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Surgery Clerkship > Ortho > Flashcards

Ortho Flashcards

1
Q

Presentation of carpal tunnel syndrome

A

Sensory loss on first three digits +/- thenar wasting. Exacerbated by hyperflexion and tapping carpal tunnel

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2
Q

How to diagnose carpal tunnel syndrome?

A

Nerve conduction velocity

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3
Q

How to treat carpal tunnel syndrome

A

Splinting, injected steroids, release surgery.

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4
Q

DeQuervain’s Tenosynovitis presentation

A

Thumb pain

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5
Q

How to diagnose dequervain’s tenosynovitis?

A

Fist + ulnar deviation

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6
Q

How to treat dequervain’s?

A

NSAIDs + splinting

Steroids if unresponsive

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7
Q

Trigger finger pathogenesis?

A

Inflammation of middle finger fascia

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8
Q

How does trigger finger present?

A

Patient unable to extend finger, pop when extended

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9
Q

Treatment for trigger finger?

A

Steroids

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10
Q

Jersey finger pathogenesis

A

Torn flexor tendon

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11
Q

Jersey finger presentation

A

Can’t flex finger.

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12
Q

How to treat jersey finger?

A

Splinting

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13
Q

Mallet finger pathogenesis

A

Torn extensor tendon

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14
Q

Presentation of mallet finger?

A

Can’t extend finger

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15
Q

Treatment for mallet finger?

A

Splinting

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16
Q

Dupuytren’s contracture pathogenesis?

A

Fascia of palm hardens

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17
Q

Typical dupuytren’s contracture patient?

A

Old, scandanavian, alcoholic with palpable nodules on palm

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18
Q

How to treat dupuytren’s contracture?

A

Surgical release

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19
Q

Felon. Patient presentation?

A

Abscess of finger pulp that develops post penetrating injury. Finger is exquisitely tender to palpation. Patient has leukocytosis and fever.

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20
Q

How to treat felon?

A

I+D and antibiotics

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21
Q

Plantar fasciitis typical patient

A

Old overweight with heel pain when walking that’s worse in the morning.

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22
Q

How to diagnose plantar fasciitis?

A

Foot XR reveals bony spur, but true pathogenesis is still unknown.

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23
Q

How to treat plantar fasciitis?

A

Wait 12-18 months, possibly remove bony spur.

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24
Q

Morton neuroma pathogenesis?

A

Inflammation of common digital nerve at the 3+4th toe space. From wearing shoes like cowboy boots.

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25
Q

Presentation of morton neuroma?

A

Tender and palpable nodule.

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26
Q

How to treat morton neuroma

A

Better shoes, pain control. Surgery eventually

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27
Q

Age, presentation, diagnosis, treatment of developmental dysplasia of hip

A

Newborn, pt has clicky hip on barlow and ortolani, diagnose with ultrasound. Treatment with a harness.

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28
Q

Age, presentation, diagnosis, treatment of Legg-Calve-Perthes

A

Age 6, presentation insidious with antalogic gait, diagnosis with XR, treatment with casting.

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29
Q

Age, presentation, diagnosis, treatment of slipped capital femoral syndrome

A

Age 13, presentation is in fat kid/growth spurt with atraumatic hip and knee pain, diagnose with frog leg XR, treat with surgery

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30
Q

Age, presentation, diagnosis, treatment of septic hip/

A

Any age, presentation with fever and hip pain, dx with arthocentesis, treat with drainage and antibiotics

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31
Q

Osgood schlatters pathogenesis?

A

Osteochondrosis

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32
Q

Presentation of osgood schlatters/osteochondrosis?

A

Teenage athlete with knee pain and swelling.

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33
Q

Treatment of osgood schlatters?

A

Two options: work through it, will cause permanent palpable nodule. Rest and cast is completely curative

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34
Q

Scoliosis presentation

A

In teenage girl, if moderate only cosmetic deficit. If severe can cause shortness of breath.

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35
Q

How to diagnose scoliosis?

A

Adam’s test, have patient bend down, feel spine. Look for different shoulder height?

Then get XR

36
Q

How to treat scoliosis

A

Wear a brace. That’s all that’s necessary. No surgery or rods.

37
Q

Ewing’s sarcoma pathology and location

A

t (11,22), midshaft bone lesion with onion skinning on pathology

38
Q

Presentation of Ewing’s sarcoma?

A

Atraumatic focal bone pain.

39
Q

Diagnosis of ewing’s sarcoma

A

XR/MRI. Then take a biopsy

40
Q

Treatment of ewing’s sarcoma

A

Surgery

41
Q

Osteosarcoma pathology and location?

A

Rb gene (patient may also have had retinoblastoma), sunburst pattern on XR. Location is metaphyseal and usually around the knee, distal femur/proximal tibia.

42
Q

Presentation of osteosarcoma

A

Atraumatic focal bone apin

43
Q

Diagnosis of osteosarcoma

A

XR/MRI. Biopsy is necessary

44
Q

Treatment of osteosarcoma?

A

Surgery.

45
Q

How to treat fracture in kids

A

If involves the growth plate, ORIF is needed. If it doesn’t involve the growth plate, only casting needed.

46
Q

Acute hematogenous osteomyelitis patient and presentation

A

Usually in kids that have had febrile illness. Usually around metaphysis

47
Q

How to diagnose acute hematogenous osteomyelitis

A

MRI is best because XR isn’t telling for several weeks.

48
Q

Genu Varum, normal until what age? What happens after

A

Bow-legs, normal until age 3. Past age 3, there is a concern for blount disease (which is a disturbance of medial growth plate function). Treat with surgery

49
Q

Genus Valgus, normal until what age

A

(Knock knees) Normal from 4-8. No treatment needed

50
Q

Club foot and treatment

A

Can be seen at birth (in equinovarus). Treat with serial casting.

51
Q

One of the worst childhood fractures. Why?

A

Supracondylar humeral fracture. Occurs with hyperextension of elbow during fall on outstretched arm. High frequency of vacsular and nerve damage and can cause a Volkman contracture (claw hand).

52
Q

How to treat supracondylar humeral fracture in children?

A

Treat with casting or traction with special attention to neurovascular status.

53
Q

Can childhood fractures that involve growth plate be subject to closed reduction

A

Yes if they don’t penetrate the growth plate or cross the joint.

54
Q

Location of soft tissue sarcoma mets?

A

Lung, not lymph nodes.

55
Q

How to treat soft tissue sarcoma?

A

Wide excision, radiation, chemo

56
Q

Most common location of clavicular fractures?

A

Between middle and distal thirds. Treat with sling

57
Q

Common complication of anterior shoulder dislocation

A

Numbness of deltoid from axillary nerve injury

58
Q

How to ensure posterior shoulder dislocation isn’t missed

A

Get axillary or scapular views on XR

59
Q

Colles Fracture and tx

A

Common in elderly after fall on outstretched hand. Dorsally displaced dorsally angulated distal radius fracture. Treat with closed reduction and long arm cast.

60
Q

Monteggia Fracture

A

Occurs when ulna gets direct blow. Proximal ulnar fracture with dislocation of radial head at elbow.

61
Q

Galeazzi fracture

A

Direct blow to radius causes distal radius fracture followed by anterior dislocation of ulna at wrist.

62
Q

How to treat monteggia and galeazzi fractures

A

ORIF of broken bone, closed reduction of dislocation

63
Q

Scaphoid fracture and treatment

A

From fall on outstretched hand, pain in anatomic snuffbox. Treat with thumb cast but careful because scaphoid fractures have high rate of nonunion.

64
Q

What causes a metacarpal neck fracture?

A

Fist hitting wall.

65
Q

Appearance of patient with hip fracture

A

Leg is shortened and is externally rotated.

66
Q

How to treat femoral neck fracture.

A

Blood supply will probably be compromised so femoral head must be replaced

67
Q

Intertrochanteric femur fracture treatment

A

Treat with ORIF because less risk of AVN. Ensure post operative anticoagulation.

68
Q

Femoral shaft fracture treatment

A

Treat with intramedullary rod fixation.

69
Q

Complications of femoral shaft fracture

A

If bilateral and comminuted can cause shock. If open, take patient for emergency surgery within 6 hours.

70
Q

How to treat knee ligamentous injuries?

A

Fix if athletes, otherwise immobilize and rehab.

71
Q

Meniscal tear presentation

A

Pain and slow swelling. Click when knee is tended.

72
Q

Presentation of tibial stress fracture?

A

Very specific point tenderness. From forced marches.

73
Q

Compartment syndrome presentation and causes

A

Seen in forearm and lower leg, Pulses may still be present but patient will have numbness and tingling first. Caused by crush injuries, reperfusion injury, trauma.

74
Q

How to treat compartment syndrome?

A

Emergency fasciiotomy.

75
Q

Action if pain under cast?

A

Remove and examine

76
Q

Open fractures?

A

OR cleaning and reduction within 6 hours.

77
Q

How does posterior dislocation of hip occur?

A

Femur driven backwards after head-on collision.

78
Q

Appearance of patient with posterior dislocation of hip? Treatment?

A

Leg is shorted and INTERNALLY rotated. Need to treat emergently because it can disrupt blood supply

79
Q

How to treat gas gangrene

A

IV penicillin, hyperbaric O2, emergency debridement.

80
Q

What injuries damage the radial nerve? Patient presentation? Treatment needed?

A

Fractures at middle and distal 1/3 of humerus. Patient can’t extend wrist. If function back after closed reduction then no surgery needed, if not, then surgery needed

81
Q

Popliteal artery can be injured when?

A

Posterior dislocation of knee. Prompt reduction is best but prophylactic fasciotomy may be needed to avoid compartment syndrome.

82
Q

How to diagnose developmental hip dysplasia? Why use that technique?

A

Sonogram because hip joint isn’t calcified yet.

83
Q

Which malleolus breaks in an ankle injury?

A

Both!!!!

84
Q

Most reliable physical finding for compartment syndrome?

A

Excruciating pain with passive extension

85
Q

How to deal with pain under a cast?

A

Removal of cast

86
Q

Next step if patient has a facial fracture or closed head injury?

A

Evaluate the c spine!

Surgery Clerkship (11 decks)

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