2022 Flashcards
Emerg doc calls you and wants to know how to reduce and MCP dislocation?
a. Hyperextend MCP to release tension on extensors
b. Use standard orthopaedic technique of inline traction as long as you have adequate anesthesia
c. Flex wrist and PIP to release tension on the long finger flexors
d. Flex MCP to reduce tension on volar plate
C
JAAOS 2009:
Reduction technique:
Simple distraction as a reduction maneuver for MCP joint dislocations is usually unsuccessful and can inadvertently convert a reducible dislocation into an irreducible one. This is because traction on the affected joint can draw the entire volar plate dorsally so that it can be completely folded between the base of the proximal phalanx and the metacarpal head.
The closed reduction maneuver for a dorsal dislocation of the MCP joint is to flex the wrist and the proximal interphalangeal joint of the injured digit to relax the flexor tendons. Pressure is then applied from dorsal to volar to the base of the proximal phalanx. This reduction technique slides the proximal pha- lanx and its attached volar plate over the metacarpal head into a reduced position
What muscle(s) are affected if the suprascapular nerve is impinged at the spinoglenoid notch?
a. Supraspinatous and infracspinatous
b. Infraspinatous
c. Infraspinatous and teres minor
d. Infraspinatous and teres major
B
Two most common sites of compression are the suprascapular notch, and the spinoglenoid notch.
Spinoglenoid ONLY affects the infraspin
Suprascapular notch has SUPRA in it (affects both)
All are associated with Peroneal Tendon tears except:
a. Low lying Peroneus Brevis muscle belly
b. Peroneus Quartus muscle
c. Valgus hindfoot alignment
d. Hypertrophied Peroneal Tubercle
C
JBJS 2008: https://doi.org/10.2106/jbjs.g.00965
Ankle and hindfoot alignment is an important factor predisposing an indivudiaul to tendinopathy
>Cavovarus foot position may cause
overloading of the PTs particularly the PL
Low lying PB muscle belly
Peroneus quartus muscle
>Both low lying PB and PQ result in stenosis within the retromalleolar groove and attenuation of the retinaculum, which increases risk of peroneal tendon disorders
Hypertrophy of the peroneal tubercle
Which of the following is true in regards to uncommon upper extremity amputations?
a. You should avoid doing ray resections for tumours in the index finger
b. Multiple ray resections can be consistent with a functional hand
c. There no is benefit to leaving the carpal bones when doing an amputation at the level of the wrist
d. Amputation of the distal phalanx of the thumb requires some form of reconstruction
B
A: False, need negative margins. Index resection tolerated well.
B: True
C: False. Transcarpal amputations preferred over wrist disarticulations because some flex/ex of wrist is preserved and more functional.
D: False. Amputations distal to the IP joint are well tolerated.
What is true in regards to compartment syndrome?
a. Arteries close first, then arterioles
b. Muscle is more sensitive to ischemia then nerves
c. Ischemia followed by inflammation is the cause of cell damage
d. Muscle injury causes hypokalemia
C
2024F consensus
4yO limping for 2 months with decreased abduction and IR - given an xray of a lateral pillar b femoral head with small amount of extrusion.
a. Physio
b. Varus femur osteotomy
c. Salter
d. Adductor tenotomy and Petrie cast
A
What is THE MOST LIKELY cause of failure in 8yo supracondylar
A - flexion type
B - sagittal obliquity
C - coronal fracture
D - Age
B
What is NOT a cause of persistent thoracolumbar kyphosis in achondroplasia
A - developmental motor delay
B - apical vertebral translation
C - apical wedge vertebrae
D - Hydrocephalus and foramen decompression
D
22M involved in MVC. Abdominal bruising. L1 chance on mri with disruption of posterior ligament complex on T2 sagittal cut. What is the best management?
A. Open approach, pedicle screws, posterior instrumentation and fusion of T12-L1 under compression
B. Percutaneous posterior stablization of T12-L1
C. anterior Corpectomy and cage
D. Non-operative with early weight bearing / mobilization
A
Which of of the following is not a risk factor for negative outcome post acetabulum ORIF?
a. Female
b. >3mm displacement post reduction
c. Smoking
d. Surgeon experience <10 cases per year
C
2024F consensus
53F involved in MVC. Has ⅘ deltoid, but 0/5 all below. C5-C6 fracture with retropulsion shown. Intact bulbocavernosus reflex. No perianal sensation. What is true?
a. Complete injury, decompression and stabilization within 24 hours will improve chances of neurologic recovery/outcomes
b. Incomplete injury, decompression and stabilization within 24 hours will improve chances of neurologic recovery/outcomes
c. Complete injury, decompression and stabilization within 24 hours will worsen neurologic outcomes
d. Complete injury, decompression and stabilization within 24 hours will increase 30-day mortality
A
33M lytic spondy L5-S1 with CT showing the same. Has back pain and radiculopathy below the knees. What is the most likely pattern of symptoms?
a. L4 radiculopathy
b. L5 radiculopathy
c. S1 radiculopathy
d. Central canal stenosis
B
88 year old man with hip OA failed conservative trial and wants THA. What is true of geriatric THA?
a. Worse morbidity and mortality
b. Less pain and functional relief
c. Geriatric consultation doesn’t help
d. Similar periprosthetic # rates between cemented and uncemented THA
A
13F Risser 4 Sanders TOCI score 7 R thoracic curve 40 degrees from T4-T10. 2 years post-menarche. Parents are concerned about physical appearance due to deformity. What is the recommended treatment?
A. Observe B. Brace C. Posterior instrumentation and fusion D. AVBT
A
What is the acetabular dysplasia associated with trisomy 21?
a. Acetabular anterior deficiency
b. Acetabular anteversion
c. Acetabular retroversion
d. Acetabular lateral deficiency
C
All true regarding prevalence except:
a. Proportion of people with a particular disease during a given time period
b. Affected by length of disease process
c. Affected by incidence
d. Measured over a specific period in time
D
I think 4 is most incorrect, but I think all of them are technically correct? Because it doesn’t have to be a specific period of time. You can have point prevalence.
Prevalence definition
total number of cases of a disease existing in a population divided by the total population at a given tine
Incidence definition
the occurrence, rate, or frequency of a disease, crime, or something else undesirable
Point prevalence refers to the prevalence measured at a particular point in time. It is the proportion of persons with a particular disease or attribute on a particular date.
Period prevalence refers to prevalence measured over an interval of time. It is the proportion of persons with a particular disease or attribute at any time during the interval.
Prevalence is based on both incidence and duration of illness. High prevalence of a disease within a population might reflect high incidence or prolonged survival without cure or both. Conversely, low prevalence might indicate low incidence, a rapidly fatal process, or rapid recovery.
64 year old lady with dorsal wrist pain. No trauma. Gradual onset of symptoms. Worse with power grip. Tenderness over ulnar head and radioulnar joint other than that all special signs are normal.X-rays are normal. MRI ordered by family doctor shows TFCC tear. What is true?
a. TFCC is a common MRI finding in this age group
b. Your next step is an ulnar shortening osteotomy
c. You should scope her wrist to evaluate the TFCC
d. Repeat MRI because you can’t tell the location of the test unless it is an MRI arthrogram
A
50M sustains low-energy distal radius fracture. He asks you about his risk of future fracture and developing OP. What do you tell him?
a. Men >40yrs who sustain a distal radius fracture have a higher risk of fracture and OP relative to baseline
b. Incidence of distal radius fractures is high in Canada. It is not cost effective to screen all of these patients for OP unless they have additional risk factor.
c. FRAX score predicts hip fractures and includes age, BMI, and OA as risk factors
d. Association between distal radius fractures and OP is for post menapausal women only
A
2024F consensus
What is NOT true about cement?
a. Can add rifampin to cement to create antibiotic-laden cement
b. Benzoyl peroxide is the polymer which actives the cement
c. Cement is weaker in tension than compression
d. Adding less than 1g of Vanco to cement is unlikely to meaningfully change the structural properties of the cement.
A
Guys gets laceration to ulnar side of wrist. You expect his ulnar nerve is lacerated at the level of guyon’s canal. What physical exam findings would confirm your suspicion?
a. Will have no motor findings because the motor branch comes off proximal to Guyon’s canal.
b. Will have 4th and 5th clawing because the lumbricals are dennervated
c. Will not have clawing because the motor nerve innervates flexor digiti minimi
d. Will have numbness of/to volar aspect of ulnar 1st and half (worded exactly like this)
D
22 year old guy has anterior knee pain, associated with activity (specifically jumping), with focal tenderness to inferior pole of the patella. What treatment has been proven to be MOST effective for managing his symptoms?
a. Eccentric exercises
b. Surgical debridement
c. Intra-articular injection
d. Shock wave therapy (ESWT)
A
40M with tibial fracture. You tell the patient that these are all benefits to IM nail compared to closed treatment, except
a. Faster time to union
b. Less chance of malunion
c. Decreased risk of compartment syndrome
d. Faster return to work
C
What is MOST commonly associated with radiographic progression of congenital coxa vara:
a. HE (hilgenreiner/epiphyseal angle) > 60
b. Femoral neck shaft angle < 100
c. Female
d. < 5 yo
A
Following surgical hip dislocation for the management of chronic SCFE, which is not associated with increased risk of hip instability?
a. Shortening of the femoral neck
b. Soft tissue internal rotation contracture
c. Femoral Anteversion
d. Overcorrection to valgus alignment
B
2024F consensus
Regarding vertebral artery injury in c spine
a. Roy camille lateral mass is safer than magrel screw technique
b. Most common with c1-2 transarticular screw
c. High riding C2 foramen is a contraindication for pars screw
d. Anterior approach is more dangerous than posterior
B
Regarding less common sarcoma
a- Telangectatic osteo has at least as good a prognosis as conventional osteosarcoma
b- Paraosteal has medullary canal connection
c- Periosteal better prognosis than paraosteal
d- Paraostel has very good prognosis even if has high grade component.
A
First branch of lat plantar nerve innervates:
a-Adductor hallucis and Abductor digiti minimi
b-Quadratus plantae and 3rd interosseous
c-Flexor digiti minimi brevis and 3rd plantar interosseous
d-Quadratus plantae and abductor digiti minimi
D
Best describes general prominence of disc (outpouching of annulus fibrosus) without (focal) nucleus pulposus displacement:
a. Disc bulging
b. Disc protrusion
c. Disc herniation
d. Disc sequestration
A
FDP is repaired but has to be shortened approx 2cm to allow for repair. What is result?
a. Normal grip strength, decreased tendon excursion
b. Normal grip strength, normal tendon excursion (and ROM)
c. Decreased grip strength, normal tendon excursion (and ROM)
d. Decreased grip strength, decreased tendon excursion
D
XR of bilateral congenital dislocation of knees. What is not associated with this?
a. Larsens
b. Arthrogryposis
c. CP
d. Meningomyelocele
C
50’s female with known metastatic breast cancer and metastatic lesion in femoral neck, pain with WB. X-ray of pelvis and long leg femur. Obvious lesion in neck. Unclear if there was a distal femur lesion. What is the best management of the metastatic lesion?
a. Cemented hemiarthroplasty with post op radiation
b. DHS with cement augmentation and post op radiation
c. Long CMN with post op radiation
d. Radiation only
A
RCT on tibial plafond regarding locking plates and HWR. 5/15 in locked plate group have 2nd surgery. 5/20 in non locked Group. Which is true regarding locked group?
a. Risk difference is 0.33
b. Relative risk is 1.33
c. Odds ratio 0.66
d. Incidence 0.48
B
The multiplier method can be used to predict limb length inequality in all the following conditions except which one?
a. Juvenile Idiopathic Arthritis
b. Proximal focal femoral deficiency
c. Ollier’s
d. Hemihypertrophy
A
56 yo M was in an MVC and sustained a type 2 odontoid #, treated in hard cervical collar for 3 months. Comes back at 6 months and complains of severe neck pain but is neuro intact. Sagittal CT shown as well as flex ex xrays, showed non-union and instability. What is the BEST management option?
a. C1-2 posterior arthrodesis
b. Anterior screw osteosynthesis
c. PT and NSAIDS
d. Hard collar x 3 months then repeat CT and xrays
A
Paeds Amputation. All true except:
a. Residual limb may be too short
b. Residual limb may be too long
c. Use of an epiphyseal cap to prevent overgrowth
d. Transosseous amputation is favored over disarticulation
D
Which structure is most responsible for vertical stability in AC injuries.
a. Conoid ligament
b. Trapezoid ligament
c. AC ligament
d. Coracoacromial ligament
A
A 4 month old boy with an L1 myelomeningocele presents with bilateral hip dislocations (Ortolani positive). What is the best management?
a. Pavlik harness
b. Observation and hip range of motion exercises
c. Closed reduction and adductor tenotomy, spica casting
d. Open reduction and spica casting
B
All true regarding CMN for proximal femur fractures EXCEPT:
a. CMN preferred for atypical femur fracture
b. Short nail has less intraoperative bleeding and OR time compared to long nail
c. Short nail suitable for fractures <6cm from LT
d. With trochanteric nail , if you start the nail more lateral that will result in varus deformity
C
With regards to bilateral femur fractures, what is FALSE?
a. Higher in hospital mortality than unilateral
b. Reduced complications associated with early fixation
c. 2 staged fixation has lower rates of ARDS
d. Single stage and 2 stage fixation had equivalent in hospital mortality
C
An elderly women (age?) sustains a distal radius fracture. It is reduced anatomically. What is true about her risk of re-displacement?
Which of the following is true?
a. Age is an independent risk factor for re-displacement
b. Age is only a relevant risk factor if associated with osteoporosis
c. Age is only a relevant risk factor if associated with comminution
d. Age is not a risk factor for re-displacement (? Not sure if this was one or not)
A
UPS of bone, what is false?
a. On xray, looks lytic, permeative and cortical destruction
b. With appropriate treatment, 5 year survival is less than 25%
c. Management is the same as osteosarcoma with chemo and wide resection
d. Can be associated with radiation, Paget’s, and chronic osteomyelitis
B
At Approximately what age patient has normal maximum physiological valgus
A. At birth
B. 1 month
C. 4 years
D. 8 years
C
What represent the sequence of adhesive capsulitis?
a- fibroblast proliferation, synovial hypertrophy and synovitis, fibrosis then adhesion
b- synovial hypertrophy and synovitis, fibroblast proliferation, dense adhesion then fibrosis
c- fibroblast proliferation, fibrosis, synovial hypertrophy then adhesion
d- synovial hypertrophy and synovitis , fibroblast proliferation, fibrosis then adhesion
A
25yo M with a forearm open fracture while water skiing in a freshwater lake. Beside I/D, what is the best addition to treatment?
a. Delayed closure and ciprofloxacin
b. Immediate closure and metronidazole
c. Delayed closure and doxycycline
d. Immediate closure and cloxacilin
A
56yo M with pain in his lower back for a week. Previously healthy and independent ambulator 2 weeks ago. Needs a walker for distances more than a couple meters. Lower extremity weakness. MRI shows a lesion at L3 spreading into the canal but some CSF is present (Bilsky 1a or 1b?). Biopsy shows lymphoma. What is the best treatment?
a. Radiotherapy + chemotherapy
.b Decompression + fusion and postop radiotherapy
c. Decompression+fusion
d. Kyphoplasty
A
2024F consensus
42 yo male labourer, C/O elbow instability, no hx of trauma, has mild discomfort,on exam has interossei wasting, image associated. What is the next best step?
a. MRI elbow
b. MRI C spine
c. EMG/NCS
d. CBC/ESR/CRF, RF
B
MRI C-spine to rule out syringomyelia
Syringomyelia = most common etiology of neuropathic arthropathy of the upper extremity
25% of Charcot joints are a result of syringomyelia
monoarticular (shoulder > elbow)
For ACL reconstruction, what’s the most important thing for determining outcome success?
A. Graft size
B. Graft type
C. Isolated injury
D. Surgical timing
C
When doing the Retroperitoneal approach to the lumbar spine, what’s the order of anatomic structures medial to lateral?
A. Aorta, ureter, genitofemoral nerve
B. Aorta, genitofemoral nerve, ureter
C. Ureter, aorta, genitofemoral nerve
D. Genitofemoral nerve, aorta, ureter
A
Given an X-ray of a displaced Type 2 odontoid fracture that was fixed with a trans articular screw and wiring. What’s a contraindication to this fixation method?
A. Comminution
B. Poor bone quality
C. Aberrant internal carotid artery anatomy
D. irreducible posterior translation
D
Langerhans cell histiocytosis (aka eosinophilic granuloma), what is true?
A. Often heal after simple biopsy
B. Often involve posterior elements of spine
C. Uncommon in diaphyseal region of long bones
D. More common in long bones than spine
E. Monostotic disease more likely to recur (think this is from polyostotic question)
A
