Clin med 2 buzzy final (ortho, rheum, peds)

greenstick fracture

torus fracture

6 Ps for compartment syndrome

Pain, pallor, pulselessness, paresthesias, paralysis, poilkilothermia

normal intracompartmental pressure

adults: 8

kidsL 13-16

two gold standard dx for osteomyelitis

MRI

bone culture/bx

pt presents with pain, fever, hx of trauma and cell count on joint fluid aspirate is > 50k, how to treat?

I&D

IV abx

Which types of AC joint dislocations require surgery

4-6

grandma FOOSH w/ pain in clavicle and tenting of the skin in the middle 1/3, tx?

needs surfery

Patient fell and now has numbness/weakness with abduction of arm

proximal humerus fx

pt fell, has wrist drop and cannot extend wrist, what nerve was injured along w/ the humeral shaft fracture?

radial n

Pt has scapular winging, overhead activity pain, painfult, but intact ROM. Dx and tx

subacromial impingement syndrome

PT

Pt complaining of nocturnal shoulder pain. On exam, you find loss of AROM of the shoulder w/ intact PROM. What is the most likely dx?

rotator cuff injury

what are bankart lesions and hill sach lesions associated with

anterior shoulder dislocation

Pt has DM and thyroid disease and can't lift her shoulder past 90º. On exam you find loss of ROM and pain. How to treat?

adhesive capsulitis

PT

sx of labral tear

vague, deep shoulder pain

popping or clicking

weakness

Young guy carrying something heavy feels a pop. popeye deformity noted on exam. WHat is this?

biceps tendon rupture

best tx for osteoarthritis

weight loss

which muscles/tendons are affected with medial epicondylitis?

flexors

pain at lateral epicondyle with resisted wrist ___________?

extension (tennis elbow)

how to differentiate aseptic and septic bursitis on PE

no ROM loss w/ aseptic

which fingers are affected in cubital tunnel syndrome

q1/2 of ring and pinky finger

what is indicated when the anterior humeral line is off on an XR of the elbow

distal humerus fracture

Hyperextension of the elbow from a fall and posterior fat pad and sail sign on imaging. What is this?

supracondylar fx

Pt had a FOOSH and is presenting with pain at the proximal radius and decreased ROM. what did they fracture?

radial head/neck

what nerve are we worried about with an olecranon fx?

ulnar nerve

fracture oef the proximal 1/13 of the ulna w/ dislocation of the radial head

monteggia fracture

what fingers are affected with carpal tunnel syndrome

first three and lateral 1/2 of ring

A woman who just had a baby comes in with thumb pain, dx and tx?

DeQuervain's tenosynovitis

Thumb spica

catching of the thumb or finger after forceful extension (common w/ DM)

trigger finger (stenosing tenosynovitis)

what finger problems get braced in extension

trigger finger

mallet finger

maybe boutinneire

Pt has ganglion cyst, what is first step?

observe

painless, flexion contractures of MCP joints. Dx and tx>

Dupuytren

collagenase

FOOSH resulting in pain over anatomical snuff box but nothing on XRay. Tx?

thumb spica splint

Difference between Colles and Smith fracture

Colles goes backwards (dinner fork)

Smith goes forwards

tx for boxer's fx

Ulnar gutter splint

difference btwn Bennett fx and rolando fx?

rolando has a Y type fracture, bennet is more stable

What treatment will you get if you fall and your thumb is forced into radial deviation?

thumb spica

MC causes of AVN (2)

steroids

trauma

In a hip fracture, which types of fracture get hip replacement and which get CMN

head/neck = hemiarthroplasty

trochanter = CMN

painless limp, young kid

Legg-Clave-Perthes

fat kid hip problem, painful limp

SCFE

Sinding-Larsen-Johansson Disease sx

painful @ inferior pole of patella

pain where achilles inserts at calcaneus

sever's disease

PE tests for ACL

lachman's and anterior drawer

Pts knee is giving away when squatting and there is popping and clicking

meniscal injury

What artery are we worried about w/ tibial plateau fx?

popliteal, emergent ORIF

Adult female runners w/ knee pain? how to tx?

PT - strengthen quad (weak) and hamstring (strong) imbalance

MC ankle ligament sprained

ATFL

sudden pain and pop in lower leg. Thompson test has no planta flexion

Achilles tendon rupture

fall off a ladder onto heels, what did you fracture?

calcaneus

difference between psuedo-jones fracture and jones fracture?

pseudo = more proximal

pain and bruising on the bottom of the midfood with a gab on XR indicates what?

lisfranc injury

Someone who wears high heels a lot has pain between 3rd and 4th digits. What is this?

morton's neuroma

back pain worsened with extension and improved with flexion (shopping cart)

spinal stenosis

Pt is HLA-B27 positive with bamboo spine seen on XRay, what symptoms are they probably experiencing

ankylosing spondylitis

morning stiffness in SI joint that improves with activity during the day

back pain worsened with flexion and relieve with extension (lying flat on the ground)

disc herniation

what dx for disc herniation

MRI (XRay first)

unilateral pain down the back of the leg, worse w/ flexion, twisting, or bending

sciatica

saddle anesthesia and bowel/bladder incontinence, dx and tx?

cauda equina

emergent MRI

surgical emergency

when does scoliosis need surgery?

>45º

common injury with gymnasts, pinpoint pain at L5, scotty dog sign on XR

spondlolysis

3 or more ADJACENT RIBS are fractured, low SpO2

flail chest

tietz syndrom vs costochondritis

tietz = pain and swelling of a single costal cartilage

costochondritis = diffuse regional pain

MC type of thoracic outlet syndrme

neuorgenic

young swimmer with abrupt onset of entire arm swelling, cyanotic limb w/ heaviness and pain

vasogenic TOS

clear, sclerotic limb with tumor occurring around growth plate, well demarcated

joint pain and effusion

chondroblastoma

(Chondro-bleed-lung-oma)

teen with dull, nocturnal pain at proximal femur, relieved by NSAIDS

central, lytic nidus

osteoid osteoma

(osteoid owie-oma)

big cloud lesion on long bone just above the knee

associated with RANK

Giant Cell tumors

centrally located tumor, often incidental finding

enchondroma

tumor that grows away from the bone, looks crazy

osteochondroma

(osteo common horn droma)

most common benign tumor in kids

pseudoloculated lytic center

XRay soap bubble

eccentric

non-ossifying fibroma

what tumor has solitary cyst that is centrally located and a fallen leaf sign when there is an associated fracture

simple unicameral bone cyst

what does CRAB stand for in multiple myeloma

hyperCalcemia, Renal insuff, Anemia, Bone lytic lesions/Back pain

atypical plasma cells

bence jones proteins

punched out lesions

things found in multiple myeloma

what tumor has sunburst appearance, codman's triangle, and is MC at distal femur

osteosarcoma

(osteo sun coma)

what tumor presents with persistent dull pain over a long time and on XR they have multiple rings and arcs

chondrosarcoma

onion skin and hair on end

fever

ewing sarcoma

hot, swollen, tender joint is _____________ until proven otherwise

septic arthritis

triad for SLE

joint pain, fever, malar rash

labs for SLE

+ANA = GS

anti-dsDNA

anti-smith

which med to give to a pregnant woman with SLE

azathioprine

what yearly screenings do SLE patients get

urine --> for proteinuria

eye exam --> HCQ

Pt with history of miscarriages and DVT with two positive aPLs, what is the treatment

heparin (if preggo)

warfarin (if not preggo)

what lab differentiated drug induced lupus from normal lupus

normal complements in drug induced

sicca sx, arthritis, salivary gland enlargment

positive ANA, anti-RO, anti-LA, and + RF

sjogren's

what to avoid in sjogrens

decongestants

Pt presents with symmetric, proximal weakness and a heliotrope rash (eyelids), what would you expect their CK levels to be?

VERY high

what does CREST stand for?

calcinosis, esophagus, sclerodactyly, telangiectasias

what med to avoid in scleroderma

steroids

what antibody is positive in limited scleroderma

antiCentromere

antibodies to RNP

mixed CTD

high fever, sore throat, short lived salmon colored rash

adult-onset still's disease

allergic sx with a pancreatic mass

IgG4 related diseases

treatment for widespread MSK pain

APAP and NSAIDs

duloxetine, amitriptyline

gabapentin and pregablin

PT/exercise

pt comes in with pain localized to one arm (or leg) and swelling of the involved extremity with a hx of surgery (or trauma). What is the dx?

complex regional pain syndrome

sx of gonococcal arthritis

asymmetrical, warm, swollen joint pain

systemic sx

rash on hands and feet

can't see, can't pee, can't dance w/ me

chlamydial (reactive) arthritis

tx for non-gonococcal arthritis

IV vanco + ceftriaxone

+ drainage, lavage, and debridement

pt with sarcoidosis presents with polyarticular and symmetric arthralgias & arthritis. What do you see on bx?

noncaseating granulomas

Pt with DM neuropathy history presents with enlarged, boggy, warm, painful joint. What do you suspect?

charcot joint