2024 Flashcards
What is true about club foot?
a. Start correction by pronating the forefoot
b. Simultanously Dorsiflex foot by 10-15deg as casting continues
c. Abduct forefoot in pronation while maintaining counter pressure on the head of the talus
d. The navicular is medially displaced on the talus, and the calcaneus is inverted under the talus
D
consensus
The method begins with the Ponseti manipulation and consists of the following steps: (1) Identify the head of the talus by palpation. (2) Supinate the forefoot to eliminate the cavus deformity and create a normal-appearing arch. (3) Abduct the forefoot with the vector of force parallel to the sole of the foot while using the lateral head of the talus as the fulcrum and maintaining the reduction of the cavus deformity. (4) This manipulation is followed by the application of an above-the-knee cast with the foot in the corrected position. (5) The manipulation and casting steps are repeated every 5 to 7 days until the foot is abducted approximately 50° from the frontal plane of the tibia. (6) In most patients (60% to >90%), a percutaneous tenotomy of the Achilles tendon is necessary to correct the residual ankle equinus after gaining full abduction of the foot with the manipulations. (7) The final cast is applied and worn for three weeks. (8) After removal of the final cast, the patient is managed with bracing with a foot abduction orthosis for 23 hours per
day for 3 months.
Lady with MC fracture and 10 degree of dorsal angulation and 2 mm shortening of the ring finger, what is the outcome if treated non-op in this position?
a. IP flexion contracture
b. MCP extensor lag
c. Normal function
d. Flexor Lag
B
consensus
Mejia A, Lichtig AE, Ghosh A, Balasubramaniyan A, Mass D, Amirouche F. The Effect of Metacarpal Shortening on Finger Strength and Joint Motion: A Cadaveric Biomechanical Study. J Hand Surg Glob Online. 2023 Apr 6;5(4):407-412. doi: 10.1016/j.jhsg.2023.03.007. PMID: 37521540; PMCID: PMC10382880.
Metacarpal shortening does not affect flexion range of motion regardless of the amount of shortening, but it significantly affects finger strength. The loss of strength after shortening was approximately 6.5% per mm of shortening for the fractured metacarpal.
17 year old male with clinical photo of medial scapular winging 4 months after a football injury. Treatment?
a. Scapulothoracic fusion
b. PT and reassess
c. EMG and nerve repair
d. Tendon transfer
B
consensus
Ahearn, B. , Starr, H. & Seiler, J. (2019). Traumatic Brachial Plexopathy in Athletes: Current Concepts for Diagnosis and Management of Stingers. Journal of the American Academy of Orthopaedic Surgeons, 27 (18), 677-684. doi: 10.5435/JAAOS-D-17-00746
https://oce-ovid-com.ezproxy.lib.ucalgary.ca/article/00124635-201909150-00002/PDF
Although most stinger injuries do not require neurophysiologic evaluation,electromyography (EMG) can be useful in the setting of persistent neurologic symptoms. EMG is more sensitive in the presence of motor deficits than with isolated pain or sensory deficits. The ideal time to perform an EMG is within 2 to 4 weeks from injury.19 The presence or absence of denervation in the setting of clinical weakness can help determine whether the injury is simply a neurapraxia versus a more severe deficit. In addition, EMG can help differentiate between a preganglionic nerve root avulsion or injury and a postganglionic or brachial plexus injury by the presence or absence of abnormalities in the paraspinal musculature.
The initial management of stingers simply involves rest, pain control,and physical therapy focused on the cervical spine and upper extremity.Grade 1 injuries are milder injuriesand players tend to return to play right after symptoms resolve and the physical examination normalizes.Moderate and severe injuries may require withdrawal from play with serial examinations and consider-ationofimagingandan electrophysiologic study.
Healthy child with 3 days of atlantoaxial rotatory displacement. XR normal. What do you do next/Best next step in management. (REPEAT)
a. Static CT
b. Dynamic CT
c. Collar and NSAID
d. MRI
C
consensus
Modified brostrom, what do you use to augment your repair ?
a. SPR (superior peroneal retinaculum)
b. IPR (inferior peroneal retinaculum)
c. Peroneus tertius
d. Half of peroneus tertius
B
consensus
What is the cause of ulnar drift in fingers?
a. Incompetence of radial sagittal band
b. Incompetence of ulnar sagittal band
c. Radial subluxation of the lateral bands
d. Ulnar subluxation of the lateral bands
A
consensus
8M with spastic diplegic CP present with toe-walking. He had no heel strike with walking. On exam, he has dorsiflexion to -10 with knee extended and to 0 degrees with knee flexed. He has a popliteal angle of 40 degrees with spastic hamstrings. There is no knee flexion contracture. He has failed nonoperative management including botox. What is the best treatment? REPEAT
a. Percutaneous TAL
b. Open TAL
c. Gastrocnemius recession
d. Hamstring release
C
consensus
Regarding radiation associated fractures, what is true:
A. After radiation and resection of a large thigh soft tissue sarcoma, prophylactic IM nail of the femur is NOT indicated
B. Salvage options for non union of radiation associated fractures are vascularized fibula graft or endoprosthetic reconstruction
C. Periosteal stripping is NOT a risk factor for radiation associated fracture
D. 10-15% nonunion rate after surgical management of radiation associated fracture
B
consensus
According to the American Medical Association, physician impairment is defined as a physician’s inability to provide safe and reliable patient care which may be secondary to a physical or mental issue including alcohol or drug use. Which of the following is least likely to be a warning sign that the physician is impaired?
a. Feelings of frustration, detachment, and loss of compassion.
b. Often late to clinical and educational activities.
c. Delay to return calls and rude to other healthcare providers.
d. Poor anger management.
A
consensus
Regarding metastatic bone disease. Which of the following is true:
a. Mirel’s score is reproducible for predicting fracture risk.
b. Denosumab is a monoclonal antibody that directly interferes with metastatic tumor cells.
c. Like bisphosphonates, Denosumab can cause hypocalcemia & jaw osteonecrosis.
d. Denosumab has not been shown to have reduced skeletal-related events.
C
consensus
Regarding measured guided resection in balancing TKA, which of the following is true:
a. The transepicondylar axis is the most reliable method for determining rotation intraoperatively.
b. The posterior condylar axis is externally rotated with respect to the transepicondylar axis.
c. Whiteside’s line is perpendicular to the transepicondylar axis.
d. Measured guided resection relies on posterior referencing
C
consensus
Geriatric distal femur fracture dual plate/ nail VS DFR. What is true?
a. More range of motion with DFR
b. More peri-implant fracture or failure with ORIF
c. Both allow weight bearing
d. Higher rate of deep infection with distal femoral replacement
D
consensus
What is the BEST predictor of bone loss in shoulder dislocation? Repeat
a. Young age
b. History of repeated dislocations that require less force each time
c. Previous soft tissue stabilization surgery
d. Beighton score 6
B
consensus
Regarding the Biomechanics of spine rod, what is true?
a. The stiffness of rod is proportional to the radius to the 4th power
b. Titanium is stiffer than steel
c. Decreased Density of screw increase stiffness
d. Plastics deformation when the rod will return to its original shape after removing the tension
A
consensus
Regarding the management of geriatric olecranon fractures, which of the following is true?
a. There is greater K wire migration with transcortical vs intraosseous placement
b. Tension band wiring has a higher rate of early post-operative complications
c. Non-operative management leads to a high rate of symptomatic non-union
d. When there is a high degree of comminution, a locking plate is biomechanically superior to a non-locking plate
B
consensus
A healthy 55yoM presents with 2 months of severe right groin pain. He takes no medications, uses no alcohol. No trauma. Radiographs are normal. Bone scan indicates increased uptake in the right femoral head. MRI is included below. Which of the following should be part of the management?
a, Femoral neck rotational osteotomy
b. Vascularized fibula graft
c. Non-op treatment
d. Core decompression with biopsy
C
consensus
The diagnosis of atlanto-occipital dislocation is assisted by the radiographic criteria of harris rule of 12. Which of the following indicates an anterior dislocation?
a. Basion-Axial Interval >12mm
b. Basion-Axial Interval <12mm
c. Basion-Dens Interval >12mm
d. Basion-Dens Interval <12mm
A
consensus
Some surgeons excise distal scaphoid during RSL fusion. What are the benefits?
a. Improves pain and increases risk of STT arthritis
b. improves pain and decreases risk of Dequervains
c. improves ROM and decreases non union
d. improves ROM and grip
C
consensus
What is the most common nerve injured during elbow arthroscopy?
a. superficial branch of radial nerve
b. median nerve
c. ulnar nerve
d. PIN
C
consensus
What is true regarding addition of PSIF to pars reduction in a spondylolisthesis?
a. decreased shear forces
b. residual slip can be more than 50%
c. decreased neuro complications
d. superior to ALIF
A
consensus
22M slipped on carpet, with the follow x-ray. What is true?
a. Same healing time
b. IMN preferred
c. Disease is due to overactive osteoblast.
d. Higher risk of osteomyelitis
D
Consensus
When comparing titanium LC-DCP to steel LC-DCP, what is true?
a. Titanium lowers bone porosity at the fracture site
b. Titanium Plate has better moving strength than steel
c. Titanium plate has higher tensile breaking point
A
consensus
5 years old with supra-condylar. AIN. Cold and pulseness. What is the next step?
a. Consult radio for angio
b. Consult radio for echo
c. Open exploration for artery
d. Closed reduction and assess vascular
D
consensus
40 year old female with 3 part proximal humerus fracture. Which one of the following will reduce risk of failure?
a. put the plate superior and level with the humeral head for better screws
b. diverging locking screws to prevent/decrease pull out
c. avoid an inferomedial screw in the humerus to avoid posterior humeral circumflex injury
d. place the screws greater than 5mm from subchondral bone to avoid cut out
B
consensus
All of the following are radiographic findings of the cavovarus foot except:
a. Increased calcaneal pitch
b. Posterior subluxation of the fibula
c. Stacking of the metatarsals on lateral xray
d. Increased talocalcaneal (kite) angle
D
consensus
AP and LAT wrist XRs showing a large radial styloid fracture. Which the following is most at risk of being injured:
a. LT lig
b. SL lig
c. Radioscaphocapitate
d. TFCC
B
consensus
Pediatric bacterial diskits which of the following is true?
a. MRI is modality of choice
b. WBC is a highly predictable
c. End plate erosion seen in radiographs withing 24 hours
d. Kingela is the most likely bacteria with needle aspiration
A
consensus
Which of the following is true of pelvic Chondrosarcoma?
a. Wide resection remains the standard for treatment of all grades of chondrosarcoma
b. Pelvic location does not carry a worse prognosis than the extremity
c. Pelvis is a rare location for secondary chondrosarcoma in MHE
d. Osseous recon after resection is required regardless of the location in pelvis
A
consensus
What is true about C acnes?
a. genta in cement effective treatment
b. GP anaerobic bacillus
c. Chorlohex prep is effective in eradication
d. Low virulence, no biofilm
B
consensus
Which statement is false regarding an isolated malignant tumor of bone:
a. An isolated Ewing’s sarcoma lesion can be treated with wide resection or local radiation therapy in some scenarios
b. Plasmacytoma is usually treated with aggressive curettage followed by radiation therapy
c. In a scenario where osteosarcoma continues to progress under neoadjuvant chemotherapy, amputation is strongly advised over wide resection
d. Extended curettage is an acceptable method of treatment for some grade 1 chondrosarcomas
B
consensus
What is true regarding multi-level ACDF compared to one level ACDF?
a. increased infection
b. increased dysphagia
c. increased infection
d. increased C5 palsy
B
consensus
MRI and tumours - what is correct?
a. Subtypes of lipoma can be reliably differentiated on MRI
b. Lipomas and atypical lipomatous lesions are easily distinguishable on MRI
c. Myxoid neoplasm and simple cysts appear similar on non-contrast MRI
d. Intramuscular hemangiomas have no to little fat on MRI.
C
consensus
15F with AIS. What is the best way to minimize VTE risk?
A. Central venous catheterization at the time of surgery
B. Early post-op mobilization and/or compression stockings
C. Pre-op screening of coagulation factors
D. Chemical DVTp with LMWH
B
consensus
You are performing a primary varus TKA. After performing your cuts, the knee is tight in flexion and loose in the extension. Which is the MOST appropriate strategy.
a) increase the poly and posterior capsule release
b) increase tibial cut and increase slope
c) increase the poly and downsize the femur
d) increase distal femur cut and increase the poly
C
consensus
Repeat (with the same numbers) (2022)- 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
Branches of the axillary artery distal to pectoralis minor:
A. Anterior humeral circumflex artery, subscapular artery, thoracoacromial artery
B. Anterior humeral circumflex artery, posterior humeral circumflex artery, thoracoacromial artery
C. Anterior humeral circumflex artery, posterior humeral circumflex artery, subscapular artery
D. Posterior humeral circumflex artery, subscapular artery, thoracoacromial artery
C
consensus
What’s NOT associated with hemihypertrophy?
a. Wilms tumour
b. Retinoblastoma
c. Neurofibroma
d. Hepatoblastoma
B
consensus
Which of the following is associated with SCFE:
a. Renal osteodytrophy
b. Homocystinuria
c. Hypoaldosteronism (Addison’s)
d. Pernicious anemia
A
consensus
Swan neck, what is true? REPEAT
a. Central slip rupture
b. Jersey finger
c. Attenuation of the volar plate
d. Sagittal band rupture
C
consensus
What is true about cyst in the hand?
a. Cyst around flexors sheath rarely disappear
b. Mucous cyst are not associated with DIP arthrosis
c. Palmar wrist cyst are between APL and FCR
d. Dorsal wrist ganglion rarely spontaneously resolve
C
consensus
14 year old with bilateral pes planus with X-rays having pain while playing hockey. Best next/initial step?
*Bilateral foot x-rays show talocalcaneal coalition C-sign, flatfoot deformity
a. Surgery
b. CT scan
c. Orthotics and modification
d. Activities restrictions
D
consensus
All of the following are medications for osteoporosis- which is an antiresorptive agent?
a. Teriparatide
b. Aboloparatide
c. Romosuzamab
d. Denosumab
D
consensus
4-yo, presented with knee pain. Given with knee pain. AP and LAT knee XRs were given, showing lateral osteochondroma & genu valgum + ? sign of Osgood Schlatter disease [XR showed left lateral sessile osteochondroma with valgus deformity, right sessile posterior osteochondroma with normal alignment]
a. Leukemia
b. OI
c. Osgood Schlatter disease
d. MHE
D
consensus
What is true about the elbow?
a. Posterior band MCL inserts on the sublime tubercle
b. Lateral epicondyle is posterior to medial epicondyle
c. Distal humerus is 40-45 degrees to longitudinal axis
d. LUCL originates distal portion of the lateral epicondyle
D
consensus
Giant cell tumour what is true?
a. Adjuvants have been shown to consistently reduce recurrence rates
b. Preoperative denosumab prevents recurrence
c. Bone destruction is mediated by osteoclast-like giant cells
C
consensus
inability to extend pipj with MCP flexion but when MCP extended is able to extend PIP.
What is injured? REPEAT
a. extensor tendon
b. radial nerve
c. lateral band
d. sagittal band
D
consensus
Which of the following approaches provides the most extensive exposure to the posterior humerus and radial nerve?
a. Anterolateral (Henry) approach
b. Modified posterior (Gerwin) approach
c. Paratricipital approach
d. Triceps splitting approach
B
consensus
Patient is 2 weeks post op from an ankle fracture ORIF. All of the following are risk factors for prolonged opioid use, except?
a. smoker
b. catastrophizing pain
c. High vs low energy (pilon vs simple ankle)
d. History of major depressive disorder
C
consensus
Tib post avulsion in 24 year old male soccer. No arch collapse bilateral. What is the best option?
a. Cast in PF and inversion
b. Surgery repair with FDL augment
c. Surgery repair with FHL augment
d. Surgery repair with Calc osteotomy
B
consensus
