gemc: musculoskeletal jeopardy: 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 (1 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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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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Infection It hurts! Physis fun Lend me a Hand?
Under Pressure
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
Joints
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This anerobe is resistant to multiple antibiotics
and felt partially responsible for the high morbidity of human bite
wounds. 7
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What is Eikenella corrodens?
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This is infection of the distal finger that may
be confused with a felon and improperly
excised. 9
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What is herpetic whitlow?
James Heilman, Wikimedia Commons Rangerrina, Flickr Commons
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This is the most common organism present in dog and cat bite infections
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What is
Pasteurella multocida? (50-55%)
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This domestic animal’s bite
causes the highest rates of infections.
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What are cats?
Cats – 15-50%
Dogs – 1.6-30%
Humans – 3.4-9.3% 14
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This type of infection is suggested by a
paronychia on both the radial and ulnar sides
of the nail.
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What is a subungual
infection? (requires removal of the nail)
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This tibial spiral fracture is commonly seen in 1-3 yo may be mistaken for child abuse.
Daily Double!!!
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What is a toddler’s fracture?
Source undetermined 18
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These are 3 of the most common traumatic
amputations considered for replantation by hand
surgeons
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What are?:
1. Children
2. Multiple finger amputations
3. Thumb
4. Hand
5. Arm 20
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These are 4 physical exam
findings that imply a pelvic fracture.
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What are?: 1. AP instability 2. Perineal hematomas 3. Blood at urethral meatus 4. Vaginal blood 5. Rectal blood
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This test is performed to diagnose a traumatic
open joint.
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What is Arthrogram?
(Inject methylene blue or saline and inspect for
egress of the fluid)
Sargon_Starblade, flickr
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These two mechanisms are the most common cause of
massive bleeding pelvic fractures
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What are vertical shear and
anteroposterior compression
fractures? 26
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The findings of these crystals on microscopic analysis of synovial
fluid suggests what disease?
27 Patho, Wikimedia Commons
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What is Gout? (Monosodium urate crystals long and thin or needle-shaped and show
strong negative birefringence).
Patho, Wikimedia Commons Qiao’s Pathology, Flickr Commons
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This is the definitive test for ruling out septic
arthritis.
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What is synovial fluid culture?
Source undetermined
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This the “WBC threshold” for
synovial fluid in septic arthritis.
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What is > 50k?
Acute Disorders of the Joints and Bursae, 5th ed.
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This is the most common cause of septic arthritis in young,
sexually active people; it can present with mono or
polyarthritis.
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What is Gonococcal Arthritis?
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This is the antibiotic and duration of therapy to treat
lyme arthritis.
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What is doxycycline for 30 days?
[Guideline] Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. Nov 1 2006;43(9):1089-134. [Medline]. 36
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This is an accurate description of the “line” that is closely scrutinized
by a radiologist when evaluating an xray for
SCFE. 37
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What is ‘Klein’s line?’
Pediatric Rheumatology, 7th ed.
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This injury seen in children is due to microtrauma to the tubial tubercle tuberosity
apophysis.
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What is Osgood-Schlatter Disease?
Source undetermined
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This is the most common type of
Salter Harris Fracture?
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What is Salter Harris II?
Frank Gaillard, Wikimedia Commons 42
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This type of Salter Harris Fracture has
the greatest incidence of growth
disturbance. 43
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What is Salter Harris IV fracture?
Frank Gaillard, Wikimedia Commons 44
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Early xrays of this type of ‘disease’ may demonstrate only
joint space widening, while later xrays may show a flattened
femoral head known as “coxa plana.”
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What is Legg-Calve-Perthes
Disease?
Source undetermined
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This type of finger injury involves rupture of the
flexor digitorum profundus tendon.
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What is jersey finger?
American Academy of Family Physicians, aafp.org
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This is the structure that is injured in
mallet finger.
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What is an avulsion of the extensor tendon from the
dorsum of the distal phalanx?
American Academy of Family Physicians, aafp.org Howcheng, Wikimedia Commons
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This ligament is torn in
gamekeeper’s thumb (skier’s
thumb). 51
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What is a torn ulnar collateral ligament of
the thumb MCP joint?
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Fractures of these metacarpals require more
anatomic reduction to ensure proper
functioning. 53
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What are metacarpals 2 and 3, the “fixed center of
the hand.”
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This is the diameter of fingertip amputations that can heal without grafting.
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What is 10 mm?
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While an exact number may be debated, a compartmental
pressure greater than this is considered to be diagnostic.
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What is
> 35mmHg?
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The 2 most common physical exam findings in
compartment syndrome
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Ulmer T: The clinical diagnosis of compartment syndrome of the lower leg: Are clinical findings predictive of the disorder? J Orthop Trauma 16: 572, 2002.
What is pain out of proportion to physical
exam with passive stretch and
paresthesias?
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These are 4 mechanisms that
can cause compartment
syndrome. 61
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What are?:
1. Fractures
2. Ischemic-reperfusion injury
3. Vascular puncture in anticoagulated patients
4. Burns
5. Crush injury
6. Prolonged Limb compression
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These are the two most common injuries causing compartment
syndrome in the upper extremity?
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What are supracondylar
fractures in children and both both bone forearm fractures?
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These are the two most common compartments
that develop compartment syndrome.
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What are the?:
1. Volar compartment of the forearm
2. Anterior compartment of the leg
Gray’s Anatomy, Wikimedia Commons Gray’s Anatomy, Wikimedia Commons 66
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Make your wager
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Final Answer
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Final Question
69