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#2 BOARDS > Miscellaneous 3 > Flashcards

Miscellaneous 3 Flashcards

1
Q

4th-5th IMA

A 
Normal = 7 degrees
High = 8-10 degrees
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2
Q

5th metatarsal lateral deviation angle

A

Bisection of 5th metatarsal head and neck compared to medial cortical margin of proximal shaft

Normal = 3 degrees
High = 8 degrees
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3
Q

Osteochondrosis

A

AKA Epiphyseal ischemic necrosis
- A disease of the growth or ossification center in children, which begins as a degeneration or necrosis and is followed by regeneration or recalcification

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4
Q

Blount’s disease

A

Osteochondrosis of medial proximal epiphyseal ossification center of the tibia

This can cause limping and lateral bowing of the leg

Infantile type

  • Occurs before age 6
  • Caused by early walking/obesity

Adolescent type

  • Occurs at 8-15 years
  • Caused by trauma and infection
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5
Q

Freiberg’s infarction

A

Osteochondrosis of the metatarsal head - most commonly 2nd (followed by 3rd, 4th and 5th)

  • Sclerosis, fragmentation and flattening of articular surface
  • Pain on ROM, swelling
  • Treat with offloading, immobilization, removal of exostosis. MPJ implant if severe
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6
Q

Kohler disease

A

Osteochondrosis of the navicular

  • More common in boys, occurs between 3-6 years
  • Often asymptomatic, can cause pain/swelling
  • Sclerotic/flattened appearance (con on edge, silver dollar sign)
  • Self-limiting disease, recovery takes 2-4 years with normal shape/density restored
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7
Q

Legg-Calve-Perthes disease

A

Osteochondrosis of femoral head (most common osteochondrosis)

  • Occurs between 3-12 years, 10% bilateral, younger onset = better prognosis
  • Limping, groin pain, referred knee pain
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8
Q

Osgood Schlatter disease

A

Osteochondrosis of tibial tuberosity

  • More common in boys, occurs 10-15 years
  • Caused by excessive traction of the patellar ligament
  • Local pain, swelling, tenderness
  • Self limiting with symptomatic treatment
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9
Q

Sever’s disease

A

Osteochondrosis of the calcaneal apophysis

  • Caused by excessive traction of the Achilles tendon
  • Ages 6-12, more common in equinus
  • Difficult radiographic diagnosis due to normal epiphysis potentially having 2+ centers, appearing fragmented, irregular borders, sclerotic
  • Treat with RICE, NSAIDs, rest, heel lift, Achilles stretching
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10
Q

Islin’s disease

A

Osteochondrosis of 5th metatarsal base

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11
Q

Treve’s disease

A

Osteochondrosis of fibular sesamoid

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12
Q

Renandier’s disease

A

Osteochondrosis of tibial sesamoid

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13
Q

Lance’s disease

A

Osteochondrosis of the cuboid

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14
Q

Assmann’s disease

A

Osteochondrosis of the 1st met head

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15
Q

Ortolani’s sign

A

The hip is already out

With baby supine, hips and knees are flexed to 90 degrees, grasp thigh with middle finger over greater trochanter, lift and abduct thigh

If there is a palpable click, the test is positive, as the femoral head was out and the click was felt as it was relocated into the acetabulum

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16
Q

Barlow’s sign

A

Dislocatable hips

With baby supine, hips and knees are flexed, thumb placed on greater trochanter laterally, apply pressure down and lateral

The dislocatable hip becomes displaced with a palpable clunk as the head slips over the posterior acetabulum

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17
Q

Club foot (3 deformities)

A

Talipes equinovarus

  • Ankle equinus
  • Hindfoot varus
  • Forefoot adduction
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18
Q

Radiographic angles in club foot

A

Kite’s ankle low

  • Normal = 20-40 degrees
  • Clubfoot = 0-15 degrees

Calcaneal inclination low

  • Normal = 20-25 degrees
  • Clubfoot = 17 degrees

Talar head/neck to body adduction high

  • Normal = 10-20 degrees
  • Clubfoot = 80-90 degrees

Talar head to body plantarflexion high

  • Normal = 25-30 degrees
  • Clubfoot = 45-65 degrees
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19
Q

Reduction of clubfoot deformity should be performed in the following order:

A

AVE “clubfoot AVEnue”

  • Adduction
  • Varus
  • Equinus
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20
Q

Congenital vertical talus

A
  • Primary dislocation of the navicular dorsally on the neck of the talus, locking the talus in a vertical position
  • Forefoot is abducted and dorsiflexed at the midtarsal joint
  • Calcaneus is in valgus and equinus
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21
Q

Treatment

A
  • Closed reduction rarely successful

- Surgical reduction of TN joint and posterior release

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22
Q

Evans

A

Calcaneal opening wedge osteotomy 1.5 cm proximal to CC joint

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23
Q

Kidner

A
  • Removal of prominent navicular tuberosity or accessory navicular
  • Transplantation of posterior tibial tendon onto underside of navicular bone
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24
Q

Hoke

A
  • Closing plantar wedge from navicular and medial and intermediate cuneiform
  • Opposite of Cotton - plantarflexes forefoot to re-establish arch
  • Performed with TAL
25
Q

Miller

A
  • Fusion of the navicular-medial cuneiform joint and the first TMTJ
  • Take a plantar wedge out for each fusion in order to plantarflex the forefoot and re-establish an arch
  • Posterior tibial tendon and spring ligament advancement using an osteo-periosteal flap
26
Q

Young

A

Keyhole technique

  • Reroute anterior tibial tendon through a keyhole in the navicular without detaching it from its insertion
  • Posterior tibial advancement under the navicular
27
Q

Skewfoot

A
  • Adducted forefoot, normal midfoot, valgus hindfoot

- Usually aquired from gradual compensation of metatarsus varus that occurs with WB or improper manipulation/casting

28
Q

Tarsal coalition

A
  • Most common cause of peroneal spastic flatfoot (spasm results from immobilization of STJ)
  • Incidence 1%, 50% bilateral
  • TC and CN coalitions account for about 45% of coalitions each
  • TN coalition rare
29
Q

Talocalcaneal coalition

A
  • Almost all involve the middle facet
  • Begin at 12-18 years
  • Pain at sinus tarsi or over middle facet
  • Decreased ROM at STJ and MTJ
  • Harris-Beath shows mid and post facets are not parallel, mid facet not well demarkated
  • Lateral shows talar beaking, no mid facet, ball-and-socket ankle joint, halo sign or C-sign (sclerotic ring around sinus tarsi)
  • Treat with immobilization, steroid injection, NSAIDs, resection, triple arthrodesis if DJD
30
Q

Calcaneonavicular coalition

A
  • Extraarticular coalition
  • Begin at 8-12 years
  • Pain at location of coalition
  • Lateral shows prolonged anterior process of calcaneus - “anteater sign”
  • Treat with immobilization, NSAIDs, resection, interposition of EDB, triple arthrodesis if DJD
31
Q

Cerebral palsy

A
  • A broad term used to describe several static NON-PROGRESSIVE neuromuscular disorders resulting from brain damage before, during or immediately after birth
  • Scissors gait due to adductor spasticity
  • Speech defects, retardation, seizures, visual defects
  • Ankle equinus
  • Treat with PT/OT, splinting, bracing
32
Q

Muscular dystrophies

A
  • Inherited, chronic, PROGRESSIVE myopathic disorders

- Progressive weakness, atrophy, loss of DTRs, contractures, deformity

33
Q

Duchenne’s muscular dystrophy

A
  • Onset 2-5 years
  • Pelvic girdle weakness
  • Rapid progression with wheel chair bound by 10 to 12 years old
  • Die around 20 years (respiratory sepsis, cardiac arrest)
  • Toe walking, difficulty with stairs, lordosis, wadling gait, Gower’s sign, decreased IQ, pulmonary disorder
34
Q

Becker’s muscular dystrophy

A
  • Age of onset 5-25 years (later than Duchenne’s)
  • Weakness of pelvic girdle
  • Less severe contractures/cardiac involvement than Duchenne’s
  • Slow progression with wheel chair bound by 20-50 years
  • Die around 40 years (some have normal life span)
  • A milder form of Duchenne’s but no decrease in IQ
  • Pes cavus in 60%
35
Q

Silfverskoild test

A

Tests for gastroc equinus

  • Passive dorsiflexion is measured with knees extended then with knees flexed
  • If the dorsiflexion increases when knees are flexed, the equinus is due to a tight gastroc because the gastroc crosses the knee joint and is eliminated upon knee flexion
36
Q

Lisfranc amputation

A

Remove metatarsals, leave all cuneiforms, cuboid and navicular

37
Q

Chopart’s amputation

A

Remove all cuneiforms, cuboid and navicular, leave just talus and calcaneus

ChopartT = Calc and Talus

38
Q

Symes

A

Remove both malleoli and distal tibia

39
Q

Normal compartment pressure

A

5 mmHg

Can get as high as 50 mmHg during exercise

40
Q

Pressure at which fasciotomy is indicated

A

30-40 mmHg

41
Q

MPJ sequential release for hammer toe

A 
1 - Release extensor expansion 
2 - Tenotomy/lengthening of EDL/EDB
3 - Transverse MPJ capsulotomy 
4 - Release of collateral ligaments 
5 - Plantar plate release (McGlamry elevator)
42
Q

Stress fracture on x-ray

A

May take 14-21 yeas to present radiographically after a bony callus has developed

43
Q

Mondor’s sign

A

Ecchymosis from malleoli to the sole of the foot

Pathognomic for calcaneal fractures

44
Q

Steida’s process/Shepard’s fracture

A

Stida’s process is the lateral tubercle of the posterior process of the talus

Shepard’s fracture is a fracture of the lateral tubercle of the posterior process of the talus - MOI forced plantarflexion where posterior process is compressed between posterior malleoli and calcaneal tuberosity

45
Q

Toyger’s angle

A

A line drawn down the posterior aspect of the Achilles tendon should produce a straight line, but will be a curved line (<180 degrees) with achilles rupture

46
Q

Burn depth

A

Partial thickness burn

  • 1st degree
  • 2nd degree

Full thickness burn
- 3rd degree

47
Q

1st degree burn

A

Involves only the epidermis

  • Superficial epidermis
  • Appears erythematous with normal texture and pinprick sensation intact
  • Heals in 5-10 days with no scar
48
Q

2nd degree burn

A

Involves the dermis but does NOT penetrate the dermis

Superficial partial thickness

  • Edematous blister with pinprick sensation intact
  • Heals in 10-21 days with minimal scar

Deep partial thickness

  • Pink or white in appearance with thick texture
  • Heals in 25-60 days with a dense scar
49
Q

3rd degree burn

A

Full thickness (damage extends through the dermis)

  • Appears white, black or brown with leathery texture, no pinprick sensation intact,
  • No spontaneous healing, usually requires skin graft and heals with a dense scar
50
Q

Dog bites

A
  • Staph, strep, pseudomonas

- Pasturella multocida

51
Q

Cat bites

A
  • Pasteurella multocida (responsible for the majority of infections)
  • Cat scratch fever - bartonella henselae
52
Q

Human bites

A
  • Strep viridans

- Eikenella

53
Q

Puncture wounds

A
  • Staph aureus&raquo_space; cellulitis

- Pseudomonas&raquo_space; osteomyelitis

54
Q

Medial compartment of the foot

A
  • Abductor hallucis
  • Flexor hallucis brevis
  • FDL tendon
55
Q

Central compartment of the foot

A
  • FDB
  • Lumbricles
  • Quadratus plantae
  • Adductor hallucis
  • FDL, PT and PL tendons
56
Q

Lateral compartment of the foot

A
  • Abductor digiti minimi

- Flexor digiti minimi

57
Q

Interosseous compartment of the foot

A
  • All 4 dorsal interosseous muscles

- All 3 plantar interosseous muscles

58
Q

Malignant hyperthermia

A
  • Due to a reduction in the reuptake of calcium by the sarcoplasmic reticulum
  • Most frequently seen when receiving a combination of muscle relaxant (succinylcholine) and inhalation general anesthetic (halothane)
  • Treated with cool IV NS (not ringer’s) and IV dantrolene

#2 BOARDS (14 decks)

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