All Subjects Flashcards
1
Q
How do you make the diagnosis of Buerger’s disease
A
CT angiography
2
Q
This type of trauma has highest risk of HO development
A
blast injuries, especially if amputation is performed through the zone of the injury
3
Q
Lateral scapular winging is caused by injury to:
A
Cranial nerve XI (traps, rhomboids)
4
Q
When should you brace for osteofibrous dysplasia?
A
When the lesion is PAINFUL otherwise, just observe
5
Q
ADI limit for Downs Syndrome participation in sports:
A
ADI of 5 or greater should be limited from contact sports - normal ADI is <4
6
Q
Slocum Anterior rotary drawer test:
A
assess ACL/MCL injury with anterior drawer in 30 deg external rotation - anteromedial rotatory instability
7
Q
What are the salvage osteotomies for acetabular dysplasia in CP hip?
A
Shelf Chiari Do these if skeletally mature
8
Q
Layer of the physis affected by distal femoral fractures:
A
multiple zones injured - due to undulating topography of the physis here - this is different than all other physeal fractures
9
Q
C6 External Landmark
A
Cricoid cartilage
10
Q
C3 external landmark
A
Hyoid Bone
11
Q
C4 external landmark
A
Thyroid cartilage - upper border
12
Q
C5 external landmark
A
Thyroid cargilage - lower border
13
Q
Incidence of major complications following adult spinal deformity surgery?
A
20%
14
Q
Serum marker with highest correlation with PJI:
A
IL-6
15
Q
Lateral scapular winging is caused by injury to:
A
Cranial nerve XI (traps, rhomboids)
16
Q
3 components of the lateral elbow collateral ligament complex:
A
annular ligament LUCL radial collateral ligament (most posterior)
17
Q
ADI limit for Downs Syndrome participation in sports:
A
ADI of 5 or greater should be limited from contact sports - normal ADI is <4
18
Q
Absolute contraindication to TTC nailing?
A
severe peripheral vascular disease (AVI < 0.4)
19
Q
Management of Shoulder AVN:
A
Grade I and II (pre-collapse) = core decompression Early collapse with normal glenoid = hemiarthroplasty With glenoid changes = TSA
20
Q
Layer of the physis affected by distal femoral fractures:
A
multiple zones injured - due to undulating topography of the physis here - this is different than all other physeal fractures
21
Q
Schwann cell response to chronic peripheral nerve compression is:
A
proliferation and apoptosis - there is no wallerian degeneration
22
Q
Brooker classification of:
A
heterotopic ossificaiton
23
Q
risk factors for HO in trauma:
A
- prolonged ventilator course - spinal cord injury - severe burns - amputations through zone of a blast injury
24
Q
Management of septic prepatellar bursisits:
A
complete bursectomy and IV antibiotics
25
Becker's Muscular Dystrophy
- X linked dominant - pseudohypertrophy of calves - elevated CK levels - some dystrophin is present
26
Serum marker with highest correlation with PJI:
IL-6
27
Last muscle to reinnervate following peroneal nerve axonotmesis:
EHL
28
These muscles lie on the posterior tibia:
FDL, post Tib
29
Mannerfelt lesion:
attritional rupture of the FPL in RA (STT joint arthritis) - reconstruct with palmaris longus
30
Ocular trauma with secondary visual field changes requires:
emergent CT to evaluate for traumatic optic neuropathy
31
What is the next best step in an adult following a shoulder dislocation and exam suggestive of RCT?
- get an MRI - do PT after
32
Congenital pseudoarthrosis of the clavicle is typically in this location:
right side middle 1/3
33
When is it not appropriate to eccentrically ream the gleniod
in patients with \>15 deg retroversion, can't eccentrically ream because you enter the glenoid vault. Instead, do posterior allograft or augment - otherwise, for retroversion \<15 deg you can eccentrically ream
34
if you do a central ray amputation in the hand, should consider this reconstructions:
index or small finger transfer to close down the interdigital space
35
Preserve this artery during lateral retinacular release of patella:
superior lateral geniculate artery
36
Mazabraud's Syndrome
polyostotic fibrous dysplasia with multiple intramuscular myxomas - associated with mutations in the GNAS1 gene
37
Primary deforming force in basilar joint OA:
EPB - pulls the thumb MP joint into extension and adduction
38
Blood supply to the heel pad
medial calcaneal branch of the posterior tibial artery
39
Blood supply to the lateral flap along the calcaneus
lateral calcaneal artery - branch of the peroneal artery
40
Paget's disease can metastatize and turn into:
- chondrosarcoma - fibrosarcoma (spindle cell sarcoma) - osteosarcoma
41
Scurvy affects on the growth plate:
changes to the primary spongiosa - widening of calcification - see a broad white stripe across the physis near the metaphysis
42
What is the Geyser sign
swelling at the AC joint in cuff tear arthropathy - synovial fluid can communicate above the cuff, and with recurrent effusions makes a large swelling about the AC joint
43
Deforming forces in Bennet's Fracture:
- APL - metacarpal abduction (PIN) - Adductor Pollicis - distal adduction;supination (ulnar n)
44
OPerate on a boxer's fracture?
rare - can tolerate extensive angulation - treat in remoable splint
45
Dorsal MP joint dislocation - what prevents reduction?
volar plate
46
Pedicle for the medial femoral condyle bone graft for scaphoid nonunion:
descending geniculate
47
In a Mayfield IV Injury, waht ligament is still attached to the lunate?
the short radiolunate - the SL, RSC, LRL are all disrupted
48
most common block to reduction for Galeazzi fractures?
ECU
49
strongest component of the IOL?
central band of the interosseous ligament
50
Most common neurapraxia with Bado 1 injuries:
AIN - anterior dislocation
51
Most common neurapraxia with Bado 2 injuries:
PIN - posterior dislocation
52
What is the angle of a Weil Osteotomy
nearly parallel to the plantar surface of the foot - to prevent plantar migration of the distal segment
53
tendon transfer to treat chronic foot drop?
PTT (plantar medial navicular) to the dorsal lateral cuneiform
54
Self-passivization:
adherent oxide layer on titanium prevents titanium corrosion
55
fretting corrosion:
frictional corrosion on metal modular implants - think trunion disease
56
galvanic corrosion:
two dissimilar metals causing corrosion - titinium and stainless
57
Spine manifestations in McCune Albright
scoliosis occurs at vertebral levels of fibrous dysplasia - get spine radiographs if there is back pain
58
If a person has upper extremity lymphadenopathy and caseating granulomas, the answer is probably:
Bartonella henselae (cat scratch disease) - could be mycobacterium, but upper estremity suggests cat scratch
59
The correct procedure to perform for UCL reconstruction is:
- flexor-pronator mass split - dock graft technique - NO ulnar nerve transposition
60
Indications for C spine surgery in RA:
- PADI \< 14 - cervicomedullary angle \< 135 deg - basilar invagination w \>5mm migration of dens proximal to McGregor's line - \<14mm subaxial canal diameter
61
This PADI value corellates with poor recovery following decompression for myelopathy
\<10 mm have no recovery \>14mm have full recovery
62
Limb length discrepancy following clubfoot
- due to full limb hypoplasticity - anterior tibial artery is hypoplastic
63
most commonly injured retroperitoneal vessel during posterior spine surgery:
common iliac artery
64
Where does the aorta most commonly bifurcate:
most common is at L4
65
Spiral cord displaces the NV bundle in this direction:
palmarly and ulnarly
66
most common complication of halo placement:
abducens nerve palsy - can't laterally deviate the eye
67
best way to make dx of ganglion cyst at wrist:
aspiration and cytology
68
How does BMP-2 change the composition of the intervertebral disk?
increases its chondrogenic phenotype increases disk matrix synthesis
69
Primary function of the posterior oblique ligament of the knee:
resist internal rotation with the knee in full extension
70
What is the best radiographic view to determine displacement of a peds medial epicondyle fracture:
distal humerus axial view
71
Are arthrogrypotic contractures progressive?
No
72
what is the gold standard meniscal repair technique:
inside-out with vertical mattresses
73
where do salter-harris 1 fractures occur?
zone of hypertrophy/zone of provisional calcification - both are correct - provisional calcification is a region of the hypertrophic zone
74
Proven method to decrease shoulder and elbow injuries in throwing athletes
Posterior capsular stretching
75
Type 1 SMA
Auto recessive Presents Near birth, age \<6 months Tongue fasciculations Global weakness Death by age 2
76
Type 2 SMA
Auto recessive Presents between 6 months and 2years Wheelchair bound by teenage years Death in the 5 or 6 decade
77
What gene in SMA is most important to determine severity?
SMN2 gene Type 1has no SMN1or 2whereas the less severe types have increasing amounts of SMN 2 genes
78
Doing an MUA after TKA for stiffness results in best outcomes if done within:
12 weeks
79
What are the important findings from LEAP study on patient outcomes?
Two year patient satisfaction outcomes are most dependent upon ability to return to work, have a good walking speed, Have a limited pain, and at baseline do not have depression
80
What is the most appropriate culture medium for the HACEK bacteria
Standard blood culture medium for a one week duration
81
The arcuate Ligament complex inserts here
On the fibular head Avulsion of the complex occurs sometimes association with ACL injury Avulsion fx is called arcuate sign
82
Contraindication for ulnar shortening osteotomy for ulnar impaction syndrome
Degenerative change in the druj
83
What is the first toe Jone’s procedure?
First MTP fusion with EHL transfer for a extension MTP deformity following correction of cavus foot
84
The smallest pedicle is:
L1
85
How do you calculate relative risk
Incidents in the study population is divided by incidents in the control population. This is the result of a prospective study
86
PCL single bundle Reconstructions should be tension and at what degrees flexion
90°
87
What surgery can be done to treat a long-standing foot drop with a supple ankle joint
Tibialis posterior transfer to the lateral cuneiform through the interosseous membrane
88
SSEP monitoring allows for evaluation of what tracts?
Dorsal columns only. The anterior tracts and may be injured without changing signal
89
Negative predictors of diabetic wound healing
Transcutaneous oxygen \< 30 ABI \< 0.45 Albumin \< 3 Lymph’s \< 1500
90
Most common structure preventing reduction of a dorsal MTP dislocation
The volar plate
91
When is Akin closing wedge osteotomy indicated?
When HVI angle is \>10 degrees
92
Supergior Gluteal nerve innervates:
medius minimus tensor fascia
93
Dinstinction between spinoglenoid notch vs suprascapular notch cysts:
anatomically in different locations - spinoglenoid notch cysts affects only infraspinatus - suprascapular notch cyst affects supra/infra compression is typically from a ganglion
94
TKA following HTO can be complicated most commonly by:
- patella baja (lost flexion, challenging exposure) - challenges with ligamentous balancing causing TKA instability
95
Most likely wrist extensor tendon to rupture in the setting of RA is:
EDQ - overlies the ulnar head - Vaughn Jackson Syndrome
96
Chondromyxoid Fibroma
biphasic histology
chondroid areas AND low grade spindle cell areas
aggressive radiographically
bright on T2
Wide resection is grafting
25% recurrenc rate
97
Treatment of Wassel type 1, 2, and 3 deformities:
radial thumb ablation
extensor tendon centralization
collateral ligament preservation
OR a Bilhaut Cloquet Procedure
98
How long until frostbite tissue "declares" itself?
1-3 months
99
At what age should you avoid SLAP repair and opt instead for LHBT tenodesis?
\> 40 years
100
Dinstinguishing features of EIP and EDC in the 4th dorsal compartment
EIP is deep and ulnar to EDC
EIP has a more distal muscle belly
101
What is a funnel plot
for systematic reviews/meta-analysis
detects publication bias
102
What is Rothmund Thomson Syndrome
- growth retardation
- thin eyebrows/lashes
- teeth abnormalities
- hypogonadism
- high risk of cancers: osteosarcoma
103
Physiologic progression of genu valgum in children:
0-2 years physiologic varus
14 months may reach neutral
by 3 years peak genu valgus
by 7 years is normal physiologic valgus
104
Contents of deep posterior compartment
tibial nerve
tibialis posterior
FDL
FHL
105
Duchenne's Muscular Dystrophy is from this mutation:
Deletion in Xp21 gene
106
Anakinra is:
IL-1 Receptor antagonist
competitively inhibits IL-1
107
Location of the 3,4 Wrist Arthroscopy Portal
1cm distal to Lister's tubercle
108
What saline load volume to the knee will produce a 99% sensitivity for traumatic arthrotomy?
175cc
109
What artery is implicated in compartment syndrome following tibial tubercle avulsion fractures
recurrent anterior tibial artery
- letter D in the image
110
Thoracic disk herniations occur most commonly through which region?
lower 1/3
- the T11 and 12 ribs do not protect against the concentration of flexion forces in this area.
111
Thumb soft tissue defects of up to 2cm - treat with:
Moberg flap
112
Thumb soft tissue volar losses of 2.5-3.5cm treat with:
Island volar advancement
- this is NOT a Moberg flap
113
Warfarin acts on clotting factors:
II, VII, IX, X
114
Treatment of Camptodactyly
if \<30 deg contracture, then passive stretching and observation
if \>30 deg contracture, then do FDS tenotomy
115
Arcade of Struthers vs Ligament of Struthers
Arcade = ulnar nerve entrapment
Ligament = supracondylar humerus to the medial epicondyle, entrapping MEDIAN nerve
can remember this by "median nerve is compressed by ligaments" - the transverse carpal, and Struthers
116
Diastrophic Dysplasia Inheritance is:
Autosomal Recessive
117
Contraindications to AMZ?
proximal medial patellar facet and medial femoral condyle (trochlear) chondrosis/arthrosis
- these become the knee load bearing surfaces
118
The pulmonary effects of doing a thoracotomy for AIS release in an adult?
Transient as well as long term functional pulmonary losses.
- long-term improvement compared with pre-op is uncommon
119
Most common treatment for failed total ankle arthroplasty?
Ankle and Subtalar Fusion
120
Management of dorsiflexion malunion of the 1st metatarsal following proximal crescenting osteotomy for hallux valgus?
Plantarflexion producing 1st MT ostseotomy
121
Effect of PTH on Serum PO4
decreases it
122
This biomarker correlates with likelihood of recurrence of Chondrosarcoma:
Telomerase
123
Is there a proven difference in post-operative ROM dependent upon the type (PS, CR, mobile bearing) of TKA performed?
No
- but UKA has higher post-op ROM than TKA
124
Conditions associated with atlantoxial rotatory displacement?
Downs syndrome
Tumors
Viral Illnesses (grisel's)
Congenital anomalies
RA
125
Treatment of Type I AARD for \<1week
soft collar, NSAIDs, gentle stretching
126
Treatment of AARD Type I for \>1 week
head halter traction (5lb)
NSAIDs
Benzos (muscle relaxation)
Hard collar x3 Months
127
Treatment of AARD Type I for \>1 month
Halo traction + Halo Vest
128
Treatment of AARD Type I for \>3 months (or late diagnosis)
C1-2 posterior fusion
129
Risks involved with use of perc long lateral locked plating of tibia?
Superficial peroneal nerve injury
- in the distal holes (10-13) the nerve may be milimeters away
- make incision larger and bluntly dissect down to bone
130
Largest risk of mortality in patients with closed head injury comes with this medial error:
hypotension (especially intraoperative)
131
Free antegrade lateral arm flap
- goes where?
- is based on what pedicle?
coverage of the forearm
based on the posterior recurrent radial artery pedicle
maximum flap width 8cm
can be transposed 8cm distal
132
Complications of medial sesamoidectomy?
removal of medial sesamoid can leave the flexor hallucis brevis deficient, causing
- hallux valgus
- claw toe
133
Imhauser Osteotomy
used for correction of late presenting SCFE deformity
- flexion
- internal rotation
- valgus
134
C8 Radiculopathy Manifests As:
Numbness on medial hand
Weakness to long finger flexors of all digits including the thumb
135
Lengthening along the mechanical axis of the femur reuslts in what change to the mechanical axis of the limb?
Lateralizes it.
136
What ligament is ruptured in a dorsal thumb CMC dislocation?
Dorsoradial ligament is torn
This is the primary restraint to dorsal dislocation
The volar oblique ligament may avulse also
137
What intra-articular abnormalities are seen with internal impingement:
- SLAP tears (#1)
- partial articular sided rotator cuff tears
138
Deactivating mutation in PTHrP Receptor would have what affect on the physeal zone of hypertrophy?
- would cause more rapid maturation
physeal chondrocytes secrete Indian Hedgehog (Ihh) which stimulates PTHrP receptors which SLOWS down physeal maturation
-
139
Cellular function of BMP3
antagonizes BMP2
Most abundant in DBM
BMP3 knockout mice have excessive trabecular bone
140
Indications for resection of a hindfoot coalition?
involves \<50% of the joint surface
\*if \>50% consider primary arthrodesis
\*consider a triple if there is deformity an arthrosis among the remaining hindfoot joints
141
To decrease risk of transient hypotension in a pregnant patient with a closed head injury, position them in the :
left lateral decubitus position
- prevents inadvertant aortocaval compression by the fetus which may occur in supine position
142
Define: Secondary amenorrhea
absent menses x 6 months
