Ortho

Question 1

Children have uneven gluteal folds, and physical examination of the hips show that they can be easily dislocated posteriorly with a jerk and a “click,” and
returned to normal with a “snapping.”

What condition?

Answer 1

Congenital dysplasia of the hip runs in families

Question 2

_________ disease is avascular necrosis of the capital femoral epiphysis and occurs around age 6,
with insidious development of limping, decreased hip motion, and hip or knee pain

Answer 2

Legg-Calve-Perthes

Question 3

The typical patient is a chubby (or lanky) boy around age 13 who complains of
groin or knee pain, and who ambulates with a limp

Answer 3

Slipped capital femoral epiphysis (SCFE)

Question 4

Persistent varus age >3 is most commonly ___________a disturbance of the medial proximal
tibial growth plate, for which surgery is corrective

Answer 4

Blount disease,

Question 5

_________) is normal between ages 4–8; no treatment is needed

Answer 5

Genu valgus (knock-knee

Question 6

________ is seen in teenagers
with persistent pain right over the tibial tubercle, which is aggravated by contraction
of the quadriceps

Answer 6

Osgood-Schlatter disease (osteochondrosis of the tibial tubercle)

Question 7

Osgood-Schlatter disease (osteochondrosis of the tibial tubercle) Tx

Answer 7

treatment is immobilization of the knee in

an extension or cylinder cast for 4–6 weeks

Question 8

Most Sn finding for Scolio

Answer 8

The most sensitive screening finding is to look at the girl from behind while
she bends forward, a hump will be noted over her right thorax

Question 9

The only areas where children have special problems include_____ and _________

Answer 9

supracondylar fractures of the humerus and fractures of any bone that involve the growth plate or epiphysis.

Question 10

_____________ occur with hyperextension of the elbow in a child who falls on the hand with the arm extended

Answer 10

Supracondylar fractures of the humerus

Question 11

Why are supracon fx dangerous?

Answer 11

The injuries are particularly dangerous due to

the proximity of the brachial artery and ulnar nerve.

Question 12

Fractures that involve the growth plate or epiphysis can be treated by closed reduction if ________

Answer 12

the
epiphyses and growth plate are displaced laterally from the metaphysis but they are in one piece
(i.e., the fracture does not cross the epiphyses or growth plate and does not involve the joint).

Question 13

X-rays for suspected fracture in adults should always include the following:
1
2
3

Answer 13

• Two views at 90° to one another
• Joints above and below the broken bone
• If suggested by the mechanism of injury, bones that are in “the line of force,” which
might also be broken (

Question 14

Clavicular fracture is typically at the junction of_____

Answer 14

middle and distal thirds.

Question 15

Less popular Tx for clavicular fx

Answer 15

Figure-of-8 bandage treatment is now less popular

Question 16

______is by far the most common shoulder dislocatio

Answer 16

Anterior dislocation of the shoulder

Question 17

What nerve may be affected by Anterior dislocation of the shoulder ?

Answer 17

There may be numbness in a small area over the deltoid, from stretching of the axillary nerve.

Question 18

___________ is rare and occurs after massive uncoordinated muscle contractions,
such as epileptic seizure or electrical burn.

Answer 18

Posterior shoulder dislocation

Question 19

The deformed and painful wrist looks like a “dinner fork.” The main lesion is an older, dorsally
displaced, dorsally angulated fracture of the distal radius. Treatment is with close reduction
and long arm cast.

Answer 19

Colles’ fracture

Question 20

________ results from a direct blow to the ulna (i.e., on a raised protective arm hit by a nightstick).

There is diaphyseal fracture of the proximal ulna, with anterior dislocation of the radial head

Answer 20

Monteggia fracture

Question 21

_________ is the mirror image: the distal third of the radius gets the direct blow and has the fracture, and there is dorsal dislocation of the distal radioulnar joint

Answer 21

Galeazzi fracture

Question 22

_________ affects a young adult who falls on an outstretched hand. Chief complaint is typically wrist pain, with physical exam revealing localized tenderness to palpation over the anatomic snuff box

Answer 22

Fracture of the scaphoid (carpal navicular)

Question 23

TX of scaphoid fx

Answer 23

thumb spica cast is indicated just with the history and physical findings.
X-rays will show the fracture 3 weeks later.

Question 24

Scaphoid fractures are notorious for a very high rate of nonunion secondary to_____

Answer 24

avascular necrosis

Question 25

______(typically the fourth or fifth, or both) happens when a closed fist hits a hard surface (like a wall)

Answer 25

Metacarpal neck fracture

Question 26

Tx of Metacarpal neck fracture

Answer 26

Kirschner wire or plate fixation is indicated for bad fractures

Question 27

Intertrochanteric fracture is less likely to lead to avascular necrosis, and is usually treated

Answer 27

with open reduction and pinning

Question 28

Femoral shaft fracture is often treated with ______

Answer 28

intramedullary rod fixation

Question 29

Open femoral shaft fx tx?

Answer 29

If open, it is an orthopedic emergency, requiring OR irrigation and closure within 6
hours

Question 30

_______ is usually sustained when the force of impact

is the side of the knee, a common sports injury

Answer 30

Collateral ligament injury

Question 31

Abduction demonstrates the medial injuries ______, whereas adduction diagnoses the lateral injuries _______

Answer 31

(valgus stress test)

varus stress test

Question 32

With the knee flexed 90°, the leg can be pulled anteriorly, like a drawer being opened (anterior drawer test).

Answer 32

Anterior cruciate ligament injury

Question 33

What test for ACL injury?

Answer 33

knee flexed at 20° by grasping the thigh with

one hand, and pulling the leg with the other (Lachman test).

Question 34

Tx of meniscal tear Cx

Answer 34

• Complete meniscectomy leads to the late development of degenerative arthritis

Question 35

_____________ is seen in young men subjected to forced marches. There is tenderness to palpation over a very specific point on the bone, but x-rays are initially normal

Answer 35

Tibial stress fracture

Question 36

_________ is seen in out-of-shape middle-age men who subject themselves to severe strain (tennis, for instance).

As they plant the foot and change direction, a
loud popping noise is heard (like a rifle shot), and they fall clutching the ankle

Answer 36

Rupture of the Achilles tendon

Question 37

Precipitating events of compartment syndrome

Answer 37

Precipitating events include prolonged ischemia followed by reperfusion, crushing
injuries, or other types of trauma

Question 38

In the lower leg, by far the most common cause of compartment syndrone is a ________

Answer 38

fracture with closed reduction

Question 39

The most reliable physical finding of compartment syndrome is ________

Answer 39

excruciating pain with passive extension.

Question 40

Pain under a cast is always handled by________

Answer 40

removing the cast and examining the limb.

Question 41

_______________ occurs when the femur is driven backward, such as in a headon
car collision where the knees hit the dashboard

Answer 41

Posterior dislocation of the hip

Question 42

Tx of gas gangrene

Answer 42

Treatment includes IV penicillin, extensive emergency surgical debridement, and possibly hyperbaric oxygen

Question 43

The ______ can be injured in oblique fractures of the middle to distal thirds of the humerus

Answer 43

radial nerve

Question 44

Why the need to evaluate popliteal artery with UTZ

Answer 44

the popliteal artery must be evaluated with U/S, because even if distal pulses which were absent return following reduction of the dislocation, there may be an intimal flap
or local dissection that may need either further evaluation with CT angiogram or surgical
exploration.

Question 45

Falls from a height landing on the feet may have obvious foot or leg fractures, but fractures of the _______

Answer 45

lumbar or thoracic spine may be less obvious and must be assessed.

Question 46

Head-on automobile collisions may produce obvious injuries in the face, head, and
torso, but if the knees hit the dashboard, the________

Answer 46

femoral heads may be driven backward

into the pelvis or out of the acetabulum and thus cause a fracture or dislocation

Question 47

Dx of CTS

Answer 47

The diagnosis is clinical, but the American Academy of Orthopaedic Surgery recommends that wrist x-rays (including carpal tunnel view) be done to rule out other
pathology

Question 48

_________ is more common in women and presents with acute finger flexion and the inability to extend it unless pulled with the other hand, which results in a painful “snap.”

Answer 48

Trigger finger

Question 49

Tx of Trigger finger

Answer 49

Steroid injection is the first line of therapy; surgery is the treatment of last resort

Question 50

_______________ is seen in young mothers who, as they carry their baby, force their
hand into wrist flexion and thumb extension to hold the baby’s head. They complain of pain
along the radial side of the wrist and the first dorsal compartment.

Answer 50

De Quervain tenosynovitis

Question 51

There
is contracture of the palm of the hand, and palmar fascial nodules can be felt. Surgery may be
needed when the hand can no longer be placed flat on a table.

Answer 51

Dupuytren contracture

Question 52

A_________ is an abscess in the pulp of a fingertip, caused by a neglected penetrating injury

Answer 52

felon

Question 53

_________ is an injury to the flexor tendon sustained when the flexed finger is forcefully extended (as in someone unsuccessfully grabbing a running person by the jersey).

When making a fist, the distal phalanx of the injured finger does not flex with the others

Answer 53

Jersey finger

Question 54

What to do with traumatically amputated digits

Answer 54

The amputated digit should be cleaned with sterile saline, wrapped in a saline-moistened gauze, placed in a
sealed plastic bag, and the bag placed on a bed of ice. The digit should not be placed in antiseptic
solutions or alcohol, should not be put on dry ice, and should not be allowed to freeze

Question 55

_________ is seen in men in the third and fourth decades of life who complain of chronic back pain and morning stiffness

Answer 55

Ankylosing spondylitis

Question 56

MC mets in the spine

Answer 56

The most common pathology is lytic breast cancer metastases in women and blastic prostate metastases in men

Question 57

Diabetic ulcer is typically indolent and located at pressure points (heel and metatarsal head).
It starts because of the neuropathy, and does not heal because of the ___________

Answer 57

microvascular disease

Question 58

It looks dirty, with a pale base devoid of granulation tissue. The patient has other manifestations of arteriosclerotic occlusive disease (absent pulses, trophic changes, claudication, or rest pain)

Answer 58

Ulcer from arterial insufficiency

Question 59

_________ develops in chronically edematous, indurated, and hyperpigmented skin
above the medial malleolus

Answer 59

Venous stasis ulcer

Question 60

Tx for Venous stasis ulcer

Answer 60

Treatment revolves around physical support to keep the veins empty: support stockings, Ace
bandages, and Unna boot.

Surgery may be required (vein stripping, grafting of the ulcer, injection sclerotherapy); endovascular ablation with laser or radiofrequency may also be used

Question 61

________ is a squamous cell carcinoma of the skin that has developed in a chronic leg ulcer

Answer 61

Marjolin’s ulcer

Question 62

What is the classic setting of a Marjolin’s ulcer?

Answer 62

The classic setting is one of many years of healing and breaking down, such as seen in untreated third-degree burns that underwent spontaneous healing, or in chronic draining sinuses secondary to osteomyelitis

Question 63

_______is a very common but poorly understood problem affecting older, overweight patients who complain of disabling, sharp heel pain every time their foot strikes the ground

Answer 63

Plantar fasciitis

Question 64

Xray of plantar fascitis

Answer 64

X-rays show a bony spur matching the location of the pain, and physical exam shows exquisite tenderness to palpation over the spur, although the bony spur is not likely
the cause of the problem as many asymptomatic people have similar spurs

Question 65

_________ is an inflammation of the common digital nerve at the third interspace, between the third and fourth toes.

Answer 65

Morton’s neuroma

Question 66

Tx for gout

Answer 66

Treatment for the acute attack is indomethacin

and colchicine; treatment for chronic control is allopurinol and probenicid

Question 67

_________ is the most common primary malignant bone tumor.
–– It is seen in ages 10–25, usually around the knee (lower femur or upper tibia).
–– A typical “sunburst” pattern is often described on x-rays

Answer 67

Osteogenic sarcoma

Question 68

–– It affects younger children (ages 5–15) and it grows in the diaphyses of long bones.
–– A typical “onion skinning”–type pattern is often seen on x-rays.

Answer 68

Ewings

Question 69

Most malignant bone tumors in adults are metastatic, from the breast in women (_______ lesions)
and from the prostate in men (______ lesions).

Answer 69

lytic

blastic

Question 70

Other dx tests for MM

Answer 70

They also have Bence-Jones protein in the urine and abnormal immunoglobulins
in the blood, best demonstrated by serum proptein electrophoresis (SPEP

Question 71

Tx of MM

Answer 71

Treatment is chemotherapy; thalidomide can be used in the event that chemotherapy
fails.

Question 72

has relentless growth of soft tissue mass over several months. It is firm and typically fixed to surrounding structures.

Answer 72

Soft tissue sarcoma

Question 73

Soft tissue sarcoma mets

Answer 73

lungs