for 12 weeks |
|
|
Term
| Describe the treatments for a Colles fracture that is non-displaced and displaced. |
|
Definition
Non = cast for 6 weeks.
Displaced = closed reduction, pinning or ORIF depending on case. |
|
|
Term
| What is a torus or buckle fracture? Treatment? |
|
Definition
Extremely common injuries seen in children because children have softer bones, one side of the bone may buckle upon itself without disrupting the other side.
Treatment is usually a short arm cast for 3 weeks. |
|
|
Term
| What is the common result of a non-treated or malunion of a Monteggia fracture? |
|
Definition
|
|
Term
| What is a volar plate fracture? |
|
Definition
| Avulsion fracture of a PIP joint due to hyperextension injury. |
|
|
Term
| What is the typical treatment for a femoral neck fracture? |
|
Definition
| Almost always surgical (percutaneous pinning in young and hemiarthroplasty in elderly or severe). |
|
|
Term
| How do you prevent a fatty emboli with a mid-shaft femoral fracture? |
|
Definition
| Albumin for volume expansion and corticosteroids for hydrolysis of fatty acids. |
|
|
Term
| Describe a Boutonniere deformity. |
|
Definition
| Flexion of PIP and hyperextension of DIP due to rupture of extensor tendon at the PIP. |
|
|
Term
| Describe a Mallet finger. |
|
Definition
| DIP is in flexion and PIP stays in extension due to extensor tendon rupture at the DIP. |
|
|
Term
| What tests can be used to detect someone that may be faking back pain to get narcotics or bc of a workman's comp issue? |
|
Definition
| Waddle's test and the Hoover test |
|
|
Term
| What is the best view for a patellar fracture? |
|
Definition
|
|
Term
| What is a pilon fracture and what is the treatment? |
|
Definition
Comminuted fracture of the distal tibia.
Treatment is ORIF. |
|
|
Term
| What advice would you give someone with a patellar fracture? |
|
Definition
| Can take up to 1 year to heal. |
|
|
Term
| If a woman has foot drop, which bone did she probably break and which nerve did she injure? |
|
Definition
| Fibula and common peroneal nerve |
|
|
Term
| Describe the Yergason test. |
|
Definition
Testing for biceps tendonitis/instability.
The examiner has the patient put their elbow at their side, flex their elbow to 90 degrees and then palpate the bicipital tendon which the patient supinates their hand. A positive test will be painful or will demonstrate the tendon slipping out of the groove. |
|
|
Term
| Describe the patellar ballottment test. |
|
Definition
Tests for a knee effusion.
Press directly perpendicular to the patella and it will spring back towards you when you release it if there is an effusion. |
|
|
Term
| Describe the Hoover test. |
|
Definition
Done during a straight leg raise to determine if a patient is really trying to lift their leg or if they are a malingerer.
If the opposite leg does not exert pressure back against your hand then they are not trying fully. |
|
|
Term
| What is a Hill-Sachs lesion? |
|
Definition
| When the glenoid fossa rim causes an indentation on the humoral head when it dislocates. |
|
|
Term
| What is a bony Bankhart lesion? |
|
Definition
| When the humoral head causes a glenoid fossa rim fracture as it dislocates. |
|
|
Term
| Injury to which nerve would cause a winged scapula? |
|
Definition
| Long thoracic nerve (serratus anterior) |
|
|
Term
| Which nerve is at risk for injury in a person with repetitive rapid overhead accelerations of the arm? |
|
Definition
| Suprascapular nerve (supraspinatus and infraspinatus muscles) |
|
|
Term
| What nerve needs to be assessed in a patient with a posterior shoulder dislocation? |
|
Definition
|
|
Term
| Which nerve needs to be assessed in a patient with a posterior hip dislocation? |
|
Definition
|
|
Term
| What is the most common type of elbow dislocation? Which type is associated with neurovascular injuries? Which nerve and artery are associated with those injuries? |
|
Definition
| Posterior is the most common. Anterior is associated with injury to the brachial artery or median nerve. |
|
|
Term
| Describe the classic late finding with Paget's disease. What is the most common bone affected? How do you treat it? |
|
Definition
Classic late finding is bowing of the legs.
Pelvis is the most common bone affected.
Treated symptomatically and with Bisphosphonates. |
|
|
Term
| The main concern with a patient taking long term NSAIDs is irreversible damage to which organ? |
|
Definition
|
|
Term
| The prophylactic antibiotic of choice used during joint replacement is? |
|
Definition
| First or Second generation cephalosporins |
|
|
Term
| What is typically indicated by an anterior and posterior fat pad sign? |
|
Definition
| Anterior is usually a normal finding but posterior is indicative of an occult radial head fracture. |
|
|
Term
| What other conditions should an individual with scoliosis be worked up for? |
|
Definition
| Leg length discrepancy, abnormal joint laxity, neuromuscular abnormalities, cerebral palsy, muscular dystrophy, myelomeningocele and spinal muscular atrophy. |
|
|
Term
| What is the management for a patient that had a traumatic patellar dislocation that spontaneously reduced? |
|
Definition
| 2-3 weeks of reduction in a brace |
|
|
Term
| What is the typical ligament injury with an external rotation injury to the foot (high ankle sprain)? |
|
Definition
|
|
Term
| Which nerve is associated with tarsal tunnel syndrome? |
|
Definition
|
|
Term
| Describe the typical complain of a patient with plantar fascitis. |
|
Definition
| The pain is located on the bottom of the foot and is usually more severe upon waking up in the morning and lessens with ambulation. |
|
|
Term
| Describe the interphalangeal joint involvement with OA. |
|
Definition
| Involves both the DIP (Heberden's) and PIP (Bouchard's) joints. |
|
|
Term
| Describe the typical presentation and treatment for patellofemoral syndrome. |
|
Definition
Vague anterior knee pain that is worsened with stair climbing or with gentle pressure to the patella.
Tx is PT to strengthen the quadriceps. |
|
|
Term
| Which fracture has the highest mortality rate? |
|
Definition
|
|
Term
| What is the treatment when both forearm bones are broke? |
|
Definition
|
|
Term
| How did femoral fracture use to be treated? How are they now? |
|
Definition
Old = traction for 4-6 weeks.
New = Intramedullary rod placement. |
|
|
Term
| What is the chief concern following tibial fractures? |
|
Definition
|
|
Term
| Which nerve and artery are at risk with an anterior shoulder dislocation? |
|
Definition
|
|
Term
| Describe the mechanism of injury for turf toe. |
|
Definition
| Hyperextension of the great toe resulting in a tear of the flexor hallucis brevis. |
|
|
Term
| What is Kienbock's disease? |
|
Definition
|
|
Term
| Describe the typical x-ray findings for Fibrous Dysplasia of the bone? |
|
Definition
| Bubbly lytic lesion, "ground glass" appearance |
|
|
Term
| What is the most common benign bone tumor? |
|
Definition
|
|
Term
| Is OA or RA typically symmetrical? |
|
Definition
|
|
Term
| Describe the classic wrist and finger deviation with RA. |
|
Definition
| Wrist = radial deviation. Fingers = ulnar deviation. |
|
|
Term
| What is the most common organism to cause septic arthritis? |
|
Definition
|
|
Term
| What should be suspected in a 17 year old boy with fever, myalgia, joint pain, non-pruritic salmon colored rash on the truck/extremities, LAD and is negative for RF and ANA? |
|
Definition
|
|
Term
| What is the reason why salicylates are not usually prescribed to elderly to control OA? |
|
Definition
| They can further contribute to hearing loss |
|
|
Term
| How long does it take for tissue death to occur with compartment syndrome? |
|
Definition
|
|
Term
| Describe the treatment options for a vertebral compression fracture. When is surgical intervention necessary? |
|
Definition
Limited bed rest, NSAIDs, early mobilization, orthosis or lumbar corset for a short period of time, bisphosphonates, possible vertebroplasty/kyphoplasty.
Surgical intervention is necessary whenever neurologic dysfunction or instability is noted. |
|
|
Term
| *What should be suspected in a football player that is hit on his head and develops pain, numbness and weakness of an arm? |
|
Definition
| Brachial plexus neuropraxia (burner, stinger) |
|
|
Term
| *Which knee ligament is most commonly associated with an MVA? |
|
Definition
|
|
Term
| *What should be suspected in a lady with DM and osteopenia that wakes up with a stiff shoulder for 6 weeks that loosens up during the day. |
|
Definition
|
|
Term
| *What is the most common cause of heel pain in runners? |
|
Definition
|
|
Term
| *What type of cast is appropriate for osteomyelitis/ulcer? |
|
Definition
|
|
Term
| *What is the next study recommended for a patient with a knee injury with no sign of Fx on x-ray but decreased distal pulses? |
|
Definition
| Popliteal artery arteriogram |
|
|
Term
| What joint and ligament are involved in a high ankle sprain? |
|
Definition
Joint = tibiofibular.
Ligament = syndesmotic. |
|
|
Term
| What is a pencil and cup abnormality seen on x-ray indicative of? |
|
Definition
|
|
Term
| How long should a patient with a Jones fracture be in a cast/splint/walking boot? |
|
Definition
|
|
Term
| *What is the treatment for a child with a positive Galeazzi sign (knees are not equal when flexed)? |
|
Definition
| It is indicative of developmental hip dysplasia and they should be placed in a Pavlik harness. |
|
|
Term
| What is the most common primary bone tumor? What is the most common primary bone tumor that affects the non-marrow part of the bone? |
|
Definition
Multiple Myeloma
Osteosarcoma |
|
|
Term
| What is the treatment for Osgood-Shlatter's? |
|
Definition
| Self-limited activity, ice and anti-inflammatory medication as needed |
|
|
Term
| :a congenital foot disorder characterized by plantar flexion of the ankle, adduction of the heel, high midfoot arches, and adduction of the forefoot |
|
Definition
| Clubfoot, or talipes equinovarus |
|
|
Term
| What is the treatment for Clubfoot, or talipes equinovarus? |
|
Definition
| Treat with manipulation and casting immediately |
|
|
Term
| What is another name for Paget's disease? |
|
Definition
|
|
Term
| What is the initial treatment for Reiter's syndrome? |
|
Definition
| NSAIDs or steroid injections |
|
|
Term
| _____________are the most common elbow fractures in children between the ages of 2 and 12 |
|
Definition
| Supracondylar fractures of the distal humerus |
|
|
Term
| Which nerve roots supply the biceps, triceps, brachioradialis, patellar and achilles reflexes? |
|
Definition
Biceps = C5
Brachioradialis = C6
Triceps = C7
Patellar = L3-4 but 4 if test
Achilles = S1 |
|
|
Term
| What is the treatment for isolated polymyalgia rheumatica? What if there is also symptoms of temporal arteritis? |
|
Definition
| Low dose steroids if isolated, otherwise high dose prednisone |
|
|
Term
| What is the most effective treatment to prevent bone erosion in RA? |
|
Definition
| DMARDs, the NSAIDs just provide symptomatic relief |
|
|
Term
| Which x-ray view is best for visualizing a SCFE? |
|
Definition
|
|
Term
| What is the best initial course of action against septic arthritis? What about osteomyelitis? |
|
Definition
Dicloxacillin 500mg 4x/day for 10 days for septic arthritis.
2nd or 3rd generation cephalosporin for osteomyelitis bc it has coverage against the 2 most common organisms (staph and gonorrhea) |
|
|
Term
| What is the MOA of bisphosphonates? |
|
Definition
| Inhibit bone resorption by inhibiting osteoclast function |
|
|
Term
| What is the most likely cause of limp in a child following a URI? |
|
Definition
| Toxic synovitis of the hip |
|
|
Term
| What is the recommended follow up DEXA scan for post menopausal women that had results that were (-1 to -1.5), (-1.5 to -2) and (>-2)? |
|
Definition
-1 to -1.5 = q5 years.
-1.5 to -2 = q3-5 years.
> -2 = q1-2 years |
|
|
Term
| What is the initial treatment for mild to moderate osteoarthritis? What is next if this does not prove effective? |
|
Definition
| Tylenol is first and then NSAIDs |
|
|
Term
| What is the management for an individual with TMJ that presents to the ER with an acute spasm and dislocation? |
|
Definition
| IV valium and then manual reduction |
|
|
Term
| What is a clay-shoveler fracture? |
|
Definition
| Fx using occuring at the lower cervical or upper thoracic spine due to repetitive use injury in which there is an avulsion of the spinous process. |
|
|
Term
| In children with sufficient growth left an angular deformity of how many degrees will self correct? |
|
Definition
|
|
Term
| Is whiplash a cervical sprain or strain? |
|
Definition
|
|
Term
| What is the initial drug therapy of choice to treat AS? |
|
Definition
| Indomethacin, or other NSAIDs |
|
|
Term
| What is the name of the splint used for humeral fractures? |
|
Definition
|
|
Term
| What is the name of the brace used in tennis elbow? |
|
Definition
|
|
Term
| What is the name of the cast used to treat a boxer's fracture? |
|
Definition
|
|
Term
| What is osteitis pubis and what is the treatment? |
|
Definition
It is a painful inflammation of the pubic symphysis commonly occuring after a urologic procedure.
Tx = NSAIDs and rest for 2 weeks |
|
|
Term
| How much blood can be contained in the leg with a femoral shaft fracture? |
|
Definition
|
|
Term
| What is the treatment for a Morton's neuroma? |
|
Definition
|
|
Term
| Describe the typical color, clarity, WBC count and neutrophil percentage on joint aspiration analysis for osteoarthritis, SLE, Gout, Psuedogout, RA, and bacterial arthritis. |
|
Definition
OA: yellow, transparent, <2000 WBCs, <25% neutrophils.
SLE: yellow, translucent, <9000 WBCs, <25% neutrophils.
Gout: Yellow or white, translucent or opaque, 100-160k WBCs, 90% neutrophils.
Psuedogout: Yellow or white, translucent or opaque, 50-75k WBCs, 90% neutrophils.
RA: Yellow or purulent, translucent or opaque, 3-50k WBCs, 50-75% neutrophils.
Bacterial: Purulent, opaque, 50-300k WBCs, >90% neutrophils. |
|
|
Term
| Describe the motor loss with L3-L4, L4-L5 and L5-S1 disc herniations. |
|
Definition
L3-L4 = L4 nerve distribution = quads.
L4-L5 = L5 nerve distribution = foot dorsiflexors.
L5-S1 - S1 nerve distribution = foot plantarflexors. |
|
|
