MSK-Surgery

Question 1

DM with low back pain, elevated ECR and CRP. Dx? NSIM?

Answer 1

Spondylodiscitis (vertebral osteomyelitis), CT guided biopsy

Question 2

“Clunk” heard and felt on abducting a flexed hip is called__________ suggestive of ________

Answer 2

Ortolani sign , Dysplasia of the hip (DDH)

Question 3

Dysplasia of the hip (DDH) tx?

Answer 3

Apply a rigid harness of the hips (von Rosen harness) that maintains the hips in 90-100 degree flexion and 50% abduction

Question 4

Shoulder adducted, internally rotated, appears flattened with prominent coracoid process. Dx? NSIM? TX?

Answer 4

• Posterior shoulder dislocation,
• Axillar radiograph of shoulder
• Closed reduction (after imaging)

Question 5

Fever, elevated ESR, CRP, x-ray with bacterial infection of the hip. NSIM?

Answer 5

Synovial fluid drainage plus nafcillin and cerfazolin therapy

Question 6

Child with antalgic gait, limited abduction and internal rotation at his hip, x-ray shows erosion of the femoral epiphysis with minimal damage to the femoral head. Dx? NSIM?

Answer 6

• Legg-Calve-Perthes disease,
• Limited weight bearing and physical therapy
• Casting and bracing (If femoral head deformities start to develop or ROM worsens)

Question 7

Tx for scaphoid fracture

Answer 7

Thumb spica cast and repeat x-ray in 2 weeks

Question 8

Rear-end collision, right groin pain, right leg shorter, flexed, adducted and internally rotated. Dx? Tx?

Answer 8

• Posterior Hip dislocation, (dashboard injury)

- Emergent closed reduction

Question 9

Tibia is displaced posteriorly when force is applied to the proximal tibia after flexing the knee. This is called? Dx?

Answer 9

Postive posterior drawer sign. Posterior cruciate ligament injury (PCL)

Question 10

Pain in the calf muscle on passively dorsiflexing the foot is called? Suggests?

Answer 10

+ stretch test

Compartment syndrome

Question 11

Tx for compartment syndrome

Answer 11

fasciotomy

Question 12

how long before doing fasciotomy to prevent necrosis

Answer 12

6hrs

Question 13

Test used to differentiate rotator cuff tear from rotator cuff tendinopathy

Answer 13

Subacromial lidocaine (it also helps to relief pain)

Question 14

Knee pain worst at the end of the day, crepitus, limited ROM, osteophytes, subchondral sclerosis and joint space narrowing . Dx? NSIM?

Answer 14

osteoarthritis

Weight loss program (if that fails- Total joint replacement)

Question 15

Laterally displaced patella, right knee effusion & pain, hx of similar episodes, hx of Ehlers-Danlos syndrome. Dx? NSIM?

Answer 15

Acute patella dislocation

Arthroscopy

Question 16

What to do before attempting reduction in shoulder dislocation

Answer 16

Test sensation of the lateral shoulder to assess for axillary nerve palsy

Question 17

Medial joint tenderness, laxity, and positivity valgus stress test is

Answer 17

Medial Collateral ligament injury

Question 18

Treatment for mid shaft fracture of the clavicle without neuromuscular damage

Answer 18

apply simple shoulder sling 4-6 weeks

Question 19

When to do physiotherapy for mid shaft fracture or the clavicle

Answer 19

2-4 weeks after sling.

Question 20

Obese children age 10-16 with hip pain and externally rotated thigh. Dx?NSIM?

Answer 20

• Slipped capital femoral epiphysis

- X-ray

Question 21

what bacteria is risk with prosthetic joints, prosthetic cardiac valves, iv catheters, and pacemakers

Answer 21

Staph epidermidis

Question 22

acute onset knee pain, hx of locking and popping, joint line tenderness, + McMurray test. Dx? Imaging?

Answer 22

• Meniscal tear
• MRI- hyper intense line in the meniscus
• Arthroscopy if pt have metal implants

Question 23

Passive flexion causes external rotation and abduction-called

Answer 23

Drehmann sign

Question 24

Drehmann sign and widening of the hip joint, inferiorly displaced femoral head on x-ray. Dx? NSIM?

Answer 24

Slipped capital femoral epiphysis (SCFE)

Surgical pinning of femoral head

Question 25

Empiric antibiotic treatment for osteomyelitis

Answer 25

Ciprofloxacin (Pseudomonas)

vancomycin (Staphlococci)

Question 26

Flexed distal interphalangeal joint, inability to actively extend the distal phalanx after an indirect trauma to the finder. Dx? Tx?

Answer 26

• Extensor digitorum tendon injury (Mallet finger)

- Stack splint - to stabilize the joint for 6-8 weeks

Question 27

Recent URI on a child with hip pain

Answer 27

Transient synovitis- Effusion will improve over 2 weeks

Question 28

Child with hip slightly abducted and external rotated indicates

Answer 28

pain

Question 29

Avascular necrosis of the femoral head

Answer 29

Legg-Calve-Perthes disease (Coxa plane)

Question 30

Hx DM, swollen and erythematous and tender knee with fever and leukocytosis, Dx? NSIM?

Answer 30

• Septic arthritis

- Arthrocentesis of the knee

Question 31

Tx for trimalleolar ankle fracture

Answer 31

Open reduction and internal fixation (ORIF) is always required

Question 32

Nerve that innervates the radial aspect of the forearm and the thumb

Answer 32

C6 nerve root

Question 33

Test that is high specificity for C6 radiculopathy

Answer 33

Spurling’s maneuver

Question 34

C6 nerve affects what motor function and reflex ?

Answer 34

wrist extensor and brachioradialis reflex

Question 35

extending the neck to the side of pain and applying downward pressure to the head

Answer 35

Spurling test - + if limb pain/paresthesia