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Orthobullets/ FRCSC Canadian Board > 2012 SAQ > Flashcards

2012 SAQ Flashcards

1
Q

Name the following Dermatomes: Nipple line, Umbilicus, Groin, medial calf

A
  • T4
  • T10
  • L1
  • L4
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2
Q

List 4 features of Brown Sequard

A
  1. Ipsilateral loss of motor (paralysis)
  2. Ipsilateral loss of proprioception
  3. Contralateral loss of pain
  4. Contralateral loss of temperature

(Good prognosis)

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3
Q

List four successful things to non-operatively manage carpal tunnel syndrome

A
  1. Activity modification
  2. Night splint
  3. NSAIDs
  4. Corticosteroid injection
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4
Q

What are the three phases of muscle repair

A
  1. Acute inflammatory and degenerative phase
  2. Repair phase
  3. Remodeling phase
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5
Q

Four changes in and around muscle with endurance training

A
  1. Increase mitochondria (number)
  2. Increased capillarization
  3. Hypertrophy of slow twitch fibers.
  4. Increased oxidative capacity
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6
Q

Name two radiographic risk factors for SCFE development

A
  1. Vertical orientation of subcapital epiphysis.
  2. Larger pelvis, larger femora
  3. Coxa vara
  4. Increased retroversion
  5. Epiphyiolysis (? May already indicate SCFE presence)
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7
Q

Name 4 radiographic reasons for progression of infantile Blount’s

A
  1. Physeal bar formation
  2. Increased metaphyseal-diaphyseal angle (>16)
  3. Increased varus deformity
  4. Increased internal tibial torsion (Wheeless)
  5. Metaphyseal beaking
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8
Q

Name the Four components of the WOMAC

A
  1. Pain
  2. Stiffness
  3. Symptoms
  4. Physical function / Daily living
  5. (WOMAC is for knee and hip arthritis only)
  6. (SF-36: functional health and well-being: 8 scales: 4 physical: Physical Functioning, Role-Physical, Bodily Pain, General Health. 4 Mental: Vitality, Social functioning, Role-Emotional, Mental Health)
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9
Q

What is the formula for pelvic incidence

A

PI= Sacral slope (SS) + Pelvic Tilt (PT)

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10
Q

Three ways to size a radial head

A
  1. Extracting the pieces of broken radial head and sizing it intra-operatively using the sizer in the radial head arthroplasty set.
  2. Pre-operatively getting a CT scan of the contralateral elbow
  3. Radiographically checking for the “delta river” sign.
  4. Trialing your component and directly visualizing the congruity of the lateral ulnohumeral joint intraoperativly for any gap (and radiologically assessing the medial ulnohumeral joint)
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11
Q

Four principles of managing a Pilon excluding soft tissue

A
  1. Fix fibula first in order to restore length
  2. Restore articular congruity with provisional k-wires and then cannulated interfragmentary screws between all large articular fragments
  3. Use plate fixation to fix the metaphysis to the diaphysis.
  4. Using bone graft if needed
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12
Q

WHO pre-op checklist; list 5 points to be included (“List the 5 main components”

A

Sign in (before induction) (5):

  1. Confirm patient identity, site, procedure and consent.
  2. Mark surgical site
  3. Anesthesia machine and medication check
  4. Pulse oximeter
  5. Confirm patient allergies, airway concerns, and bleeding risks.

Pre-op checklist (before incision) (5):

  1. Confirm all members have introduced themselves by name and role
  2. Confirm patient identity, procedure and incision site
  3. Confirm prophylactic antibiotics in the last 60 min.
  4. Anticipated critical events (surgeon, anesthesia, nursing)
  5. Confirm any essential imaging is displayed

Sign out (before patient leaves room) (2):

Nurses verbally confirm:

  • Procedure done
  • Instrument, sponge, and needle count
  • Specimen labeling
  • Whether any equipment problems need to be addressed

Communicate any key concerns for the recovery and management of the patient

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13
Q

Three reasons for the progression of congenital kyphosis

A
  1. Vertebrae morphology (ie, unilateral bar with contralateral hemivertebrae)
  2. Rib fusion
  3. Young age
  4. Level of defect (ie, worse at junctional regions) ??
  5. Number of levels involved
  6. Failure of formation
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14
Q

List 8 organ systems associated with congenital scoliosis

A
  1. Cardiac
  2. Genitourinary
  3. Renal
  4. Neurologic (Dysraphism, Chiari, tethered cord, syringomyelia, diastatomyelia, intradural lipoma)
  5. Respiratory (Thoracic insufficiency syndrome)
  6. Gastroenteric (Tracheoesophageal fistula, Anal atresia)
  7. MSK (Limb defects)
  8. Auditory deficits
  9. Craniofacial abnormalities
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15
Q

List 4 principles for establishing causality

A
  1. The cause and effect must be related (ie, must be correlated)
  2. The casue variable must produce its influence before the effect occurs. (ie, a linear or temporal relationship)
  3. Other possibile explanations (ie, a third variable) must be eliminated.
    1. Emperical association, time order, spuriousness, Mechanism and context.
  5. Strong correlation
  6. Temporal relation
  7. Dose-response relation
  8. Consistency
  9. Plausibility
  10. Coherence (same as above, but simply be compatible to a generally agreed scientific paradigm/concept)
  11. Confounding variables removed
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16
Q

List the 5 structures of the shoulder superior suspensory complex (SSSC)

A
  1. Glenoid
  2. Coracoid
  3. Acromion
  4. Acromioclavicular ligament (joint)
  5. Coracoclavicular ligaments
  6. Coracoacromial ligament (Yes, some consider this a part of the complex)
  7. Distal clavicle
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17
Q

Terrible triad; list the three injuries making this up

A
  1. Elbow dislocation
  2. Radial head fracture
  3. Coronoid fracture
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18
Q

5 things to systemically stage a Ewings; femoral lesion in stem

A
  1. Bone marrow biopsy
  2. CT chest
  3. CXR
  4. Bone scan
  5. MRI whole bone (? skip lesions)
  6. Bloodwork (CBC+D, lytes (Na, K, Cl, CO3), secondary lytes (Ca, Mg, PO4), ESR, CRP, LD, ALP.)
  7. Biopsy of the lesion?
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19
Q

List six anatomical releases for balancing a varus knee

A
  1. Osteophytes and meniscus
  2. Capsule
  3. Deep MCL
  4. PLC-àSemimembranosus (PM corner)
  5. Superficial MCL (sub-periosteal release only)
  6. PCL
20
Q

List 3 radiographic features associated with C2-3 pseudosubluxation

A
  1. spinolaminar line drawn from spinolaminar point on C1 to C3 “Swischuk’s line”
  2. spinolaminar point on C2 should be within 1.5 mm of spinolaminar line
  3. More horizontally oriented facet joint (compared to adult)
  4. Reduction of subluxation on extension views
  5. Absence of soft tissue swelling
  6. Disruption of the anterior spinal line of C2 on C3 <4mm (If >4mm then bad)
21
Q

List 5 radiographic or clinical features suggesting an unstable C spine injury

A
  1. Increased ADI >3mm (Decreased PADI/SAC <14mm)
  2. Sum of lateral mass displacement (on open mouth odontoid view) >7.0mm (??or >8.1mm)
  3. Facet dislocation
  4. Vertebral body compression fracture with >11 degrees angulation or 25% loss of vertebral height
  5. >3.5 mm anterior body displacement.
  6. Widened gap in the posterior spinous processes (posterior ligamentous disruption)
  7. Midline tenderness
  8. Step deformity
  9. Neurological findings
22
Q

List three complications with managing a pediatric tibial tubercle fracture

A
  1. Growth arrest causing recurvatum of the knee
  2. Hardware irritation causing bursitis
  3. Compartment syndrome
  4. Stiffness
  5. Infection
23
Q

List three predictors of a poor outcome in a pediatric radial neck fracture

A
  1. Elbow dislocation
  2. Neurologic injury (ie, PIN) disagree…
  3. Essex-Lopresti
  4. Open injury
  5. Angulation > 30 degrees ……….. (should be >30°)
  6. Translation > 3mm
  7. ROM< 45 degrees of pronation/supination
24
Q

List 6 types of failure of a TKA requiring a revision

A
  1. Infection
  2. Polyethylene wear
  3. Osteolysis causing Bone loss and aseptic loosening
  4. Ligamentous injury causing instability
  5. Periprosthetic fracture
  6. Patellofemoral maltracking (Most common!)
  7. Arthofibrosis
  8. Abnormal joint line (patella baja, flexion instability)
25
Q

List 6 causes for groin pain and decreased function in a total hip

A
  1. Infection
  2. polyetheline wear
  3. osteolysis of the bone with aseptic loosening
  4. malpositioning of the acetabular component with impingement and instabilty
  5. hip dislocation
  6. iliopsoas tendon impingement
  7. Arthrofibrosis
  8. Heterotropic ossification…. Disagree usually not painful
  9. Periprosthetic fracture
  10. Pseudotumor
26
Q

List 4 ways a plate can function other than a buttress

A
  1. Bridge plate
  2. Neutralization plate (in combination with a lag screw)
  3. Compression plate
  4. Locking plate (internal ex-fix)
  5. Dynamic Tension band plate
27
Q

List three considerations for applying a pediatric halo safely

A
  1. Use more screws (6-8)
  2. Finger tight screws only (2-4 inches per pound, as compared to 8 in adults)
  3. CT of skull prior (looking for open sutures or thin cortices)
28
Q

List 5 indications for ORIF of a mid shaft humerus fracture

A
  1. Open fracture (absolute)
  2. Vascular injury (absolute)
  3. Multiply injured patient
  4. Floating elbow
  5. Bilateral humerus fractures
  6. (Others: Brachial plexus injury (?), Pathologic, Burns or soft tissue injury (?), Fracture characteristics: distraction at fracture site, proximal, intraarticular extension, >20 deg in AP, >30 varus/valgus, >3cm shortening, Segmental (?))
29
Q

List 4 contraindications to an HTO in a varus Knee

A
  1. Lateral joint OA, (or PF joint OA)
  2. Ligamentous unstable knee
  3. Inflammatory arthritis
  4. Obese (BMI>35)
  5. (Others: Flexion contracture > 15 degrees, Knee flexion <90 degrees, Varus thrust in gait, Correction > 20 degrees needed)
30
Q

List 4 ways to manage an ACL injury in an 11 yr

A
  1. Physio, strict activity restrictions, then repair ACL once skeletally mature in a few years.
  2. All epiphyseal ACL reconstruction using soft tissue graft
  3. Physeal-sparing combined extra- and intra-articular ACL reconstruction with autogenous IT band: turn-down of the IT band, keeping its insertion on the tibia and passing it behind the lateral femoral condyle into the joint and securing it back to the tibia (best choice for Tanner Stage 1 or 2).
  4. Trans-physeal ACL Reconstruction using soft tissue graft, vertical bone tunnels, as small as possible bone tunnels, using endobutton fixation (best choice if Tanner Stage 3 or 4).
31
Q

List 4 causes for decreased extension in an ACL recon

A
  1. Cyclopes lesion
  2. Tibial tunnel too anterior (due to impingement)
  3. Femoral tunnel too posterior
  4. Overtightening the graft (ie, tightening the graft in knee flexion)
  5. Infection
  6. Bracing post-op
32
Q

List 4 reasons to do ORIF of a scaphoid fracture

A
  1. Initial displacement (>1mm)
  2. Humpback (flexion) deformity (intraschaphoid angle > 35 deg)
  3. Proximal pole fractures
  4. Part of a perilunate injury (ie, greater arc)
  5. Comminution
  6. Vertical sheer or oblique fractures
  7. DISI deformity (>60 deg scapholunate angle, >15 deg radiolunate)
  8. Non-union?
  9. Delayed diagnosis
33
Q

List 2 motion sparing techniques to manage a stage II SLAC wrist

A
  1. Four corner fusion (with scaphoid excision)
  2. Proximal row carpectomy (PRC)
34
Q

List 4 components of the postero-lateral corner

A
  1. Popliteus tendon
  2. Lateral collateral ligament
  3. Popliteofibular ligament
  4. Lateral capsule
  5. Iliotibial band
  6. Bicepts femoris
  7. Lateral head of the gastrocnemius
  8. Arcuate ligament
  9. Fabellofibular ligament
35
Q

List 5 features associated with increased risk of peri-operative mortality in hip fractures

A
  1. Male
  2. Ambulatory status pre-op (ie, household ambulators)
  3. Delay in O.R. greater than 48 hours.
  4. Medical co-morbidities
  5. Poor mental status (ie, demented or institutionalized)
  6. Age
36
Q

List 4 complications with a traction table and hemi-lithotomy position

A
  1. Increased risk of compartment syndrome (of the hemi-lithotomized leg)
  2. Injury to the sciatic or peroneal nerve (of the hemi-lithotomized leg)
  3. Injury to the pudendal nerve
  4. Injury to the perineal soft tissues
37
Q

List 5 causes of a cavovarus foot in an adult

A
  1. Hereditary Motor Sensory Neuropathies (ie, Charcot-Marie-Tooth disease, Freidrichs ataxia)
  2. Cerebral injuries (ie, Stroke)
  3. Cerebral palsy
  4. Anterior horn cell disease (Spinal root injury)(polio)
  5. Residual club foot
  6. Talar neck fracture (?)
38
Q

List three considerations for successfully managing CVT in a minimally invasive fashion

A
  1. Pre-operative serial casting to reduce the deformity and stretch the dorsal soft-tissues. Cast the foot in plantarflexion and inversion.
  2. Closed reduction and percutaneous pin the Talonavicular joint in a reduced position. Release the capsule surrounding the talus to obtain reduction if necessary (This is more maximally invasive, maybe don’t do the large soft tissue release).
  3. Percutaneous achilles tendon lengthening.
39
Q

List 4 nerves to block in an ankle block

A
  1. Sural nerve
  2. Saphenous nerve
  3. Posterior Tibial nerve
  4. Peroneal nerves (superficial and deep)
40
Q

List 4 risk factors for developing SMA syndrome with doing peds scoliosis surgery

A
  1. Low BMI (<18)
  2. Short (height percentile <50%)
  3. Large curve
  4. Large correction
  5. Increased lumbar lordosis
  6. Increased lumbar lateralization
  7. increase Sagittal kyphosis
41
Q

List three spinal conditions that have gadolinium enhancement

A
  1. Infection
  2. Tumor
  3. Post-op scar
42
Q

Order of ossification of the pediatric elbow (didn’t ask for age)

A
  1. Capitulum (1 female, 1 male)
  2. Radial head (3 female, 4 male)
  3. Medial epicondyle (5 female, 6 male)
  4. Trochlea (7 F, 8 M)
  5. Olecranon (9 F, 10 M)
  6. Lateral epicondyle (11 F, 12 M)
43
Q

Chronic posterior shoulder dislocation; intra-op still unstable and large Hill-Sachs. List 4 ways to manage the Reverse Hill-Sachs.

A
  1. Modified McLaughlin’s to “fill in” the defect with subscapularis tendon
  2. Osteochondral allograft.
  3. De-rotational osteotomy of proximal humerus
  4. Hemiarthroplasty
  5. Reverse or total shoulder arthroplasty (if glenoid is shit)
  6. Reduction of the intra-articlular fragments of the Hill-Sachs by elevation of the impacted cartilaginous pieces and bone grafting underneath. (This is for acute)
44
Q

What components make up Mirel’s criteria?

A
  1. Lesion size (<1/3, 1/3-2/3, and >2/3 the cortical diameter)
  2. Pain (mild, moderate, severe)
  3. Location (Upper Extremity, Lower extremity, Intertrochanteric region)
  4. Lesion characteristics (Blastic, Mixed, Lytic)
45
Q

In soft tissue sarcoma, other than metastatic disease, what are the 3 most important determinants of a worse prognosis?

A
  1. Extra compartmental
  2. Size (>5 cm in cross section is a poor prognostic factor)
  3. Histological Grade
  4. Deep vs Superficial
  5. mets

Orthobullets/ FRCSC Canadian Board (121 decks)

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