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All Subjects Flashcards

1
Q

How do you make the diagnosis of Buerger’s disease

A

CT angiography

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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

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3
Q

Lateral scapular winging is caused by injury to:

A

Cranial nerve XI (traps, rhomboids)

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4
Q

When should you brace for osteofibrous dysplasia?

A

When the lesion is PAINFUL otherwise, just observe

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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

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6
Q

Slocum Anterior rotary drawer test:

A

assess ACL/MCL injury with anterior drawer in 30 deg external rotation - anteromedial rotatory instability

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7
Q

What are the salvage osteotomies for acetabular dysplasia in CP hip?

A

Shelf Chiari Do these if skeletally mature

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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

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9
Q

C6 External Landmark

A

Cricoid cartilage

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10
Q

C3 external landmark

A

Hyoid Bone

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11
Q

C4 external landmark

A

Thyroid cartilage - upper border

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12
Q

C5 external landmark

A

Thyroid cargilage - lower border

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13
Q

Incidence of major complications following adult spinal deformity surgery?

A

20%

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14
Q

Serum marker with highest correlation with PJI:

A

IL-6

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15
Q

Lateral scapular winging is caused by injury to:

A

Cranial nerve XI (traps, rhomboids)

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16
Q

3 components of the lateral elbow collateral ligament complex:

A

annular ligament LUCL radial collateral ligament (most posterior)

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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

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18
Q

Absolute contraindication to TTC nailing?

A

severe peripheral vascular disease (AVI < 0.4)

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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

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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

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21
Q

Schwann cell response to chronic peripheral nerve compression is:

A

proliferation and apoptosis - there is no wallerian degeneration

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22
Q

Brooker classification of:

A

heterotopic ossificaiton

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23
Q

risk factors for HO in trauma:

A
  • prolonged ventilator course - spinal cord injury - severe burns - amputations through zone of a blast injury
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24
Q

Management of septic prepatellar bursisits:

A

complete bursectomy and IV antibiotics

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25
Q

Becker’s Muscular Dystrophy

A
  • X linked dominant - pseudohypertrophy of calves - elevated CK levels - some dystrophin is present
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26
Q

Serum marker with highest correlation with PJI:

A

IL-6

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27
Q

Last muscle to reinnervate following peroneal nerve axonotmesis:

A

EHL

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28
Q

These muscles lie on the posterior tibia:

A

FDL, post Tib

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29
Q

Mannerfelt lesion:

A

attritional rupture of the FPL in RA (STT joint arthritis) - reconstruct with palmaris longus

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30
Q

Ocular trauma with secondary visual field changes requires:

A

emergent CT to evaluate for traumatic optic neuropathy

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31
Q

What is the next best step in an adult following a shoulder dislocation and exam suggestive of RCT?

A
  • get an MRI - do PT after
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32
Q

Congenital pseudoarthrosis of the clavicle is typically in this location:

A

right side middle 1/3

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33
Q

When is it not appropriate to eccentrically ream the gleniod

A

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

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34
Q

if you do a central ray amputation in the hand, should consider this reconstructions:

A

index or small finger transfer to close down the interdigital space

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35
Q

Preserve this artery during lateral retinacular release of patella:

A

superior lateral geniculate artery

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36
Q

Mazabraud’s Syndrome

A

polyostotic fibrous dysplasia with multiple intramuscular myxomas - associated with mutations in the GNAS1 gene

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37
Q

Primary deforming force in basilar joint OA:

A

EPB - pulls the thumb MP joint into extension and adduction

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38
Q

Blood supply to the heel pad

A

medial calcaneal branch of the posterior tibial artery

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39
Q

Blood supply to the lateral flap along the calcaneus

A

lateral calcaneal artery - branch of the peroneal artery

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40
Q

Paget’s disease can metastatize and turn into:

A
  • chondrosarcoma - fibrosarcoma (spindle cell sarcoma) - osteosarcoma
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41
Q

Scurvy affects on the growth plate:

A

changes to the primary spongiosa - widening of calcification - see a broad white stripe across the physis near the metaphysis

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42
Q

What is the Geyser sign

A

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

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43
Q

Deforming forces in Bennet’s Fracture:

A
  • APL - metacarpal abduction (PIN) - Adductor Pollicis - distal adduction;supination (ulnar n)
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44
Q

OPerate on a boxer’s fracture?

A

rare - can tolerate extensive angulation - treat in remoable splint

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45
Q

Dorsal MP joint dislocation - what prevents reduction?

A

volar plate

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46
Q

Pedicle for the medial femoral condyle bone graft for scaphoid nonunion:

A

descending geniculate

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47
Q

In a Mayfield IV Injury, waht ligament is still attached to the lunate?

A

the short radiolunate - the SL, RSC, LRL are all disrupted

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48
Q

most common block to reduction for Galeazzi fractures?

A

ECU

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49
Q

strongest component of the IOL?

A

central band of the interosseous ligament

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50
Q

Most common neurapraxia with Bado 1 injuries:

A

AIN - anterior dislocation

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51
Q

Most common neurapraxia with Bado 2 injuries:

A

PIN - posterior dislocation

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52
Q

What is the angle of a Weil Osteotomy

A

nearly parallel to the plantar surface of the foot - to prevent plantar migration of the distal segment

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53
Q

tendon transfer to treat chronic foot drop?

A

PTT (plantar medial navicular) to the dorsal lateral cuneiform

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54
Q

Self-passivization:

A

adherent oxide layer on titanium prevents titanium corrosion

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55
Q

fretting corrosion:

A

frictional corrosion on metal modular implants - think trunion disease

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56
Q

galvanic corrosion:

A

two dissimilar metals causing corrosion - titinium and stainless

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57
Q

Spine manifestations in McCune Albright

A

scoliosis occurs at vertebral levels of fibrous dysplasia - get spine radiographs if there is back pain

58
Q

If a person has upper extremity lymphadenopathy and caseating granulomas, the answer is probably:

A

Bartonella henselae (cat scratch disease) - could be mycobacterium, but upper estremity suggests cat scratch

59
Q

The correct procedure to perform for UCL reconstruction is:

A
  • flexor-pronator mass split - dock graft technique - NO ulnar nerve transposition
60
Q

Indications for C spine surgery in RA:

A
  • PADI < 14 - cervicomedullary angle < 135 deg - basilar invagination w >5mm migration of dens proximal to McGregor’s line - <14mm subaxial canal diameter
61
Q

This PADI value corellates with poor recovery following decompression for myelopathy

A

<10 mm have no recovery >14mm have full recovery

62
Q

Limb length discrepancy following clubfoot

A
  • due to full limb hypoplasticity - anterior tibial artery is hypoplastic
63
Q

most commonly injured retroperitoneal vessel during posterior spine surgery:

A

common iliac artery

64
Q

Where does the aorta most commonly bifurcate:

A

most common is at L4

65
Q

Spiral cord displaces the NV bundle in this direction:

A

palmarly and ulnarly

66
Q

most common complication of halo placement:

A

abducens nerve palsy - can’t laterally deviate the eye

67
Q

best way to make dx of ganglion cyst at wrist:

A

aspiration and cytology

68
Q

How does BMP-2 change the composition of the intervertebral disk?

A

increases its chondrogenic phenotype increases disk matrix synthesis

69
Q

Primary function of the posterior oblique ligament of the knee:

A

resist internal rotation with the knee in full extension

70
Q

What is the best radiographic view to determine displacement of a peds medial epicondyle fracture:

A

distal humerus axial view

71
Q

Are arthrogrypotic contractures progressive?

A

No

72
Q

what is the gold standard meniscal repair technique:

A

inside-out with vertical mattresses

73
Q

where do salter-harris 1 fractures occur?

A

zone of hypertrophy/zone of provisional calcification - both are correct - provisional calcification is a region of the hypertrophic zone

74
Q

Proven method to decrease shoulder and elbow injuries in throwing athletes

A

Posterior capsular stretching

75
Q

Type 1 SMA

A

Auto recessive Presents Near birth, age <6 months Tongue fasciculations Global weakness Death by age 2

76
Q

Type 2 SMA

A

Auto recessive Presents between 6 months and 2years Wheelchair bound by teenage years Death in the 5 or 6 decade

77
Q

What gene in SMA is most important to determine severity?

A

SMN2 gene Type 1has no SMN1or 2whereas the less severe types have increasing amounts of SMN 2 genes

78
Q

Doing an MUA after TKA for stiffness results in best outcomes if done within:

A

12 weeks

79
Q

What are the important findings from LEAP study on patient outcomes?

A

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
Q

What is the most appropriate culture medium for the HACEK bacteria

A

Standard blood culture medium for a one week duration

81
Q

The arcuate Ligament complex inserts here

A

On the fibular head Avulsion of the complex occurs sometimes association with ACL injury Avulsion fx is called arcuate sign

82
Q

Contraindication for ulnar shortening osteotomy for ulnar impaction syndrome

A

Degenerative change in the druj

83
Q

What is the first toe Jone’s procedure?

A

First MTP fusion with EHL transfer for a extension MTP deformity following correction of cavus foot

84
Q

The smallest pedicle is:

A

L1

85
Q

How do you calculate relative risk

A

Incidents in the study population is divided by incidents in the control population. This is the result of a prospective study

86
Q

PCL single bundle Reconstructions should be tension and at what degrees flexion

A

90°

87
Q

What surgery can be done to treat a long-standing foot drop with a supple ankle joint

A

Tibialis posterior transfer to the lateral cuneiform through the interosseous membrane

88
Q

SSEP monitoring allows for evaluation of what tracts?

A

Dorsal columns only. The anterior tracts and may be injured without changing signal

89
Q

Negative predictors of diabetic wound healing

A

Transcutaneous oxygen < 30 ABI < 0.45 Albumin < 3 Lymph’s < 1500

90
Q

Most common structure preventing reduction of a dorsal MTP dislocation

A

The volar plate

91
Q

When is Akin closing wedge osteotomy indicated?

A

When HVI angle is >10 degrees

92
Q

Supergior Gluteal nerve innervates:

A

medius minimus tensor fascia

93
Q

Dinstinction between spinoglenoid notch vs suprascapular notch cysts:

A

anatomically in different locations - spinoglenoid notch cysts affects only infraspinatus - suprascapular notch cyst affects supra/infra compression is typically from a ganglion

94
Q

TKA following HTO can be complicated most commonly by:

A
  • patella baja (lost flexion, challenging exposure) - challenges with ligamentous balancing causing TKA instability
95
Q

Most likely wrist extensor tendon to rupture in the setting of RA is:

A

EDQ - overlies the ulnar head - Vaughn Jackson Syndrome

96
Q

Chondromyxoid Fibroma

A

biphasic histology

chondroid areas AND low grade spindle cell areas

aggressive radiographically

bright on T2

Wide resection is grafting

25% recurrenc rate

97
Q

Treatment of Wassel type 1, 2, and 3 deformities:

A

radial thumb ablation

extensor tendon centralization

collateral ligament preservation

OR a Bilhaut Cloquet Procedure

98
Q

How long until frostbite tissue “declares” itself?

A

1-3 months

99
Q

At what age should you avoid SLAP repair and opt instead for LHBT tenodesis?

A

> 40 years

100
Q

Dinstinguishing features of EIP and EDC in the 4th dorsal compartment

A

EIP is deep and ulnar to EDC

EIP has a more distal muscle belly

101
Q

What is a funnel plot

A

for systematic reviews/meta-analysis

detects publication bias

102
Q

What is Rothmund Thomson Syndrome

A
  • growth retardation
  • thin eyebrows/lashes
  • teeth abnormalities
  • hypogonadism
  • high risk of cancers: osteosarcoma
103
Q

Physiologic progression of genu valgum in children:

A

0-2 years physiologic varus

14 months may reach neutral

by 3 years peak genu valgus

by 7 years is normal physiologic valgus

104
Q

Contents of deep posterior compartment

A

tibial nerve

tibialis posterior

FDL

FHL

105
Q

Duchenne’s Muscular Dystrophy is from this mutation:

A

Deletion in Xp21 gene

106
Q

Anakinra is:

A

IL-1 Receptor antagonist

competitively inhibits IL-1

107
Q

Location of the 3,4 Wrist Arthroscopy Portal

A

1cm distal to Lister’s tubercle

108
Q

What saline load volume to the knee will produce a 99% sensitivity for traumatic arthrotomy?

A

175cc

109
Q

What artery is implicated in compartment syndrome following tibial tubercle avulsion fractures

A

recurrent anterior tibial artery

  • letter D in the image
110
Q

Thoracic disk herniations occur most commonly through which region?

A

lower 1/3

  • the T11 and 12 ribs do not protect against the concentration of flexion forces in this area.
111
Q

Thumb soft tissue defects of up to 2cm - treat with:

A

Moberg flap

112
Q

Thumb soft tissue volar losses of 2.5-3.5cm treat with:

A

Island volar advancement

  • this is NOT a Moberg flap
113
Q

Warfarin acts on clotting factors:

A

II, VII, IX, X

114
Q

Treatment of Camptodactyly

A

if <30 deg contracture, then passive stretching and observation

if >30 deg contracture, then do FDS tenotomy

115
Q

Arcade of Struthers vs Ligament of Struthers

A

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
Q

Diastrophic Dysplasia Inheritance is:

A

Autosomal Recessive

117
Q

Contraindications to AMZ?

A

proximal medial patellar facet and medial femoral condyle (trochlear) chondrosis/arthrosis

  • these become the knee load bearing surfaces
118
Q

The pulmonary effects of doing a thoracotomy for AIS release in an adult?

A

Transient as well as long term functional pulmonary losses.

  • long-term improvement compared with pre-op is uncommon
119
Q

Most common treatment for failed total ankle arthroplasty?

A

Ankle and Subtalar Fusion

120
Q

Management of dorsiflexion malunion of the 1st metatarsal following proximal crescenting osteotomy for hallux valgus?

A

Plantarflexion producing 1st MT ostseotomy

121
Q

Effect of PTH on Serum PO4

A

decreases it

122
Q

This biomarker correlates with likelihood of recurrence of Chondrosarcoma:

A

Telomerase

123
Q

Is there a proven difference in post-operative ROM dependent upon the type (PS, CR, mobile bearing) of TKA performed?

A

No

  • but UKA has higher post-op ROM than TKA
124
Q

Conditions associated with atlantoxial rotatory displacement?

A

Downs syndrome

Tumors

Viral Illnesses (grisel’s)

Congenital anomalies

RA

125
Q

Treatment of Type I AARD for <1week

A

soft collar, NSAIDs, gentle stretching

126
Q

Treatment of AARD Type I for >1 week

A

head halter traction (5lb)

NSAIDs

Benzos (muscle relaxation)

Hard collar x3 Months

127
Q

Treatment of AARD Type I for >1 month

A

Halo traction + Halo Vest

128
Q

Treatment of AARD Type I for >3 months (or late diagnosis)

A

C1-2 posterior fusion

129
Q

Risks involved with use of perc long lateral locked plating of tibia?

A

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
Q

Largest risk of mortality in patients with closed head injury comes with this medial error:

A

hypotension (especially intraoperative)

131
Q

Free antegrade lateral arm flap

  • goes where?
  • is based on what pedicle?
A

coverage of the forearm

based on the posterior recurrent radial artery pedicle

maximum flap width 8cm

can be transposed 8cm distal

132
Q

Complications of medial sesamoidectomy?

A

removal of medial sesamoid can leave the flexor hallucis brevis deficient, causing

  • hallux valgus
  • claw toe
133
Q

Imhauser Osteotomy

A

used for correction of late presenting SCFE deformity

  • flexion
  • internal rotation
  • valgus
134
Q

C8 Radiculopathy Manifests As:

A

Numbness on medial hand

Weakness to long finger flexors of all digits including the thumb

135
Q

Lengthening along the mechanical axis of the femur reuslts in what change to the mechanical axis of the limb?

A

Lateralizes it.

136
Q

What ligament is ruptured in a dorsal thumb CMC dislocation?

A

Dorsoradial ligament is torn

This is the primary restraint to dorsal dislocation

The volar oblique ligament may avulse also

137
Q

What intra-articular abnormalities are seen with internal impingement:

A
  • SLAP tears (#1)
  • partial articular sided rotator cuff tears
138
Q

Deactivating mutation in PTHrP Receptor would have what affect on the physeal zone of hypertrophy?

A
  • would cause more rapid maturation

physeal chondrocytes secrete Indian Hedgehog (Ihh) which stimulates PTHrP receptors which SLOWS down physeal maturation

-

139
Q

Cellular function of BMP3

A

antagonizes BMP2

Most abundant in DBM

BMP3 knockout mice have excessive trabecular bone

140
Q

Indications for resection of a hindfoot coalition?

A

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
Q

To decrease risk of transient hypotension in a pregnant patient with a closed head injury, position them in the :

A

left lateral decubitus position

  • prevents inadvertant aortocaval compression by the fetus which may occur in supine position
142
Q

Define: Secondary amenorrhea

A

absent menses x 6 months

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