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Surgery > musculoskeletal > Flashcards

musculoskeletal Flashcards

1
Q

MC fractured carpal bone

A

scaphoid

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2
Q

scaphoid fractures - presentation

A

pain at the radial wrist proximal to the base of the thumb

examination: tenderness in the shallow depression
- risk of osteonecrosis

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3
Q

scaphoid fractures - management

A

initial x-rays can be normal in nondisplaced fractures

if scaphoid fracture is suspected: CT or MRI to confirm or repeat x-ray in 7-10 d.

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4
Q

scaphoid fractures - treatment

A

Displaced fractures –> surgical intervention

nondisplaced –> wrist immobilization (but monitor with serial x-ray to rule out osteonecrosis)

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5
Q

ganglion cysts - age and area

A

age 15-40

arise in most cases due to repetitive stress or inflammation

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6
Q

all patients with clavicular fracture should have

A

a careful neurovascular examination to rule out injury to the underlying brachial plexus and subclavian artery
- if bruise is heard –> angiogram to rule out injury of vessel

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7
Q

MC clavicle fractures are at … (area) / how to treat every area

A

midline 3rd
fractures of the middle 3rd: nonoperatively with a brace, rest and ice
fractures of the lateral 3rd: open reduction and internal fixation

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8
Q

clavicular fractrues - presentation

A

pain + immobility of the affected arm
the contralateral hand is classically used to support the weight of the affected arm
- the affected shoudler is displaced inf + posteriorly

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9
Q

Meniscal tears - etiology

A

younger: rotational force on planted foot
older: degeneration of meniscal cartilage

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10
Q

meniscal tears - symptoms

A
  1. acute popping sensation
  2. catching, locking, reduced range of motion
  3. slow onset joint effusion
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11
Q

meniscal tears - examination

A
  1. joint line tenderness

2. pain or catching in provocative tests (Thessaly, McMurray

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12
Q

medical tears - diagnosis

A

MRI

arthroscopy

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13
Q

medical tears - management

A

mild symptoms, older: rest, activity modification

persistent symptoms, impaired activity: surgery

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14
Q

meniscus injury - effusion

A

not immediately because is not perfused very well

in several hours

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15
Q

Thessaly test

A
  • patient stands on 1 leg with knee flexed 20 degrees

- then internally and externally rotates on flexed knee

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16
Q

succinylcholine - mechanism of action and severe SA

A

depolarizing neuromuscular blocker that can cause life-threatening hyperkalemia in patients with a condition leading to upregulation of postynaptic ACE receptors (eg. skeletal muscle trauma, atrophy, burn injury, stroke) or prior hyperkalemia (muscle trauma)
Nondepolrizing neuromuscular blocking agents should be used with these patients

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17
Q

situations that increase the risk for hyperkalemia in succinylochine use

A

upregulation of postsynaptic ACE receptors (skeletal muscle truama, atrophy, burn injury, stroke, denervation

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18
Q

hip fracture - how can we wait for the surgery

A

72 hours (if needed to undress unstable medical cormobitity)

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19
Q

supracondylar fracture of the humerus - mechanism

A

fall on an outstretched hand most common

20
Q

supracondylar fracture of the humerus - complications (MC)

A
  1. Brachial artery injury (MC)
  2. median nerve injury (MC)
  3. cubitus varus deformity
  4. compartment syndrome (rare: less than 1%)
  5. volkman ischemic contracture (due to ischemia and infraction from compartment syndrome)
21
Q

acute collateral ligament tear - acute effusion/hematthrosis?

A

uncommon unless there is concurrent inury to the anterior crciate ligament

22
Q

medial collateral ligament - treatment

A

uncomplicated: nonoperatively with rest, ice, compression + elecation and analgesics

23
Q

fat embolism syndrome - etiology

A
  1. fracture of marrow-contaning bone
  2. orthopedic surgery
  3. PANCREATITIS
24
Q

fat embolism syndrome - clinical presentation

A

24-72 h following inciting event:

triad: resp distress, neurologic, petechial rash

25
Q

Fat embolism syndrome - diagnosis

A

based on clinical presentation

26
Q

Fat embolism syndrome - prevention + treatment

A

ealy immobilization of fracture

2. supportive care (eg. mechanical ventilation)

27
Q

trochanteric bursitis

A

middle age adult, unilateral hip pain that is exacerbated by external pressure to the upper lateral thigh (as when lying on the affected side in bed)
superficial pain

28
Q

hip osteoarthritis - pain exacerbated by

A

internal rotation

deep pain

29
Q

athrocentesis in recommended to

A

evaluate unexplained joint effusion

30
Q

chronic exertional compartment syndrome

A

increased pressure within a muscle group during exercise –> young athletes (no point tenderness)

31
Q

Popliteal (Baker) cysts - etiology

A

extrusion of fluid from knee joint space into seminmembranous/gastrocnemius bursa

32
Q

popliteal (Baker) cyst - RF

A
  1. trauma (e. meniscal tear)

2. joint disease (RA or OA)

33
Q

popliteal (Baker) cysts - clinical presentation

A

asymptomatic

posterior knee pain, swelling, stiffness

34
Q

popliteal (Baker) cyst - complication

A
  1. venous compression
  2. dissection into calf (erythema, de,a, (+) Homan sign)
  3. Cyst rupture (acute calf pain, warmth, erythema, ecchymosis
35
Q

causes of chronic low back pain

A
  1. mechanical
  2. radiculopathy
  3. spinal stenosis
  4. inflammatory
  5. metastatic
  6. infectious
36
Q

when to referral to orthopedic surgeon for a stress fracture

A

at high risk for malunion (anterior tibial corte, 5th metatarsal)

37
Q

meniscial tear - surgery or not

A

surgery in young

38
Q

Common causes of shoulder pain - DDX

A
  1. rotator cuff impingement or tendinopathy
  2. rotator cuff tear
  3. Adhensive capsulitis (frozen shoulder)
  4. Biceps tendinopathy/rupture
  5. Glenohumeral osteoarthritis
39
Q

rotator cuff impingement or tendinopathy

A
  • pain with abduction, external rotation
  • subacromial tenderness
  • normal range of motion with positive impingement tests (eg. Neer, Hawkins)
40
Q

rotator cuff tear

A
  • similar to rotator cuff tendinopathy
  • weakness with external rotation
  • older than 40
41
Q

adhensive capsulitis (frozen shoulder)

A
  • decreased passive + active range motion

- more stiffness than pain

42
Q

Biceps tendinopathy / rupture

A
  • anterior shoulder pain
  • pain with lifting, carrying, or overhead reaching
  • weakness less common
43
Q

Glenohumeral osteoarthritis

A
  • uncommon + usually caused by trauma
  • gradual onset of anterior or deep shoulder pain
  • decreased active + passive abduction + external rotation
44
Q

neer test

A

with the patient;s shoulder internally rotated and forearm pronated, the examiner stabilizes the scapula + flexes the humerus –> if pain is positive

45
Q

non heeled strees fracture (non in malunion position) - next step

A

podiatric shoe

46
Q

prepaterllar bursitis

A

anterior knee pain, tenderness, erythema, localized swelling, common in occupations requiring repetitive kneling

  • it is often due to S. aureus
  • active motion is often decreased and painful, passive is normal
  • culture (-) –> NSAID + rest
  • culutre (+) –> drainage + antibiotics

Surgery (10 decks)

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