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Surgery Clerkship > Dr. Pestana's Notes--Orthopedics > Flashcards

Dr. Pestana's Notes--Orthopedics Flashcards

1
Q

Developmental dysplasia of the hip should ideally be diagnosed ______

A

right after birth

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2
Q

Developmental dysplasia runs in families and physical exam shows ____ and ______

A

uneven gluteal folds; easily posteriorly dislocation w/ a “click” and returned w/ a “snapping”

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3
Q

Dx Developmental hip dysplasia; why not Xrays?

A

sonogram; hip is NOT calcified in newborn

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4
Q

Tx Developmental hip dysplasia

A

abduction splinting w/ Pavlik harness for about 6mo

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5
Q

Hip pathology in children may show up as hip or ___ pain

A

knee

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6
Q

What is Legg-Calvé-Perthes dz?

A

avascular necrosis of capital femoral epiphysis

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7
Q

Clinical presentation Legg-Calvé-Perthes dz

A

about 6yo; insidious limping w/ dec hip motion and hip/knee pain; antalgic gait

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8
Q

Dx Legg-Calvé-Perthes dz; Tx

A

AP/lat hip xrays; can cast and use crutches

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9
Q

Clinical presentation Slipped capital femoral epiphysis

A

fat/lanky 13yo boy w/ groin or knee pain and are limping

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10
Q

Slipped capital femoral epiphysis: when legs dangling, sole of foot on affected side points _____ other foot

A

toward

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11
Q

Slipped capital femoral epiphysis: on PE, hip is [flexed/extended] and thigh goes into [internal/external] rotation

A

flexed; external

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12
Q

Tx Slipped capital femoral epiphysis

A

surg emergency–pins to put femoral head back in place

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13
Q

Clinical pres Septic hip

A

toddlers w/ febrile illness suddenly refuse to move hip

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14
Q

Septic hip: on PE, pts hold leg with hip [flexed/extended] in slight [abduction/adduction] and [internal/external] rotation; pts won’t allow passive movement!!

A

flexed; abduction; external

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15
Q

Dx/Tx Septic hip

A

high ESR; aspiration of hip (under gen anesthesia) and open drainage if pus

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16
Q

Clinical presentation Acute hematogenous osteomyelitis

A

little kids w/ febrile illness w/ severe localized bone pain

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17
Q

CanNOT see Acute hematogenous osteomyelitis on ____ until a couple of wks later; therefore must use ____ for diagnosis; tx w/ ____

A

xrays; MRI; antibiotics

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18
Q

Bowlegs, aka ____, is normal up to age ____, after which it is known as Blount dz

A

genu varum; three

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19
Q

Define Bount dz; tx

A

disturbance of medial proximal tibial growth plate; surgery

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20
Q

Knock-kneed, aka _____, is normal btwn 4 and 8yo; no tx needed

A

genu valgus

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21
Q

Osgood-Schlatter, aka _____, is seen in ____ w/ persistent localized pain and is aggravated by ______

A

osteochrondrosis of tibial tubercle; teenagers; contraction of quadriceps

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22
Q

In Osgood-Schlatter, there is NO _____; tx includes ____ before seeing an orthopedic surgeon

A

knee swelling; Rest Ice Compression Elevation

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23
Q

If RICE tx is unsuccessful for Osgood-Schlatter, ortho surg will use extension cylinders or cast leg for _____

A

4 to 6 wks

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24
Q

Talipes equinovarus, aka _____, is seen at ____.

A

club foot; birth

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25
Q

Talipes equinovarus: both feet turned [in/out] and plantar [flexion/extension] of ankle, [eversion/inversion] of foot, [adduction/abduction] of forefoot and [internal/external] rotation of tibia

A

in; flexion; inversion; adduction; internal

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26
Q

Primary tx Talipes equinovarus; tx refractory to primary

A

serial plaster casts +/- Achilles tenotomy and part/long-term braces; surgery between 9 and 12 mo old

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27
Q

Clinical pres Scoliosis: adolescent ____ w/ thoracic spines curved toward ____. Tx includes ___ or ___.

A

girls; RIGHT; bracing; surgery

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28
Q

Severe cases of scoliosis can cause ___

A

decreased pulmonary function

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29
Q

Greater degrees of angulation in fractures are okay to leave alone in children because ____ happens to a high degree; in adults, ____ and ___ is usually done.

A

remodeling/healing; reduction; immobilization

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30
Q

Child fractures that can cause problems (2)

A

(1) supracondylar fractures of humerus

(2) fractures involving growth plate

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31
Q

Cause of supracondylar fractures of humerus

A

hyperextension of elbow falling onto outstretched hand (child)

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32
Q

Volkmann contracture

A

happens w/ supracondylar fractures of humerus–vascular and nerve injuries

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33
Q

(A) Tx child supracondylar fractures of humerus (B) pay careful attention to prevent this complication because often times vasculature/nerves are involved

A

(A) casting or traction; (B) compartment syndrome

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34
Q

Tx of growth plate fracture is _____ if the epiphyses and growth place are displaced laterally from the metaphysis and are in one piece.

A

closed reduction

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35
Q

Tx of growth plate fracture is ____ if the growth plate is in two pieces [need careful alignment or deformity will occur]

A

open reduction and internal fixation

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36
Q

Primary malignant bone tumors are diseases of ____ people.

A

young

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37
Q

MC primary malignant bone tumor

A

osteogenic sarcoma

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38
Q

Osteogenic sarcoma is seen in ages _____, usually around the _____; has a typical ____ pattern on xrays

A

10 to 25yo; knee (lower femur or upper tibia); sunburst

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39
Q

2nd MC primary malignant bone tumor

A

Ewing sarcoma

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40
Q

Ewing sarcoma is seen in ages ____ and grows in _____ of long bones; has a typical ___ pattern on xrays

A

5 to 15yo; diaphysis; onion-skinning

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41
Q

Most malignant adult bone tumors are mets from ____ in women and ____ in men

A

breast (lytic); prostate (blastic)

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42
Q

Earliest finding of most malignant adult bone tumors; best imaging (put in descending order–MRI, xray, CT)

A

localized bone pain; MRI > CT > xray

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43
Q

Pathologic fractures can be indicative of _____ lesions

A

lytic

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44
Q

Multiple myeloma is seen in _____ men with these 3 sxs.

A

old; fatigue, anemia, localized bone pain in different places on several bones

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45
Q

Dx Multiple myeloma

A

xrays showing punched-out lytic lesions; Bence-Jones proteins in urine; abnormal IgG in serum

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46
Q

If chemo fails in multiple myeloma patient, ____ is the next drug of choice

A

thalidomide

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47
Q

Soft tissue sarcomas grow for ______ anywhere in the body and have these 2 main characteristics:

A

several months; (1) firm (2) fixed to surrounding structures

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48
Q

Soft tissue sarcomas mets to ___ but not to ____

A

lungs; LN

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49
Q

Dx soft tissue sarcoma

A

incisional bx +/- MRI (shows only location)

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50
Q

Tx soft tissue sarcoma

A

wide local excision + rad + chemo

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51
Q

Xrays of suspected fractures should ALWAYS have ___ views that are ____ degrees to one another and ALWAYS include the ____ above and below the broken bone.

A

at least 2; 90; joints

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52
Q

Broken bones not badly displaced or angulated can be treated via ____ and/or _____; otherwise sx is required

A

external manipulation; immobilized by cast (closed reduction)

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53
Q

Clavicular fractures are typically located at the junction of the ______ of the clavicle.

A

middle and distal thirds

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54
Q

Tx clavicular fractures

A

figure-of-eight device that aligns bones + sling; can also do open reduction and internal fixation if cosmetically desired

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55
Q

MC type of shoulder dislocation; Dx imaging

A

anterior; AP/lat xrays

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56
Q

Pts w/ anterior shoulder dislocation hold their arm [close to/away from] their body but rotated [inward/outward]

A

close to; outward

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57
Q

Stretching of the _____ nerve can cause numbness in a small area over the deltoid post-anterior shoulder dislocation

A

axillary

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58
Q

MCC posterior shoulder dislocation

A

massive uncoordinated muscle contractions–epileptic seizure or electrical burn

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59
Q

Pts w/ posterior shoulder dislocation hold their arm [close to/away from] their body but rotated [inward/outward]

A

close to; inward

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60
Q

Because regular xrays can miss a posterior shoulder dislocation, ____ views or ____ views are needed

A

axillary; scapular lateral

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61
Q

An old osteoporotic woman who falls on an outstretched hand could get a _____ fracture. Tx

A

Colles; close reduction and long-term cast

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62
Q

Colles fracture is a dorsally displaced, dorsally angulated fracture of the _____

A

distal radius

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63
Q

A direct blow to the ulna (protective arm hit by a nightstick) causing a broken bone is called a _____ fracture.

A

Monteggia

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64
Q

Monteggia fracture: [epiphyseal/diaphyseal/metaphyseal] fracture of the [distal/proximal] ulna w/ [anterior/posterior] dislocation of radial head

A

diaphyseal; proximal; anterior

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65
Q

Galaezzi fracture: distal third of ____ gets direct blow causing fracture, [ventral/dorsal] dislocation of the [proximal/distal] radioulnar joint

A

radius; dorsal; distal

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66
Q

In Monteggia (ulnar) and Galaezzi (radius) fractures, broken bones call for ____ tx and dislocated bones only call for ____ tx.

A

open reduction + internal fixation; closed reduction

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67
Q

Fracture of the scaphoid (carpal navicular) affects _____ who fall on outstretched hand; pt complains of ____ localized to _______

A

young adults; wrist pain; anatomic snuffbox

68
Q

(A) Tx of undisplaced carpal navicular fractures (B) Tx displaced and angulated carpal navicular fractures

A

(A) thumb spica cast (B) open red + internal fixation

69
Q

_____ carpal navicular fractures won’t show up on xrays until ___ weeks later.

A

undisplaced; three

70
Q

Scaphoid fractures are known for a VERY high rate of ____

A

nonunion

71
Q

Tx of metacarpal neck fractures (usually ___ or ____ metacarpal) depends on these 3 things

A

fourth; fifth; (1) degree of angulation (2) displacement (3) rotary malalignment

72
Q

Tx of (A) mild and (B) severe metacarpal neck fractures

A

(A) closed reduction + ulnar gutter splint (B) Kirschner wire or plate fixation

73
Q

Hip fractures (elderly) present when pt is on a stretcher w/ affected leg ______ and [internally/externally] rotated

A

shortened; externally

74
Q

Displaced femoral neck fractures can compromise _____ of the femoral head; faster healing/earlier mobilization can be achieved by _______

A

blood supply; replacing the femoral head w/ prosthesis

75
Q

Most risk of having a intertrochanteric fracture is _____. How do we prevent this?

A

the immobilization post open reduction + internal fixation; can cause DVT/PE; tx w/ anticoagulation

76
Q

Tx femoral shaft fractures

A

intramedullary rod fixation

77
Q

Bilateral multiple-fractured femoral shafts can cause ____ or ____. If they are open wounds, they are an ortho emergency requiring ______ within _____ hours.

A

shock (lots of blood loss); fat emobli; cleaning/closure; 6

78
Q

Knee injuries often present with _____ and are viewed best with [this imaging]

A

swelling; MRI

79
Q

(A) A medial blow to the knee causes pain when the patient [adducts/abducts] the leg at the knee flexed 30 degrees. (B) What is the pain test that adduction elicits on the knee? (C) What is the pain test that abduction elicits on the knee?

A

(A) abducts [Lateral blow = adduct causes pain]
(B) Varus stress test
(C) Valgus stress test

80
Q

Tx Collateral ligament injuries

A

hinged cast or surgery (if severe)

81
Q

MC collateral knee ligament injury? Presentation…

A

ACL; knee swelling + pain + positive anterior drawer

82
Q

What is the Lachman test?

A

knee flexed 20 degrees by grasping thigh with one hand and pulling leg with other

83
Q

Dx for ACL/PCL tears. Tx

A

MRI; immobilize/rehab or surgery (if athletic)

84
Q

Dx meniscal tears; Tx

A

MRI; repair to save as much meniscus as possible (otherwise can cause degenerative arthritis)

85
Q

Clinical presentation meniscus tear

A

protracted pain with swelling post-knee injury; catching and locking w/ “click” when forcefully extended

86
Q

The three most simultaneously injured ligaments

A

medial meniscus, medial collateral, anterior cruciate

87
Q

Clinical presentation tibial stress fracture

A

tenderness to palpation over specific point on bone w/ normal xrays initially; [young men marching lots]

88
Q

Tx tibial stress fracture

A

cast plus repeat xrays in 2 weeks +/- crutches (usually due to pedestrian hit by a car)

89
Q

(A) Tx easily reduced tibia/fibula fractures (B) Tx extremely angulated tibia/fibula fractures

A

(A) casting (B) intramedullary nailing

90
Q

Increasing pain after long leg last has been applied requires immediate removal due to potential _____

A

compartment syndrome

91
Q

Clinical picture Achilles tendon rupture

A

as plant foot, loud popping noise heard and fall, clutching ankle; limited plantarflexion possible; palpation of tendon reveals gap

92
Q

Tx Achilles tendon rupture

A

casting in equinus position or surgery

93
Q

When fall on inverted/everted foot and break ankle, ______ breaks.

A

both maleoli

94
Q

Dx ankle fracture. Tx.

A

AP/lateral/mortise xrays; open reduction and internal fixation (if fragments displaced)

95
Q

Which orthopedic events can precipitate compartment syndrome?

A

ischemia followed by reperfusion, crushing injuries, other trauma, fracture w/ closed reduction

96
Q

Major physical exam finding for compartment syndrome

A

excruciating pain w/ passive extension [PULSES MAY BE NORMAL]

97
Q

Open fractures require cleaning and suitable reduction within _____ from time of injury

A

6 hours

98
Q

In a MVA, ____ is caused when someone’s knees hit the dashboard

A

posterior hip dislocation

99
Q

Describe the position in which someone lying on a stretcher with a posterior hip dislocation would be found

A

leg shortened, adducted and internally rotated

100
Q

In a broken hip, the leg would be shortened, adducted and _____ rotated

A

externally

101
Q

Tx posterior hip dislocation

A

EMERGENCY reduction; must avoid vascular necrosis

102
Q

After acquiring gas gangrene from a rusty nail and/or dirty wound, it takes about ____ days for the patient to look extremely sick.

A

three

103
Q

Sxs gas gangrene

A

site tender, swollen, discolored, gas crepitation

104
Q

Tx gas gangrene

A

IV PCN, surgical debridement, hyperbaric oxygen

105
Q

Galloping soft tissue infections are seen in ______ pts; consist of _____ and ____

A

immunocompromised; synergistic bacterial gangrene; necrotizing fasciitis

106
Q

___ infections can be seen in pts w/ extensive burns or widespread trauma; the worst one is ____

A

fulminating fungal; mucormycosis (turn black)

107
Q

Dx mucormycosis. Tx

A

tissue bx. debridement and amphotericin B

108
Q

Middle to distal third of humerus fracture can injure the ______ nerve; pt is unable to ______ [movement]

A

radial; dorsiflex wrist

109
Q

Tx of middle/distal third humerus fracture

A

reduction and arm on handing cast or coaptation sling [will regain radial nerve motor ability, if not, must do surgery]

110
Q

_____ artery injuries can occur with posterior dislocation of the knee

A

popliteal

111
Q

Dx popliteal artery injury

A

pulses, doppler studies, CT angio

112
Q

Tx popliteal artery injury

A

reduction of posterior knee dislocation [if don’t fix right away, need prophylactic fasciotomy]

113
Q

Hidden injuries: falls from height

A

fractures lumbar and/or thoracic spine; foot/leg fractures

114
Q

Hidden injuries: head-on MVA

A

femoral heads driven backward into pelvis or out of acetabulum

115
Q

Hidden injuries: facial fractures and closed head injuries

A

cervical spine problems

116
Q

Sxs carpel tunnel syndrome

A

numbness/tingling in hands, particularly at night [distribution of median nerve]

117
Q

Numbness and tingling from carpel tunnel can be reduced by ____

A

hanging hand limply for few minutes OR taping/pressuring median nerve over carpal tunnel

118
Q

Ddx carpel tunnel syndrome imaging

A

wrist xray; clinical diagnosis

119
Q

Tx carpel tunnel syndrome

A

splints and anti-inflammatories; surgery preceded by electromyography

120
Q

_____ and _____ are hand problems that affect women primarily

A

Carpel tunnel syndrome; trigger finger

121
Q

In trigger finger, pts are unable to ____;Tx

A

extend their finger; steroid injection is first line, surgery is last resort

122
Q

______ is seen in young mothers who, when carrying baby, force hand into wrist flexion and thumb extension to hold the baby’s head

A

De Quevrvain tenosynovitis

123
Q

Sxs De Quevrvain tenosynovitis

A

pain along radial wrist w/ first dorsal compartment; pain reproduced by asking pt to hold thumb inside closed fist then forcing wrist into ulnar deviation

124
Q

Tx De Quevrvain tenosynovitis

A

splint and anti-inflammatories and/or steroid injection; [surgery rarely needed]

125
Q

Sxs Dupuytren contracture. Tx

A

contracture of palm of hand and presence of palmar fascial nodules; surgery [when hand not flat on table]; [also Norwegian ancestry in older men]

126
Q

_____ is an abscess of the pulp of a fingertip. Sxs include throbbing pain and fever

A

Felon

127
Q

In a felon, why does pressure build up to lead to tissue necrosis? Tx

A

pulp is closed space w/ mult fascial trabecula; surgical drainage [urgent!]

128
Q

Gamekeeper thumb is an injury of the ______ ligament sustained by forced hyperextension of the thumb.

A

ulnar collateral [usually due to skiing injury]

129
Q

Sxs Gamekeeper thumb; can lead to ____ if not treated w/ ____.

A

collateral laxity at thumb-metacapophalangeal joint; arthritis; casting

130
Q

Jersey finger is injury to ______ sustained when flexed finger is forcefully extended.

A

flexor tendon

131
Q

Sxs Jersey finger

A

when making fist, distal phalanx doesn’t flex

132
Q

Mallet finger is injury to _____ sustained when the extended finger is forcefully flexed (common in volleyball)

A

extensor tendon

133
Q

Sxs Mallet finger

A

when hand extended, affected finger remains flexed

134
Q

Tx both Jersey and Mallet finger

A

splinting

135
Q

Traumatically amputated digits are surgically reattached when possible by preserving with [these 4 steps].

A

(1) cleaned w/ sterile saline
(2) wrapped in saline-moistened gauze
(3) placed in sealed plastic bag
(4) bag on ice

136
Q

Amputated digit should NOT be placed in ____ solutions or put on ______ or allowed to _____.

A

antiseptic/alcoholic; dry ice; freeze

137
Q

Surgeons can use _____ to preserve muscular functions of entire amputated extremities that are reattached.

A

electric nerve stimulation

138
Q

Where does lumbar disk herniation almost exclusively occur? At what age usually?

A

L4-L5 or L5-S1; 45-46yo

139
Q

Sxs lumbar disk herniation; exacerbations

A

vague aching pain [pressure on anterior spinal ligament] w/ sudden neurogenic pain caused by doing activities like lifting a heavy object, (+) straight leg test; coughing/sneezing/defecating

140
Q

If the radicular pain in lumbar disk herniation radiates to the big toe, the pt most likely has the herniation between ____; if it radiates to the little toe, then the herniation is between _____

A

L4-L5; L5-S1

141
Q

Dx lumbar disk herniation

A

MRI

142
Q

Spontaneous resolution usually occurs as the body _____ the disk, which usually takes ____ weeks and the pain is controlled most often with nerve blocks.

A

reabsorbs; three

143
Q

Tx severe lumbar disk herniation that doesn’t heal and/or has neurological deficits that are progressing; emergency if sxs of ______

A

surgical intervention; cauda equina syndrome

144
Q

Sxs cauda equina syndrome

A

distended bladder, flaccid rectal sphincter, perineal saddle anesthesia

145
Q

Sxs Ankylosing spondylitis

A

young men (30s or 40s) w/ chronic back pain and morning stiffness; pain worse at rest and improves w/ activity

146
Q

Dx Ankylosing spondylitis

A

bamboo spine on xray; many have HLAB27 antigen

147
Q

Tx Ankylosing spondylitis

A

ani-inflammatories and PT

148
Q

HLAB27 antigen dzs

A

uveitis, IBD, ankylosing spondylitis

149
Q

Elderly w/ progressive back pain that is worse at night and unrelieved by rest or positional changes indicates potential _____.

A

metastatic malignancy [seen on xrays]

150
Q

Metastatic malignancy in spine is usually ____, seen on xray as ___, for women and ____, seen on xray as ____, for men

A

breast cancer; lytic lesion at pedicles; prostate cancer; blastic lesions

151
Q

Locations of diabetic ulcers

A

Pressure points: heel, metatarsal head, tip of toes

152
Q

Progression of diabetic ulcers, starting with neuropathy

A

neuropathy, microvascular disease, injury, failure to heal, possible amputation/debridement

153
Q

Ulcers from arterial insufficiency are usually located _____ and appear ____

A

at tips of toes; dirty w/ pale base devoid of granulation tissue

154
Q

Workup and tx of ulcers due to arterial insufficiency

A

Doppler studies [look for pressure gradient], CT angio, MRI angio, arteriograms, surgical revascularization/angioplasty/stents

155
Q

Common morbidities (2) of pts w/ chronic foot ulcers

A

diabetes, arteriosclerotic occlusive dz

156
Q

Ulcers from venous stasis are usually located ____ and appear ____

A

above medial malleolus; chronically edematous, indurated and hyperpigmented, painless w/ granulating bed [pt usually has varicose veins and PMH of cellulitis

157
Q

Dx and tx ulcers due to venous stasis

A

Duplex scan, support stockings, surgery [vein stripping/grafting], endovascular ablation

158
Q

Marjolin ulcer

A

SqCC of skin that develops into chronic leg ulcer; dirty-looking ulcer w/ heaped up tissue growth at edges

159
Q

Cause of Marjolin ulcers

A

untreated 3rd degree burns, chronic draining sinuses secondary to osteomyelitis

160
Q

Dx and Tx Marjolin ulcer

A

Bx; wide local excision and skin grafting

161
Q

Sxs Plantar fasciitis

A

older, overweight patients w/ disabling, sharp heel pain when foot hits ground; pain worse in AM

162
Q

Plantar fasciitis: xray shows ____ and PE shows local tenderness to palpation, but that is NOT cause of the problem. Spontaneous resolution in _____ months

A

bony spur; 12-18 months [symptomatic tx]

163
Q

Morton neuroma

A

inflammation of common digital nerve at third interspace btwn third and fourth toes; palpable and tender

164
Q

Cause Morton neuroma

A

usually high-heeled shoes or pointy cowboy boots

165
Q

Tx Morton neuroma

A

analgesics and sensible shoes; sometimes surgical excision

166
Q

Sxs Gout

A

swelling, redness, pain of sudden onset at first metatarsal-phalangeal joint in middle-aged obese man w/ high serum uric acid;

167
Q

Dx and Tx gout

A

uric acid crystals on aspirate of joint; Acute attack = indomethacin and colchicine, Chronic = allopurinol and probenicid

Surgery Clerkship (7 decks)

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