2013 Flashcards
An injury to the Rubrospinal tract of the spinal cord will result in dysfunction of what?
a. Autonomic nervous system disruption
b. Muscle Tone and involuntary muscle control
c. Decreased flexor strength of upper extremity
d. Voluntary Muscles
B
2024F consensus
The importance of the tract lies in the maintenance of muscle tone and in the regulation of rudimentary motor skills that are refined by corticospinal control.[9] With the corticospinal tract, the rubrospinal tract controls hand and finger movements in addition to flexor muscles.
Sacral level (S2-4) myelomeningocele, community ambulator, hip dislocation. What osteotomy is contra-indicated?
a. Salter
b. Pemberton
c. Chiari
d. Dega
A
Salter is redirectional osteotomy and provides anterior coverage at expense of posterior coverage, hips in myelo have deficiencies posterior therefore will make that worse. Do NOT do salter on neuromuscular and CP kids
B and D: are acetabuloplasty which are used to reduce the volume of the cup and redirect, and are ok for neuromuscular kids. In particular, the Dega aims to achieve more posterior coverage… the Pemberton actually provides anterolateral coverage so not a great option if posterior insufficiency like in CP.
C: Chiari is a salvage procedure
REPEAT: The recurrent laryngeal nerve is a branch of the:
a. Ansa cervicalis
b. Vagus nerve
c. Subclavian nerve
d. Thoracic major
e. Phrenic nerve
f. Superior laryngeal nerve
B
Branch of the vagus nerve. Supplies all the intrinsic muscles of the larynx except cricothyroid muscles. The nerve emerges from the vagus at the level of the aortic arch. The left loops under the arch. The right loops under the right subclavian. The reason why they are called “recurrent” is that the path is the opposite from the direction of the nerve they branch from. The posterior cricoarytenoid muscle is the only muscle that can open the vocal cords and it’s innervated by the recurrent laryngeal nerve.
REPEAT: What plexus can be injured in pelvic surgery, leading to retrograde ejaculation?
a. Lumbar
b. Lumbosacral
c. Superior hypogastric
d. Inferior hypogastric
e. Superior pre sacral
f. Inferior pre sacral
C
Sup Hypogastric = Retrograde ejaculation
Lumbar plex = numb scrotum (genitofemoral nerve)
Pudendal = erectile dysfunction
Which portal for elbow arthroscopy has the highest risk of nerve injury?
a. Anteromedial
b. Posteromedial
c. Posterolateral
d. Anterolateral
D
2024F consensus
If stem specifies sensory only then anteromedial. (2024F consensus)
70 year old woman with Xray showing a comminuted spiral subtroch femur fracture, described as being “high energy”. treated with a blade plate, two screws into intertroch region, then 8 screws distal to comminution (bridge), which was not anatomically reduced (ie, a bridge plate). Repeat question, which we found confusing going through previous years – seeing it didn’t really help.
a. Will fail as bone graft wasn’t used
b. Will fail as bone is osteopenic
c. Will fail as reduction wasn’t anatomic
d. Won’t fail as force is distributed over a long plate
e. Will fail because it was not nailed
D
Retarded question, but prior consensus has been D, so that’s what we’re going with
What findings do you have in Osteomalacia:
a. Osteoid is highly mineralized
b. May present with pseudofractures
c. Increased serum Calcium
d. Decrease ALP
B
Answer: B - most common cause is Vit D deficiency
A: False - Osteoid is unmineralized.
C: False - Hypocalcemia is common (can have Chvostek sign) (Vit D is also low)
D: False - Alk Phosp is high because osteoblasts are compensating and being active
Osteomalacia is a metabolic bone disease where defective mineralization results in a large amount of UN-mineralized osteoid. Qualitative defect. (osteoporosis is quantitative). Rickets and Osteomalacia is a manifestation of the same process. Incidence in the US is low due to exposure to sunlight and Vitamin D in dairy products. Risk factors: Vit D deficiency, celiac disease, renal osteodystrophy, hypophosphatemia, chronic EtOH, tumours. On imaging will see: Looser’s zones (stress fractures) - often seen in medial femoral cortex, pubic ramus, scapula; proximal femur fractures, biconcave vertebral bodies, protrusion. Diagnosis is obtained through histology after doing a transiliac biopsy. Treatment is typically large doses of PO Vit D.
What blood work would you expect to find in Hypophosphatasia?
a. Low ALP, low Ca, normal PTH
b. Low ALP, normal Ca, normal PTH
c. Normal ALP, low Ca, normal PTH
d. Normal ALP, normal Ca, low PTH
B
Treatment of malignant undifferentiated pleiomorphic sarcoma of bone aka. fibrous histiocytoma (MFH) of bone?
a. Wide resection
b. Wide resection and chemo
c. Wide resection and radiation
d. Wide resection and chemo and radiation
B
WHO says chemo plus wide resection.
Soft tissue is treated with wide resection and rads. Bone is treated with chemo
For any sarcoma of bone, Tx is: Neoadjuvant chemo 🡪 Repeat staging 🡪 Wide excision (send specimen to pathology to assess % necrosis) 🡪 Adjuvant chemo
*Exception is chondrosarcoma, as these are chemo-resistant
UPS mets to Lung is most common but can also go to lymph nodes, bone and liver.
Bisphosphonates in children, all of the following are true EXCEPT:
a. Flu-like illness
b. Immediate drop in Calcium
c. Growth suppression
d. Chronic lower bone remodeling
C
Answer: C - FALSE: although believed, this has not been proven
A: true - see below. With IV administration
B: Symptomatic hypocalcemia can occur and lead to ECG changes
If GERD was mentioned this would be true
If erosive esophagitis was mentioned, this would be true
Regarding Osteogenesis Imperfecta all are true, EXCEPT:
a. Fractures take longer to heal
b. Fractures heal with decreased/abnormal strength
c. 50% risk of scoliosis
d. With age symptoms improve
A
JAAOS 2008 Osteogenesis Imperfecta: Diagnosis and Treatment
Fracture healing itself is not necessarily prolonged in OI, and injuries need not be immobilized longer than normally required
All are true of Down Syndrome EXCEPT?
a. Don’t need screening before most sports
b. C-spine x-rays not good predictors of future instability
c. 25% have C1-2 instability
d. Only affects C1-C2
e. Usually asymptomatic (from Saskatchewan exam)
D
Occipitocervical + atlantoaxial instability
ADI > 10mm warrants MRI and possibly surgery
Screening radiographs for upper c-spine instability do not meet the criteria for an effective screening test and are not warranted in asymptomatic individuals.
Screening if participation in high risk sports (gymnastics/diving)
Screening before surgery
Lateral radiographs have low reproducibility, leading to decreased sensitivity and specificity in detecting instability.
They also asserted that asymptomatic instability has not been proved to be a risk factor for symptomatic instability.
All are causes of compression at the cubital tunnel EXCEPT:
a. Arcade of Struthers
b. Arcuate (Osborne) ligament
c. Medial edge of brachialis
d. 2 heads of FCU
e. MCL
C
All of the following are cause of medial elbow pain in the overhead athlete EXCEPT:
a. Flexor-Pronator tendinosus
b. Valgus-extension overload
c. Ulnohumeral OA
d. Cubital tunnel syndrome
C
JAAOS: Valgus instability, valgus extension overload, medial epicondylitis, Flexor pronator injuries or ruptures, ulnar neuropathy can also present with pain and paresthesia
Ligaments disrupted in a lesser arc perilunate dislocation (all EXCEPT):
a. Volar radiolunate
b. Dorsal radiocarpal
c. Scapholunate
d. Lunocapitate
e. Lunotriquetral
A
