Derm
This disorder has an unknown etiology, though is believed to be an autoimmune condition. It presents as asymptomatic depigmented macules or papules with no inflammation. It is diagnosed using a Wood's lamp, and treatment is highly variable
What is vitiligo?
This dislocation has the arm slightly abducted, externally rotated, and inferior
What is an anterior shoulder dislocation?
This x-ray finding always indicates an elbow fracture
What is the posterior fat pad sign?
In deQuervain's tenosynovitis, there is swelling of the sheath surrounding the tendons of these two muscles
What are the abductor pollicus longus and extensor pollicus brevis?
This x-ray angle is unique to patellar fractures
What is the sunrise view?
An 11-year-old boy presents with an osgood schlatter fracture. How do you treat him?
NSAIDs, protective padding, rest from strenuous activity until improvement, PT
A patient is brought to the ER with no identification after an MVA. What's your first step in case of a neck injury?
Immediate immobilization!
These 2 tests are used to determine whether or not a patient has an ACL injury
What are the Lachmann and anterior drawer tests?
This injury is also referred to as a "dinner fork deformity"
What is a Colles fracture?
Differentiate the four types of psoriasis
1. Plaque: silver scaly erythematous patches, papules and plaques
2. Inverse: erythematous patches in the skin folds
3. Guttate: "dew drop" lesions salmon pink with fine scaling
4. Erythrodermic: Generalized erythema covering nearly entire BSA
Describe a SLAP lesion. What does SLAP stand for?
SLAP Lesion tear occurs when the labrum (soft tissue that molds to fit the humeral head) has been damaged.
SLAP lesion stands for Superior Labrum Anterior Posterior lesion
List 3 complications possible with radial head fractures
Nerve injury (posterior interosseous nerve)
Elbow stiffness with extension and supination
Avascular necrosis of the radial head
Nonunion/ malunion
Elbow OA
Heterotrophic bone
Joint instability
This is important to remember in regards to a scaphoid fracture
The blood supply to the scaphoid enters in a retrograde fashion, so a fracture holds risk for avascular necrosis
How does the more commonly occuring hip dislocation present?
Posterior hip dislocation will present with the leg appearing shortened, adducted, internally rotated, and slightly flexed.
Describe the Salter Harris fracture types
Type 1: separation through the growth plate
Type 2: through the growth plate and metaphysis
Type 3: through the growth plate and epiphysis
Type 4: through the metaphysis, growth plate, and epiphysis
Type 5: crush injury of the growth plate
Describe the dermatomes for C5-C8
C5: lateral shoulder
C6: thumb and index finger
C7: middle finger
C8: small finger
These 5 tests are used to diagnose SLAP lesions
What are: anterior glide, compression rotation, O'Brien's, crank, and speeds tests?
Professor Hsieh's describes this as the only way to manage PA school stress
What is smoking?
Describe the treatment for bullous pemphigoid vs pemphigus vulgaris
Bullous pemphigoid is treated with high potency topical corticosteroid, doxycycline first line, and methotrexate and azathioprine second line.
Pemphigus vulgaris is treated with systemic glucocorticoids (oral prednisone daily), or rituximab with lower dose prednisone.
It is common to "hear a pop" with this type of muscle injury
What is a biceps tear?
Describe the terrible triad seen in elbow dislocations
Elbow dislocation, radial head fracture, coronoid fracture
Describe a Colles fracture vs a Smith fracture
Colles fracture: More common, a fracture of the distal radius with dorsal displacement
Smith fracture: A fracture of the distal radius with volar (anterior) displacement
Describe the grading scales for an ACL sprain
grade 1: ligament is mildly damaged, stretched but still able to keep the joint stable
grade 2: the ligament is stretched to the point of looseness in the joint. this is often referred to as a partial tear
grade 3: complete tear/ rupture of the ligament, making the joint unstable
How will you differentiate a SCFE from Legg-Calve-Perthes disease?
SCFE: seen w 10-14 y/o, obese patients. Presents with hip/knee pain with poor internal rotation and requires surgical correction. Imaging will show femoral cap slipped from growth plate
LCPD: seen with 4-10 y/o kids, small for their age. resents with hip/knee pain with poor internal rotation and requires bracing and rest. Imaging will show avascular necrosis of the femoral head
Spondylosis vs Spondylolysis vs Spondylolisthesis
Spondylosis: general degeneration of the spine, associated with disk degeneration
Spondylolysis: (Hseih says this is the same as spondylosis) a break or defect of the pars interarticularis, causing instability, leading to spondylolisthesis
Spondylolisthesis: anterior slippage of a vertebral body off of the inferior disk, putting pressure on the spinal cord.
Describe the tests/ signs for ulnar neuropathy(3) and radial tunnel syndrome(1)
Ulnar neuropathy: tinel at elbow, froment's sign, wartenberg sign
Radial tunnel syndrome: middle finger test
Describe the severity "levels" for atopic dermatitis
Mild: areas of dry skin with infrequent pruritus and +/- small areas of erythema. Little impact on ADLs
Moderate: areas of dry skin, frequent pruritus and erythema (+/- localized skin thickening). Moderate impact on ADLs
Severe: widespread areas of dry skin, incessant pruritus and erythema (+/- skin thickening, bleeding, oozing). Severe limitation on ADLs
List at least 5 drugs that induce photosensitivity reactions
Tetracyclines, Sulfonamides, Metformin, Hydrochlorothiazide, Fluoroquinolones, NSAIDs, Amiodarone, really any drug you can think of is probably right
These are two differentials for rotator cuff tendonitis
What are: rotator cuff tears, shoulder impingement syndrome, osteoarthritis, bursitis, or tumors?
What muscles are associated with lateral and medial epicondylitis?
Lateral: origin of the extensor carpi radialis brevis
Medial: Common tendinous origin of the anterior forearm muscles (flexors/ pronators)
Describe Bennett fracture vs a gamekeeper/ skier's thumb
Bennett: oblique intra-articular fracture at the base of the 1st metacarpal involving the anterior oblique ligament
Gamekeeper's thumb: a sprain or tear of the ulnar collateral ligament, possibly involving avulsion at the MCP joint of the 1st phalanx
A 52 year old female is presenting with lateral hip pain. She has tenderness over the greater trochanter upon palpation and weakness with abduction of the hip. PMH shows obesity and mild scoliosis. What does she have?
Trochanteric bursitis
A patient presents with Volkmann's syndrome. What is this, and what is the likely cause?
An ischemic contracture of the forearm and hand (flexion at the wrist, extension at the MCP joint), resulting from brachial artery injury, as a complication of compartment syndrome from any displaced, specifically supracondylar fractures, tight casts, or thermal burns
A patient with osteoporosis is presenting with the most common type of compression fracture. X rays show about 30% height reduction of the vertebral body, and patient complains of 10/10 incapacitating pain despite medical management. What type of fracture is this, and how will you treat the patient?
You're doing a pediatric check with a month old infant, and are checking for developmental hip dysplasia. What physical exams will you conduct? (Describe the mechanisms for each test)
Galeazzi: adduct and internally rotate both legs to determine if one knee appears lower than another
Barlow: adduction of the hip and application of posterior force on the knee
Ortolani: abduction of the hip with anterior force on the femur
What are the 7 I's for drug administration?
Instilled, Inhaled, Ingested, Inserted, Injected, Incognito, Intermittent
These are immediate drug reactions vs delayed drug reactions. (Name some from each type) and what type of hypersensitivity rxn are these?
Immediate: Includes urticaria, angioedema, anaphylaxis
Delayed: Exanthematous eruptions, fixed drug eruption, SJS/TEN
Type 1 hypersensitivity, IgE mediated (even delayed)
Describe the 6 classifications of AC joint injuries
Type 1: Sprain of AC ligaments
Type 2: Tear of AC ligs, CC ligs still intact
Type 3: Complete disruption of AC and CC ligaments
Type 4: Complete AC and CC disruption with displacement of the distal clavicle
Type 5: AC and CC ligament tear, disruption of muscular and fascial attachments, superior clavicle displacement
Type 6: Disruption of ligaments and muscular attachments
Compare Monteggia and Galeazzi fractures, including MOI for both
Monteggia: fracture of the proximal ulna with radial head dislocation, MOI includes direct blow
Galeazzi: fracture of the distal radius with dislocation of the distal radio-ulnar joint. MOI includes FOOSH and direct blow
Differentiate mallet finger from jersey finger. What is affected in each and how do they present?
Mallet finger: avulsion of the extensor digitorum tendon from the distal phalanx. Presents with flexion at the DIP joint
Jersey finger: avulsion of the flexor digitorum profundus tendon from the distal phalanx. Presents with inability to flex at the DIP joint
Describe a scenario in which you would recommend a Birmingham hip resurfacing procedure over a total hip replacement to a patient. (Pros and cons of both)
Patient is a young athlete with osteoarthritis. BHR procedure keeps much more of the original bone and reduces risk of leg length discrepancy, but holds potential for metal ion toxicity
THR would reduce mobility and likely end a professional sports career. It also has complications including DVT, infection, blood loss during the procedure, and hip dislocation
Name and differentiate the four types of bone tumors
Osteosarcoma: MC bone malignancy in kids. X-ray will show"hair on end" bone, indistinct margins
Ewing Sarcoma:Giant cell tumor. X-ray will show "moth-eaten" or layered periosteum appearance
Chondrosarcoma: Malignancy of cartilage. X-rays will show punctate ring/ arc findings, CT and MRI good for visualization
Osteochondroma: Non-cancerous bony growth. X-ray will show distinct borders and growth away from growth plate
Lower back pain red flags that will indicate spondyloarthritis vs infection or cancer
Spondyloarthritis: morning stiffness and improving with activity but not rest, alternating gluteal pain, age >40
Infection/ cancer: hx of cancer, unexplained weight loss, nocturnal pain (because of cortisol levels!), age >50
Name and demonstrate the six tests used to diagnose rotator cuff tendonitis
Isometric strength test, painful arc, drop arm test, empty can test,isometric testing of the infraspinatus tendon, Gerber's lift-off test
Chicago Bulls legend Derrick Rose suffered this injury in the 2012 Eastern Conference finals
What is an ACL tear?