CT Exam I

45 y.o. F with wrist pain for several months that is worse at night. She states that it has been progressively getting worse. Has a tingly sensation in her thumb and index finger. Pt denies fever, joint involvement, neck pain, traumatic injury or past injury to the wrist. What is the next step in this pts evaluation?
A. inspect the hand and wrist
B. start motor testing of the mucles of hand and wrist
C. send pt for an x-ray
D. start sensory testing of the hand and wrist

43 y.o. F presents with a several month history of wrist pain and hand parasthesia of the first 3 digits. On PE you note no swelling or erythema the skin is intact, no atrophy of the greater thenar prominence, no atrophy of the lesser thenar prominence, no neck pain, nails normal, wrist extension/flexion strength is 5/5 bilaterally. the wrist and hand ROM is normal, She has decreased grip strenght 4/5 on the affected hand with the unaffected hand being 5/5. What would be the next PE test to perform?
A. Finklestein
B. O.K sign test
C. Phalen test
4. X-ray

50 y.o. M presents with several month history of wrist pain and hand parasthesia of the first 2 digits. His PE is unremarkable except for decreased strength 4/5 on the grip strength of the affected hand and a pain with the Phalen test. Pt denies any trauma to the wrist. What is his Dx?

How would you treat Carpal Tunnel syndrome initially?

"numbness and tingling to the radial 3 digits of the hand and vauge aching of the thenar area"

What is the treatment for severe, persistent carpal tunnel that is refractory to conservative therapy?

Pt presents with a painful finger.
PE: volar aspect of the DP of digit 2 is swollen, erythematous, warm to the touch and very painful to palpation. Swelling does not extend past the DIP

What is the Tx for a Felon?

T or F you should X-ray a Felon?

What is DeQuervain's Tenosynovitis?

What is the test for Dequevain's tenosynovitis?

How do you perform a Finkelstein's test?

What is the first line treatment for dequevain's tenosynovitis?

Pt has pain and swelling over the radial styloid and says that the pain is worse when he tries to move his thumb or make a fist what is your diagnostic suspicion? what test would you use to confirm?

You have a high suspicion that your patient has flexor tenosynovitis but they only have 2 of the 4 signs. What imaging study would you use to confirm your diagnosis?

What will happen if you let flexor tenosynovitis go untreated?

What are the 4 signs of kanavel?

What is the dispostion for a pt with flexor tenosynovitis?

What is the treatment for flexor tenosynovitis?

When the flexor tendon sheath becomes infected

A colles fracture is ___ (dorsally or volarly) displaced while a smith's fracture is (dorsally or volarly) displaced.

What is the cause of a colles fracture?

"dinner fork" deformity

What is the most common cause of a Smith fracture?

A 53 y.o. M with CC: Wrist pain. Pt states that he fell on the ice outside his car and fell on the palm of his hand. He has no swelling or deformity he has minimal tenderness and full range of motion. What exam do you want to perform? What fracture are you worried about?

Pain in anatomical snuffbox

What is the treatment for a scaphoid fracture

What are the 2 things you should always do before and after reduction of a fracture or dislocation???!!

Pt presents to ED after injuring the 4th digit right hand pt reports injuring the finger in a basketball game when a small blonde girl fired a pass at him. On physical examination you note pain, erythema, and inability of the DIP of the 4th digit to extend sensation and skin are both intact. What do you suspect could be a possible cause of the finger pain? What would you order to confirm?

What don't you let a pt with a mallet finger do?

What is the treatment for mallet finger?

What is the typical mechanism of injury for a Mallet finger?

What ligament is injured in Game keepers thumb?

How do you treat Gamekeeper's thumb?

What is the mechanism of injury for gamekeepers thumb?

What is Jersey Finger?

What is the treatment for Jersey finger?

What do you do if a boxer's fracture has an open lac?

What is the treatment for a Boxer's fracture?

What should you always look for/remove when working with a hand/finger injury?

How would you treat a finger dislocation?

Car crash pt is fine except for a hip that is flexed internally rotated and adducted

Car crash pt is fine except for a hip that is minimally flexed, externally rotated and markedly abducted

The majority of hip dislocations are (anterior or posterior)

Where/How do you check sciatic nerve function?

The peroneal nerve is responsible for (dorsiflexion or plantar flexion)?

The tibial nerve is responsible for (dorsiflexion or plantarflexion) ?

You have an 80 y.o. F who fell what do you have to establish about her fall?

A hip that presents shortened externally rotated and abducted is most likely...

Mrs. Banderez is an 82 y.o. female with pmhx of htn well controlled who presents to ED with hip pain. Pt stated that she was going to see a movie with her husband (Once Upon a Time in Mexico) when she tripped over him. Pt watched the movie then came to the ED afterwards due to persistent pain and limp. Pt denies head trauma, LOC or neck pain
PE: no ecchymosis, skin intact no swelling over right hip, tender to palpation over greater trochanter. pain with active and passive movement (ext/flex/int/ext rotation) Pt can ambulate with limp. Pt is NVI
What test do you do next

65 y.o. male with worsening right hip pain. Per pt he has had intermittent hip pain for years. It only uesd to hurt when he ran that cleared with rest however progressed until he had pain with only walking and now he has pain at rest. What is your highest clinical suspicion?

What are the 4 classic findings of Osteoarthritis on X-ray?

What is the treatment for OA?

When testing extension in a knee injury what crucial tendon are you testing?

56 y.o. male falls while ice skating and injures knee. It has minimal swelling and is minimally tender. What is your next step? What "rules" suggest this course of action?

Can a patient sleep with a knee immobilizer on? why?

43 y.o. F who presents complaining of rt knee pain after running and fell into a hole approx 1 foot deep.
PE: pt cannot extend lower leg and cannot maintain extension
What do you suspect is involved in her injury?
Who should you get involved in her injury?

What part of your exam would you delay until post X-ray with a patient whom you suspect this?

Pittsburg rules are for ____ and Ottowa rules are for ___

Bimalleolar fracture involves the __ and ___ maleolus while a Trimalleolar fracture involves the ___, __ and ___

Test that tests function of the achilles

Test for dequairvains

Test for carpal tunnel

Why do you X-ray an achiles tendon rupture?

T or F when you splint an achilles tendon rupture their foot should be at 90degrees

How do you perform a Thompson test?

"feels like a baseball bat hit the back of my calf"

___ hours or compartment syndrome can cause irreversible damage

Pt with hx of recent lower leg fracture presents with pain out of proportion to current state of injury.
Increase in pain with passive stretching
area is swollen firm and tender

Pallor, pulselessness, poikilothermia, parasthesias, paralysis, pain SEVERE pain, pain with PROM, swollen tender firm area
Sx of what?

an acute swollen hot and tender joint with limited ROM is a __ until proven otherwise

Synovial fluid that has WBC >50,000 with a decreased glucose and increased protein is indicative of

What is the treatment for a septic joint?

Large swollen knee which is nontender not erythematous and not hot with full ROM

When a pt presents with a calcaneal fracture what is the mos common secondary fracture?

What other fracture would you be worried about in a pt who presented with this?

A proximal 5th metatarsal fracture is also known as a ...

What is a pseudojones fracture?

how would you treat a distal phalyngeal fracture of the first digit on the right foot?

Ms. Seamus complains of left foot pain x2 weeks getting progressively worse. she denies any trauma to the foot. pt states pain is worst during her first steps in the morning and as the day goes on the pain gets better pt recently started running what do you DX

T or F carpal tunnel syndrome is worse at night
True False

Phalen's test tests what ?

What is the treatment for a mild case of carpal tunnel with first presentation.

What is Carpal tunnel?

"numbness and tingling to the radial 3 digits of the hand with vauge aching in the thenar area"

With any fall/trauma what else are you concerned about besides the primary fracture?

If you suspect surgery will be needed it is important to keep the patient ___

With any hand or arm injury where you expect swelling you should remove what?

Pt presents with distal humerus fracture on PE you note decreased 2 point descrimination over the volar aspect of the 5th digit what are you concerned about?
a. median nerve
b. ulnar nerve
c. axillary nerve
d. radial nerve

Pt presents with fracture of proximal humerus, you note decreased sensation over the lateral aspect of the upper arm you suspect
a. axillary nerve injury
b. long thoracic nerve injury
c. median nerve injury
d. radial nerve injury

After suffering a mid shaft humeral fracture a pt can not extend his wrist or fingers against resistance what nerve is injured?

"wrist drop" is an injury to what nerve

Pt presents after falling off his bike with a cc of shoulder pain. Pt is holding the painful arm with his uninjured arm the first intervention you take is to...
A. stat xray
B. 2 percocet
C. assess for other injuries
D. determine NVI status

Most common part of the clavical fractured is

Pt who has clavical fracture with no skin tenting who is NVI what is the treatment along with pain meds?

What muscle is responsible for the displacement of the proximal segment of a clavicular fracture superiorly?

"Skin tenting"

MOI of clavicular fracture is

swelling and tenderness localized to clavicle is supicious for a ___ fracture

You suspect an AC separation. On physical exam you note a step off deformity without prominent distal clavicle what grade of separation do you expect?
a. Grade I
b. Grade II
c. Grade III

What major joint is most commonly dislocated in adults?

If you have a shoulder dislocation do you let it calm a few hours to days or reduce it immediatly?

What artery is most likely to be inured with an anterior shoulder dislocation?

What nerve is most likely to be injured in an anterior shoulder dislocation?

What is the most common type of shoulder dislocation?

What is the most common artery injured in a humeral fracture?

Pt cannot extend wrist what nerve is injured?

A carpenter presents with localized pain over the lateral aspect of his right elbow. He states that the pain gets worse when he has to manually drive a screw into place. He denies trauma. What manuver will cause him the most pain during physical exam?
A. pain with resisted wrist extension and radial deviation
B. pain with elbow flexion and wrist flexion
C. pain with resisted wrist flexion and ulnar deviation
D. pain with resisted pronation

Impaired sensation over the lateral aspect of the deltoid, lack of contraction of the deltoid. what nerve is injured

This nerve controls sensation to the dorsum of the thumb and index web space and controls extension of the wrist and fingers

This nerve controls ability to abduct the index finger, and sensation to the tip of digit 5

This nerve controls making the O.K. sign with the thumb and forefinger as well as abduction of the thumb and radial side of palm

What are the 3 types of AC separations?

AC joint is usually less than __ mm

CC ligament is usually ___-___ mm

How do you treat AC separation types I and II?

How do you treat a type III AC separation?

How would you treat a AC separations type IV-VI?

What is a Hill Sachs Lesion

Medial epicondylitis is better known as

Lateral epicondylitis is better known as

clenched fist with wrist extension and radial deviation is most painful for pts with
A. Carpal Tunnel
B. Golfer's elbow (Medial epicondylitis)
C. Tennis elbow (Lateral epicondylitis)

clenching the first with the wrist in flexion and ulnar deviation is mos painful for
A. carpal tunnel
B. Tennis elbow
C. Golfer's elbow

Golfer's elbow is (Medial or lateral) epicondylitis while Tennis elbow is (medial or lateral) epicondylitis.

Medial epicondylitis has the added risk of affecting what nerve?

Fracture of the radius with dislocation of the distal ulnar-radial joint

Fracture of the proximal third of the ulna with a dislocation of the radial head (proximal)

57 y.o. M presents with fatigue x3 mo. You note that he is paler than he has been on previous visits. His labwork shows Hb 11, MCV 74 and low Hct. What is the most likely cause of his anemia? What is your next step?

A 30 y.o. F pt comes to you with sx consistend with anemia. Her labs are as follows
Hb: 10.2, MCV 116, MCH 33, RDW nl What type of anemia does she have? (macro or micro or normo)

Name 2 vitamin deficencies that cause macrocytic anemia

What are some causes of Cobalamin deficency?

Pt presents with fatigue, pallor, anorexia, wt loss, glossitis, angular chelosis, melanin skin hyperpigmentation and peripheral neuropathy...

What are some causes for Folate deficency?

What are some things that precipitate sickle cell pain crisis?

A pt who you see often for sickle cell anemia checkups presents to you with diffuse muscle pain in their leg and hip you suspect

What is the most common cause of acute aplastic anemia in sickle cell?

How would you manage a sickle cell pt in pain crisis?

Sickle cell crisis with pulmonary symptoms and new pulmonary infiltrate

A pt whom you follow for sickle cell presents with shortness of breath, fever, nonproductive cough, tachypnea and some chest pain 3/10
What do you suspect they have and how would you manage them?

Tx for priapism

One of your Sickle cell pts comes in 2wks after a short summer cold with increaseing fatigue and pallor. You note that retuclocyte count is low aprox. 0.2% What do you think they have

A 5 y.o. with sickle cell presents to the ED with tachycardia, pallor, hypotension, lethargy and anorexia. What do you suspect and what would you find on PE?

How do you treat splenic sequestration

A sickle cell pt whom you are treating in the ED for an acute pain crisis suddenly developes a mild fascial droop what do you have to worry about? what do you want to treat with?

Asplenic status (mechanical or functional) makes a pt more suseptible to what types of organisms?

Name some conditions that would cause you to admit a sickle cell patient (6)

Name the 4 microcytic hypochromic anemias

What lab value measures the concentration ofthe major carrying pigment of the blood?

What lab value measures the percent of whole blood occupied by intact red blood cells?

__ measures the volume of the average circulating red blood cell

___ measures the hemoglobin content of the average RBC

__ measures the variation of RBC volumes

What lab value is an indirect measure of transferritin?

protein that stores iron in cells

iron transport protein

What lab value measures how well the body is binding and transporting iron?

variation in shape of red blood cells on peripheral smear

cells with irregularly spaced bulbous projections

Microcytic anemia with low serum ferritin, low serum iron, and high TIBC, normal Transferrin saturation

What are some causes of inadequate iron supply?

What are some things that would cause increased iron requirement?

Should iron supplements be taken with food?

What are some SEs of Iron supplements?

36 y.o. male complaining of jaundice and anemia what labs do you think may be abnormal?
A. Hb and Cr
B. Hb and bilirubin
C. Hb and platelets
D. Hb and ast

What is the treatment for Beta thalassemia major?

What is the treatment for betha thalassemia intermedia?

Name a chelation drug