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Surgery > Orthopedic Surgery - Part 1 > Flashcards

Orthopedic Surgery - Part 1 Flashcards

1
Q

What x-ray should be ordered for fractures?

A

Plain radiograph with at least 2 views at 90 degrees from one another (AP and Lat)

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2
Q

How soon should open fractures go into the OR?

A

Within 4-8 hours (ideally less than 6)

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3
Q

What abx are given for open fractures?

A

1st generation cephalosporin (add aminoglycoside for lg wounds or soft tissue injury)

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4
Q

What abx should be given for farm injuries?

A

Penicillin

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5
Q

What organism should be considered for “through the shoe injuries”?

A

Pseudomonas

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6
Q

What five features should be included when describing a fracture?

A 
Open vs Closed
Type
Displacement
Angulation
Location
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7
Q

What is an open type 1 fracture?

A

Low energy MOI
Less than 1 cm in length
Are usually transverse or short oblique

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8
Q

What is an open type II fracture?

A

Greater energy
Wound more than 1 cm long
Typically with comminution and minimal to moderate crushing

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9
Q

What is an open type III fracture?

A

Wound greater than 10 cm
Significant comminution and extensive soft tissue injury
High energy
Grossly contaminated

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10
Q

What is an open type III A fracture?

A

Adequate bone coverage of remaining skin (wont need a graft)

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11
Q

What is an open type III B fracture?

A

Bone exposure that requires a flap or graft

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12
Q

What is an open type III C fracture?

A

Circulatory compromise requiring vascular repair or reconstruction to reperfusion of the limb

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13
Q

What is a torus fracture?

A

A “bulge” in the cortex of the bone does not go all the way through, seen in children

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14
Q

What is a greenstick fracture?

A

A break in one cortex, seen in children

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15
Q

What is a transverse fracture?

A

A break through the bone horizontally

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16
Q

What is an oblique fracture?

A

The fracture runs at an oblique angle to the long axis of the bone

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17
Q

What is a spiral fracture?

A

Wraps in a spiral along the long axis of the bone

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18
Q

A spiral fracture of the femur in a non-weight bearing child is indicative of what?

A

Child abuse

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19
Q

What is a comminuted fracture?

A

A bone broken into many pieces (shattered)

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20
Q

What is a segmental fracture?

A

A fracture above, one below, and a middle piece broken out

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21
Q

What is an avulsion?

A

A piece of bone is pulled off by a ligament or tendon

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22
Q

What is an impacted bone?

A

Bone fragments are driven into one another

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23
Q

Salter harris pneumonic:

A 
S = separated
A = above
L = lower
T = through
ER = Everything's ruined
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24
Q

What is a non-displaced fracture?

A

The two ends of bone are not displaced from one another

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25
Q

What is a displaced fracture?

A

Bone ends are separated

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26
Q

What is angulation?

A

Relation of long axis of fragments in relation to each other described by the direction the distal fragment points and amount of angle

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27
Q

How long can muscles and nerves survive ischemic conditions without irreversible damage?

A

4 hours

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28
Q

At what point does nerve and muscle ischemia become permanent?

A

8 hours

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29
Q

What are the 5 p’s of compartment syndrome?

A 
Pulselessness (Late finding, bad sign)
Paresthesias (Late finding, bad sign)
Paralysis 
Pallor 
Pain

Do serial exams

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30
Q

What is the diagnostic exam technique of compartment syndrome?

A

Severe pain with PROM of the muscles of the affected compartment that is out of proportion

31
Q

How is compartment syndrome treated?

A

Fasciotomy

32
Q

How are amputations treated?

A

Stop bleeding

Wrap amputated segment in sterile gauze and soak in lactated ringer’s, place in plastic bag, and place on ice

33
Q

What is Virchow’s triad for DVT?

A

Stasis
Intimal injury
Hypercoaguability

34
Q

What two features gives high clinical suspicion for DVT?

A

Calf pain + risk factors

35
Q

What physical exam signs signify DVT

A

Homan’s sign
Palpable cords
Tenderness
Edema

36
Q

Gold stander for diagnosis of DVT

A

Venography

37
Q

Best test for DVT

A

Venous doppler US

38
Q

What are the signs and symptoms of PE?

A

Pleuritic chest pain, Tachypnea, Tachycardia, EKG R BBB

EKG S1Q3T3

39
Q

Treatment for PE?

A

IV heparin

40
Q

What is Necrotizing fasciitis?

A

Infection along fascial planes by group A strep (or sometimes clostridia)

41
Q

How is necrotizing fasciitis treated?

A

Debridement ahead of the infection, IV abx, high risk of amputation

42
Q

What is the most common hand infection?

A

Paronychia, infection at the nail fold

43
Q

How is paronychia treated?

A

Abx, I&D prn

44
Q

What is the infection of the nail pulp at the tip of the finger?

A

Felon

45
Q

How is a felon treated?

A

Abx, I&D

46
Q

What is kanavel signs and what do they indicate?

A

Tenderness along tendon sheath proximally, finger is held flexed with pain on passive extension. Sausage digit. Indicative of Flexor Tenosynovitis

47
Q

When does a dog/human/cat bite become a surgical emergency?

A

When it is intra-articular

48
Q

What is the most common intra-articular human bite?

A

3rd and 4th metacarpal from punch to face “fight bite”

49
Q

What is the treatment for a fight bite?

A

Intra-articular I&D

50
Q

What antibiotic is given for a fight bite and for which organisms?

A

Augmentin for strep viridians, S aureus, Eikenella

51
Q

What organisms are most common in dog bites?

A

S viridians> Pasturella multicocida > s aureus

52
Q

What abx are given for dog bites?

A

Augmentin

53
Q

What are the most common organisms in a cat bite?

A

Pasteurella>S. aureus

54
Q

What abx are given for cat bites?

A

Augmentin

55
Q

When can a cervical collar be removed in a trauma pt?

A

When C-spine XR from occiput to T1 are neg in ap, lat, and odontoid views. Should be awake, sober, alert, have full ROM without pain or neuro deficits

56
Q

When should an x-ray of entire spine be considered?

A

If there is an altered LOC

57
Q

Which XR view should be checked for alignment and soft tissue swelling?

A

Lateral

58
Q

What is a Jefferson’s fx?

A

Fx of C1 ring

59
Q

What is a hangman’s fx?

A

Fx of C2 isthmus

60
Q

What is a clay-shovelers fx?

A

C6-T1 Spinous process avulsion

61
Q

What is the anterior column of the spine?

A

Anterior longitudinal ligament and anterior vertebral body

62
Q

What is the middle column of the spine?

A

Posterior vertebral body and posterior longitudinal ligament

63
Q

What is the posterior column of the spine?

A

Posterior longitudinal ligament to spinous processes

64
Q

What is a compression fracture of the spine?

A

Failure of the anterior column with preservation of the middle column

65
Q

What is a burst fx of the spine?

A

Fx of anterior and middle column with axial load with or without posterior column involvement (more likely to be unstable)

66
Q

At what spinal level does the spinal cord end?

A

L2

67
Q

A burst fracture at L1-L2 can lead to what?

A

Bladder/bowel dysfunction

68
Q

What are signs of a coccyx fx?

A

Pain with rectal exam and defication

69
Q

How are coccyx fxs treated?

A

Stool softener, donut pad, time

70
Q

What should be given for any neuro deficit with a spine fx?

A

IV Methylprednisolone

71
Q

What should always be checked with a spinal fracture?

A

Rectal exam, reflexes, and perianal sensation

72
Q

When is methylprednisolone contraindicated?

A

Pregnancy
<13
Open spine surgery
Uncontrolled DM

73
Q

What causes cauda equina syndrome?

A

multilevel LS root compression through trauma, hematoma, infection, post surgical

74
Q

What are the signs and symptoms of cauda equina syndrome?

A

Saddle anesthesia, bilateral radiculitis, LE numbness, weakness, hyporeflexia, loss of bowel/bladder fxn

Surgery (10 decks)

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