gemc: musculoskeletal jeopardy 2: resident training
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This is a lecture by Dr. Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.TRANSCRIPT
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Project: Ghana Emergency Medicine Collaborative Document Title: Musculoskeletal Jeopardy (2 of 2), 2013 Author(s): Jeff Holmes MD, Maine Medical Center License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/
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Instructions for using this template. • Remember this is Jeopardy, so where I have
written “Answer” this is the prompt the students will see, and where I have “Question” should be the student’s response.
• To enter your questions and answers, click once on the text on the slide, then highlight and just type over what’s there to replace it. If you hit Delete or Backspace, it sometimes makes the text box disappear.
• When clicking on the slide to move to the next appropriate slide, be sure you see the hand, not the arrow. (If you put your cursor over a text box, it will be an arrow and WILL NOT take you to the right location.) 3
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Choose a category. You will be given the answer.
You must give the correct question. Click to begin.
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Click here for Final Jeopardy
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Physical Exam
Roentegrams Lumbago Cool Hand Luke
10 Point
20 Points
30 Points
40 Points
50 Points
10 Point 10 Point 10 Point 10 Point 10 Point
20 Points 20 Points 20 Points 20 Points 20 Points
30 Points
40 Points
50 Points
30 Points 30 Points 30 Points 30 Points
40 Points 40 Points 40 Points 40 Points
50 Points 50 Points 50 Points 50 Points
Jazzy Joints
PotPouri
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Fractures at these two areas of long bones require forces
not produced by usual accidental trauma of
infancy and are suspicious for child abuse.
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What are metaphyseal and epiphyseal
fractures?
8 Wikipedia
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This is overuse injury is strongly suggested
by a positive Finkelstein’s test.
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What is de Quervan’s tenosynivitis?
10
Wikipedia
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This describe the anatomic and management difference between a Jones and pseudo-
jones fracture.
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What is the location of the fracture and longer splint +/- surgery for Jones fracture?
12 Lucien Monfils, Wikimedia Commons
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This is an intrarticular fracture of the ulnar aspect of the base
of the thumb with disruption of the carpometacarpal joint.
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What is a Bennett’s fracture?
14 Stroytika, Wikimedia Commons
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This is the most commonly misdiagnosed foot injury.
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What is a Lis-Franc Fracture-Dislocation?
16 Source Undetermined
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This is an accurate description of the straight leg test.
17
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What is having the patient supine while the straight symptomatic leg is passively raised
keeping the knee straight . . . the presence of back pain, which radiates past the knee when the leg is
elevated 30 to 70 degrees?
18 Davidjr74, Wikimedia Commons
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This test should be performed in the knee examination to
evaluate for quadriceps tendon rupture.
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What is the straight leg raise test when supine?
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This presence of this abnormality is assessed in metacarpal fractures by looking at the alignment of the nailbeds with the
fingers flexed. 21
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What is rotational deformity/malrotation?
22 Source undetermined
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This is the most accurate method of evaluating sensation to the hand.
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What is 2 point discrimination?
24
Source undetermined
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This test evaluates for partial dislocation or
recent patellar dislocation that has
spontaneously reduced.
25
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What is the apprehension sign?
26 WebMD, reference.medscape.com
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This nerve is carefully evaluated for injury in a hip dislocation.
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What is the sciatic nerve?
28 Wikipedia
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This demonstrates the two
recommended ways to reduce
nursemaid’s elbow. 29
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What are?:
30
Therese Clutario, Wikimedia Commons
hyperpronation supination
flexion
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These are two mechanisms that cause posterior
dislocation of the shoulder.
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What are tonic clonic seizures, electrical
shock, direct anterior shoulder trauma?
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This nerve is the most common nerve at risk of
injury in anterior shoulder dislocation.
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What is the axillary nerve (sensation to lateral aspect of
shoulder).
34
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These are 3 reasons why a posterior sternoclavicular
dislocation is more significant than an anterior one.
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What are?:
1. Rupture/compression of the trachea
2. Esophageal occlusion or rupture
3. Lung contusion
4. Laceration/occlusion of superior vena cava/subclavian vein or artery
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This is the name for the injury depicted in the xray.
37
Source undetermined
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What is Galleazzi fracture?
Galeazzi fracture consists of a fracture of the radius with angulation and
associated dislocation of the distal ulna
38
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These are the four components of the ottawa ankle rules
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What are?: 1. Tenderness of distal lateral malleolus (posterior edge or tip) 2. tenderness of the distal medial malleolus (posterior edge or tip) 3. pain in the malleolar zone (distal 6 cm) 4. inability to bear weight both immediately and in the ED
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These are the four components of the
Ottawa Knee Rules
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What are:?
1. Patient older than 55 years
2. Tenderness at head of fibula
3. Isolated tenderness of patella
4. Inability to flex knee to 90 degrees
5. Inability to transfer weight four steps both immediately an in the ED
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In addition to the fractures seen, this xray depicts an
injury to what?
43
Source undetermined
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What is diasthesis of the tibiofibular
ligament?
44
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This injury is depicted in this xray.
Daily Double!!!
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What is patellar tendon rupture?
(proximal patellar displacement)
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This is the average age of disk herniation.
47
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Rosen’s
What is 30-50 years of age?
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These serious concomitant injuries
can be found with transverse process
fractures.
49
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What is intrabdominal injury
(21%) and pelvic fracture (29%)?
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In cauda equina syndrome, this is the most sensitive finding after back
pain. 51
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What is urinary retention? (90%)
Rosen’s 52
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These are 4 indications for
xrays in the evaluation of
lower back pain
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What are:?
1. Extremes of age (<18 yo or > 50 yo)
2. Hx of malignancy/weight loss
3. Hx of fever, immunocompromised, IVDU
4. Recent trauma (other than lifting)
5. Neuro deficits or bowel-bladder changes
6. Prolonged symptoms (> 4-6 weeks)
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Pseudoclaudication is a concerning symptom for what cause of subacute
back pain?
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What is spinal stenosis? (back pain better at rest,
worse when walking, especially uphill)
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These 3 historical factors should be in the first sentence of a presentation to a consulting
hand surgeon.
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What are:
1. Age
2. Occupation
3. Handedness
“45 yo male, RHD jazz guitarist presents with a crush injury/distal amputation of L small digit.”
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These are the areas of autonomous sensation when evaluating nerve function of the hand.
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What are?:
1. Volar Tip of Index – Median
2. First dorsal webspace – Radius
3. Volar tip of 5th finger - Ulnar
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The injury depicted in this xray.
61 Source undetermined
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What is scapholunate dissociation?
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Irreducible DIP dislocations are
usually a result of one of these
injuries.
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What is?:
1. Entrapment of avuslion fracture of FDP
2. Buttonhole tear in the volar plate, requiring operative reduction
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High pressure injection injuries to this part of the hand results in the highest
rate of amputation.
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What is the volar aspects of finger and underlying
flexor tendon sheath? (50%, none of hand entry
wounds)
66 Hayes CW, Pan HC. High – pressure injection
injuries to the hand. South Med J. Dec 1982; 75 (12): 1491 – 1498,
1516.
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Make your wager
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This famous sports injury ended Bo Jackson’s career.
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What is a hip pointer (avascular
necrosis of his hip)?
69