Carpal and Knee Bone Injuries Quiz

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Questions and Answers

What is the most common fracture of the carpal bones?

Smith's Fracture

Ulnar Styloid Fracture

Scaphoid Fracture (correct)

Colles Fracture

Which mechanism of injury is associated with a Colles fracture?

Direct blow to the wrist

FOOSH with wrist flexion

FOOSH with wrist extension (correct)

Twisting motion of the wrist

What symptom is most indicative of a scaphoid fracture?

Swelling over the ulnar styloid

Pain along the ventral wrist

Tenderness in the anatomical snuffbox (correct)

Dorsal deformity of the wrist

What is the typical physical exam finding associated with a Smith's fracture?

Dinner fork deformity Signup and view all the answers

If initial X-rays are negative for a scaphoid fracture but clinical suspicion remains high, when should repeat imaging be performed?

7-14 days Signup and view all the answers

What is the most common mechanism of injury for a patellar fracture?

Fall on a flexed knee Signup and view all the answers

Which knee injury is indicated by O’Donoghue’s triad?

ACL, MCL, and medial meniscus injury Signup and view all the answers

What diagnostic test is considered the most sensitive for detecting meniscus injuries?

MRI Signup and view all the answers

Which manifestation is associated with a tibial plateau fracture?

Foot drop or decreased sensation in the foot Signup and view all the answers

Which management strategy is appropriate for a nondisplaced patellar fracture?

Immobilization of the knee in extension Signup and view all the answers

What injury can occur as a complication of a femoral condyle fracture?

Popliteal artery injury Signup and view all the answers

Which of the following is a common symptom of knee meniscus injuries?

Popping, clicking, or catching sensations Signup and view all the answers

What is the primary treatment approach for managing knee joint injuries in the initial phase?

RICE (Rest, Ice, Compression, Elevation) Signup and view all the answers

What is the most common type of allergic rhinitis?

IgE mediated rhinitis Signup and view all the answers

Which medication is considered the most effective for managing allergic rhinitis?

Intranasal corticosteroid Signup and view all the answers

Which of the following is NOT a nasal symptom associated with allergic rhinitis?

Persistent cough Signup and view all the answers

Which physical exam finding is characteristic of allergic rhinitis?

Edematous, pale, boggy turbinates Signup and view all the answers

What does Samter's Triad consist of?

Asthma, allergic rhinitis, and aspirin sensitivity Signup and view all the answers

Which of the following is a common cause of acute viral rhinosinusitis?

Rhinovirus Signup and view all the answers

What is the recommended management for acute viral rhinosinusitis lasting less than 4 weeks?

Symptomatic support with analgesics Signup and view all the answers

What physical finding may suggest the presence of allergic rhinitis based on nasal examination?

Transverse nasal crease Signup and view all the answers

What is the primary management for a lunate fracture?

Closed reduction with sugar tong splint or cast Signup and view all the answers

What complication is associated with lunate fractures?

Extensor pollicis longus tendon rupture Signup and view all the answers

Which of the following is a benefit of using stitches for wound closure?

Optimal healing and recovery Signup and view all the answers

Which treatment is the mainstay for managing an abscess?

Incision and drainage Signup and view all the answers

What is a common cause of localized abscesses?

Staphylococcus aureus (MRSA) Signup and view all the answers

What kind of fracture is a Barton’s fracture?

An intra-articular distal radius fracture with carpal displacement Signup and view all the answers

Which wound care instruction should be followed immediately post-repair?

Use antibiotic ointment and non-adhesive dressing Signup and view all the answers

What is a possible complication after using dermal adhesives for wound closure?

Keloid or hypertrophic scarring Signup and view all the answers

Which factor contributes to delayed healing in wounds?

Consistent pressure on the wound Signup and view all the answers

What should be considered when managing animal bites?

Allow healing by secondary intention in non-cosmetic areas Signup and view all the answers

What is the first-line antibiotic treatment for bacterial infections persisting for more than 10-14 days with worsening symptoms?

Augmentin Signup and view all the answers

Which physical exam finding is most commonly associated with sinus infections?

Maxillary sinus tenderness Signup and view all the answers

Which bacterial organism is considered the most common cause of pharyngitis?

Group A Streptococcus (S.pyogenes) Signup and view all the answers

What is the hallmark symptom of acute laryngitis?

Hoarseness Signup and view all the answers

Which treatment is generally NOT recommended for viral pharyngitis?

Corticosteroids Signup and view all the answers

In cases of chronic rhinosinusitis, what is a common physical manifestation?

Facial pain and pressure Signup and view all the answers

What diagnostic tool is typically needed for patients showing signs of infection beyond the paranasal sinuses?

CT Scan Signup and view all the answers

Which bacteria are most commonly implicated in chronic rhinosinusitis?

S.aureus and Aspergillus Signup and view all the answers

What is the primary management approach for laryngitis?

Vocal rest and hydration Signup and view all the answers

Which symptom is indicative of a viral cause of pharyngitis?

Hoarseness and cough Signup and view all the answers

What is the primary management for a child diagnosed with Group A beta hemolytic streptococcal pharyngitis?

Penicillin Signup and view all the answers

Which symptom is NOT an indication for testing for streptococcal pharyngitis in children?

Recent viral illness Signup and view all the answers

For the diagnosis of streptococcal pharyngitis, which test is considered definitive?

Throat Culture Signup and view all the answers

What complication can arise from untreated streptococcal pharyngitis?

Rheumatic fever Signup and view all the answers

In managing COVID-19 symptoms, when should corticosteroids like dexamethasone be administered?

In hospitalized patients Signup and view all the answers

Which of the following is an inappropriate treatment option for pharyngitis caused by streptococcal infection?

Antivirals Signup and view all the answers

What symptom is most commonly associated with mild to moderate COVID-19 illness?

Fever Signup and view all the answers

What is indicated for management in patients with acute exacerbations of asthma or COPD during COVID-19?

Glucocorticoids Signup and view all the answers

Which patient demographic is at the highest risk of developing rheumatic fever from untreated streptococcal pharyngitis?

Children aged 5-15 years Signup and view all the answers

What diagnostic criterion should be met to test children for streptococcal pharyngitis?

Evidence of acute tonsillopharyngitis Signup and view all the answers

Study Notes

Allergic Rhinitis

IgE mediated mast cell histamine release due to allergens (pollen, dust, mold, dander)
Seen in atopic patients
Rhinovirus is the most common viral cause
Vasomotor rhinitis is nonallergic/noninfectious
Symptoms include nasal congestion, sneezing, clear watery rhinorrhea, nasal itching, cough
Allergic symptoms include edematous pale boggy turbinates, nasal polyps with cobblestone mucosa, allergic shiner (blue/gray under eye), transverse nasal crease
Management includes intranasal corticosteroids (most effective for allergic rhinitis, especially with nasal polyps), second-generation oral antihistamines (Loratidine, Cetirizine, Fexofenadine), antihistamine nasal sprays (Azelastine, Olopatadine), allergen & environmental avoidance

Acute Viral Rhinosinusitis

Symptomatic inflammation of nasal cavity and paranasal sinuses for less than 4 weeks.
Majority of cases are viral.
Viral symptoms include nasal congestion & obstruction, clear rhinorrhea, hyposmia, cough, headache, malaise,
Acute Rhinosinusitis (compared to viral) includes facial pain, pressure/fullness worse when bending down, headache, malaise, purulent nasal discharge, fever, and maxillary tooth discomfort
Physical exam shows erythematous, engorged nasal mucosa without intranasal purulence.
Management: supportive care with analgesics (NSAIDs/acetaminophen), nasal lavage, decongestants, and intranasal glucocorticoids. Symptoms typically resolve within 7-10 days.

Acute Bacterial Rhinosinusitis

Secondary bacterial infection of the sinuses with less than 4 weeks
Due to impaired sinus drainage
Complication of viral infection
Common bacteria: S. pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis (HSM)
Management includes analgesics, nasal lavage, and intranasal glucocorticoids and antibiotics (e.g., Augmentin).

Chronic Rhinosinusitis

Inflammation of the nasal cavity and paranasal sinuses lasting 12 or more consecutive weeks
Etiologies include bacterial (e.g., S. aureus), granulomatosis with polyangiitis (Wegner's granulomatosis), and fungal (e.g., Aspergillus)
Manifestations include nasal obstruction & congestion, facial pain and pressure, mucopurulent nasal discharge, decreased olfaction
Diagnosis: sinus CT, allergy testing
Management: supportive treatment (nasal lavage, intranasal glucocorticoids), and ENT follow up. Antibiotics if bacterial infection suspected.

Viral Pharyngitis/Tonsillitis

Viral respiratory viruses are the most common cause of pharyngitis (Adenovirus, Rhinovirus, Enterovirus, Epstein-Barr virus).
Symptoms include sore throat, pain on swallowing, cervical lymphadenopathy, rhinorrhea, coryza, conjunctivitis, and diarrhea in some cases.
Diagnosis mainly clinical, but some cases might require testing (Influenza, Mono)
Management symptomatic treatment such as hydration, warm saline gargles, topical anesthetics, lozenges, and NSAIDs.

Laryngitis

Acute inflammation of the larynx, self-limiting lasting 3-7 days but less than 3 weeks.
Etiologies include viral respiratory viruses (e.g., adenovirus, rhinovirus, influenza), bacterial (S. pneumoniae, H. influ, M. catarrhalis), and (HSM), and Mycoplasma pneumoniae), and also vocal strain (screaming/singing), GERD or polyps, and cancer.
Hallmark symptoms include hoarseness (raspy or breathy voice), aphonia(loss of voice), and other upper respiratory symptoms including cough, rhinorrhea, sore throat, and diarrhea.
Management supportive care, vocal rest, hydration, and airway humidification. ENT follow-up if needed.

Streptococcal Pharyngitis

Group A beta-hemolytic streptococci (S. pyogenes)
Abrupt onset of sore throat, odynophagia, fever, chills, headache, abdominal pain, nausea, and vomiting.
Diagnoses through strep rapid antigen tests or throat cultures
Management: antibiotics, penicillin (v, G, amoxicillin), cephalosporins if allergic) and analgesics as pain management.

COVID-19

Usually presents with mild to moderate respiratory illness
Spread through close-range contact via respiratory droplets.
Duration of transmissibility is typically 7-10 days after illness onset; transmission is unlikely after that.
Symptoms are fever, fatigue, dry cough, dyspnea, sputum.

Acute Cystitis

Ascending infection of the lower urinary tract, most frequently caused by E. coli. Staph saprophyticus is second most common pathogen.
Symptoms include irritative symptoms such as burning, frequency, urgency, hematuria, and suprapubic tenderness
Risk factors include women, pregnancy, infants, and underlying conditions.
Management includes Nitrofurantoin, Trimethoprim or Fosfomycin (1st line): Ciprofloxacin, Levofloxacin, and Cephalosporins (2nd line)

Acute Pyelonephritis

Infection of the upper GU (urinary) tract.
Common cause is E. coli.
Symptoms are fever, chills, back or flank pain, nausea, vomiting, dysuria, urgency, and frequency.
Definitive diagnosis uses urinalysis with specific findings (WBCs, leukocyte esterase, nitrates, hematuria, cloudy urine), and urine cultures.

Urethritis

Inflammation of the urethra.
Common STI.
Nongonococcal causes include Chlamydia trachomatis, Mycoplasma genitalium.
Gonococcal cause is Neisseria gonorrhoeae.
Manifestations are typically asymptomatic; can include dysuria, urethral discharge, penile pururis, or vaginal purulitis.
Diagnosis: urine analysis, dipsticks, and specific testing for C. trachomatis

Syphilis

Caused by Treponema pallidum spirochetes.
Primary syphilis presents as painless genital ulceration (chancre) appearing 2–10 weeks after exposure
Secondary syphilis manifests with maculopapular rash on palms and soles, fever, headache and lymphadenopathy 1 -3 months post exposure
Tertiary syphilis includes CNS involvement like: neurosyphillis, aortic aneurysm & aortic regurg. Gummas of the CNS, heart, and great vessels.
Diagnosis via rapid tests/nontreponemal tests (RPR) followed by confirmation with treponemal tests (FTA-ABS)
Treatment penicillin

Chlamydia

Caused by Chlamydia trachomatis
Typically asymptomatic; can lead to dysuria, frequency, or purulent discharge.
Diagnosis with NAAT (Nucleic Acid Amplification Test)
Treatment: Doxycycline (100mg x 7days) or Azithromycin (single dose IM for patients weighing less than 300lbs, 2g oral single dose >300 lbs).

Trichomonas

Flagellated protozoan
Manifests with pruritus, malodorous, frothy, greenish/gray vaginal discharge
Petechiae are observable on the cervix (strawberry cervix).
Diagnosis via wet mount microscopy
Treatment: Metronidazole 2g orally or 500 mg twice daily x 7 days

(Condylomata Acuminata/Genital Warts)

Sexually transmitted infection (STI) caused by HPV types 6 and 11.
Manifests with painless, soft, fleshy, cauliflower-like lesions.
Can be located on the vulva, vaginal wall, cervix, and perineum
Diagnosis: visual examination, biopsy.
Treatment varies, but topical treatments or surgical removal may be necessary

Herpes

Caused by HSV-2 (or HSV-1)
Symptoms may include pain, paresthesias, burning, followed by painful vesicles/ulcers
Diagnosis: viral culture, PCR, or Tzank test
Treatment: acyclovir, valacyclovir, or famciclovir.

Human Immunodeficiency Virus (HIV)

Characterized by persistent generalized lymphadenopathy, early symptomatic infection, and opportunistic infections like oropharyngeal and vulvovaginal candidiasis, seborrheic dermatitis.
Diagnosis confirmed by detection of HIV antibodies in blood tests (ELISA or Western blot) or HIV RNA
Treatment is with antiretroviral therapy (ART)

Acute Abdomen

General term for various conditions causing pain in the abdomen
Causes vary greatly by the area involved, (Renal, Gallbladder, Stomach)
Thorough clinical history and physical examination to narrow a differential diagnosis

Ankle Sprains

Lateral sprains (most common) involve the lateral ligament complex, commonly the anterior talofibular (ATFL).
Symptoms include pain, tenderness, swelling
Grades 1-3 (increasing severity).
Initial management with RICE (rest, ice, compression, elevation) and supportive care.

Ankle Fractures

Weber classification system for ankle fractures in lateral malleolus region of the fibula (Weber A, B, C).
Indications for surgical intervention: open reduction and internal fixation (ORIF) for displaced or unstable fractures.

Knee Sprains

MCL is the most common injury (lateral trauma.)
Anterior Cruciate Ligament and Posterior Cruciate Ligament injuries common as well.
Diagnosis with physical exam (e.g., lachman, pivot shift, anterior drawer) and radiographs.
Management of grade 1-2 = conservative care, NSAIDS, immobilization. Grade 3 = surgical.

Knee Fractures

Patellar and Femoral condyle fractures.
Diagnosis with X-rays and MRI if needed (grade 3).
Management for Nondisplaced = immobilization. Displaced = surgical intervention ORIF.

Wrist Fractures

Scaphoid is the most common wrist fracture (FOOSH).
Colles (distal radius with dorsal angulation), and Smith's (reverse Colles, ventral angulation) are common as well.
Diagnosis through x-rays, clinical exam, (garden spade deformity.)
Management: nondisplaced fractures usually treated conservatively with splint or cast; displaced fractures need surgical intervention

Lacerations

Risks associated with lacerations are infection, blood loss, nerve damage possible scarring, and impaired functionality
Benefits are preservation of function and minimally risk of infection.
Alternatives for suture closure include adhesive strips, topical skin adhesives, clips.
Complications from poor healing: scar tissue, chronic pain, nerve damage, infection.
Initial treatment: wound cleaning and wound dressing for 24 hrs

Burns

Classification of different types of burn injuries, including superficial, partial thickness, and full thickness.
Initial care, topical antibiotics, dressing, and fluid resuscitation.

Altered Mental Status

Due to systemic infection, metabolic problems, vascular events
Can lead to irreversible brain injury
Diagnosis/treatment: ABCs (airway, breathing, and circulation), vital signs, blood glucose level, neuro exam.
Consider naloxone, thiamine, or glucose for potential opiate overdose or Wernicke encephalopathy

Foreign Body Aspiration

Occurs when an object is inhaled or ingested into respiratory tract or GI tract.
Ingestions often unwitnessed, especially in children (6 months -3 years)
Most often passes spontaneously; however, serious complications (bowel obstruction, perforation)
Management: bronchoscopy indicated in cases where object is suspected to be difficult to pass

Hypertensive Crisis

Hypertensive urgency: SBP >180 and/or DBP >120 without end-organ damage.
Hypertensive emergency: SBP >180 and/or DBP >120 with evidence of end-organ damage
Manifestations: headache, dyspnea, chest pain, focal neurologic deficits, AMS, seizures, N/V.

Myocardial Infarction

NSTEMI = critical coronary artery stenosis, myocardial injury, and ischemia

Orbital Cellulitis

Infection of the orbit (fat and ocular muscles)
Often secondary to a sinus infection
Manifestations are ocular pain, ophthalmoplegia, diplopia, proptosis (bulging eyes), and visual changes.
Diagnosis made with high resolution CT scan.
Treatment with intravenous vancomycin/ceftriaxone/cefotaxime; surgical intervention also possible.

Pulmonary Embolism (PE)

Mechanical obstruction of pulmonary blood flow from a blood clot (thromboembolism)
Sources often a deep vein thrombosis (DVT).
Symptoms include dyspnea, chest pain, and hemoptysis.
Diagnosis: CXR, V/Q scan, CT pulmonary angiography (CTA)
Management includes anticoagulation (LMWH, Direct oral anticoagulants) and potentially thrombolytics.

Third Trimester Bleeding

Placenta Previa: Abnormal placenta placement over or close to the cervical os, typically presenting with painless vaginal bleeding.
Abruptio Placentae: Premature separation of the placenta causing painful uterine bleeding with abdominal/back pain.
Vasa Previa: Fetal vessels cross over the cervical os presenting with painless vaginal bleeding when membranes rupture.
Management depends on the specific diagnosis and severity of the bleeding. Stabilisation of mother and fetus to allow time for delivery.

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Description

Test your knowledge on common fractures, mechanisms of injury, and physical exam findings associated with carpal and knee injuries. This quiz covers topics including Colles and Smith fractures, as well as scaphoid and patellar injuries, enhancing your understanding of orthopedic principles.