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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
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terms of the Creative Commons Attribution Share Alike-3.0 License:
http://creativecommons.org/licenses/by-sa/3.0/
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ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly
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Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis
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speak to your physician if you have questions about your medical condition.
Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.

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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
3
right location.)
Choose a category.
You will be given the answer.
You must give the correct
question. Click to begin.
4
Click here for
Final Jeopardy
5
Infection It hurts!

Joints

Physis fun

Lend me
a Hand?

Under
Pressure

10 Point

10 Point

10 Point

10 Point

10 Point

10 Point

20 Points

20 Points

20 Points

20 Points

20 Points

20 Points

30 Points

30 Points

30 Points

30 Points

30 Points

30 Points

40 Points

40 Points

40 Points

40 Points

40 Points

40 Points

50 Points

50 Points

50 Points

50 Points

50 Points

50 Points
6
This anerobe is resistant
to multiple antibiotics
and felt partially
responsible for the high
morbidity of human bite
wounds.
7
What is Eikenella
corrodens?
8
This is infection of the
distal finger that may
be confused with a
felon and improperly
excised.
9
What is herpetic whitlow?

Rangerrina, Flickr Commons

James Heilman, Wikimedia Commons

10
This is the most
common organism
present in dog and
cat bite infections
11
What is
Pasteurella
multocida? (50-55%)

12
This domestic
animal’s bite
causes the highest
rates of infections.
13
What are cats?
Cats – 15-50%
Dogs – 1.6-30%
Humans – 3.4-9.3%
14
This type of infection is
suggested by a
paronychia on both the
radial and ulnar sides
of the nail.
15
What is a
subungual
infection? (requires
removal of the nail)
16
Daily
This tibial spiral fracture is
Double!!!

commonly seen in 1-3 yo may
be mistaken for child abuse.

17
What is a toddler’s
fracture?

Source undetermined

18
These are 3 of the most
common traumatic
amputations considered for
replantation by hand
surgeons
19
What are?:
1. 

Children

2. 

Multiple finger
amputations

3. 

Thumb

4. 

Hand

5. 

Arm

20
These are 4
physical exam
findings that imply
a pelvic fracture.
21
What are?:
1. AP instability
2. Perineal hematomas
3. Blood at urethral meatus
4. Vaginal blood
5. Rectal blood
22
This test is performed
to diagnose a traumatic
open joint.

23
What is Arthrogram?
(Inject methylene blue or
saline and inspect for
egress of the fluid)

24
Sargon_Starblade, flickr
These two mechanisms are
the most common cause of
massive bleeding pelvic
fractures
25
What are vertical
shear and
anteroposterior
compression
fractures?
26
The findings of these crystals on
microscopic analysis of synovial
fluid suggests what disease?

27
Patho, Wikimedia Commons
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

28
This is the
definitive test for
ruling out septic
arthritis.
29
What is synovial
fluid culture?

30
Source undetermined
This the “WBC
threshold” for
synovial fluid in
septic arthritis.
31
What is > 50k?

32
Acute Disorders of the Joints and Bursae, 5th ed.
This is the most common cause
of septic arthritis in young,
sexually active people; it can
present with mono or
polyarthritis.
33
What is Gonococcal
Arthritis?

34
This is the antibiotic and
duration of therapy to treat
lyme arthritis.

35
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
36
Diseases Society of America. Clin Infect Dis. Nov 1 2006;43(9):1089-134. [Medline].
This is an accurate
description of the “line”
that is closely scrutinized
by a radiologist when
evaluating an xray for
SCFE.
37
What is ‘Klein’s
line?’

38
Pediatric Rheumatology, 7th ed.
This injury seen in children is
due to microtrauma to the
tubial tubercle tuberosity
apophysis.

39
What is Osgood-Schlatter Disease?

40
Source undetermined
This is the most
common type of
Salter Harris
Fracture?
41
What is Salter
Harris II?

Frank Gaillard, Wikimedia Commons

42
This type of Salter
Harris Fracture has
the greatest
incidence of growth
disturbance.
43
What is Salter
Harris IV fracture?

Frank Gaillard, Wikimedia Commons

44
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.”
45
What is LeggCalve-Perthes
Disease?

46
Source undetermined
This type of finger
injury involves
rupture of the
flexor digitorum
profundus tendon.

47
What is jersey
finger?

48
American Academy of Family Physicians, aafp.org
This is the structure
that is injured in
mallet finger.
49
What is an avulsion of the
extensor tendon from the
dorsum of the distal phalanx?

50
American Academy of Family
Physicians, aafp.org

Howcheng, Wikimedia Commons
This ligament is
torn in
gamekeeper’s
thumb (skier’s
thumb).

51
What is a torn ulnar
collateral ligament of
the thumb MCP joint?

52
Wikipedia
Fractures of these
metacarpals require more
anatomic reduction to
ensure proper
functioning.
53
What are
metacarpals 2 and 3,
the “fixed center of
the hand.”
54
This is the diameter of
fingertip amputations that
can heal without grafting.

55
What is 10 mm?

56
While an exact number may be
debated, a compartmental
pressure greater than this is
considered to be diagnostic.

57
What is
> 35mmHg?
58
The 2 most
common physical
exam findings in
compartment
syndrome
59
What is pain out of
proportion to physical
exam with passive
stretch and
paresthesias?
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. 60
These are 4
mechanisms that
can cause
compartment
syndrome.
61
What are?:
1. Fractures
2.  Ischemic-reperfusion injury
3.  Vascular puncture in anticoagulated patients
4.  Burns
5.  Crush injury
6.  Prolonged Limb compression

62
These are the two
most common injuries
causing compartment
syndrome in the
upper extremity?
63
What are
supracondylar
fractures in children
and both both bone
forearm fractures?
64
These are the two most
common compartments
that develop compartment
syndrome.
65
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
Make your wager
67
Final Answer

68
Final Question

69

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GEMC: Musculoskeletal Jeopardy: Resident Training

  • 1. 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/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers. 1  
  • 2. Attribution Key for more information see: http://open.umich.edu/wiki/AttributionPolicy Use + Share + Adapt { Content the copyright holder, author, or law permits you to use, share and adapt. } Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105) Public Domain – Expired: Works that are no longer protected due to an expired copyright term. Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain. Creative Commons – Zero Waiver Creative Commons – Attribution License Creative Commons – Attribution Share Alike License Creative Commons – Attribution Noncommercial License Creative Commons – Attribution Noncommercial Share Alike License GNU – Free Documentation License Make Your Own Assessment { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in your jurisdiction may differ { Content Open.Michigan has used under a Fair Use determination. } Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. 2   To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
  • 3. 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 3 right location.)
  • 4. Choose a category. You will be given the answer. You must give the correct question. Click to begin. 4
  • 5. Click here for Final Jeopardy 5
  • 6. Infection It hurts! Joints Physis fun Lend me a Hand? Under Pressure 10 Point 10 Point 10 Point 10 Point 10 Point 10 Point 20 Points 20 Points 20 Points 20 Points 20 Points 20 Points 30 Points 30 Points 30 Points 30 Points 30 Points 30 Points 40 Points 40 Points 40 Points 40 Points 40 Points 40 Points 50 Points 50 Points 50 Points 50 Points 50 Points 50 Points 6
  • 7. This anerobe is resistant to multiple antibiotics and felt partially responsible for the high morbidity of human bite wounds. 7
  • 9. This is infection of the distal finger that may be confused with a felon and improperly excised. 9
  • 10. What is herpetic whitlow? Rangerrina, Flickr Commons James Heilman, Wikimedia Commons 10
  • 11. This is the most common organism present in dog and cat bite infections 11
  • 13. This domestic animal’s bite causes the highest rates of infections. 13
  • 14. What are cats? Cats – 15-50% Dogs – 1.6-30% Humans – 3.4-9.3% 14
  • 15. This type of infection is suggested by a paronychia on both the radial and ulnar sides of the nail. 15
  • 16. What is a subungual infection? (requires removal of the nail) 16
  • 17. Daily This tibial spiral fracture is Double!!! commonly seen in 1-3 yo may be mistaken for child abuse. 17
  • 18. What is a toddler’s fracture? Source undetermined 18
  • 19. These are 3 of the most common traumatic amputations considered for replantation by hand surgeons 19
  • 21. These are 4 physical exam findings that imply a pelvic fracture. 21
  • 22. What are?: 1. AP instability 2. Perineal hematomas 3. Blood at urethral meatus 4. Vaginal blood 5. Rectal blood 22
  • 23. This test is performed to diagnose a traumatic open joint. 23
  • 24. What is Arthrogram? (Inject methylene blue or saline and inspect for egress of the fluid) 24 Sargon_Starblade, flickr
  • 25. These two mechanisms are the most common cause of massive bleeding pelvic fractures 25
  • 26. What are vertical shear and anteroposterior compression fractures? 26
  • 27. The findings of these crystals on microscopic analysis of synovial fluid suggests what disease? 27 Patho, Wikimedia Commons
  • 28. 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 28
  • 29. This is the definitive test for ruling out septic arthritis. 29
  • 30. What is synovial fluid culture? 30 Source undetermined
  • 31. This the “WBC threshold” for synovial fluid in septic arthritis. 31
  • 32. What is > 50k? 32 Acute Disorders of the Joints and Bursae, 5th ed.
  • 33. This is the most common cause of septic arthritis in young, sexually active people; it can present with mono or polyarthritis. 33
  • 35. This is the antibiotic and duration of therapy to treat lyme arthritis. 35
  • 36. 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 36 Diseases Society of America. Clin Infect Dis. Nov 1 2006;43(9):1089-134. [Medline].
  • 37. This is an accurate description of the “line” that is closely scrutinized by a radiologist when evaluating an xray for SCFE. 37
  • 39. This injury seen in children is due to microtrauma to the tubial tubercle tuberosity apophysis. 39
  • 40. What is Osgood-Schlatter Disease? 40 Source undetermined
  • 41. This is the most common type of Salter Harris Fracture? 41
  • 42. What is Salter Harris II? Frank Gaillard, Wikimedia Commons 42
  • 43. This type of Salter Harris Fracture has the greatest incidence of growth disturbance. 43
  • 44. What is Salter Harris IV fracture? Frank Gaillard, Wikimedia Commons 44
  • 45. 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.” 45
  • 47. This type of finger injury involves rupture of the flexor digitorum profundus tendon. 47
  • 48. What is jersey finger? 48 American Academy of Family Physicians, aafp.org
  • 49. This is the structure that is injured in mallet finger. 49
  • 50. What is an avulsion of the extensor tendon from the dorsum of the distal phalanx? 50 American Academy of Family Physicians, aafp.org Howcheng, Wikimedia Commons
  • 51. This ligament is torn in gamekeeper’s thumb (skier’s thumb). 51
  • 52. What is a torn ulnar collateral ligament of the thumb MCP joint? 52 Wikipedia
  • 53. Fractures of these metacarpals require more anatomic reduction to ensure proper functioning. 53
  • 54. What are metacarpals 2 and 3, the “fixed center of the hand.” 54
  • 55. This is the diameter of fingertip amputations that can heal without grafting. 55
  • 56. What is 10 mm? 56
  • 57. While an exact number may be debated, a compartmental pressure greater than this is considered to be diagnostic. 57
  • 59. The 2 most common physical exam findings in compartment syndrome 59
  • 60. What is pain out of proportion to physical exam with passive stretch and paresthesias? 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. 60
  • 61. These are 4 mechanisms that can cause compartment syndrome. 61
  • 62. What are?: 1. Fractures 2.  Ischemic-reperfusion injury 3.  Vascular puncture in anticoagulated patients 4.  Burns 5.  Crush injury 6.  Prolonged Limb compression 62
  • 63. These are the two most common injuries causing compartment syndrome in the upper extremity? 63
  • 64. What are supracondylar fractures in children and both both bone forearm fractures? 64
  • 65. These are the two most common compartments that develop compartment syndrome. 65
  • 66. 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