1. AAA: more pain = increased likelihood of rupture = more emergent
2. Subclavian steal can happen with vertebral aa; someone who experiences arm claudication and neurological symptoms at the same time needs a doppler of their subclavian artery.
3. In evaluating peripheral arterial disease, look for a gradient on doppler; the presence of one indicates stenosis, and thus ability to be resolved with bypass graft. No gradient means the problem is in the smaller vessels, which will not be fixed with surgery. Do an angiogram to find the stenosis and a good distal vessel; smaller blocks can be stented, bigger ones need grafts. Do not do prophylactic grafts, wait until the symptoms interfere significantly with normal life (until then, lifestyle changes and cilastazol). When evaluating perfusion with the doppler, if they don't have symptoms at rest, you may need to induce exercise in order to get good findings.
4. Skin cancers: diagnose with full-thickness punch biopsy at margin including normal skin.
-Basal cell, ulcer or raised waxy lesion, favor face above mid-lip line, do not metastasize, 1mm margins.
-Squamous cell, ulcerated lesion, favor below mid-lip line, can metastasize, need up to 2 mm margins, LN dissection if margins+
-Melanoma: <1mm invasion good prognosis, 1-4 do aggressive resection and LN dissection, >4 bad prognosis. Mets to weird places, unpredictable course
5. Optho: 
-Strabismus in a kid that develops later in infancy may be due to refraction error; glasses will correct immediately.
-Glaucoma: frequently presents as pain and seeing halos around lights after a long session of dilated pupils (movies/TV at night). Physical exam, eye is hard, cornea is greenish, pupil is mid-dilated and non-reactive. Next step: refer to optho, in the meantime treat with diamox (carbonic anhydrase inhibitor) or mannitol, topical b-blockers, a2-agonists, or pilocarpine.
-Orbital cellulitis: key is pupil is dilated and non-reactive, no extraocular movements. Next step: emergency CT and drainage
-Retinal detachment signs: flashes of light + floaters (more floaters= worse outcome). Bad signs: see snowstorm in eye, curtain coming down.
-Emboli to opthalmic artery: sudden loss of vision. Breathe into paper bag and have someone press and release on their eye: the idea is to vasodilate and propel clot further downstream so a smaller part of the retina is lost to ischemia.
-Every new DM diagnosis needs to have a retinal evaluation, since it may have been undiagnosed for years.
6. Peds ortho diagnosis & management: 
-DDH: dx with ortolani and barlow, tx abduction splinting with pavlik harness for 6 mos
-Legg-Calve-Perthes: dx with AP and lateral xrays, treat with casting and crutches
-SCFE: sole of affected foot points towards other foot; when you flex the hip, the thigh will not internally rotate; AP x-rays. Tx: surgery to pin the femoral head into place.
-Septic hip: toddlers who hold their hip flexed, abducted, and externally rotated, resistant to motion. Aspirate joint fluid to r/o transient synovitis (also: Kocher criteria, fever>101.5, ESR>40, WBC>12, non-weight-bearing, >2 criteria = >40% chance of septic hip), open drainage if the aspirate is pus. Antibiotics to cover gram-pos.
-Osteomyelitis: bone scan, antibiotics
-Genu varum: no treatment until age 3, at which point it's blount disease (medial growth plate overgrowth), surgery to shave it down.
-Genu valgus normal between age 4-8.
-Osgood Schlatter: TTP at tibial tuberosity or with quad flexion. Treat by putting knee in extension cast for 4-6 weeks
-Club foot (plantarflexion, inversion, adduction of forefoot). Serial casts to correct first adduction, then  inversion, then plantarflexion. 50% are corrected this way, the other half require surgery after 6-8 mos but before 1-2 years.
-Supracondylar fractures (along with growth plate fractures, are worrisome in kids): 2/2 hyperextension of elbow from fall on extended arm. Volkmann contracture can occur-- from damage to brachial artery either directly or via compartment syndrome, leading to ischemia, and later fibrosis of muscles of the arm. All muscles are affected, but the flexors are more numerous and stronger than extensors, so there are more flexor than extensor features; both are engaged, so it is painful to attempt to straighten the fingers. Treat these fractures with normal casting, but watch out for the development of these contractures
-Growth plate fractures: closed reduction if the growth plate is in one piece and it's laterally displaced from metaphysis, ORIF if its any more complex.
-Osteosarcoma: ages 10-25, around knee, sunburst. Ewing's 5-15, diaphysis of long bones, onion skinning.
7. Adult ortho
-Bone pain, suspect mets: bone scan first, then x-ray, because bone scan is more sensitive but less specific and x-ray is vice-versa.
-Old man with anemia, bone pain, protinuria, hypercalcemia: think multiple myeloma. Tx with chemo, or thalidomide if chemo fails.
-Sarcomas metastasize to lungs, not LN.
-Closed reduction: fractures that are not badly displaced/angulated that can be easily reduced.
-Clavicle fracture: figure of 8 device for 4-6 weeks
-Shoulder dislocation: anterior (arm is adducted and externally rotated, may have some deltoid numbness from axillary nerve stretch), posterior (adducted and internally rotated)- rare, occurs after massive muscle contraction (seizure, electrical burn), may go undetected for a long time; need axillary or scapular lateral x-rays.
8. Ortho specific fractures: 
-Colles fracture: fall on extended wrist, radius displaced dorsally, "dinner fork" wrist. Tx: closed reduction, cast.
-Monteggia fracture: blocking a nightstick. Fracture of proximal ulna, anterior displacement of radial head (part closer to elbow)
-Galeazzi fracture: fracture of distal radius, displacement of distal ulnar posterior.
-Scaphoid fracture: fall on extended wrist, fracture of scaphoid, TTP over anatomical snuffbox. Tx with thumb spica cast even if x-rays are negative (i.e based on history/physical); these are notorious for non-union.
-Metacarpal neck fractures: usually 4th/5th, from punching with a closed fist; closed reduction and unlar splint if its mild, ORIF for bad.
-Hip fractures: femoral neck (esp displaced) need total hip replacement since it's likely to damage vascular/nerve structures; intertrochanteric needs an ORIF with pins, diaphyseal can treat with intramedullary rod fixation.
-Complex bone fractures: if they are open need OR fixing within 6 hours, comminuted can lose a lot of blood, watch out for shock; if they are multiple watch out for fat emboli
-Collateral ligament: knee swelling, TTP on affected side; knee flexed 30 degrees, passive ab/adduction wil make pain. Tx with hinged cast, surgery if there are multiple injuries
-ACL: anterior drawer. Surgery if its someone whos going to be active, can immobilize and do rehab if its a relatively immobile person.
-Meniscal tears: hard to dx on physical, show up great on MRI. Protracted pain and swelling, knee catches and "clicks" upon extension.
-Tibial stress fractures (shin splints): TTP over specific point, x-rays will be normal at first. Treat with cast/crutches, re-x-ray in 2 weeks.
-Achilles injury: popping sound. Cast in equinus position.
9. Ortho emergencies: 
-Pain under a cast is never OK to be watched-- always take off the cast and look at the limb. Forearm and lower leg most likely to develop compartment syndrome.
-Posterior hip dislocation: patient holds leg adducted, flexed, internally rotated. emergency reduction to avoid fem head ischemia.
-Gangrene: looks toxic, treat with high dose IV Penicillin, debridement, hyperbaric oxygen.
-Radial nerve injury: from upper humerus oblique fractures. Weakness of hand extension. If it doesn't get better with closed reduction, the nerve is caught, go to surgery.
-Posterior knee injury: watch out for pop artery damage (get pulses). If you missed it for a while, do prophylactic fasciotomy.
10. Ortho, arm and hand and feet: 
-Anterior arm dislocation, worry about axillary nerve damage.
-Humerus fracture, worry about radial nerve damage.
-De Quervain's tendonsynovitis: hand flexion and thumb extension, pain in tendons of anatomical snuffbox, worsened by flexing thumb and ulnar-devation of wrist
-Trigger finger: finger acutely flexed,  tendon caught on tendon sheath, treat with steroid injections
-Depuytren's contracture: finger contracture, palmar nodule, treat with surgery
-Gamekeeper thumb: ulnar collateral ligament of thumb injury, caused by hyperextension, treat with casting
-Morton's neuroma: mass or tender point between 3rd and 4th metatarsals. Inflamm of common digital nerve.