Blue boxes

Question 1

Excision and pathologic analysis of axillary lymph nodes are often necessary for what?

Answer 1

Staging and determining appropriate treatment for cancer (ex. breast cancer)

Question 2

Why is it important to remove and evaluate axillary lymph nodes in a specific order?

Answer 2

Axillary lymph nodes are arranged and recieve lymph in a specific order, important to remove in this order to determine progression of cancer

Question 3

What is a sentinel lymph node biopsy?

Answer 3

Only nodes with potential of draining the tumor site are removed/examined for less chance of injury to surrounding tissues

Question 4

What could cause lymphedema (swelling of accumulated lymph) in the subcutaneous tissue?

Answer 4

Impaired lymphatic drainage due to removal/radiation of lymph nodes

Question 5

Which nerves are at risk for injury during an axillary node dissection?

Answer 5

Long thoracic nerve and thoracodorsal nerve

Question 6

If the long thoracic nerve is cut during surgery, what could happen?

Answer 6

Winged scapula

Question 7

If the thoracodorsal nerve is cut during surgery, what could happen?

Answer 7

Medial rotation and adduction of the arm are weakened

Question 8

In a case of a tumor around the long thoracic nerve and the thoracodorsal nerve, would you remove the tumor or spare the nerves?

Answer 8

Remove the tumor cells, nerve may have to be sacrificed to remove malignancy

Question 9

What is dupuytren contracture?

Answer 9

A disease of the palmar fascia that results in progressive shortening/thickening/fibrosis of the palmar aponeurosis

Question 10

If the palmar aponeurosis is shortened/thickened on the medial side of the hand, what would happen?

Answer 10

The 4th and 5th fingers (ring finger and pinky finger) will be pulled into partial flexion at the MCP and PI joints

Question 11

Is dupuytren contracture unilateral or bilateral?

Answer 11

Commonly bilateral

Question 12

Who is dupuytren contracture most commonly seen in?

Answer 12

Men over 50

Question 13

What is the cause of dupuytren contracture?

Answer 13

Unknown but could be hereditary

Question 14

How does dupuytren contracture first manifest?

Answer 14

Painless nodular thickening of the palmar aponeurosis that adhere to skin

Question 15

How does dupuytren contracture progress?

Answer 15

Contracture of longitudinal bands of palmar aponeurosis causes raised ridges in palmar skin

Question 16

The raised ridges of the palmar aponeurosis during dupuytren contracture extend from which areas of the hand?

Answer 16

From the proximal part of the hand to the base of the 4th and 5th digits (ring finger and pinky)

Question 17

What is the treatment for dupuytren contracture?

Answer 17

Usually surgery to remove the fibrotic tissue of the palmar fascia to free fingers

Question 18

Fractures of the radius and ulna are often inncomplete in which age population?

Answer 18

Children, “greenstick fractures”

Question 19

Fractures of both the radius and ulna in adults are often due to what?

Answer 19

Severe injury

Question 20

Direct injury will result in transverse fractures at what levels of the radius and ulna?

Answer 20

Usually at the same levels (middle third of the bones)

Question 21

Do isolated fractures of the radius and ulna ever occur?

Answer 21

Yes

Question 22

Due to the radius and ulna being held together by the interosseous membrane, what does a fracture of these bones usually involve?

Answer 22

Dislocation of the nearest joint

Question 23

What fracture is common in adults 50 years and over? Who is more prone to these?

Answer 23

Fracture of the distal end of the radius, women with osteoporosis more prone

Question 24

What is a colles fracture?

Answer 24

A complete transverse fracture of the distal 2cm of the radius *most common fracture of the forearm

Question 25

During a colles fracture, how is the distal fragment of the radius affected?

Answer 25

Distal fragment is displaced dorsally and often comminuted (broken into pieces)

Question 26

How do colles fractures often occur?

Answer 26

Forced extension of the hand, usually from bracing a fall

Question 27

What is often broken off (avulsed) during a colles fracture?

Answer 27

Radial styloid process

Question 28

What happens to the radial styloid and ulnar styloid relationship during a colles fracture?

Answer 28

It is reversed, the ulnar syloid now projects more distally than the radial styloid caused by shortening of the radius

Question 29

What is a dinner fork deformity (from colles fracture)?

Answer 29

Posterior angulation/bending occurs in the forearm just proximal to the wrist due to the posterior displacement of the distal fragment of the radius

Question 30

When the distal end of the radius fractures in children, the fracture line may extend through what?

Answer 30

The distal epiphyseal plate *may result in malalignment of the plate/disturb radial growth

Question 31

Who are distal epiphyseal plate injuries more common in?

Answer 31

Older children because of their frequent falls