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Orthobullets/ FRCSC Canadian Board > 2016 SAQ > Flashcards

2016 SAQ Flashcards

1
Q

List 6 risk factors for non-therapeutic opioid abuse

A
  1. Age <45
  2. Personal or family hx of substance abuse
  3. Nicotine dependency
  4. Depression
  5. Other psychiatric diagnoses (e.g. schizophrenia, bipolar disorder)
  6. Lower level of education
  7. History of preoperative opioid use
  8. Early refill requests
  9. Reports of “lost or stolen” prescriptions
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2
Q

List 3 advantages of opening wedge HTO over closing wedge for genu varum

A
  1. Avoid proximal tib/fib joint
  2. Avoid risk of injury to peroneal nerve
  3. Provides the ability to achieve a predictable correction in coronal and sagittal planes
  4. Restores bone stock; easier reconstruction to TKA in the future
  5. Can be combined with other procedures such as ligament reconstruction with relative ease
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3
Q

List 5 indications to perform acute ORIF of a scaphoid fracture

A
  1. Open #
  2. Proximal pole #
  3. Displaced scaphoid waist # >1mm
  4. Unstable vertical or oblique #
  5. Humpback deformity (intrascaphoid >35°)
  6. DISI deformity (radiolunate >15°)
  7. Trans-scaphoid perilunate fracture-dislocation
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4
Q

List 3 causes of swan neck deformity associated with synovitis in rheumatoid arthritis

A
  1. Synovitis of MCP joint causes alteration of the volar plate and MCP joint subluxation. At the end, it produces a shortening of the intrinsic muscles leading to PIP joint hyperextension (MCP subluxation/dislocation, intrinsic tightness)
  2. Synovitis of PIP joint produces degeneration of the FDS insertion and of the volar plate and collateral ligaments. It ultimately determines abnormal hyperextension of the PIP joint (PIP volar plate attenuation, FDS rupture over PIP)
  3. Synovitis of the DIP joint produces the rupture of the terminal extensor tendon insertion. Mallet finger is the result of the synovitis (terminal extensor tendon rupture at DIP)
  4. Intrinsic tightness
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5
Q

List 6 stabilizers of the DRUJ

A
  1. TFCC (Volar/dorsal radioulnar ligament, Meniscal homologue, Articular disc, ECU subsheath, Ulnar collateral ligament, Volar ulnocarpal ligament complex (ulnotriquetral ligament, Ulnolunate ligament)
  2. Bony congruence
  3. PQ
  4. ECU
  5. Joint capsule
  6. Interosseous membrane
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6
Q

List 4 technical considerations for surgical management of an anteromedial coronoid facet fracture.

A
  1. Ulnar nerve needs to be released
  2. Exposure can be obtained by Taylor medial approach (elevate the medial muscles from the base of the olecranon, this can be extended by cutting the flexor-pronator mass and elevating it distally – leave some of the tendon for later repair)
  3. Lateral collateral ligament should be evaluated
  4. Stable fixation with plate or screws is used
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7
Q

List 4 intra-operative ways to assess the height of a shoulder hemi-arthroplasty for a proximal humerus fracture to avoid proud implantation

A
  1. Medial calcar: a portion of medial calcar is usually intact, and the medial collar of the prosthesis should be flush with remaining calcar.
  2. Pectoralis major tendon: the average distance from the proximal edge of the tendon to the highest point of the humeral head is 5.6±0.5cm.
  3. Tuberosity position: with the trial head in place, the tuberosity should reduce to the shaft and remain beneath the humeral head without undue tension. Head-to-tuberosity distance should be ~10mm.
  4. Intraoperative examination of soft-tissue tension including the deltoid, rotator cuff and long head of biceps.
  5. If the arm is pulled distally, the humeral head should not be able to be subluxed more than one third in relation to the glenoid.
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8
Q

List 3 local biologic or anatomical factors to predict poor healing of a rotator cuff

A
  1. Age >65
  2. Fatty degeneration/fatty atrophy
  3. Massive cuff tear; tear size >2cm
  4. Greater muscle-tendon unit retraction
  5. Comorbidities: smoking, DM, dyslipidemia
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9
Q

List 4 surgical options for a large (~25%) reverse Hill-Sachs defect from posterior dislocation.

A
  1. Lesser tuberosity transfer
  2. Subscapularis transfer
  3. Humeral head allograft
  4. Hemiarthroplasty
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10
Q

List 4 options to manage posterior glenoid bone loss when doing an arthroplasty for osteoarthritis

A
  1. Eccentric reaming (<15° of retroversion)
  2. Humeral head autograft/allograft (>15° of retroversion of <15mm of glenoid bone)
  3. Augmented glenoid component
  4. RTSA (primary reverse is indicated if >27° retroversion or >80% of humeral head subluxation)
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11
Q

Name the 4 borders of the Quadrangular space. Name the two structures pass through this space

A
  • 4 borders: teres minor, teres major, shaft of humerus, long head of triceps
  • Content: axillar nerve, posterior circumflex humeral artery
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12
Q

Name the 2 muscles innervated by the lower subscapular nerve

A
  1. Subscapularis
  2. Teres major
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13
Q

List 4 adverse effects associated with BMP-2 use in spinal surgery

A
  1. Cervical spine swelling (including life threatening retropharyngeal swelling)
  2. Nerve root compression/postoperative radiculopathy
  3. Neuroforaminal and soft tissue ectopic bone and bone cyst formation
  4. Vertebral bone resorption
  5. Infection
  6. Seroma/hematoma
  7. Retrograde ejaculation
  8. Ectopic bone formation
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14
Q

List 6 radiographic findings in the cervical spine in Juvenile Rheumatoid Arthritis

A
  1. (Synovial inflammation/pannus formation at the occipitoatlantoaxial joints)
  2. Ankylosis of zygoapophyseal joints (most frequent finding)
  3. Erosion of odontoid waist (odontoid peg) due to synovial hypertrophy (“apple core” appearance)
  4. Atlantoaxial impaction (cranial settling)
  5. Widening of ADI
  6. Hypoplasia of vertebral bodies in both AP and transverse planes
  7. Narrowing of intervertebral disk spaces
  8. Subaxial subluxation
  9. Soft-tissue calcification
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15
Q

List 4 radiographic features suggesting that the lumbar curve below a throracic structural curve is also structural

A
  1. If it doesn’t bend down to <25° on ipsilateral bending films
  2. Segmental kyphosis >20°, such as for proximal thoracic curve (T2-T5) or thoracolumbar curve (T10-L2)
  3. If larger magnitude than the thoracic curve
  4. Others (not as strong)
  • Absolute curve >55°
  • C modifier
  • Apical vertebral translation/rotational ratio>1.2
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16
Q

List 4 radiographic features to predict progression of infantile scoliosis

A
  1. RVAD >20°
  2. Phase II rib
  3. Cobb angle >20°
  4. Double curves
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17
Q

List 5 risk factors for poor prognosis in a type II odontoid fracture

A
  1. Older age (age>50)
  2. Initial fracture displacement >5mm
  3. Posterior displacement
  4. Fracture comminution
  5. Inability to achieve or maintain a reduction
  6. Delay in treatment
  7. Angulation >10°
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18
Q

List 4 factors indicating instability and late progressive deformity in a pediatric patient with spinal TB infection

A
  1. Retropulsion
  2. Subluxation
  3. Lateral translation
  4. Toppling: line in front of the distal healthy vertebral meets the top part of healthy vertebrae above it
19
Q

List 3 upper extremity and 3 lower extremity clinical findings associated with cervical spondylytic myelopathy.

A
  1. Upper extremity: Hoffman, finger escape sign, inverted radial reflex, grip and release test
  2. Lower extremity: Babinski, Clonus, wide-based gait, altered tandom-gait
20
Q

List 4 neurophysiologic protective measures taken when doing spinal surgery to maintain perfusion to the cord

A
  1. Maintaining MAP>65
  2. Avoid hypothermia
  3. Temporary clamping of the segmentals
  4. Monitoring MEPs
21
Q

List 11 myotomes used in the ASIA spinal assessment

A
  1. C5: elbow flexion
  2. C6: wrist extension, elbow flexion
  3. C7: elbow extension, wrist flexion
  4. C8: finger flexion
  5. T1: finger abduction
  6. L2: hip flexion
  7. L3: knee extension
  8. L4: ankle dorsiflexion
  9. L5: great toe extension, hip abduction, hip extension
  10. S1: ankle plantarflexion
  11. S2,3,4: voluntary anal contraction
22
Q

List 4 radiographic findings associated with femoroacetabular impingement

A
  1. Abnormal alpha angle (>42° is considered abnormal [some people say >50]; >63° is more likely to be symptomatic)
  2. Abnormal head-neck offset (<0.15)
  3. Cross-over sign
  4. Posterior wall sign
  5. Prominent ischial spine sign
23
Q

List 5 reasons for persistent groin pain post THA causing decreased function

A
  1. Infection
  2. Aseptic loosening
  3. Iliopsoas impingement/tendonitis
  4. Synovitis
  5. Component malpositioning
  6. Component impingement
  7. Periprosthetic fracture
  8. Pelvic fracture
  9. Other pathologies (inguinal hernia, tumor, spinal pathology)
24
Q

List 4 soft tissue releases for valgus knee

A
  1. Lateral capsule
  2. Ext tight: release IT band, posterolateral corner/posterolateral capsule, or lateral head of gastrocnemius
  3. Flex tight: check PCL involvement then consider releasing popliteus
  4. Both flex/ext tight: release LCL
25
Q

List 5 reasons for decreased extension post ACL reconstruction

A
  1. Impingement (cyclops lesion=anterior intercondylar notch scar tissue)
  2. Tibial tunnel too anterior
  3. Femoral tunnel at over the top position
  4. Graft tensioning in flexion (you have to do the final tensioning in flexion)
  5. Postop immobilization in flexion
  6. Poor rehab/prehab
  7. Capsulitis (you lose both flexion and extension as opposed to arthrofibrosis when they only lose extension)
26
Q

List 6 indications to do acute amputation in severe lower extremity trauma

A
  1. Severe soft tissue injury/loss
  2. Unreconstructable bony injury
  3. Irreparable vascular injury
  4. Prolonged (>8hrs) warm ischemia time
  5. Patient condition precluding salvage (e.g. unstable or in extremis)
  6. EtOH/socioeconomic status
  7. Serious associated polytrauma
  8. Severe ipsilateral foot trauma
27
Q

List 6 points to discuss when obtaining informed consent

A
  1. Nature of diagnosis/disease
  2. Details of proposed treatment
  3. Benefits of proposed treatment
  4. Risks associated with proposed treatment
  5. Alternative options
  6. Prognosis and expected outcomes
28
Q

Describe how to perform a Canale view

A
  1. maximum equinus, 15 degrees pronated, Xray 75 degrees cephalad from horizontal
  2. Optimal view for talar neck
29
Q

List 4 radiographic relationships to assess a Lisfranc injury

A
  1. Medial border of the second MT and the medial border of the middle cuneiform on AP
  2. Medial border of the fourth MT and the medial border of the cuboid on oblique
  3. Diastasis between the first MT–medial cuneiform and second MT of 2 mm greater than on the contralateral side
  4. TMT joint subluxation of 2 mm greater than on the contralateral side
  5. Avulsion of the second MT base or medial cuneiform produces a fleck sign
  6. Step-off at the second TMT joint (any TMT joint) on lateral
30
Q

List 4 causes other than diabetes for Charcot foot.

A

SAMPLe CDS

  1. Syphilis
  2. Alcohol
  3. Myelomeningocele
  4. Polio
  5. Leprosy
  6. Congenital insensitivity to pain
  7. (Diabetes)
  8. Syrinx
31
Q

List 6 pathoanatomic feautures associated with idiopathic flat foot

A
  1. Hindfoot valgus
  2. Decrease in medial longitudinal arch
  3. Talar head is uncovered and plantarflexed
  4. Forefoot abduction
  5. Forefoot pronation
  6. Tight heel cord
  7. Reconstitution of arch with heel rise
  8. Painless
  9. Decreased calcaneal pitch
  10. Decreased talo-first MT angle
32
Q

Patient with fibrous dysplasia of the whole humerus. List one benign tumor that may develop. List one malignant tumor that may develop

A
  1. Benign: intramuscular myxoma in Mazabraud syndrome
  2. Malignant: osteosarcoma, fibrosarcoma, malignant fibrous histiocytoma
33
Q

List 6 sites of compression of the ulnar nerve at the elbow

A
  1. Arcade of struther
  2. Medial intermuscular septum
  3. Medial epicondyle
  4. Osborne’s ligament
  5. 2 heads of FCU
  6. Deep flexor fascia
  7. Anconeus epitrochlearis
34
Q

Label 5 zones on slide of articular cartilage

A
  1. Superficial zone
  2. Intermediate zone
  3. Deep layer
  4. Tidemark
  5. Subchondral bone
35
Q

List 4 features on a pediatric AP hip xray (only right hip shown) that suggest DDH.

A
  1. Ossific nucleus is superior to Hilgenreiner line
  2. Ossific nucleus is lateral to Perkins line
  3. Delayed appearance/smaller ossific nucleus
  4. Disrupted Shenton’s line
  5. Widened tear drop
  6. Shallow acetabulum (increased acetabular index)
  7. Decreased CE angle
  8. Decreased femoral head coverage
36
Q

List 3 radiographic features suggesting AVN in pediatric DDH

A
  1. Failure of appearance or increase in size of ossific nucleus within 1 year after reduction
  2. Broadening of femoral neck within 1 year after reduction
  3. Fragmentation or increased density of ossific nucleus
  4. Deformation of ossified femoral head or neck
37
Q

List 3 reasons to prophylactically pin a 13 year old with stable grade 2 SCFE

A
  1. Associated endocrinopathy
  2. Obesity
  3. Unable to have reliable follow-up or chance of significant delay in presentation
  4. Posterior slope angle 12-15°
  5. (Age <10 or >16)
38
Q

List 4 long term outcomes of osteomyelitis in a pediatric patient

A
  1. Pathologic #
  2. Angular deformity
  3. LLD
  4. Chronic pain
  5. Chronic draining sinus
  6. Brodie’s abscess
  7. Septic arthritis
  8. Malignant transformation (Marjolin’s ulcer)
39
Q

List 4 “MAJOR” seronegative spondyloarthropathies

A
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Reactive arthritis
  • Inflammatory bowel disease
40
Q

List 3 strategies for tourniquet management in surgery planned with projected tourniquet time of 2.5 hours

A
  1. Do not inflate unless necessary
  2. Deflated for 5 min for every 30 min of inflation time
  3. Limit tourniquet pressure (typically systolic BP +100 mm Hg for upper arm and SBP + 100–150 mm Hg for thigh)
41
Q

List 4 complications of fracture table and hemi-lithotomy position

A
  1. Pudendal nerve injury
  2. Sciatic nerve injury
  3. Common peroneal injury
  4. Well-leg compartment syndrome
  5. Skin ulceration
42
Q

List 3 ways to assess rotation when nailing a femoral shaft fracture

A
  1. Match the lesser trochanter profile to the contralateral side
  2. Fluoroscopic assessment of cortical width
  3. Tornetta method: match the femoral neck version with preoperatively determined femoral neck version of the contralateral side
  4. Clinical examination
43
Q

List 3 ways to reduce varus deformity when nailing a subtrochanteric femur fracture.

A
  1. Avoid lateral starting point with trochanteric entry nail
  2. Use piriformis entry nail
  3. Open reduction and clamping
  4. Ream in reduced position
  5. AP blocking screw
  6. Abduction of the lower extremity
  7. Medially directed force using the entry reamer or awl
44
Q

List 4 radiographic features that predict progression in infantile Blount’s disease

A
  1. MDA >16°
  2. Medial physeal bar
  3. Sloping of medial epiphysi/depressed medial hemiplateau (the angle between a line through medial physis and a line through lateral physis) >60°
  4. Varus LE alignment
  5. Philadelphia sign: lateral subluxation of tibial epiphysis
  6. Contribution of tibial deformity as a percentage of the total (TV/LV) >50%

Orthobullets/ FRCSC Canadian Board (121 decks)

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