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Orthobullets/ FRCSC Canadian Board > 2014 SAQ > Flashcards

2014 SAQ Flashcards

1
Q

Name 5 stabilizers of the DRUJ

A
  1. TFCC (volar and dorsal radioulnar ligaments, meniscus homologue, articular disc, ECU subsheath, ulnolunate and ulnotriquetral, ulnar collateral ligament)
  2. Bony congruity
  3. Joint capsule
  4. IOM
  5. Pronator quadratus
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2
Q

Describe the “push-up” test to diagnose posterolateral instability of the elbow

A
  1. Full supination
  2. From flexed to extended position at elbow
  3. Pain, subluxation, apprehension positive
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3
Q

Name 5 modifiable risk factors for osteoporosis (other than drugs/medications)

A
  1. low body weight
  2. low protein intake
  3. smoking
  4. heavy ETOH consumption
  5. sedentary life style
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4
Q

Name 4 guidelines parameters to perform selective thoracic fusion for adolescent idiopathic scoliosis

A
  1. Apical vertebral translation ratio >1.2
  2. Apical vertebral rotation ratio > 1.2
  3. Cobb angle ratio > 1.2
  4. Flexibility with side bending to < 25°
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5
Q

Name 3 radiographic ways to judge rotation of a diaphyseal femur fracture

A
  1. Lesser trochanter profile
  2. Fracture fragment reduction
  3. Cortical widths / Diaphyseal diameter / Endosteal diameter
  4. Tornetta method: To determine pts normal femoral antevesriosn (AV), a fluoroscope was used to perform a true lateral image of the hip. Then the C-arm was moved to the knee and rotated until both condyles showed overlapping. The difference of rotation of the C-Arm was considered as the degree of the patients normal AV
  5. CT scanogram (not intraop … or with O arm J)
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6
Q

Name 4 stabilizers of the AC joint

A
  1. AC joint capsule
  2. AC ligaments (superior strongest)
  3. CC ligaments (trapezoid – lateral, conoid – medial)
  4. Trapezius, deltoid, deltotrapezial facia
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7
Q

A patient has lunate AVN. List the 4 stages

A

1 – Xrays normal, MRI findings

2 – sclerosis

3 – fragmentation / collapse (3A without DISI, 3B with DISI)

4 – perilunate arthritis

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8
Q

Name 4 sites of compression in the elbow and proximal forearm that can cause AIN compression

A
  1. pronator teres (deep head)
  2. FDS arch / edge
  3. Lacertus fibrosis
  4. FDS to FDP accessory muscle
  5. Gantzer’s muscle
  6. Aberrant muscle of FCRB or Palmaris profundus
  7. Thrombosis of ulnar / radial artery
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9
Q

What are 3 cervical spine findings in Down syndrome

A
  1. AO instability
  2. AA instability
  3. basilar invagination/ AA Impaction
  4. subaxial subluxation
  5. Cervical spondylosis
  6. Os odontoidium
  7. Persistent dentocentral synchondrosis
  8. SB occulta of C1
  9. Ossiculum terminale
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10
Q

A patient sustains a posterior shoulder dislocation. Shown an x-ray of a reduced shoulder with a large reverse hill-sachs lesion. List 3 reasonable surgical treatment options

A
  1. Modified Maclaughlin
  2. Hemi-arthroplasty
  3. Bone grafting (osteochondral allograft or disempaction ORIF)
  4. Reverse TSA
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11
Q

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

A
  1. Perineal skin injury
  2. Sciatic / Common Peroneal nerve injury
  3. Pudendal nerve injury
  4. Obturator nerve injury
  5. Compartment syndrome
  6. Vascular injury
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12
Q

List 6 features associated with increased risk of peri-operative mortality in hip fractures

A
  1. Multiple medical comorbidities (>/= 3)
  2. Male
  3. Age (>85)
  4. Delayed treatment (>48 hrs)
  5. ASA class III / IV
  6. Cognitive status
  7. Intertroch worse than femoral neck
  8. CRF
  9. Preoperative mobility
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13
Q

List 4 relative indications to perform contralateral prophylactic pinning in a patient with SCFE

A
  1. Hypothyroidism / Endocrine abnormalities
  2. Age (<10)
  3. Obese
  4. Inability to follow up
  5. Contralateral pain
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14
Q

Three ways to size a radial head

A
  1. Based on resected radial head
  2. Symmetric medial and lateral ulnotrochlear joint (delta river sign)
  3. Proximal radioulnar joint articulation (within 1 mm of radial side of coronoid)
  4. “Jam-that-fucker-in-there” technique
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15
Q

List 6 causes of acquired coxa vara

A
  1. Femoral neck fracture
  2. SCFE
  3. Perthes / AVN
  4. Fibrous Dysplasia
  5. Osteomyelitis / Septic arthritis
  6. Tumor
  7. Rickets
  8. Cretinism
  9. Iatrogenic
  10. Pagets
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16
Q

Other than sacroilitis, name 3 clinical criteria to diagnose ankylosing spondylitis

A
  1. Low back pain and stiffness of at least 3 months duration improved by exercise and not relieved by rest
  2. Limitation of motion of the lumbar spine in both the sagittal and frontal planes
  3. Limitation of chest expansion relative to values of normal for age and sex
  4. Uveitis / Iritis
  5. Thoracic Kyphosis (Increased Occiput – wall test / Chin-Brow, Chin on chest deformity)
  6. Hip / Shoulder arthritis, hip flexion contacture
  7. Dactylitis
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17
Q

What are clinical features of Class IV shock?

A
  1. Anuria
  2. Tachycardia (>140)
  3. Decreased GCS / comatose
  4. Hypotension / decreased PP
  5. RR >40
  6. Not fluid responsive
  7. 40% , >2L blood loss
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18
Q

List three considerations for applying a pediatric halo safely

A
  1. More pins (6-8)
  2. Less torque (4 inch pounds)
  3. CT scan for skull thickness
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19
Q

List 8 components of the pre-op checklist approved by WHO that will decrease patient morbidity and mortality

A
  1. Patient name
  2. Surgical procedure
  3. Surgical site
  4. Surgical site marked
  5. Consent signed
  6. Imaging displayed
  7. Introduce team
  8. Preop antibiotics
  9. NPO status (not technically on WHO checklist, but we do this)
  10. Allergies
  11. Possibility for >500 mL blood loss
  12. Anesthetic safety check
  13. Difficult airway / aspiration risk
  14. Critical or important steps
  15. Equipment available
  16. Pulse oximeter
  17. Nursing concerns
20
Q

List 3 prognostic factors associated with poor prognosis in a patient with septic arthritis.

A
  1. Bacteremia / septic shock
  2. Resistant / atypical organism
  3. Delayed presentation / treatment
  4. Very young / old
  5. Immunocompromised
  6. Pre-existing DJD
  7. Lack of friends
21
Q

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

A
  1. Spinal cord injury
  2. Radiculopathy
  3. Translation (>3.5mm)
  4. Kyphosis (>11 degrees)
  5. Facet fracture / dislocation
  6. >7mm combined overlap of lateral masses on OMO view
22
Q

Name 4 findings on x-ray that may lead someone to falsely diagnosing a cervical spine injury in a pediatric patient

A
  1. Physiologic increased ADI (up to 5mm)
  2. Pseudosubluxation (C2/3)
  3. Increased soft tissue swelling and loss of lordosis with agitation / crying
  4. Synchondrosis
  5. Wedge shaped vertebral bodies (up to 3mm anterior wedging)
23
Q

Name 3 features of central cord syndrome

A
  1. Upper > lower
  2. Distal (hands / forearm) > proximal (upper arm)
  3. Cape distribution of sensory loss
  4. Upper extremity discoordination
  5. Unsteady gait
  6. Sacral sparing
  7. Burning upper extremity radicular pain
24
Q

According to the ASIA sheet, what level corresponds to the following actions

A

a) PIP flexion of 3rd finger à C8
b) wrist extension à C6
c) long toe extension à L5
d) elbow flexion à C5

25
Q

List three complications with managing a pediatric tibial tubercle fracture

A
  1. Compartment syndrome
  2. Recurvatum (secondary to growth arrest)
  3. Vascular injury
  4. Stiffness
  5. Bursitis
26
Q

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

A
  1. CXR / CT chest
  2. LDH
  3. Bone scan
  4. Bone marrow biopsy
  5. MRI whole bone
  6. Biopsy? (w/ CD99 staining)
  7. Chromosome analysis?
27
Q

Patient with history of thyroid cancer. Bone scan (not shown) is said to have multiple bony lesions. He has a pathologic femur fracture

A

a. What is your treatment ? (1) CMNail
b. What radiographic intervention would you want to do preoperatively? Embolize
c. What systemic adjunct would you want to give to the patient? Bisphosphonates
d. What would you want to do post-operatively to reduce the chance of progression. Radiation

28
Q

You’re involved in a study comparing tension band vs plate fixation of olecranon fractures. There is a patient in ER that fits the inclusion/exclusion criteria. You are in the OR but that patient could go next in the OR. You want to send your medical student to obtain verbal consent. What are 3 issues with doing this?

A
  1. Consent must be informed
  2. Patient must have capacity to consent
  3. Must be voluntary (not be coerced)
29
Q

Name 4 major criteria to diagnose fat embolism syndrome

A

Petechial rash, confusion / mental status changes, hypoxemia (paO2 <60), pulmonary edema on CXR

30
Q

b. Name 4 minor criteria

A
  1. Retinol emboli, fat in sputum, fat in urine, thrombocytopenia, decreased hematocrit, fever, tachycardia
  2. Additional: tachypnea, SOB, anxiety, PCO2 >55, pH<7.3
31
Q

List 6 causes of a cavovarus foot in an adult

A

Neurologic

  1. CMT
  2. CP
  3. Post stroke
  4. Anterior horn cell disease (Polio)
  5. Spinal cord lesions (injury, tumor, spina bifida)
  6. Friedrich’s Ataxia
  7. ALS
  8. Huntington’s

Traumatic:

  1. Compartment syndrome
  2. talar neck malunion
  3. Peroneal nerve injury

Residual clubfoot, idiopathic

32
Q

List 4 bony or ligamentous anatomical features of the Lis Franc joint that makes it very stable

Which ligaments are stronger - plantar or dorsal

A
  • Inset 2nd metatarsal
  • Transverse or Roman arch structure
  • High congruity
  • Multiple / broad ligamentous attachment,
  • strong Lisfranc ligament

Plantar

33
Q

Name 4 reasons to develop hallux varus after a surgery for hallux valgus

A
  1. Sesamoidectomy (fibular)
  2. Over resection of eminence
  3. Overcorrection with metatarsal osteotomy
  4. Aggressive medial imbrication
  5. Excessive lateral release
34
Q

List 4 radiographic findings in femoral acetabular impingement

A

CAM

  1. increased alpha angle (>50)
  2. femoral retroversion
  3. decreased offset
  4. decreased head neck ratio

Pincer

  1. lateral acetabular overhang / overcoverge (increased CEA)
  2. Crossover sign
  3. Acetabular protrusion
  4. Coxa profunda (deep acetabular socket. On pelvis x-rays it is seen as the acetabular fossa being medial to the ilioischial line. It should be differentiated from protrusio acetabuli, where the femoral head is seen additionally medial to the ilioischial line)
35
Q

Name 5 anatomical reasons for patellar instability

A
  • external tibial torsion
  • increased femoral anteversion
  • trochlear dysplasia
  • patella alta
  • genu valgum
  • increased TT-TG
  • lateral femoral condyle hypoplasia
  • lateral patellar tilt
  • hypoplastic lateral patellar facet
36
Q

Given a picture of an AP pelvis with bilateral BHR. R BHR has femoral neck #. List 4 risk factors why this would happen.

A
  1. Femoral neck notching
  2. varus malposition
  3. previous AVN
  4. Trauma
  5. Osteoporosis
  6. Female
  7. acetabular malposition (femoral neck impingement)
37
Q

Patient presents 8 months after TKA. His preoperative flexion was 120 degrees, but he now only has 75 degrees. In the absence of infection, mention 4 causes of decreased flexion.

A
  1. Poor rehabilitation
  2. Adhesions, Arthrofibrosis
  3. Oversized femoral component
  4. Overstuffed patellofemoral joint
  5. Patella baja
  6. Elevated joint line
  7. Posterior osteophytes
  8. HO
  9. Malrotation
  10. Excessive tightening of extensor mechanism during closure
38
Q

45 y.o. male with left hip pain. Shown an AP pelvis. List 3 common causes of his left hip pain. You had to determine that he had AVN of the left hip

A
  • Steroids
  • Trauma
  • Alcoholism
  • Radiation
  • Sickle Cell
  • Infection
  • Other: Gaucher’s, dysbarism, Lupus, Coagulopathy (hyper), leukemia, lymphoma, pancreatitis, rheumatoid, amyloid
39
Q

Patient with THA 15 years ago and sustains a periprosthetic fracture. List 3 things that may affect your treatment plan

A
  • Loosening
  • Location of fracture
  • Bony deficiencies
  • Bone quality
  • Components used
  • Infection
40
Q

3 reasons for why the Laterjet procdure is effective in decreasing instability

A
  1. Anterior bone block that increases the excursion distance
  2. Restorating bony contour of glenoid
  3. conjoint tendon sling effect
  4. CA lig. Support to the capsule
  5. Tensioning of Subscap and inferior capsule
41
Q

List 4 findings on clinical exam that you would see in a 6 month old kid to diagnose a posterior shoulder dislocation resulting from brachial plexus injury

A
  1. Impaired passive external rotation
  2. Excessive adduction and IR
  3. Asymmetry of the shoulders with palpable humeral head posteriorly
  4. Shortening of the length of the upper arm
  5. Asymmetry of skin fold due to telescoping of humerus and axillary asymmetry
  6. Prominent acromion anteriorly
42
Q

4 inverters of the subtalar joint

A
  • Gastrocnemius
  • Soleus
  • Tib Post
  • Tib Ant
  • +/- FDL / FHL
43
Q

3 ways to prevent patellofemoral maltracking in TKA

A
  1. ER the femoral component
  2. Lateralization of femorl component
  3. ER of the tibial component
  4. Medialization of the patellar component
44
Q

4 ways to determine skeletal maturity in a patient with skeletal maturity

A
  • Bone age (Hand Xray)
  • Risser’s sign
  • Closure of olecrenon apophysis
  • Closure of triradiate
  • Menarche
  • Growth chart
  • Tanner staging
  • Peak growth velocity: Risser 0, Corresponds with olecrenon closure, After triradiate, ~1 year before menarche, Bone age (10.4 men, 11.7 women)
45
Q

2 clinical findings in a patient with Trendelenburg gait

A
  • Hip abductor weakness
  • Trendelenberg sign
46
Q

What are four considerations in selective thoracic fusion for adolescent idiopathic scoliosis?

A
  1. Preserving motion segments
  2. Preventing junctional kyphosis
  3. Shoulder imbalance
  4. Maintaining short fusion lengths

Orthobullets/ FRCSC Canadian Board (121 decks)

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