2011 SAQ Flashcards
What are clinical features of Class IV shock?
- Unresponsive / coma
- HR >140
- Hypotension
- Anuria
- Low PP
- Increased RR (>35)
- 2L or >40% volume loss
- Non-responder to fluids / blood products
What are 8 chest radiographic findings of aortic arch rupture?
- Widened mediastinum
- Left Hemothorax
- Apical cap
- Loss of AP (aortopulmonary) window (space between pulm artery and aorta)
- Loss of Aortic knob
- Tracheal deviation to right
- Deviated NG tube to right
- Depression of left mainstem bronchus
- Fracture of 1st / 2nd rib and clavicle
What are 4 MRI findings of a patient with scoliosis and neurofibromatosis?
- Dural ectasia
- Intradural neurofibromas
- Foraminal widening (and dumbbell neurofibromas)
- Scalloping of vertebrae
- Penciling of ribs
- Short, sharp curve
- Vertebral wedging, Dysplastic pedicles, Widened interpedicular distance, TP spindling
What are 2 cervical spine findings in Down syndrome?
- Atlantoaxial instability
- Atlantooccipital instability
- Cervical spondylosis
- Os odontoidium
What are three conditions that have dural ectasia?
- Marfan’s syndrome
- Neurofibromatosis
- Ehlers-Danlos syndrome
- Ankylosing spondylitis
- Trauma
Given an xray of a varus malunited femoral neck fracture. List 4 clinical findings found on physical exam other than decreased ROM
- Leg length discrepancy
- Trendelenberg gait
- Trendelenberg sign
- Impingement (pain on Flexion, Adduction, Internal rotation)
- Trochonternic bursitis / prominent GT
- Hip abductor weakness
- Compensatory valgus knee / ankle
List 4 relative contraindications to total joint arthroplasty
- Active / Chronic infection / Previous OM
- Medically conditions precluding safe surgery
- Severe bone deficiency/inadequate bone stock
- Asymptomatic (ie. painless fusion)
- Charcot / neuropathic joint
- Obesity (BMI >40)
- Psoriasis / skin issues
- Inability to comply with postop regimen
- Active/laborer
List 6 complications of a malpositioned acetabular component
- Instability
- Increased osteolysis
- Accelerated wear
- Component impingement
- Poor soft tissue tension (abductor weakness)
- Increased metal ions / pseudotumor formation
- Psoas impingement
- Loosening
- Squeaking
- Fracture / protusio / pelvic discontinuity
Given a picture of an AP pelvis with bilateral BHR. R BHR has femoral neck # / osteolysis. List 4 risk factors why this would happen
- Notching of femoral neck
- Varus malalignment of femoral component
- Acetabular component impingement
- Previous AVN
- Female
- Osteoporosis
- Small femoral neck
List 4 prognostic factors associated with poor prognosis in a patient with septic arthritis
- Delayed presentation / treatment (>4 days)
- Atypical / virulent organism (ie. MRSA)
- Immunocompromised
- Extremes of age (neonate, elderly)
- Associated osteomyelitis
- Involvement of large joint (hip / knee / shoulder)
- Polyarticular
- Positive blood cultures
- Pre-existing arthritis
- Duration of immobilization
List 4 long term complications of osteomyelitis in pediatric patient.
- Arthritis
- Angular deformity
- Leg length discrepancy
- Brodie’s abscess
- Pathologic fracture
- Chronic pain
- Draining sinus tract
List 4 long term complications of radiation therapy for sarcoma treatment
- Radiation induced sarcoma
- Joint contracture
- Soft tissue fibrosis / scarring
- AVN
- Fracture
List 3 advantages for coning an xray.
- Reduced radiation to patient / surgeon
- Improved image quality (resolution)
- Decreased scatter
List 3 important radiographic relationships of a Lisfranc injury at the tarsometatarsal joint
- widened space btwn 1st and 2nd MT (widened interval between the 1st and 2nd RAY)
- bony avulsion of lisfranc ligament (base of 2nd MT)
- dorsal subluxation of 2nd MT base on lateral xray
- incongruity of metatarsals with cuneiforms
- lateral aspect of 1st MT does not line up with medial cuneiform on AP
- medial aspect of 2nd MT does not line up with middle cuneiform on AP
- medial aspect of 3rd MT does not line up with lateral cuneiform on oblique
- medial aspect of 4th MT does not line up with cuboid
List 6 causes of acquired coxa vara
- SCFE
- Perthes / AVN
- Femoral neck malunion
- Neoplasm (ie. GCT)
- Septic arthritis / OM
- Fibrous dysplasia
- Rickets
- Cretinism (hypothyroidism)
List 4 reasons why you would percutaneously pin a displaced distal radius in a pediatric patient.
- Salter III / IV
- Shortening/bayonetting >1cm
- Coronal angulation >10-20° (>10° in >9year; >15-20° in <9years)
- Dorsal angulation >20-30° (>20° in >9year; >30° in <9years)
- Malrotation >30-45° (>30° in >9year; >45° in <9years)
- Ipsilateral supracondylar fracture (floating elbow)
- Open fracture
- Compartment syndrome
- Severe soft tissue injury precluding cast / splint
- Inability to obtain / maintain closed reduction
- Vascular injury requiring repair
Other than joint aspiration, list 4 clinical findings to differentiate septic arthritis from transient synovitis
- Temp >38.5
- Inability to weight bear
- WBC >12
- ESR >40
- CRP >20
- If just clinical findings then would include progressive worsening and failure to respond anti-inflammatories
Please list the dermatomes for the following
a) medial knee: L3
b) groin: L1
c) medial calf: L4
d) clavicle: C4
In hypovolemic shock, the body relies on anaerobic metabolism. List what happens intracellularly to the following (decreased / increased / no change)
a) Na (increased)
b) K (decreased)
c) Ca (increased)
d) water (increased)
List 8 factors that would lead to DCO vs. ETC
- ISS >40
- ISS >20 with chest injury
- Lactate >2.5
- Base deficit +/- 2 or excess >8
- Hypothermia (T<35)
- Coagulopathy / DIC
- Head injury (AIS >3)
- Polytrauma with persistent hemodynamic instability / hypotension
- Pulmonary contusion visible on xray
- Bilateral femoral fractures
- Estimated surgery time >6 hours
- Requirement of >10 Units
List 3 anatomic landmarks for placing the femoral component in a TKA
- - Whiteside line
- - Epicondylar axis
- - Posterior femoral condyles
- - Intramedullary guide
List 4 complications of a radial head fracture
- Radiocapitellar arthritis
- Elbow instability
- DRUJ instability
- Elbow stiffness
- PIN palsy
List four indications for a hemi-resection interpositional arthroplasty of the distal radioulnar joint of the wrist?
- Degenerative arthritis of distal radioulnar joint
- Painful Instability
- Post-traumatic arthritis
- Rheumatoid arthritis (with synovitis)
- Ulnocarpal impaction
- Chronic dislocation
- Ulnar malunion
List 3 xray findings of Madelung’s deformity
- - Increased radial inclination
- - Increased volar angulation
- - V shaped carpus
- - Ulnar positive
- - Volar / Ulnar physeal disruption
- - Palmar carpal displacement
- - Radial bowing
List 6 risk factors of radioulnar synostosis that occurs after surgery
- Both bones fracture at same level
- Exposure of bone bones through single incision
- Hardware or bone fragments encroaching on intraosseous membrane
- Head injury
- Severe soft tissue injury / open fracture
- Acute bone grafting
- Infection
List 3 predictors for successful treatment of UBC of the proximal humerus with methylprednisone.
- Age >15
- Size (<24 cm2)
- Absence of septations
List 5 predictors of poor prognosis for Type II odontoid fractures.
- - Age >50
- - Comminuted
- - Displaced (>5mm), posterior
- - Neurologic deficit
- - Angulation >11 degrees
- - Inability to obtain or maintain a reduction (incl. late loss of position)
- - Fracture gap >1-2mm
- - Delay to treatment >4 days
What are two important considerations to take into account for placing C1-C2 trans-articular screws
- Ability to obtain a reduction
- Aberrant path of the vertebral artery
List 3 complications of doing an ankle ORIF in a patient with DM
- Increased wound complications (poor healing and loss of protective sensation)
- Delayed union (poor healing)
- Loss of reduction (poor bone quality)
- Infection (immune compromise)
- Charcot arthropathy
List 3 complications of performing an open repair of an Achilles tendon rupture vs. closed treatment.
- Wound complications (skin breakdown)
- Deep infection
- Sural nerve injury
- Anesthetic complications
List 8 components of the pre-op checklist approved by WHO that will decrease patient morbidity and mortality.
- - Patient identifies their name, surgical site, procedure proposed, consent
- - Surgical site marked
- - Anesthesia safety check
- - O2 monitor applied and working
- - Allergies
- - Identify difficult airway or aspiration risk
- - EBL > 500cc
- - Introduce team
- - Surgeon / nurse / anesthesia confirm patient / site / procedure
- - Critical / unexpected steps
- - Preop antibiotics
- - Appropriate imaging displayed
- - Procedure name
- - Instrument counts
- - Specimen labeling
- - Equipment problems
- - Anything required for recovery
16 y/o F Jehovah witness trauma patient who has lost enough blood to require a blood transfusion. You explain her that she needs blood. She gets agitated when you say this and refuses. Although she is in shock, she seems competent. What ethical principles are in conflict with each other when dealing with this situation?
- - Autonomy
- - Beneficence
What are 3 ways to decrease the rate of AVN when performing an antegrade femoral nailing in an adolescent patient
- - Lateral start point
- - Smaller diameter nail / reaming
- - Minimal proximal dissection
Give 2 advantages of doing a piriformis starting point vs. a trochanteric starting point for an antegrade femoral nail.
- *- Colinear trajectory with the long axis of the femoral shaft
- Decreased risk of iatrogenic fracture comminution
- Decreased risk of varus malalignment**
Give the 4 types of SLAP tears.
Snyder
- I: superior labral fraying
- II: superior labral fraying with detached biceps anchor
- III: superior labral detachment (bucket handle tear), stable biceps
- IV: superior labral and biceps anchor detachment
Give the 4 stages of perilunate instability
- I: SL injury
- II: SL + CL injury
- III: SL + CL + LT injury
- IV: Radiolunate dislocation
A rheumatoid patient has a 2-week history of inability to extend D4 and D5. What are 3 most likely causes?
- MCP dislocation (volar)
- Extensor tendon subluxation (sagittal band rupture)
- Extensor tendon rupture (Vaughn-Jackson syndrome, tenosynovitis)
List 3 anatomic causes of swan neck deformity in a RA patient as a result of synovitis.
- - PIP volar plate attenuation
- - FDS rupture over PIP
- - Volar MCP dislocation / subluxation
- - Extensor tendon rupture at DIP
- - Transverse retinacular ligament attenuation
- - Intrinsic tightness
What are two mechanisms of action of BMP?
- Promote differentiation of mesenchymal cells into chondrocytes and osteoblasts
- Promote differentiation of osteoprogenitor cells into osteoblasts, influencing skeletal pattern formation
List 3 spine findings in Achondroplasia
- Foramen magnum stenosis
- Congenital spinal stenosis
- - Short pedicles
- - Decreased interpedicular distance
- - Vertebral bodies shortened and enlarged
- Lumbosacral hyperlordosis due to pelvic tilt and hip flexion contractures
- Thoracolumbar kyphosis improve with walking age
DM is a common cause of arthropathy of the foot and ankle. List 3 other causes.
- - syphilis
- - alcoholism
- - congenital insensitivity to pain
- - myelomeningocele
- - polio
- - leprosy
- - syrinx
SAMPLe CDS
List 3 relative indications to perform contralateral prophylactic pinning in a patient with SCFE
- Endocrine abnormalities (growth hormone deficiency, hypothyroidism, hypopituitarism)
- Renal failure
- Age <10
- Inaccessibility for follow up
- High BMI
List 4 extraosseous findings in fibrous dysplasia.
- Café au lait spots (coast of Maine)
- intramuscular myxomas (Mazzabraud syndrome)
- renal phosphate wasting (oncogenic osteomalacia)
- endocrinopathies (precocious puberty, hyperthyroid, Cushing’s, gigantism, acromegaly)
Define the borders of the quadrangular space
- - Teres minor (superior)
- - Teres major (inferior)
- - Humerus (lateral)
- - Long head triceps (medial)
List 3 conditions that would result in a false +ve result using the Thessaly test
- - OCD lesion
- - arthritis
- - loose body
- - instability (MCL)
List 4 sites of compression of the PIN
- - Fibrous bands around the radiocapitellar joint
- - Radial recurrent vessels
- - ECRB edge
- - Arcade of Frosche
- - Supinator outlet
List 3 ways to identify a spinal cord injury during spinal deformity correction.
- - SSEPs
- - MEPs
- - Wake up test
- - Spontaneous or Triggered EMGs
List 3 features of central cord syndrome
- - Upper > Lower extremity weakness
- - Distal > Proximal
- - UE coordination difficulty
- - Gait abnormalities
- - Sacral sparing
- - Cape distribution sensory loss
- - Burning radicular pain
List 3 predictors that contribute to poor prognosis for Perthes disease on initial presentation
- - age >6
- - whole head involvement
- - horizontal physis
- - lateral subluxation
- - lateral calcification
- - Gage sign
- - metaphyseal cystic changes
What are 3 ways to decrease the risk of avascular necrosis when treating pediatric femoral neck fractures?
- - Anatomic reduction
- - Capsular decompression
- - Avoid posterior dissection
- - Urgent treatment
