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Millers > OITE 2021 > Flashcards

OITE 2021 Flashcards

1
Q

Age + location chondroblastoma

A

KIDS
Epiphysis (and pelvis, talus, calc)
Lytic
Curretage + bone graft bc can erode articular cartilage untreated

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2
Q

The majority of enchondromas are what Enneking stage?

A

Enchondroma is a benign lesion = E st 1

Enneking of benign tumors
St 1 = indolent
St 2 = active
St 3 = aggressive

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3
Q

Treat enchondroma

A

If symptomatic: curettage

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4
Q

Sarcoma screening vs myxoid liposarcoma screening tests

A

Sarcoma: MRI field, CT chest
- Met to lungs

Myxoid liposarc: “ “ + CT abd/pel
- Mets to abd and retroperitoneum

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5
Q

The dorsomedial cutaneous nerve is the terminal branch of what nerve? (inner big toe)

A

SPN (cross from P to A 5cm above the ankle joint)
Commonly cut during hallux valgus

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6
Q

What is the common deformity when nailing prox 1/3 tibia?
Where do you place the blocking screw to prevent this?

A

Valgus + apex anterior
Screw in lateral + posterior proximal segment

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7
Q

What are the resus parameters for early total care?

A

One of the following:
Lactate <4
pH > 7.25
Base excess > -5.5

WBC not included

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8
Q

3 soft CI for hip scope

A

Cystic bone changes on MRI
>45yo
BMI >24

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9
Q

Which position of tab retractor placement is most likely to increase risk of femoral nerve injury?

A

Generally thinking direct anterior approach for THA - fem n + ext iliac art
Inf-med retractors
And penetrating IP muscle

Safest = 12 o’clock

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10
Q

Which structure provides the most valgus stability in extension: dMCL, sMCL or POL?

A

POL - most valgus stability in ext and IR

dMCL - stab ant translation, min valgus restraint at 60deg flex (2ary valgus stabilizer, does its most in extension)
sMCL - 1ary valgus restraint in flexion and IR

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11
Q

What is Grisel syndrome?
- Ddx
- Best diagnostic tests

A

Kid
Recent URI/head neck surg
SCM spasm -> acute head tilt/rotation bc general lig laxity in kids (AA rotatory subluxation)
Painful!

Ddx: congenital muscular torticollis (not painful)

Get XR: open mouth odontoid - see asymmetric C1 lateral masses
CT = gold standard

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12
Q

Treat Sever disease

A

Calc apophysitis

  1. Stretching
  2. SLC

Orthotics no benefit

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13
Q

Treat Lyme in kids

A

<8 = amoxicillin
>8 = doxy

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14
Q

Compare ORIF vs TEA for distal humerus frx in elderly patients

A

TEA
- Faster in OR
- Better Mayo elbow scores

ORIF
- Higher reop

Same post op ROM

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15
Q

SNAC wrist treatment tree (4 procedures)

A
  1. Distal pole excision (take out part thats causing arthritis w/ radial styloid)
    CI: arthritis, SL instability, midcarpal instability, midcarpal arthritis
    2/3. (retain wrist motion)
    Scaphoidectomy w/ 4 corner fusion (capitate, lunate, triquetrum, hamate aka ULNAR)
    Soft CI: smoker
    PRC
    CI: arthritis @ capitate head
  2. Wrist fusion
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16
Q

Gout
- RF
- Crystals

A

RF
- Purine rich diet
- Diuretics
- EtOH
- Obesity

Monosodium urate

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17
Q

Complication of P1 fractures

A

PIP flexion contracture

Bc apex volar deformity
- Prox frag flexes 2/2 lumbrical
- Distal frag extends 2/2 central slip
The bone becomes too short for the long extensor mechanism

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18
Q

RCL injury thumb
- Where does the lig tear
- Treat

A

Evenly distributed between prox/mid/distal ligament (vs UCL = distal)
Amenable to 1ary repair even when delayed

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19
Q

What is the intrinsic tightness test

A

MCP extended, see PIP flexion
If PIP flexion improves w/ MCP flexion, then you have intrinsic tightness

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20
Q

What is the treatment for intercarpal coalitions

A

Non-op 1st since generally incidental finding
Then fusion (not resection of coalition)

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21
Q

Mechanism TXA

A

Lysine analog
Binds lysine receptors on plasminogen
Blocks plasminogen -> plasmin (cannot breakdown clots)

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22
Q

What artery lives in the biciptial groove?

A

Ax art -> ant hum circhumflex -> arcuate
Arcuate = branch that runs up medial biceps groove

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23
Q

What is the innervation of the long vs short head biceps femoris

A

Short: CPN
Long: tibial n

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24
Q

What is the most common fracture for intimate partner violence

A

Nasal

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25
Q

What foot injury has high correlation with amputation?

A

Frx all 5 MT

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26
Q

Do OATs procedures in the patellofem and tibfem joints do the same?

A

NO - patellofem 2x failure rate

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27
Q

What is the structure involved in the avulsion fracture of a “wrist sprain”?

A

Dorsal triquetral avulsion fracture
- DRC
- Dorsal intercarpal ligament

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28
Q

RF for DRUJ instab w/ DR frx

A

Ulnar styloid base frx (not tip)
Open

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29
Q

Treat Kienbock disease

A

= AVN lunate

Early = radial shortening osteotomy, core decompression distal radius
Late + active = PRC
Late + inactive = capitate resurfacing implant arthroplasty

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30
Q

What is likely happening if you have a irreducible volar PIP dislocation?

A

P1 head through lateral band + central slip (can get caught too)
Closed reduction tightens these

Dorsal - volar plate or flexor tendons

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31
Q

Thumb tip flap coverage

A

<2cm volar advancement flap
>2cm FDMA
Can do a NV island flap up to 4cm

Dorsal thumb is FDMA all the way

32
Q

What is happening with RA patients slowly lose the ability to extend their fingers

A

Progressive attritional rupture of extensor tendons
Starts ulnar (small finger)
As the wrist degenerates and falls into ulnar deviation, the subsequent tendons sublux ulnar and rupture over the ulnar head
Painless
Must resect ulnar head to treat + tendon transfers

33
Q

How splint snapping ECU

A

Pronation + wrist ext + rad dev
For acute ECU subsheath rupture

If refractory to non-op, can do subsheath recon

34
Q

Structure at risk with C1 lateral mass screws

A

Internal carotid art
Why place screws 10deg med trajectory

35
Q

SPORT outcomes

A

Spinal stenosis - surg > nonop

36
Q

What are the 3 parameters for corrective surgery in adult spinal deformity
What is the most common complication for adult spinal deformity surgery

A
  1. TK + LL + PI <45deg
  2. LL = PI (if mismatch, construct breaks)
    PT<25deg
    SVA<5cm
  3. T1 pelvic angle <14deg

Pseudarthrosis&raquo_space; PJK

37
Q

What are risk factors for progression of infantile scoliosis?
Treat

A

Progression:
- Cobb >25deg
- RVAD 40deg
- Worsening curve

Trt: elongation derotation flexion cast

38
Q

Genetics for tibial pseudarthrosis

A

NF1 chr 17 - spont mutation

39
Q

What are the pulleys in the thumb
Trt congenital trigger thumb

A

A1 oblique A2 (no cruciates in thumb)
Stretching + obs
NO role CSI
Op release

40
Q

What are the 3 diseases with radius deficiencies and how do you tell them apart

A

TAR - AR
- Thumb present
- Bilateral absent radii

Holt Oram - AD
- Cardiac defects

Fanconi anemia - AR
- Do chromosomal breakage test -> bone marrow transplant

41
Q

What nerve can be injured during an inversion ankle sprain

A

SPN

42
Q

What is the most reliable XR landmark for accurate reduction of the syndesmosis

A

Posterior overlap fib/tib on lateral XR

43
Q

What is Freiberg’s disease / 2 risk factors

A

2nd MT head AVN - looks like flattening on XRs

RF
- Long 2nd MT head (transfer loading)
- GR contracture

44
Q

What cytokines are elevated in pro-inflam conditions?

A

TNFa
IL 1B
NF kappa B

45
Q

Atypical lipomatous tumor
- 2 tumor markers
- Problematic areas
- Treat

A

MDM2, CDK4
Problematic in the retroperitoneum
Trt: marginal resection (not wide excision since benign)

46
Q

Treat sarcoma

A

Wide excision - need clear margins
Pre vs post op rads (just different complications)

EXCEPT rhabdomyosarcoma (chemo sensitive, no rads!, +/- surg)

47
Q

For MTP fusion (hallux rigidus), where can you malposition the plate causing too much MTP dorsiflexion?

A

Too proximal!!
6mm proximal to ideal position = 8deg increased DF

48
Q

Spring lig
- What is the main lig + origin/insertion

A

1 = supmed calc-navic lig = larger/more important arch stabilizer

O: sustentaculum
I: navicular

Inf cal-navic lig
O: between ant/mid calc facets

49
Q

Treat interdigital neuroma

A

Resection is the only way!!!

50
Q

CSI 2mo prior to RCR have been associated with:

A

High REVISION rate

Tendon doesn’t heal! NOT infection
Avoid 6mo before RCR

51
Q

What skin suture pattern has best mean incision perfusion?

A

Running subcuticular

52
Q

A p value cutoff of 0.05, this indicates that there is a 5% chance that….

A

A positive result is not valid

53
Q

If power is 0.9 rather than 0.8, the change in the interpretation is….

A

Increased confidence if a negative value is found

Power = 1- type 2 error
T2 error = negative result when a true difference exists
0.9 power = 10% probability of T2 error
0.8 power = 20% probability of T2 error

Increase sample size to increase power

54
Q

What is a significant change for the following during spine surgery:
- Sensory change

A

Sensory change 50%+

55
Q

What is Parsonage Tuner syndrome

A

Acute brachial neuritis

Ex: acute onset shoulder pain, subsequent weakness
MRI: diffuse T2 signal change
Trt: obs only

56
Q

Rate of NV injury w/ knee dislocation

A

Pop art 16%
Pern nerve 25%

57
Q

Insall Salvati index vs Caton Deschamps

A

IS = Patellar tendon length : patellar length
Normal <1.2

CD = inf pat articular surface distance from plateau : pat articular surface length
Normal <1.3

58
Q

Describe the 3 MCL bundles elbow

A

Ant = tight ext, 1ary valgus restraint
Post = tight flex, 2ary valgus restraint
Transverse doesn’t cross elbow joint so no stability

59
Q

Test for non-continuous data (ordinal) between 2 groups

A

Mann Whitney

60
Q

What is a Brodie abscess

A

Intraosseous abscess 2/2 chronic osteo
Usually tibia in kids
No fever
Trt: OR + abx - leave the defect, will fill in with bone over time

61
Q

Inheritance of post axial polydactyly of foot (aka extra pinky toe)

A

AD
If well formed (with nail) - high penetrance
If small or tag like - reduced penetrance

62
Q

What does a 2:1 ratio of Co:Cr mean in a THA setting

A

Indicates trunnion as ion source

Not modular neck-stem interface or bearing surface

63
Q

What is the interval for direct anterior hip approach

A

2cm dis/lat to ASIS, over TFL muscle (lateral to sartorius)

LCFN at risk (L2/3 roots)

64
Q

Which meniscus is:
More important to stability
More mobile

A

Med more impt to stability - more attached to capsule / MCL
Lat more more mobile

65
Q

ALL insertion

A

Between Gerdy + fib head (Segond frx here)
Xs tibial IR

66
Q

Anatomic landmark for radial n

A

4cm prox to triceps aponeurosis (more helpful in trauma perhaps)
Crosses posterior humerus 20cm prox med epicondyle / 14cm prox to lat epicondyle

67
Q

Goal serum 25 vit D

A

32-250 ng/mL

68
Q

RF that say you should treat FNF with SHS > cancellous screws

A

Females
High BMI
Displaced frx
Smokers

Have high rates revision surgery with screws - why do SHS

69
Q

Trt osteosarc

A

Chemo + wide resection

Chemo: MTX, adriamycin, cisplatin (MAP)

70
Q

Blocking screws for distal femur frx

A

Lateral + anterior in distal segment

71
Q

What are the osteotomies of a PAO

A

Sup pub rami
Ilium
Post col
Ischium

72
Q

Mayfield classification perilunate

A

1: SL lig disruption
2: lunocapitate disruption
3: LT lig disruption - carpus dislocates, lunate stays
4: lunate dislocates into carpal tunnel

73
Q

Nerve roots for Erbs

A

C5-6
Watch for biceps function 6mo

74
Q

SCFE blood vessel causing AVN

A

MFCa
From postmed of deep fem art

75
Q

DMD inheritance

A

X recessive

76
Q

What factor determines if a selective thoracic fusion will be successful for AIS

A

Apical vertebral translation ratio > 1.2
Ratio = distance between C7 plumb line to apex of thoracic curve / distance bet center sacral vertical line + apex lumbar curve

Millers (29 decks)

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