Term
| neck and low back pain is a _____ not a diagnosis ____ |
|
Definition
|
|
Term
| differential diagnosis of spine pain 8 |
|
Definition
idiopathic back pain
degenerative disorders
rheumatologic disorders
spinal deformities: spondylolisthesis, scoliosis
infection
tumor
fracture |
|
|
Term
| 4 conditions that mimic spine pain |
|
Definition
HIP ARTHRITIS
AORTIC ANEURYSM
DIABETIC NEUROPATHY
VISCERAL DISORDERS |
|
|
Term
| signs and treatment of cerivcal disc herniation - not objective |
|
Definition
axial pain, radiculopathy, scapular pain
surgery done from anterior approach, fusion performed with disectomy |
|
|
Term
| signs of cervical stenosis - not objective |
|
Definition
| neck pain, radiculopathy, myelopathy |
|
|
Term
| cervical spondylotic myelopathy: causes, signs, tx - not objective |
|
Definition
caused by compression, diminished vascular supply, spinal instability
painless, gait difficulty, hand clumsiness, radicular pain, numbness, arm/leg weakness, sphincter problems, progressive deterioration
tx surgery |
|
|
Term
| artificial disc replacement indications 1 and contraindications 3 |
|
Definition
APPROPIRATE FOR 5% OF PATIENTS HAVING LUMBAR SURGERY
NOT FOR PATIENTS WITH FACET ARTHROSIS, SPINAL STENOSIS, OSTEOPEROSIS |
|
|
Term
| when do you operate on a lumbar disc herniation 4 |
|
Definition
INCAPACITATING LEG PAIN BELOW THE KNEE WITH NERVE ROOT DISTRIBUTION
NERVE ROOT TENSION SIGNS +/- NEUROLOGICAL SIGNS
CONSERVATIVE TREATMENT FAILURE 4-8WKS
CORRELATIVE IMAGING STUDY
BACK PAIN IS NOT AN INDICATION FOR SURGERY |
|
|
Term
| signs of lumbar stenosis 8 |
|
Definition
BUTTOCK AND LEG SYMPTOMS WHEN WALKING
PAIN
NUMBNESS
TINGLING
BACK PAIN
SITTING RELIEVES SYMPTOMS
symptoms worse with extension and relieved with flexion (shopping cart sign)
bowel and bladder symptoms (rare) |
|
|
Term
| when do you operate on lumbar spinal stenosis 5 - not objective |
|
Definition
non operate treatment fails
severe claudication
intolerable or unresponsive leg pain
cauda equina syndrome
progressive motor deficit |
|
|
Term
| concerns with immature spine |
|
Definition
PAIN IS GENERALLY NOT THE ISSUE
concern is spinal deformity and its consequences due to future growth
spinal deformities may progress rapidly during growth years |
|
|
Term
| degenerative scoliosis concerns and treatment - not objective |
|
Definition
respiratory comporise in kids
tx adresses spinal stenosis and spinal deformity |
|
|
Term
| surgical benifits of spine surgery 3 |
|
Definition
DECREASED BACK AND LEG PAIN
CORRECTION OF POSTURAL DEFORMITY AND INCREASED FUNCTION
HIGH SATISFACTION IN APPROPIRATELY SELECTED PATIENTS |
|
|
Term
| complications of spiine surgery 7 |
|
Definition
MORTALITY
NEUROLOGIC INJURY
INFECTION
PSEUDOARTHROSIS
SPINAL DECOMPENSATION
FIXATION FAILURE AT BONE / IMPLANT INTERFACE
MEDICAL COMPLICATIONS |
|
|
Term
| cause of acrimioclavicular injury 4 |
|
Definition
DIRECT TRAUMA TO SUPEROLATERAL SHOULDER
FALL ON POINT OF SHOULDER
PLAYER STRIKE GROUND
ACROMION FORCED INFERIOR RELATIVE TO CLAVICLE |
|
|
Term
| 6 types of rockwood AC joint injuries - not objective |
|
Definition
1. sprain AC ligament 25%
2. AC complete tear - CC sprain 50%
3. AC-CC ligament disruption 100%
4. TIII w/ clavicle posterior into trapezius
5. TIII w/ 100-300% clavicle displacement
6. subacromial or subcoracoid clavicle displacement |
|
|
Term
| pysical signs of AC joint injuires 6 - not objective |
|
Definition
often with sacpulothocic dissociation and posterior SC injuries
MOI, swelling, tenderness, deformity |
|
|
Term
| x-ray signs of AC joint injuries 4 |
|
Definition
ZANCA - 20 DEG CEPHALAD (MOST IMPORTANT)
quensana - 45 deg oblique (superior/inferior)
weighted (15-20lbs): no difference between type 2 or 3, no longer recommended
coracoclavicular distance 1.1-1.3cm |
|
|
Term
| non surgical tx and surgical indications of AC injury - not objective |
|
Definition
kenny howard brace: manipulaive brace, painful, cumbersome
sling: more comfort, 7-10d followed by ROM ASAP
indications of surgery: significant displacement (rockwoof IV-VI), continued symptoms after non-op tx, ligament reconstruction |
|
|
Term
| SC joint injury; cause, signs, tx - not objective |
|
Definition
cause; axial load to abducted shoulder (MCA, sports), A/P displacement
tender, deformity, ecchymosis, x-ray serendipity views 40deg cephalic tilt, CT
tx anterior dislocation: subluxation after reduction, non-surgical
tx posterior dislocation: has more complications like trachea, esophagus, BP. needs urgent reduction, general anesthesia, traction with abd/slight extension |
|
|
Term
| risk factors for rotator cuff tendonitis 3 |
|
Definition
YOUNG
OVERUSE
SECONDARY TO WEAKNESS |
|
|
Term
| types of rotator cuff tendonitis |
|
Definition
WIDE SPECTRUM FROM IMPINGEMENT TO TENDONITIS TO BURSITIS
muscle hypertrophy
medial arch stenosis (A/C joint(
lateral arch stenosis
lateral arch impingment
medial arch stenosis causes |
|
|
Term
| treatment of rotator cuff tendonitis 6 |
|
Definition
PT
STIMULATION
NSAIDS
INJECTIONS
BRACING
SURGERY: IF YOUNG AND HAVE COMPLETE TEAR |
|
|
Term
| calcific tendonitis: signs, x-ray, tx - not objective |
|
Definition
acute onset severe pain, mimics infection, marked decreased ROM, fluffy density near greater tuberosity
tx NSAIDS |
|
|
Term
| biceps tendonitis causse - not objective |
|
Definition
occurs with other pathology
primary: bicep tendon is interarticular and attaches to glenoid
may represent early sign of impingement |
|
|
Term
| biceps tendonitis signs 4 |
|
Definition
ANTERIOR SHOULDER PAIN WORSE WITH ACTIVITY
INSIDIOUS
FOLLOWING SPECIFIC INJURY OR OVERUSE
DIFFICULTY WITH SUPINATION ACTIVITY |
|
|
Term
| biceps tendonitis physical exam 4 |
|
Definition
standard shoulder exam
TPP over bicipital groove
SPEEDS TEST (need impingement upside down?)
yeargenson's sign; resisted supination at 90deg elbow flexion neutral shoulder |
|
|
Term
| treatment of biceps tendonitis 4 - not objective |
|
Definition
tx underlying shoulder pathology
comprehensive exercise program: rotator cuff, parascapular muscles
NSAIDS
injections |
|
|
Term
| signs of shoulder instability 4 |
|
Definition
DISLOCATION AND SUBLUXATIONS
MORE IN YOUNG ATHLETES
SEEN ON CONTACT SPORTS (DISLOCATION)
SEEN IN OVERHEAD THROWING SPORTS (SUBLUXATION) |
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|
Term
| cause of shoulder dislocations |
|
Definition
| MOST COMMON TRAUMATIC AND ANTERIOR / INFERIOR INJURY |
|
|
Term
| risk factors for shoulder dislocations - not objective |
|
Definition
position: abduction and ER
90% recurrence rate in pt <22yo
independent of length of immobilization and PT
bankart lesion (bony not attached to labrum)
correlation between number of dislocations and soft tissue injury |
|
|
Term
| treatment of shoulder dislocation - not objective |
|
Definition
traction for 10-15 min
stimson - most common
hippocrates: foot in armpit
traction with arm off table |
|
|
Term
| signs of posterior GH dislocation |
|
Definition
FREQUENTLY MISSED
OFTEN PRESENTS LATE
MISTAKEN FOR STINGER (STRETCH OR BRACHIAL PLEXUS) |
|
|
Term
| cause of posterior GH dislocation 4 |
|
Definition
| ADDUCTION, AXIAL LOADING, SEIZURE, ELECTRIC SHOCK |
|
|
Term
| how common are posterior GH dislocations |
|
Definition
| 2% OF SHOULDER DISLOCATIONS |
|
|
Term
| signs and tx of joint subluxation - not objective |
|
Definition
shoulder pops out of place and have to pop it back in, multiple joint laxity
imaging (MRI), agressive PT, bracing (omitram which is dumb) |
|
|
Term
| what is the neer classification of proximal humerus fractures |
|
Definition
4 parts evaluated by x-ray or CT...
vascularity of articular fragment
displacement >1cm means its a "part"
angulation >45 deg means its a "part" |
|
|
Term
| how are proximal humerus fractures classified |
|
Definition
|
|
Term
| treatment of proximal humerus fractures based on part - not objective |
|
Definition
undisplaced and 2 part: sling
3 part; ORIF
4 part: prosthesis |
|
|
Term
| functions of the pectoralis 4 |
|
Definition
POWERFUL INTERNAL ROTATOR, FLEXOR, AND ADDUCTOR OF ARM
MAIN SOURCE OF POWER FOR UPPER TORSO IN COMPETITIVE ATHLETES
FORMS ANTERIOR AXILLARY FOLD
cosmetic performance for body builders
some think it isnt needed for shoulder function |
|
|
Term
| causes of pectoralis tears - not objective |
|
Definition
eccentric muscle contraction
forced abduction against resistance
involuntary contraction
sever traction of the arm
inirect at slow speeds
transition from ecentric to concentration
feel a pop or tearing sensation
inferior fibers at max stretch are first to rupture bench press |
|
|
Term
| what are the most common locations of pectoralis tears |
|
Definition
of 78 confirmed tears
56 TENDON AVULSIONS AT SITE OF INSERTION
21 RUPTURED AT MYOTENDINOUS JUNCTION
4 bondy avulsions
3 tendon substance ruptures
2 muscle belly tears |
|
|
Term
| treatment of pectoralis tears |
|
Definition
nonoperative tx indications: proximal tears SC origin, some partial tears, older sedentary patients
sling, rest, mobilization, stretching, 6-8wk strengthening, lifting modification no lower than 4-6cm above enterior chest wall, grip no wider than 1.5c the biacromal width
surgery provides greatest outcomes for satisfacton, strength, cosmetics, and competitive sprts |
|
|
Term
| causes of parsonage turner syndrome (acute brachial neuropathy) 5 |
|
Definition
NOT USUALLY ASSOCIATED WITH SPECIFIC TRAUMA EVENT
ASSOCIATED WITH SPORTS
VIRAL AND IMMUNOLOGICAL ETIOLOGIES IMPLICATED
MAY OCCUR ACUTE OR SUBACUTE
LASTS FOR HOURS TO WEEKS |
|
|
Term
| diagnosis of parsonage turner syndrome - not objective |
|
Definition
severe shoulder pain at rest
sudden onset
responds bad to analgeics
shoulder elbow motion aggrevates pain
shoulder abduction and elbow flexion
radiation below suggests diffuse involvement |
|
|
Term
| causes of primary 6 and secondary 1 scapular winging |
|
Definition
DAMAGE TO LONG THORACIC NERVE...
BLUNT TRAUMA
STRETCHING
REPETITIVE USE
NONTRAUMATIC EVENTS
PALSY OF SERRATUS ANTERIOR MUSCLE
OTHER...
traction injury
secondary: GH disorder |
|
|
Term
| signs of scapular winging - not objective |
|
Definition
static deformity
muscle atrophy
arm elevation, winging
pain
difficult elevation >120 deg
scapulothoracic rhythm
forward elevation at 30 deg resisted
EMG confirms dx |
|
|
Term
| tx scapular winging - not objective |
|
Definition
PT
braching
penetrating injuries: nerve exploration and repair
surgery |
|
|
Term
| define dementia puilistica |
|
Definition
| long term impairments in cognition secondary concussions |
|
|
Term
| grades of primary brain damage 4 - not objective |
|
Definition
concussion: brief LOC, period of post traumatic amnesia and confusion
grade 1 mild: no LOC, PTA less than 30 min
grade 2 moderate: LOC less than 5 min, PTA >30 min
grade 3 severe: LOC for 5 min for PTA for 24 |
|
|
Term
| evaluation and tx of head injuries 7 |
|
Definition
ABCs
if unconcious immobilize C spine
examine for chest, abd, limb injury
glasgow coma scale
mental status exam
brain imaging for fracture or contusion
head injury card of sent home |
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|
Term
| recommendatio to return to athletic activities grade 1 consussion for 1st-3rd concussion |
|
Definition
1ST: MAY RETURN TO PLAY IF ASYMPTOMATIC FOR 1WK
2ND: RETURN IN 2WK IF ASYMPTOMATIC FOR 1WK
3RD: TERMINATE SEASON, RETURN NEXT SEASON IF ASYMPTOMATIC |
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|
Term
| recommendatio to return to athletic activities grade 2 consussion for 1st-3rd concussion |
|
Definition
1ST: RETURN TO PLAY IF ASYMPTOMATIC IN 1WK
2ND: MINIMUM OF 1MO OF NO PLAY MAY THEN RETURN IF ASYMPTOMATIC FOR 1WK. CONSIDER TERMINATING SEASON
3RD: TERMINATE SEASON MAY RETURN NEXT SEASON IF ASYMPTMATIC |
|
|
Term
| recommendatio to return to athletic activities grade 3 consussion for 1st-3rd concussion |
|
Definition
1ST; MIN 1MO NO PLAY, RETURN IF ASYMPTOMATIC FOR 1WK
2ND: TERMINATE SEASON, RETURN NEXT SEASON IF ASYMPTOMATIC
3RD: TERMINATE SEASON CONSIDER PERMANENT RETIREMENT FROM CONTACT SPORTS |
|
|
Term
| spear tacklers spine - not objective |
|
Definition
permanent neuro injury from axial loading of persistently streight cervical spine from use of head impact playing techniques
at risk if developmental narrowing of C spine, persistent straightening or reversal of normal cervical lordotic curve, preexisting posttraumatic radiograph abnormalities of cervical psine, documentation of use of spear taclking technique |
|
|
Term
| nerve root brachial plexus injury (burner/stinger) |
|
Definition
traction to brachial plexus or compression to cervical nerve roots
cervical pinch stretch neuropraxis of nerve roots and brachial plexus, often go unreported and untreated |
|
|
Term
| causes of shoulder fractures |
|
Definition
proximal humerus: football, hockey, rugby, skiing, wrestling
clavicle: football, hockey, bicycling, skiing |
|
|
Term
| what is the most commonly fractured bone in sporting events |
|
Definition
|
|
Term
| tx of little league elbow |
|
Definition
| ACOID VALGUS OVERLOAD, NO CURVE BALLS, PITCH COUNT |
|
|
Term
| mallet finger - not objective |
|
Definition
terminal extensor tendon
tx splint DIPJ in extension 6wk do not remove ever |
|
|
Term
|
Definition
| APOPHYSEAL AVULSIONS, FRACTURES, CONTUSIONS OF ILIAC CREST |
|
|
Term
| knee dislocations: types, tx, prognosis - not objective |
|
Definition
lateral injury most common or ineurologi injury
tx immediate closed reduction in field then splinting, ortho/vascular exam
orthopedic emergency |
|
|
Term
| patella dislocations: pathogenesis, tx - not objective |
|
Definition
extend knee, medial pressure on patella
knee imobilizer, may WB in extension |
|
|
Term
|
Definition
SINGLE LIG: ATFL MOST COMMON
DOUBLE LIG: ARFL AND CFL (ASSESS WITH MRI( |
|
|
Term
| tx of ankle srpain types - not objective |
|
Definition
single RICE, brace, PT immediate
double: MRI, NSAID, cast 6wk |
|
|
Term
|
Definition
| hyperextension injury of first MTP associated with play on artifical turf |
|
|
Term
|
Definition
HEAT EXHAUSTION/HEATSTROKE AR SAME THING BUT DIFFERENT IN SEVERITY
>104 ORGAN DAMAGE WITHIN 1/2H |
|
|
Term
|
Definition
monitor temp (rectal most accurate)
immediate cooling ON FIELD! DO NOT TRANSPORT! |
|
|
Term
|
Definition
INTRAMEMBRANEOUS OSSIFICATION: FLAT BONE FORMATION
ENDOCHONDRAL OSSIFICATION; LONG BONE FORMATION |
|
|
Term
| how do you describe a fracture - not objective |
|
Definition
systemic description
location
degree of angulation
displacement
position
alignment
fracture line
additional injuries: vessels, compartment syndrome, dislocation |
|
|
Term
| 4 ways to describe a fracture line |
|
Definition
COMMINUTED: MORE THAN 2 FRAGMENTS REGARDLESS OF SIZE
transverse
oblique
spiral |
|
|
Term
| define varus, valgus, autograft, allograft - not objective |
|
Definition
varus: distal part medial
valgus: distal part lateral
autograft: bone graft from host
allograft: bone graft from another host |
|
|
Term
| how do you determine the degree of angulation of a fracture - not objective |
|
Definition
relationship of bone distal to fracture in respect to proximal fragment
apex of fracture: where does fracture point?
if minimally displaced it may have no angulation |
|
|
Term
| define transverse, oblique, spiral, communuted, butterfly, segmental fractures - not objective |
|
Definition
transverse: right angle to cortices or long axis
oblique: fracture line diagional to long axis
spiral: caused by torsional force, fracture line encircles shaft
comminuted: fracture with 2+ fragments
butterfly: wedge shaped fragment split off from the main
segmental: fracture which divides long bone into several segments |
|
|
Term
| what is fracture displacement, position, and alignment - not objective |
|
Definition
alignment: relationship of longitudinal axis of one fragment to another, deviation is due to angulation
position: relationship of fragment to normal anatomical structure
displacement: percent of distal bone off proximal bone |
|
|
Term
| define dislocation and subluxation - not objective |
|
Definition
dislocation: complete disruption of joint, loss of contact between articulating surfaces
subluxation: partial loss of continuity between two opposing articular surfaces |
|
|
Term
| where is a intertrochanter hip fracture located |
|
Definition
| BETWEEN GREATER AND LESSER TROCHANTER |
|
|
Term
| what x-ray views do you need to order for possible fracture |
|
Definition
|
|
Term
| 1 main types of hip dislocations, which is most common |
|
Definition
anterior
posterior - MOST COMMON
central |
|
|
Term
| cause of pure hip dislocation |
|
Definition
FLEXION/ ADDUCTION/ AXIAL LOAD
OR
DECREASED ANTIVERSION(mimics internal rotation) |
|
|
Term
| cause of fracture dislocation posterior wall or shear of femoral head |
|
Definition
| LESS ADDUCTION/INTERNAL ROTATION |
|
|
Term
| cause of posterior dislocation of hip |
|
Definition
| DECELERATION CAUSES KNEE TO HIT DASH WITH KNEE AND HIP FLEXED |
|
|
Term
| cause of anterior dislocation of hip |
|
Definition
HYPERABDUCTION AND EXTERNAL ROTATION WITH EITHER...
...FLEXION OF INTERIOR OBTURATOR
or
...EXTENSION OF SUPERIOR PUBIC |
|
|
Term
| how do you identify the type of hip dislocation on x-ray - not objective |
|
Definition
posterior: AP view smaller head, overlaping roof of acetabulum
anterior: head is larger, medial, or inferior to acetabulum
posterior: 5 views, assess congruency, head to roof on each view should have no loss of parallelism
rotations; view in trochanter position
head fracture: show retained fragment in joint |
|
|
Term
| cause of knee dislocation - not objective |
|
Definition
| HB fracture, high energy MVA (dashboard injury to axial loading of flexed knee), low energy (athletic, fall) |
|
|
Term
| types of knee injury and the disrupted anatomy and tx 4 - not objective |
|
Definition
anterior: PCL tear, popliteal artery damage proportional to extension, tx axial traction with anterior force on femur
posterior: ACL/PCL, popliteal artery displaced proportional to proximal tibial displacement, tx axial traction with anterior force on tibia
lateral: ACL/PCL torn, tx axial limb traction with medial translation of tibia
medial: opposite lateral |
|
|
Term
| how do you diagnose knee injuries |
|
Definition
REDUCE BEFORE GETTING ANY X-RAYS!!!!
x-ray
angiography
MRI anthrogram - ESSENTIAL TO ASSESS SOFT TISSUE DAMAGE |
|
|
Term
| post reduction tx of knee injury |
|
Definition
X-RAY
SPLINT 20-30 DEG FLEXION
ROM EXERCISES IN 6-12EK |
|
|
Term
| tx of knee injury after soft tissue healing |
|
Definition
GROSS KNEE DISTORTION
ARTERIAL SUPPLY PARAMOUNT - WHY WE IMMEDIATLY REDUCE, COLLATERAL CIRCULATION MAY PRESERVE DISTAL PULSES AND CAILLARY REFILL BUT IT ISNT ENOUGH FOR LIMB VIABILITY
NERVE STATUS: PERONEAL INJURY COMMON, PRIMARY EXPLORATION NOT EFFECTIVE, SECONDARY EXPLORATION 3MO SHOW POOR RESULTS, MAY NEED BRACE OR TENDON REPAIR |
|
|
Term
| 4 classifications of open fractures - not objective |
|
Definition
I. low energy <1cm
II. <10cm moderate energy
III. high energy, high velocity gunshots, shotgun shots, barnyard, >1h from injury
IV: high V >2000 ft/s |
|
|
Term
| tx of open fractures - not objective |
|
Definition
ABCs
debridment <8h from injury
antibiotics immediate
tatenus
do NOT explore in ER
sterile normal saline dressing |
|
|
Term
| cauda equina cause signs - not objective |
|
Definition
lumbar disc herniation saddle anesthesia
bowel or bladder dysfunction, LE sensory and motor function |
|
|
Term
| complications of pelvic fractures - not objective |
|
Definition
| hemorrhage may cause death: vascular, osseous, visceral (hypotensive 21 crystalloid, type O blood ASAP, peritoneal havage above unbilicus) |
|
|
Term
| how are pelvic fractures classified |
|
Definition
A: STABLE IN BOTH ROTATION AND VISCERAL
b: UNSTABLE TO ROTATION STABLE TO VERTICAL
C; UNSTABLE TO BOTH |
|
|
Term
| what is the composition of the ligaments of the knee |
|
Definition
TYPE 1 COLLAGEN 70%
elastin
ECM
longitudinal fasciculi: MCL, LDL
helical fasiculi: ACL, PCL |
|
|
Term
| epidemiolog of knee injuries 4 |
|
Definition
increasing incidence
combined injuries common
females > males
MORE IN UNCONDITIONED VS CONDITIONED |
|
|
Term
| cause of ACL injury - not objective |
|
Definition
| change in direction, stop or jump causes audible pop then instability and swelling |
|
|
Term
|
Definition
displacement
endpoint quality
LACHMAN - BEST TEST
PIVOT SHIFT - DIAGNOSTIC
ANTERIOR DRAWER - CHRONIC TEAR
ASSOCIATED INJURIES |
|
|
Term
| signs of ACL injury on MRI 2, type of MRI to get 2, accuracy |
|
Definition
95% ACCURATE
LOW SIGNAL INTENSITY
SAGITAL VIEW
ACUTE INJURY HIGH SIGNAL INTENSITY ON T2 IMAGE
BONE BRUSING |
|
|
Term
| treatment of ACL injury - not objective |
|
Definition
non-op: splint, crutches, early ROM
op: if high demandm young, good ROM, learning curve
graft: collagen llattice, reabsorption - revascularization - restructuring, bone patellar bone (fast recovery, anterior knee pain(, semitendinosus-gracilis, tensioning
rehab: closed kinetic chain strengthening, acute fixation weak, graft weakest 6-12wk |
|
|
Term
| what is the most common isolated ligament injury |
|
Definition
|
|
Term
|
Definition
VALGUS FORCE
POSTERIOR OBL LIGAMENT DAMAGE WITH ROTATION INJURY
ACL DAMAGE COMMON |
|
|
Term
| tx of MCL injury - not objective |
|
Definition
grade 1: 1-5mm symptomatic tx
grade 2: 6-10mm hinge brace 2-3wk
grade 3: 11-15mm hinge brace 3-4wk |
|
|
Term
| PCL injury: cause signs, tx - not objective |
|
Definition
primary straint posterior translation of tibia, forced flexion, dashboard
pain, posterior subluxation, posterior drawer test, quads active test, post sag sign (tibia relative to femur0
tx: rehab focus on quads, NO bracing, avoid open kinetic chain extension
surgery: indicated with grade 3 drawer test and bony avulsion, good ROM, graft >40mm |
|
|
Term
| posterolateral complex: anatomy - not objective |
|
Definition
| iliotibial bland, biceps frmoris, fibular collateral, popliteus complexu, capsule |
|
|
Term
| posterolateral complex injury: cause, signs, tx - not objective |
|
Definition
PCL, knee dislocation
pain esp descending incline, swelling brusing, gair with varus thrust, peroneal nerve injury, tibia rotation, varus rotation, posterior tibia translation, AP translation, varus stress opening test >30 deg
prone xternal rotation test
primary repair in acute injury or bony avulsion
reconstruction of biceps tenodesis/acurate ligament advancement |
|
|
Term
| what is the most common source of loose bodies in the knee |
|
Definition
| OSTEOCHONDRITIS DISSECANS |
|
|
Term
| osteochondritis dissecans: epidemiology |
|
Definition
|
|
Term
| osteochondritis dissecans: signs 2 |
|
Definition
MEDIAL FEMORAL CONDYLA MCF(85%)/LCF(15%)/PFI(5%)
SUBCHONDRAL BONE NECROSIS +/- SEPARATION OF FRAGMENT |
|
|
Term
| osteochondritis dissecans: tx - not objective |
|
Definition
intact lesion > K wire drilling
early separated lesion > in situ piining
partially detached lesion > debridment of base with pinning
salvagable loose body > debridement of base with pinning
ulsalvagable loose body > rem with base debridement |
|
|
Term
| disorders of patella causes, tx - not objective |
|
Definition
direct cause: arthritis, chondral defects, bipartite patella, instability, lateral facet overload
indirect cause: plica syndrome, meniscal tear, tendinitis, braching common
tx: nonsurgical usually |
|
|
Term
| meniscal injuries cause and tx - not objective |
|
Definition
rotation of flexed knee moves toward extension
tears seen with weak knees and associated injuries
most common are longitudinal tears
white zone does not get blood supply so it will not heal so excise, if in red zone repair because it gets blood and it will heal |
|
|
Term
| ligamentus injury (LCL/MCL/ACL/PCL) cause - not objective |
|
Definition
| contact sports, MVA causes single and milti planar instability degree of injury coupled with structures injured |
|
|
Term
| plica: cause tx - not objective |
|
Definition
embryological fold of tissue suprapatellar
surgical excision for failure of conservative management |
|
|
Term
| 4 stages of osteoarthritis |
|
Definition
LOCALIZED FIBRILLATION: disruption of superificial layers of articular cartilage
FISSURES: extension of fibrillation through cartilage to subchondrial bone
FREE FRAGMENTS: superificial tips of fibrillated cartilage tear and release into joint space while causing decrease in cartilage thickness
ENBURATED BONE: continous fissurine and thinning lead to exposured necrotic emburated bone |
|
|
Term
| minor elbow trauma signs and tx - not objective |
|
Definition
nondisplaced radial head or neck fracture, chips off epicondule or coronoid process, posterior fat pad sign
sling 2 wks then PT |
|
|
Term
| lateral epicondylitis: aka, signs, tx - not objective |
|
Definition
tennis elbow
hurts to lift things
microtearing of ECRB
wrist splint, RICE, PT, injection, surgery (wait tho it usually goes away) |
|
|
Term
| medial elbow pain: aka, signs, tx - not objective |
|
Definition
golfers elbow
pain medial epicondyle
tx same as tennis elbow, dont inject unlar nerve tho |
|
|
Term
|
Definition
pain BETWEEN epicondyle and olecranon
NUMBNESS/TINGLING 5TH FINGER ONLY
OFTEN ELBOW IS PAINFUL
DX WITH FLEXION TEST OF POSITIVE TINEL |
|
|
Term
|
Definition
TOWEL NIGHT SPLINT
AVOID PRESSURE
DO NOT INJECT
REFER IF NOT BETTWE IN 6WK
HAND ATROPHY IS LATE SIGN, REFER NOW |
|
|
Term
| elbow lumps: cause, diagnosis - not objective |
|
Definition
trophus, RA nodule, aseptic bursitis
tap for fluid, if red must aspirate, parenteral abx for cellulitis, red and angry does NOT MEAN JOINT INFECTION, usually just cellulitis
joint infection of elbow is emergency |
|
|
Term
| anterior elbow pain: cause, signs, tx - not objective |
|
Definition
lifting something heavy
high riding biceps, thick tendon not palpable in anticubetal fossa
ruptured distal biceps tendon
refer |
|
|
Term
| diffuse elbow pain: signs, dx, tx - not objective |
|
Definition
| aches all over, ROM restricted, txNSAIDS, surgery for locking or failed therapy |
|
|
Term
| capral tunnel: signs - not objective |
|
Definition
aches with grippping
over use doesnt matter
no numbness
frequent in new mom
pain over radial styloid
positive finklestein test
atrophy of abd poll brevis - VERY LATE SIGN OF NERVE DAMAGE
constant tingle/numb: BAD, REFER NOW |
|
|
Term
| carpal tunnel tx - not objective |
|
Definition
night splints
activity modification
NSAID
ro neuropathy/thyroid
injection therapy
NCV electrodiagnosis - last resolt
EMG - if now neuropathy or raticulopathy, odd history (every finger numb), occupational injury |
|
|
Term
| explain organization of carpel tunnel |
|
Definition
POSTERIOR: TENDON SHEATHS
MEDIAN NERVE: ANTERIOR BELOW LIGAMENT, SLIGHTLY MEDIAL |
|
|
Term
| deQuervains tenosynovitis: signs - not objective |
|
Definition
aching at base of thumb
trouble doing ADLs,gripping,
popping/catching
bump palpable/visible where thumb meets wrist
positive grind test |
|
|
Term
| deQuervains tenosynovitis; pathogenesis |
|
Definition
1ST DORSAL COMPARTMENT SYNOVITIS
CROWES THE TENDONS AS THEY PASS THROUGH TENDON SHEATH AT WRIST |
|
|
Term
| deQurevains tenosynovitis; tx |
|
Definition
INITIAL: THUMB SPICA SPLINT, ICE, MASSAGE, NSAID 306WK
INJECTIONS: 1ST CURES 80%, 2ND CURES 10% |
|
|
Term
| basal joint arthritis of the thumb: signs, tx - not objective |
|
Definition
severe XR changes have few symptoms
TX like arthritis, rigid splints poorly tolerated bc thumb isnt used, use soft neoprene wrap or brace, injections work well
oblideration of joint space later |
|
|
Term
| ganglion cysts: presentation - not objective |
|
Definition
injured thumb playing sports
XR normal
hurts at unlar side of thumb at edge of web
stress testing 20-30deg |
|
|
Term
| ganglion cysts: tx - not objective |
|
Definition
aspiration 30% cure
surgery has 10% recurrance |
|
|
Term
| ganglion cysts: locatls, which is most common |
|
Definition
WRIST DORSUM IS MOST COMMON
dorsoradial wrist is second most common |
|
|
Term
| unlar collateral ligament tear: aka, dx, tx - not objective |
|
Definition
skiers or gamekeepers thumb
if thumb is stable its a sprain if its loose its a tear
splint sparin 4wk
tear refer now |
|
|
Term
| presentation of trigger finger 8 |
|
Definition
VAGUE ACHING INTO PIP JOINT AREA
HURTS TO GRIP
OCCASIONALLY CATCHES
TENDER OVER A1 PULLY (DISTAL PALMAR TO PROXIMAL FINGER CREASE)
CAN FEEL NODULE WITH ACTIVE FINGER FLEXION/EXTENSION
lumpy stuff on palmar skin
doesnt hurt to flex or extend finger |
|
|
Term
| trigger finger pathogenesisi - not objective |
|
Definition
inflammed nodule slides through pully system of flexor tendons and gets stuck
release of A1 pulley is tx |
|
|
Term
| tx trigger finger - not objective |
|
Definition
injection
if 3 injections fail do surgery
initial: restrict finger flexion (bandaid over DIP/PIP knuckles)
NSAID, ice massage over A1 pully |
|
|
Term
| dupuytrens contracture: risk factors, signs, tx - not objective |
|
Definition
alcohol, N europe ancestry, male, family hx
fascia thickens into nodules then cords that contract and finger bends
early nodular phase is tender, later contractures are without pain
refer when finger contracts |
|
|
Term
| jammed finger: signs, tx - not objective |
|
Definition
usuappy POP joint, looks swollen
XR shows small chip at base of middle phalanx
alumifoam splint or buddy tape 10-14d
passive ROM
looks swollen 3-6mo |
|
|
Term
| mallet finger cause, tx - not objective |
|
Definition
extensor tendon pulls off base of distal phalynx
can occur with chip of bone, might need surgery
6-8wk in extension splint full time |
|
|
Term
| flexor tenosynovitis: cause, presentation, tx |
|
Definition
minor puncture or scratch to distal palmar crease
DIFFUSE SWELLING, TENDER ALONG ENTIRE SHEATH
SLIGHTLY FLEXED POSITION
KANAVEL'S SIGN: PAIN WITH PASSIVE EXTENSION
if all 4 signs immediate surgical consult, if not abx, splint and soak |
|
|
Term
| paroncychia: location, dx, tx - not objective |
|
Definition
nail fold or entire tip of finger
has NO pulp space etenderness
white membrane on nail is good
edge of nail is digging into nail fold
massage fold away from nail with cotton and soaks, nail edge removal, abx prn |
|
|
Term
| felon: cause, sign, tx - not objective |
|
Definition
distal finger pump space infection
pulpe is tense
need immediate surgical decompression |
|
|
Term
| bites: signs, tx - not objective |
|
Definition
dogs are clean, cats dirty, people worse
appear in 24h
distinguish joint infection from cellulitis
XR to ro foreign body
culture fluids
abx augmentin 10d
tetanus toxoid |
|
|
Term
| septic arthritis of hip: cause - not objective |
|
Definition
high risk low birth weight neonate: staph aureus > b strep
3y-3mo: H flu B > staph > strep
>3y s. aureus > strep |
|
|
Term
| septic arthritis of hip signs - not objective |
|
Definition
<4yo
pain anterior hip
pseudoparalysis
fever
hx trauma
hip position ER abd mild flexion
CBC ESR CRP 50% positive
u/s effusion
WBC >50000 90% PMN
glucose 10mg/dl less than serum
gram stain positive in 50%
culture positive in 50% |
|
|
Term
| septic arthritis of hip tx - not objective |
|
Definition
| culture synovial fluid, early dx, hp arthrotomy, theraputic procedure |
|
|
Term
|
Definition
FAMILY HX
MORE IN FEMALE
INTRAUTERINE BREECH
LOW BIRTH WEIGHT |
|
|
Term
| signs DDH - not objective |
|
Definition
| barlows, ortalanti, galeazzi positive |
|
|
Term
|
Definition
conservitive: pavlik harness 100 deg flexion mild abd, ball reduce din acetabulum until it develops
surfical; soft tissue release, osteotomies of femur or acetabluum |
|
|
Term
|
Definition
4-10yo boys
delayed skeletal maturity
non inflammatory deformity of WB surface of femoral head
knee pain, limp, effusion
decreased roM
trendelberg stance
limited internal rotation and abd
refered pain to suprapatellar (femoral n), medial thich (obturator n), buttock (sciatic n)
release of WB: bed rest, traction, spica casting, sling, grame, maintain motion, restore mobility, relieve pain |
|
|
Term
| dx of knee pain in a child |
|
Definition
| ALWAYS GET X-RAY OF HIP! COULD HAVE LCO DSEASE |
|
|
Term
| SCFE signs - not objective |
|
Definition
puberty in AA, obese, boys, family hx, 25% bilateral
femoral head in acetablum, neck displaces anterior and externally rotates
associated with hypothyroid and renal disease hormone changes
knee and hip pain, external rotation, decreased intrnal rotation, gait changes |
|
|
Term
| SCFE diagnosis: x-ray, MRI, stable vs unstable |
|
Definition
x-ray: ice cream falling off cone, adequate alone for dx
MRI: early identification
STABLE: PT CAN WALK OR BEAR WEIGHT ON LE
UNSTABLE: PT CANNOT WALK OR BEAR WEIGHT ON LE |
|
|
Term
|
Definition
DEPENDS ON STABLE OR UNSABLE
NWB INITIALLY TO PREVENT FURTHER DISPLACEMENT
SURGERY - PINNING |
|
|
Term
| risks of hip fracture and dislocation - not objective |
|
Definition
90% from falls
urban
smoking
alcohol
caffiene
psychotrophic meds
physical inactivity
previous hip fx
hip axis length
senile dementia
weight hx |
|
|
Term
| which type of hip fractre is more common |
|
Definition
introtrancheric occur at same frequency as femoral neck
subtrochanteric 15% |
|
|
Term
| intracpasular hip fractures 6 |
|
Definition
CAPITAL
TRANSCERVICAL
INTERTROCHANTERIC
SUBCAPITAL
BASICERVICAL
SUBRTROCHANTERIC |
|
|
Term
| extracpasular hip fractures 2 |
|
Definition
INTRATROPHANTERIC TEAR
SUBTRONCHANTERIC TEAR |
|
|
Term
| factors predicting hip fracture will have to stay in hospital |
|
Definition
|
|
Term
| mortality of hip fracture |
|
Definition
1Y 14-36%
GREATEST RISK AT 4-6MO
EQUAL TO AGE AND SEX CONTROLS
12% IN ELDERLY COMMUNITY WITH GOOD COGNITION
50% IN PT WITH DEPEMTIA IN INSTITUTION
DELAYS IN SURGERY FOR MEDICAL OPTIMIZATION >3D DOUBLES RISK OF DEATH IN 1Y
ASSOCIATED REHAB CAUSES MORTALITY IN 1/3 OF PT IN 1Y |
|
|
Term
| stress fractures types - not objective |
|
Definition
tension: superior neck, unstable
compression: inferior neck, stable |
|
|
Term
| femoral head capital fracture: cause, complications - not objective |
|
Definition
dislocation, shear or clevage (A/P), impact or crush (anterior)
AVN, nerve palsy, malreduction, non-union, HO, arthritis |
|
|
Term
| femoral neck - subcapital transvervical basicervical types and tx - not objective |
|
Definition
young v old
displaced v non
capsulotomy v aspiration
impacted i/ii: non displaced, low complications
displaced iii/iv
displaced tx controversial
acceptable reduction 15 deg valgus <10 deg ap angulation
less cancellous bone
derotational screw / guide wire |
|
|
Term
| intratrochanteric fracture classification, tx - not objective |
|
Definition
stable v unstable
young: percutaneous screw
old: hip replacement
surgical fixation DOC: sliding hip screw, placed into metaphysis not diaphysis, small incidence in loss od dixation
intramedullary device: mechanical and technical
prosthetic replcacement: newer stronger calcar replacing designs
more fragments mores instability
low risk of non union due to good blood supply |
|
|
Term
| subtrochanteric fracture location tx - not objective |
|
Definition
distal to lesser trochanter 4-6cm due to low energy falls
intramedullary IM nailin is DOC closed procedure |
|
|
Term
|
Definition
MOD-SEVERE TRAUMA
MOST COMMON IS MVA 70% |
|
|
Term
| hip dislocation locations and prevalence |
|
Definition
ANTERIOR 10%
POSTERIOR 90% |
|
|
Term
| anterior hip dislocation: diagnosis |
|
Definition
ER or LE with flexion and abduction
X-ray: head appears LARGER on x-ray
transchondria: ORIF if displaced or non concentric reduction, exicsion depends on size and location
indentation: no tx, poor prognosis the larger the lesion |
|
|
Term
| anterior hip dislocation: complications - not objective |
|
Definition
ON 10% with CR and delas
femoral artery injury
head fractures |
|
|
Term
| posterior hip dislocation: diagnosis |
|
Definition
flexed abducted IR of LE
x-ray: head apepars SMALLER |
|
|
Term
| posterior hip dislocation complications - not objective |
|
Definition
ON higher, CR under CS
sciatic nerve injury
incarcerated fragments |
|
|
Term
| femoral head fracture cause, classification - not objective |
|
Definition
axial force on flexxed knee adduction hip flexed
1. caudad ro foeva: CR, excision V fixation
2. cephalad to foeva: CR, ORIF anterior approach
3. has head fracure; OR, ORIF, V prosthesis
4. others with fracture: CR, ORIF, acetabular pattern |
|
|
Term
|
Definition
EVOLUTION IN TX WITH ADVENT OF CT
GO TO TRAUMA CENTER surgery is needed
closed reduction if no neck fracture |
|
|
Term
| what is the most common cause of hip dislocation |
|
Definition
|
|
Term
| complications of hip dislocation 8 |
|
Definition
INCIDENCE OF ON VARIES 2-40%
ON 2-10% IF HIP OUT <6H
UP TO 5Y POST INJURY
ROLE OF MRI DETERMINING ON CONTROVERSIAL
nerve injury
AVN
DVT
infection |
|
|
Term
|
Definition
degeneration, unilateral, groin, butt, knee pain
worse with activity and at night
surgical tx is THA
pain control
motion preservation |
|
|
Term
| surgical margins of the breast 4 |
|
Definition
CLAVICLE
inframamary crease with 5th-6th rib
sternum
mix axillary line |
|
|
Term
| surgical margins of axilla 4 - not objective |
|
Definition
axillary vein
subclavius
chest wall
inframmary crease |
|
|
Term
| explain the lymph draining of the brease - not objective |
|
Definition
majority to axilla
medial mass; mediastinum node
metastastic: supraclavicular, interpectoral |
|
|
Term
| fibroadenoma: epidemiology, path, morphology, tx - not objective |
|
Definition
young female, any age
increase in size with estrogen, regress with decrease in estrogen
cysto sarcoma phyllode may be cancer
small well circumscribed 1-3cm
tx: push for excision, could have small areas of cancer |
|
|
Term
| what is the most common lesion of the breast |
|
Definition
| FIBROCYSTIC DISEASE in women 30-50yo |
|
|
Term
| signs of fibrocystic disease |
|
Definition
PHYSICAL EXAM IS DIAGNOSTIC
IRREGULAR RUBBERY CYSTIC
FLUCTURATE WITH MENSTURAL CYCLE (TENDERNESS) |
|
|
Term
| diagnosis of fibrocystic disease |
|
Definition
| ASPIRATE CYST IF TURBID OR BLOOD AND SEND TO PATHOLOGY |
|
|
Term
|
Definition
PRIMROSE OIL
IBPROFIN TO DECREASE INFLAMMATION
VITAMIN E DECREASED FIBROUS TISSUE |
|
|
Term
| 2 types of nipple discharge and what they indicate - not objective |
|
Definition
clear/green - fibrocystic disease
unilateral bloody - papilloma benign |
|
|
Term
| risk factors for breast cancer - not objective |
|
Definition
female
>40yo
family hx
nulliparity
late pregnancy
early menarche
late menopause
gail model: race, age, reproductive risk maternal history, previous biopsy |
|
|
Term
|
Definition
35-40Y SHOULD HAVE BASELINE
40-50Y MAMMOGRAPHY E/O YEAR
50Y MAMMOGRAM EVERY YEAR |
|
|
Term
| 5 stages and 2 classifications of mammograms |
|
Definition
0 - CANNNOT INTERPERT
1 - BENIGN
2 - PROBABLLY BENIGN
3 - SUSPICIOUS CLINICAL CORRELATE
4 - PROBABLLY MALIGNANT
5 - MALGNANT
(+) PALPABLE MASS, NEEDS BIOPSY
(-) CORE, INCISIONAL |
|
|
Term
| plan for biraids mammmogram score >3 |
|
Definition
STEREOTACTIC BIOPSY OR NEEDLE LOCALIZED BIOPSY IF NON-PALPABLE
ASPIRATION IN PALPABLE |
|
|
Term
| who diagnoses breast cancer |
|
Definition
|
|
Term
| 2 non-invasive breast cancers and what to do - not objective |
|
Definition
DCIS: papillary, cribiform, solid, comedo. progresses to invasive carcinoma, diagnose by mammogram
tx: stereotactic biopsy, localized biopsy by needle
LCIS: monitor with serial imaging, no surgical tx |
|
|
Term
| types of invasive breast cancer - not objective |
|
Definition
invasive lobular carcinoma
invasive ductal
tubular carcinoma
mucinous or colloid carcinoma
medullary carcinoma
invasive criviform
invasive papillary
adenoid cystic
metaplastic |
|
|
Term
| tx lobular carcinoma - not objective |
|
Definition
| b/l mastectomy with sentinel lymph node biopsy |
|
|
Term
| inflammatory breast cancer: signs, prognosis - not objective |
|
Definition
erythema, edema, warmpth
often misdiagnosed as mastitis, abscess
high mortality 50% 5y with tx |
|
|
Term
| 5 procedures done for breast cancer - not objective |
|
Definition
radical mastectomy: breast, axillary nodes, pectoralis muscle
modified radical mastectomy: all breast tissue, axillary content, pectoralis fascia
simple mastectomy: breast tissue, pectoralis fascia
quadrantectomy: wide local excision, partial mastectomy
sentinel node boipsy: basis for breast conservation therapy, take hot node out if positive assume all nodes positive |
|
|
Term
| treatment of breast cancer - not objective |
|
Definition
breast conservation therapy: superior to mastectomy for stage I/II
wide local excision
sentinel node sampling
post op radiation
preop chemo tx if inflammatory
mastectomy with nodal dissection
post op radiation |
|
|
Term
| classification of breast cancer - not objective |
|
Definition
0- insitu carcinoma
1- tumor <2cm
2a- mobile ipsilateral node <2cm or tumor >2cm but <5cm without nodes
2b- >2cm, <5cm mobile ipsilateral node OR tumor >5cm without ones
3a - tumor <5cm, fixed ipsilateral nodes or nodes in mass >5cm without skin or chest wall involved
3b - excision into skin or chest wall or positive internal mammary nodes
4- distal spread |
|
|
Term
| treatment of breast cysts and abscess - not objective |
|
Definition
cyst - aspirate, if reoccurs excise
abscess - surgical drainage, coopers lig and lymph allow infection spread fast |
|
|
Term
| what is the #1 cause of mortality in females in the US |
|
Definition
|
|
Term
| why is preventive screening important for breast cancer |
|
Definition
| IF DIAGNOSED EARLY ITS CURABLE |
|
|
Term
| how to put in a nasla airway |
|
Definition
| STRAIGHT BACK THEN INFECTION |
|
|
Term
| which airways open into pharynx |
|
Definition
|
|
Term
| what is the function of an oral airway |
|
Definition
| HOLDS TONGUE FORWARD SO IF LIMP IT DOES NOT BLOCK AIRWAY |
|
|
Term
| internal anatomy of the trachea |
|
Definition
D SHAPED
CARDILADGES ANTERIOR
CRICOID IS CIRCUMFERENTIAL
12-15CM IN ADULT
3-5CM IN NEWBORN |
|
|
Term
| explain how to set up bag mask ventilation 5 |
|
Definition
HEAD TILT
CHIN LIFT
JAW THRUST
C PUSHES MASK DOWN AND CLOSES AIRWAY
E PULLS JAW FORWARD AND OPENS AIRWAY |
|
|
Term
|
Definition
| 3 FINGER BREATHS FROM INSIDE OF CHIL |
|
|
Term
| 4 mallempati classifications |
|
Definition
SOFT PALATE; UVLA, FAUCUS, PILLARIS VISIBLE, NO DIFFICULTY
SOFT PALATE, UVULA, FAUCES VISIBLE, NO DIFFICULTY
SOFT PALATE, BASE OF UVULA VISIBLE, MODERATE DIFFICULTY
HARD PALATE ONLY VISIBLE, SEVERE DIFFICULTY |
|
|
Term
| 6 head positions for intubation |
|
Definition
RAMPING
HEAD TILD / CHIN LIFT
SCISSOR MANEUVER
JAW THRUST
SNIFFING POSITION: WHICH EVERY WAY THE NOSE GOES THIS IS THE WAY THE AIRWAY GOES |
|
|
Term
| 2 types of blades for intubation and how to place them |
|
Definition
MAC/CURVED: SEATS INTO VALECULLA, NEED TO PULL EPIGLOTTIS FORWARD
MILLER/STRAIGHT: LIFT EPIGLOTTIS, MAKES AIRWAY ACCESS EASIER |
|
|
Term
| 2 percautions to avoid aspiration in intubation |
|
Definition
SWEEP TONGUE FROM RIGHT TO LEFT
ALWAYS MAKE SURE ET TUBE GOES THROUGH CORDS |
|
|
Term
| cormack and lehane grading 4 |
|
Definition
1. CORDS OPEN IN TRIANGLE
2. CORDS MORE CLOSED IN CIRCLE
3. CORDS CLOSE WITH SLIT OPEN
4. CORDS CLOSED |
|
|
Term
| what do you do if someone has a high cormack and lehane grade or mallepati classification |
|
Definition
| MAXAMIZE VIEW AND SPEED OF INTUBATION BY PUSHING ON CRICOID |
|
|
Term
| how can you confirm ETT was placed well 3 |
|
Definition
VISUALIZATION OF IT PASSING THROUGH CORDS ON CXR
CHEST RISE AND BREATH SOUNDS
CONDENSATION IN ETT
CO2 WAVEFORM OR COLOMETRIC TEST POSITIVE |
|
|
Term
| signs of obstructive lung disease and the diseases - not objective |
|
Definition
decreased FEV1/FCV <80%
FEV1 markedly reduced
CF, ronchiectiasis, asthma, bronchitis, COPD
obstructive sleep apnea: pickwickian syndrome obesity hypoventilation syndrome |
|
|
Term
| signs of restrictive lung disease and the diseases - not objective |
|
Definition
normal FEV1/FVC ratio due to both decreased
pneumonia, pulmonary fibrosis, sarcoid, obesity
loss of lung itssue, decreased lung expansion, decreased O2 transfer |
|
|
Term
| how to calculate and interpert BMI - not objective |
|
Definition
body weight in kg / height squared in m
obesity >30
morbid obesity >40
super morbidity obese >55 |
|
|
Term
| 5 differences of a pediatric airway |
|
Definition
tongue: larger compared to oropharynx space leaving little room for swelling
trachea; more pliable, smaller, immatire rings, hyperflexion/extension can lead to occlusion
epiglottis; large, more U shape, use straight blade which goes under epiglottis and help visualize cords
larynx; higher at 1-2nd vertebrae rather then 4th-5th like adult
mainstem bronchi angle is less: aspiration occurs in right or left main bronchi |
|
|
Term
| 3 sensory innervation of the airway |
|
Definition
NASOPHARYNX: TRIGEMINAL
OROPHARYNX: GLOSSOPHARYNGEAL
LARYNX INTO TRACHEA: VAGUS |
|
|
Term
| taste motor and sensory of the tongue |
|
Definition
VAGUS: TASTE POSTERIOR ON EPIGLOTTIS AND PHARYNX
GLOSSOPHARYNGEAL: TASTE POSTERIOR 1/3
FACIAL- CHORDA TYMPANI: TASTE ANTERIOR 2/3
CN V LINGUAL - SENSORY
HYPOGLOSSAL - MOTOR |
|
|
Term
| motor innervation of the airway main branches |
|
Definition
| vagus superior laryngeal and recurrent laryngeal |
|
|
Term
| functiosn of superior laryngeal 6 |
|
Definition
external branch: crichothyroid muscle
internal branch: mucous membranes of larynx, epiglottis, base of tongue, aryepiglottic fold, laeynx, cough reflex efferent |
|
|
Term
| functions of recurrent laryngeal |
|
Definition
intrinsic muscles of larynx excet cricothyroid
sensation to larynx below vocal fold
branches to trachea and esophagus
inferior constrictor muscles
posterior crioarytenoid muscles: opens vocal cords
interarytenoid muscle: innervated by nerve from right and left side |
|
|
Term
|
Definition
laryngeal bag mask airway
laryngeal tube or king airway |
|
|
Term
|
Definition
alt to mask anesthesia in OR or short procedure
difficult airway: cannot be intubatd but can be ventilated
prehospital management: cardiac arrest, difficult airway |
|
|
Term
|
Definition
head in neutral hold like pen in left hand
slide along hard palate
distal dip goes on epiglottis and trachea openinig
stop when approx 8cm from mouth
inflate cuff
ascultate BL breath sounds, observe chest rist |
|
|
Term
| indications for laryngeal tube 3 |
|
Definition
alternate: mask ventilation, LMA, tracheal intubation
anesthesia
cardiopulmonary rescitation |
|
|
Term
| laryngal tube parts and use |
|
Definition
tube with oropharyngeal cuff (balloon) at 30 deg angle
tilt head back, stick that shit in there, blow up balloon?? |
|
|
Term
| indicatiosn for oropharyngeal airway 2 |
|
Definition
uncouncious or semiconcious
holds tongue to not block airway |
|
|
Term
| 2 types of oropharyngeal airway and the differences |
|
Definition
berman: channels along side allowing suction cath or ETtube
gudel: tube that used for suction but not ET |
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Term
| 3 parts of oropharyngeal airway |
|
Definition
flange: protrudes into mouth, rests on lips preventing sinking into pharynx
body: follows contour of mouth, curling over, tongue
tip: sits on base of tongue |
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Term
| how to size oropharyngeal airway |
|
Definition
large adult 5-6
medium adult 4-5
small adult 3-4 |
|
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Term
| how to insert oropharyngeal airway |
|
Definition
suction mouth, tilt head back
thimbs on bottom teeth, index finger on upper teeth
insert with curvature toward tongue to preventing pushing into pharynx
when reaches back of tongue rotation 180 deg so curve follows roof
dont tape can lead to aspiration if the gag |
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Term
| general indication for positive pressure ventilation |
|
Definition
| when pt spontaneous ventilation cannot sustain life or for prophalyxis of such |
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Term
| specific indications for positive pressure ventilation 12 |
|
Definition
bradypenia, apenia, respiratory arress
acute lung injury or ARDS
tachypenia >30 bpm
vital capacity <15 mL/kg
PaO2 with FIO2 <55mmHg
alveolar gradiet with 100% O2 but <450 mmHg
clinical deterioration
respiratory muscle fatigue
obtundation or coma
hypotension
acute PCO2 >50 mmHg and pH <7.25
neuromuscular disease |
|
|
Term
| types of positive pressure ventilation 4 |
|
Definition
volume controlled; determine set volume, ventilatior cycles to exhale
pressure controlled; determine applied posiitve pressure, volume is variable, vetilator calculates pressure at expiratory circult
spontaneous controlled; flow sensed mode dependent on breathing pt to cycle (aka continous positive airways pressure)
negative pressure controlled: cycles by making negative pressure around chest and abdomen. as pressure moves across diaphragm it causes air to move into lungs normally |
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|
Term
| 10 methods of positive pressure ventilation |
|
Definition
airway pressure release ventilation
intermittent manditory ventilation
manditory minute ventilation
pressure regulated volume control
continous positive airway pressure
bilevel positive airway pressure
high fequency ventilation (active)
high fequency ventilation (passive)
positive end expiratory pressure
pressure support |
|
|
Term
| airway presure release ventilation description |
|
Definition
timed cycle between levels of positive pressure
ventilation time short to maintain alveoli inflation
continous pressure with brief release and short expiration |
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|
Term
| intermittent manditory ventilation description |
|
Definition
minute ventilation determined by RR and tidal volume
pt can increase it by taking a breath
ventlator breath is synchronized with pt inspiration effort |
|
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Term
| manditory minute ventilation description |
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Definition
allows spontaneous breathing but autonaticallya djusts manditory ventilation to meet present minimum volume requirement
no breaths delivered as long as pt meets min volume
optimal for weaning neonatal and pediatric patients
reduced long term complications |
|
|
Term
| pressure regulated volume control description |
|
Definition
ressure limited, vomume targeted, timed cycle breaths
ventilator or pt initiated
peak inspiratory pressure varies breath to breath to achieve target tidal volume |
|
|
Term
| continos positive airway pressure description |
|
Definition
non-invasive pressure at end of exhalation to keep alveoli open
helps keep PaO2 levels in blood stable |
|
|
Term
| bilevel positive airway pressure description |
|
Definition
adjustment to nininvasive positive pressure ventilation
inspiratory and expiratory positive airway pressure
good for COPD and acute respiratory failure |
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|
Term
| high freqency ventilation (active) description |
|
Definition
ventilatory uses pressure to apply inspiratory breath
applies to opposite pressure to force expiratory breath |
|
|
Term
| high frequency ventilation (passive) description |
|
Definition
ventilator uses pressure to apply inspiratory breath
returns to atmospheric pressure to allow passive expiration |
|
|
Term
| positive end expiratory pressure description |
|
Definition
| a pressure an exhalation has to bypass causing alveoli to remain open increasing PP oxygen in blood |
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|
Term
| pressure support description |
|
Definition
pt initiates breath and ventilator delivers support with preset pressure valve
pt regulates rate and tidal volume
set inspiratory pressure is kept consistant and there is decelerating flow
pressure improves oxygenation, ventilation, and decreases work of breathing |
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|
Term
|
Definition
prevent further injury
continue delivering oxygen to the cells |
|
|
Term
|
Definition
stick to ABCDE keep it simple
history
identify the quick six killers |
|
|
Term
|
Definition
AIRWAY OBSTRUCTION
PNEUMONOTHORAX
HEMOTHORAX
TRACHOBRONCHIOLE INJURY
CARDIAC TAMPONATE
MASSIVE HEMORRHAGE
neurogrnic shock |
|
|
Term
| causes of neurogenic shock 4 |
|
Definition
hight T sign fracture
hypotensive due to loss of vasomotor tone
bradycardia |
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|
Term
|
Definition
| blood loss until proven otherwise |
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|
Term
| when should you establish a definitive airway |
|
Definition
asap, low threshold of difinitive airway
dont let them decomponsate
most reliable airway is self dependent airway
second most reliable airay is ET tube
overall clinical impression is key |
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|
Term
| you've decided to intubate, what do you need |
|
Definition
assistance
supplies based on problem
MEDS: SUCS, ROCURONIUM, ETOMIDATE, KETAMINE, VERSED
bailout plan |
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|
Term
| so you've paralized your pt in intubation, now what |
|
Definition
|
|
Term
| if bag mask isnt workint what is the problem, what do you do |
|
Definition
first killer; no air in obstruction
do surgical airway |
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|
Term
| what is a tension pneumothorax how is it diagnosed |
|
Definition
hemodynamic instability unlike pneumothorax!
clinical diagnosis NOT x-ray so chest tube should be in before x-ray |
|
|
Term
| signs tension pneumothorax |
|
Definition
chest trauma
subacute air
anxiety: indicator of hypoxia
HYPOTENSION/TACHYCARDIA
jugular venous distension
difficult to bag, hard to squeeze
respiratory distress
decreased breath sounds
increased airway pressure |
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|
Term
|
Definition
NO CXR NEEDED, CLINICAL DX
needle decompression: large bore mid clavicle 2-3rd intercostal (if large breast inframammary crease)
place chest tube: 4-5th intercostal space on anterior axillary line |
|
|
Term
| tronchobrachial injury: definition and diagnosis |
|
Definition
injury disuprsing anywhere on tracheal or bronchial tract
presents like pneumothorax
leak leak in chest tube chamber; air you squeeze in just goes out the chest tube so there is still no airway |
|
|
Term
| treatment of tronchobrachial injury |
|
Definition
IF IT PRESENTS AS PTX AND YOU PUT A CHEST TUBE SHOULD THAT BE THE END OF THE IMMEDIATE LIFE THREATNING PROBLEM>
IF SEVERE ENOUGH MAY HAVE TO ISOLATE GOOD LING AND PROCEEDE TO SURGERY
PUT THE ET TUBE INTO THE GOOD LUNG TO AVOID THE BAD |
|
|
Term
| definition and signs 3 of cardiac tamponade |
|
Definition
BLOOD OUTSIDE THE HEART BUT INSIDE THE PERICARDIUM
INCREASED PRESSURE IN THE CHEST COMPRESSES THE VEINS AND IT DECREASES PRELOAD AND IT GIVES NOTHING FOR THE HEART TO PUMP
BECKS TRIAD: HYPOTENSION, JVD, MUFFLED HEART SOUNDS |
|
|
Term
| dx and treatment of cardiac tamponade |
|
Definition
ECHO
needle decompression subxiphid 45 deg angle under zyphoid aiming toward left nipple
PC WINDOW
thoracotomy/pericardotomy |
|
|
Term
| massive hemorrhage 5 places of blood loss |
|
Definition
chest
abdomen
pelvis
retroperitoneal
the floor |
|
|
Term
|
Definition
h and p
CXR
pelvic x-ray
FAST: LOOK FOR FLUID IN ABDOMEN, PELVIS, AROUND BREAST
FLUID IS DIFFICULT TO IDENTIFY ID RETROPERITONEAL
OFTEN BLUNT TRAUMA WITH NEGATIVE CXR AND FAST
DPL: peritoneal lavage, look for blood and bowel injury
CT:
exploration of the abdomen |
|
|
Term
|
Definition
STOP BLEEDING WITH DIRECT PRESSURE, TOURNICUTE, REDUCE FEACTURES, WRAP PELVIS, INTERVENTIONAL RADIOLOGY, EX-LAP
rescuscitate
IVF/blood
role of factor 7
ASA
plavix
coumadin
pradaxza
endpoints of rescucitation |
|
|
Term
| goals when a pt goes into shock 2 |
|
Definition
deliver oxygen
keep cells healthy enough to use oxygen |
|
|
Term
| causes of decreased oxygen carrying capacity |
|
Definition
anemia due to bleeding, increased destruction, decreased production
disruption in gas exchange: ALI, ARDS, infection, pulmonary edema, pulmonary emboli |
|
|
Term
| causes of decrease in cardiac output decrease 4 |
|
Definition
low pressure (absolute): bloow loss, dehydration
low pressure (relative): neurogenic shock, sepsis
poor cardiac function
increased afterload |
|
|
Term
| causes of poor cardiac function |
|
Definition
| HF: AMI, rhythm issues, tension effects (tamponade, PTX) |
|
|
Term
| physiological aspects of clotting 3 |
|
Definition
leukocytes migrate and attach to vessel walls and injury
veniles dilate
lymphatics are blocked |
|
|
Term
|
Definition
substrate phase: inflammatory/lag/exudate
proliferative phase
maturation phase; remodeling, maturation |
|
|
Term
| proliferative phase of wound healing attribues |
|
Definition
consistant regardkess of the wound
begin when wound is covered by epithelium
production of collagen in the wound
fibroblasti is primary cell and makes collagen |
|
|
Term
| types of wound healing - not objective |
|
Definition
primary healing: first intention: wound closed by direct approximation of epithelial wound edges
secondary healing: spontaneous wound closure: wound is left open and allowed to heal spontaneously from edges of the wound, wound closes by contraction and epithelization
tertiary: healing by third intention; wound closed by active means after delay of days to weeks, delayed closure should be performed only in wounds that have quantative bacterial count of less than 105 |
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|
Term
| classification of wounds - not objective |
|
Definition
avulsion injury: skin broken by shearing forces and underlyig tissue has been undermined and elevated
abrasion: superificial loss of epithelial elements
puncture: generally do not require closure
crush injuries; often accompanied by loss of significant amounts of tissue that may initially appear viable |
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|
Term
| wound closure - not objective |
|
Definition
no tension on edges can cause skin necrosis
sutures in skin of torso anx exttremities shoul dbe left in place 7-10d
sutures on face and neck left in place for 4d
knots should be secure but not so tight as to strangulate the tissue
structural material: monofilament (does not hold bacteria, used on skin), braided (infection risk), dissolvable (deep sutures, good strength for dermis), permanent |
|
|
Term
| define and describe chronic wounds |
|
Definition
wounds that are slow to heal and are classified as chronic
stalled in inflammatory stage of healing
poor granulation tissue, altered cell cycles, biochemical imbalance
increased inflamatory cytokines, tissue matrix metalloproteinases that inhibit or slow healing |
|
|
Term
| causes of chronic wounds 3 |
|
Definition
diabetic foot ulcers
venous stasis ulcers
open wounds that have failed to close |
|
|
Term
| pressure ulcers: causes, most common locations |
|
Definition
neurological impairment, bed ridden, loss of reflex movement to relieve pressure, 10% of hospitalized patients
HEEL, SACRUM, ISCHIAL TUBEROSITY |
|
|
Term
| 4 grades of pressure ulcers |
|
Definition
1. non blanching red area on intact skin
2. partial thickness skin loss with involvement of epidermis or dermis, superificial, looks like blister of abrasion
3. full thickness skin loss with necrosis of SC tissue that can extend into fascia
4. full thickness skin loss with necrosis, destruction can involve muscle, bone, tendons |
|
|
Term
| what is the most common chronic wound in adults |
|
Definition
|
|
Term
| cause of venous stasis ulcers |
|
Definition
| insufficiency from venous vascular incompetence affects approx 15% of adults |
|
|
Term
| signs of venous stasis ulcers |
|
Definition
| leg discomfort, heaviness, edema, dermatofibrosis (hemosiderin deposition in skin, brown blac spots) |
|
|
Term
|
Definition
| compression to help withv enous flow |
|
|
Term
| arterial insufficiency ulcer cause and location |
|
Definition
athlerosclerosis of main arterias supplying LE
common in toes |
|
|
Term
| appearance of arterial insufficiency ulcers |
|
Definition
chronic arterial ulcers may resemble venous ulcers
mummified black and dry gangrene
suppuration with oozing (wet gangrene) |
|
|
Term
| how is arterial insufficiency ulcers diagnosed |
|
Definition
| vascular u/s to assess arterial circulation |
|
|
Term
| signs of diabetic neuropathy |
|
Definition
polyneuropathy of long neurons of foot and LE
motor neuropathy: atrophy of intrinsic foot muscles, derangement of bones that depend on muscle tone to align
resulting deformities include charcots foot |
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