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Block 4 - Primary Conditions
Problem/Treatment/Notes
58
Biology
Graduate
03/22/2009

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Term
Maxillary Fracture
Definition
fracture of maxillary sinus; surgery
Term
Blowout Fracture
Definition
communited fracture of the orbital floor and entrapment of the inferior rectus extraocular muscle; surgery
Term
Acute Epiglottitis
Definition
infection of epiglottis that could block airway; antibiotics and monitor airway
Term
Peritonsillar Abscess
Definition
unilateral soft palate and tonsil swelling; lysed and antibiotics
Term
Retropharyngeal Abscess
Definition
thick and infected retropharyngeal soft tissues; lysed and AB
Term
Cleft Lip & Palate
Definition
failure of neural crest cell migration of facial and palatal prominences during 6th7th weeks due to genes and environmental factors; surgery
Term
Thyroglossal Duct Cyst
Definition
cyst that forms along thryglossal duct with possible abberant thyroid tissue; surgery
Term
Glaucoma
Definition
age-related diseased due to poor aqueous drainage which leads to increased IOP, vision loss, blindness; lower IOP by decreasing fluid production by ciliary body with timolol, increase outflow thru trabecular meshwork and schlemm’s canal via latanoprost and pilocarpine
Term
Fractures due to Osteoporosis
Definition
fractures induced by reduced bone density; calcium, vit D, parathyroid hormone
Term
Periorbital cellulitis
Definition
infection of connective tissues around eye without conjuctiva inclusion caused by staph, strep, h. flu; AB
Term
Horner’s Syndrome
Definition
collection of symptoms shows sympathetic innervation to head is impaired showing ptosis, pupillary constriction, impaired sweating, flushing; treat cause
Term
Duchenne’s MD
Definition
x-linked, recessive, no dystrophin causing change in costomere and sarcolemma, increased CK due to muscle breakdown and replacement with CT and fat, psuedohypertrophy, females have no clinical manifestations but high CK; symptom management no treatment
Term
Avascular Necrosis
Definition
interrupted blood supply due to trauma, diabetes, alcohol, steroids, SLE, sickle cell imaged by most sensitively by MRI, CR, bone scan, in hip pain is felt in groin; NSAIDs, early stages core decompression w/ or w/o bone graft, then joint replacement in late stages
Term
Osteosarcoma
Definition
most common primary long bone metaphyseal tumor with peaks 10-20 and 60-70, radiologically infiltrative and mineralized breaking thru tissue, histo shows plump neoblastic osteoblasts and lacelike osteoid, most high grade and spread hematogenously; chemo and surgery
Term
Ewings Sarcoma
Definition
in children, diaphyseal, neuroectodermal tumor, 11:22 translocation, histo shows malignant small round blue cells and CD99 immuno stain; surgery, rads, chemo
Term
Anklylosing Spondylitis
Definition
calcified spinal ligaments, HLA-B27 +, peripheral arthritis; control symptoms and arthritis with NSAIDs, PT to maintain ROM
Term
Atlanto-Axial Instability
Definition
increased mobility at C1/C2 articulation due to trauma, irregular transverse and alar ligaments, downs syndrome, or RA, causing neurological and sensory problems; NSAIDS/Ops for pain and surgical fixation
Term
Cervical Spinal Stenosis
Definition
gradual onset of narrowing of spinal canal due to arthritis, disk herniation, ligamentum flavum thickening which may cause neural problems and/or radiculopathy detected by MRI; NSAIDs/Ops for pain, if mild conservative PT, severe surgery
Term
Cervical Radiculopathy
Definition
irritation or injury to nerve root, most commonly C6/7, caused by OA, tumor, infection, etc described as burning/numbness in a derma/myotomal distribution revealed via Spurlings and MRI/CR and EMG to determine level of nerve involvement; NSAIDs/Neuropath meds for pain, epidural of corticosteroids for pain, conservative treatment is PT, or severe needs surgery for offending problem
Term
Cervical Disc Herniation
Definition
Annulus fibrosus weakens allowing nucleus pulposus to extrude in postero-lateral direction most common at C5,6 and C6,7 due to trauma or degenerative disk disease revealed by MRI; NSAIDs, muscle relaxants, opiates, corticosteroids(epidural), and heat/PT for conservative treatment, severe may require disc removal
Term
Lumbar Radiculopathy
Definition
most commonly affects L5/S1 with radiating pain loss of lumbar lordosis revealed via CR/MRI/EMG and + straight leg raise; NSAIDs/Neuropath meds for pain, epidural of corticosteroids for pain, conservative treatment is PT, or severe needs surgery for offending problem
Term
Lumbar Disc Herniation
Definition
most common is L4,5 and L5/S1 due to trauma or repetitive motions giving patient muscle spasms revealed thru MRI; NSAIDs, muscle relaxants, opiates, corticosteroids(epidural), and heat/PT for conservative treatment, severe may require disc removal
Term
Lumbar Spinal Stenosis
Definition
gradual onset of narrowing of spinal canal due to arthritis, disk herniation, ligamentum flavum hypertrophy, or spondylisthesis which may cause neural problems and/or radiculopathy detected by MRI/CR/EMG; NSAIDs/Ops for pain, if mild conservative PT, severe surgery
Term
Lumbar Degenerative Disc Disease (OA), Spondylosis
Definition
disease of aging associated with bony spurs due to trauma or repetitive stress gives patients midline pain without radiation, - straight leg test, MRI shows dessication(blackness); NSAIDs and PT only option because it is normally progressive
Term
Scoliosis
Definition
lateral curvature of the spine onset during adolescence usually idiopathic and not progressive but may be due to NM disease, tumor, or infection, measured by CR using Cobb’s angle; conservative treatment is observation and brace for 30 deg, surgery if severe at 50 deg
Term
Acromioclavicular Joint Sprain/Separation
Definition
direct trauma causes AC ligament terror and possible soft tissue injury, weighted arm can reveal damage via CR or MRI for higher grade tissue destruction; NSAIDs/OP for pain, conservative is brace and ice, severe is surgery grades 4 and 5.
Term
Rotator Cuff Tendonitis
Definition
trauma or repetitive use may cause wear on supraspinatus tendon which can eventually lead to subacromial bursitis and tear, X-ray is normal or calcific tendonitis, - drop arm, +impingement test; NSAIDs, ROM exercises, ice and cortico steroids for conservative, surgery for severe
Term
Rotator Cuff Tear
Definition
tear in the watershed distal aspect of supraspinatus tendon with poor abduction, + drop arm test, MRI best for diagnosis; NSAIDs, ROM to prevent adhesive capsulitis, surgical repair necessary to prevent permanent weakness.
Term
Brachial Plexopathy
Definition
upper trunk trauma causes Stinger(adult) or Erb’s (child) palsy which will show weakness in shoulder, Erb’s shows waiters tip and sensory loss in C5,6 and are self-resolving, lower trunk called Klumpke’s Palsy shows sharp pain in hand with sensory loss in C8/T1 dermatome with poor outcome; NSAIDs/Ops for pain, observation because of spontaneous recovery, surgery only for penetrating trauma.
Term
Shoulder Instability/Dislocation
Definition
most locations are anterior and due to tear in inferior glenohumeral ligament, positive sulcus sign for instability, positive rim sign shows posterior dislocation; NSAIDs for pain, joint reduction, PT to prevent future movements
Term
Clavicular Fracture
Definition
very common, non-serious due to trauma; treat with sling
Term
Calcific Bursitis
Definition
common overuse chronic inflammatory process in subdeltoid or subacromion bursa; NSAIDs, steroid injections, PT
Term
RA of Shoulder
Definition
inflammatory arthritis causes hyperemia, bone erosions, and joint destruction; symptom management
Term
Supracondylar Fracture
Definition
most common pediatric fracture with serious complications of vascular (brachial artery) and nerve structures and malunion; closed reduction and percutaneous pinning
Term
Fractured Radial Head
Definition
most common fracture of the adult elbow, posterior fat pads displaced almost always mean fracture is present; sling and PT for 3 weeks
Term
Medial Epicondylitis
Definition
golfer’s/little league elbow caused by overused wrist flexors may show calcific tendonitis on CR, should eliminate ulnar neuropathy first with NCS; NSAID, ice, cocked-wrist brace, PT, cotico for conservative treatment and surgery if not resolved after 6-12 mos.
Term
Lateral Epicondylitis
Definition
inflammation of extensor carpi radialis brevis or extensors known as tennis elbow, check for radial nerve involvement; NSAIDs, ice, brace, PT, corticos
Term
Cubital Tunnel Syndrome
Definition
repetitive trauma to ulnar nerve in groove or cubital tunnel by flexor carpi ulnaris, shows lost sensation in 4th/5th digit, + Tinels sign, use EMG; NSAIDs, steroids, and pads for conservative, surgery for severe and will move nerve to front of elbow
Term
Carpal Tunnel Syndrome
Definition
most common compression neuropathy of the median nerve, electrodiagnostic exam is standard, decreased sensation or burning in thumb and middle fingers; NSAIDs, steroids, brace, corticos injection and most severe cases require nerve release
Term
Scaphoid Fracture
Definition
most common carpal bone/wrist fracture, won’t show up on CR for 7-10 days, MRI 1-2 days; NSAIDs, PRICE, ROM PT, and surgery if conservative doesn’t help.
Term
OA of Hand
Definition
gradual onset due to overuse/age at CMC/PIP/DIP joints with possible Bouchards PIP and Herbeden’s DIP nodes, CR shows small joint space, osteophytes; NSAIDs, contrast and paraffin wax bath, splinting, coticos, it is progressive so manage pain
Term
RA of Hand
Definition
gradual, bilateral inflammation and warmth of MCP and PIP joints with ulnar deviation and swan-neck or boutaniere deformity, test ESR, ANA, CBC, and RF; NSAID, ice, contrast bath, splint, corticos, surgery may prevent tendon rupture in worst cases as the disease is progressive
Term
Greenstick fracture
Definition
incomplete fracture only in children; reduction and cast 3 wks
Term
Phalanx Growth Plate Injury (Salter Harris II)
Definition
fracture at growth plate of phalanges; reduction and cast
Term
Femur Fractures
Definition
equally common at neck or intertrochanteric line; NSAIDs/Ops for pain, active patients have reduction and fixation, sedentary/elderly have hip replacement
Term
Legg Calve Perthes Disease
Definition
AVN of femur head of young boys with groin pain imaged in CR; NSAID for pain, brace, rest for conservative treatment, severe will require osteotomy/joint replacement
Term
OA of the hip
Definition
due to age, repetitive trauma in old while in young due to AVN, infection, inheritance which is images by CR with osteophytes, joint space narrowing, and degenerative cysts; NSAID/OP for pain, PT and corticos for conservative, and if no response hip replacement
Term
Developmental Hip Dysplasia
Definition
congenital malformation of acetabulum, more often in girls, posterior-superior easy displacement of femoral head, Orlotani and Barlow tests to try and displace hip; Pavlik harness if caught early, surgical traction if found later
Term
Toxic Synovitis
Definition
diagnosis of exclusion, self-resolving, adolescent viral infection of hip joint, with WBC and ESR slightly elevated, MRI shows if fluid needs aspiration to exclude bacterial septic arthritis; resolves in 3-5 days
Term
Patellar Fractures
Definition
acute trauma to knee or extreme quad contraction (jumping), use CR to assess; Aceta/OP for pain, ice, cast/immobilzer for 4-6 weeks, if + straight leg and fracture is displaced then surgery fixation
Term
OA Knee
Definition
often associated with meniscal or ligament tear due to age, repetitive trauma in old while in young due to infection, inheritance which is images by CR with osteophytes, joint space narrowing, and degenerative cysts, crepitice may be felt; NSAID/OP for pain, PT and corticos for conservative, and if no response joint replacement
Term
Patellofemoral Syndrome
Definition
patella grinds on femur due to overuse or poor tracking, crepitice and poor tracking can be felt with weak quads common; antiinflammatories, ice, brace, rest, strengthen quads, surgery if conservative fails
Term
Ligament Tear - ACL,PCL, MCL, LCL
Definition
ACL most common tear and pop due to jumping, twisting, tackle, while PCL due to dashboard injuries, described as knee giving out and swelling, Lachman/Ant drawer test ACL, Post Drawer test PCL, Valgus/Varus for MCL/LCL, MCL,ACL, medial meniscus unhappy triad; NSAIDs, rest, ice, brace, ROM PT for most cases, surgical reconstruction for ACL in youth/athletes to prevent future knee instability
Term
Meniscal Tear
Definition
twisting motion or degenerative changes causes pain and swelling, use McMurray test and MRI; NSAIDs, rest, ice, quad PT, if there is locking or ACL tear consider surgery to prevent joint degeneration
Term
Ankle sprain
Definition
most common sprain is anterior talofibular ligament from twisting rolling inward, + anterior drawer is ATFL and + talar tilt suggests both calcanofibular and ATFL, CR determines fracture, MRI determines osteochondral lesion; NSAIDS, RICE, ROM PT, for severe strains surgery
Term
Plantar Fasciitis
Definition
overuse of foot and change in walking running habit causes fascia inflammation, imaging unnecessary but may reveal cancaneal bone spurs or thickened fascia; NSAID, PRICE, orthotics, PT, injected steroids, surgery if severe
Term
Compartment syndrome
Definition
acute or chronic life/limb-threatening issue when tissue edema(fluid or blood) in fascia-enclosed space prevents perfusion causing necrosis, anticoags and vigorous exertion associated, 5P’s not diagnostic, ultrasound rule out DVT, get CBC, CK, PT, and aPTT; IV hydration with O2, don’t elevate limb, give fasciotomy within 6 hours to save limbs
Term
Medial/Lateral Malleolar Fracture
Definition
fracture at each point only requires CR, if fracture below joint then no surgery needed; pain meds, splint->cast 6 wks->PT, however if both are fractured then surgery is necessary to maintain joint stability
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