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Surgery > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

dx of developmental dysplasia of the hip

A

sonogram. hip not yet calcified.

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2
Q

tx of developmental dysplasia of the hip

A

abduction splinting with pavlik harness for 6 mos

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3
Q

6 year old presenting with limping and decreased hip motion with hip/knee pain

A

avascular necrosis of the femoral epiphysis

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4
Q

tx of legg-calve perthes disease

A

controversial. casting with crutches to contain femoral head inside acetabulum

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5
Q

dx of legg calve perthes

A

AP and lateral hip x rays

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6
Q

chubby or lanky boy at age 13 with groin/knee pain and limping. sole of foot is inverted. Physical exam shows external rotation of the hip with flexion

A

slipped capital femoral epiphysis

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7
Q

dx and tx of slipped capital femoral epiphysis

A

X ray

Treat emergently with surgical treatment pins

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8
Q

toddler with febrile illness refuses to move the hip. Hip is held in flexed, abducted, and externally rotated.

what test should you get?

A

ESR
aspiration of the hip fluid for WBC
This is likely septic hip

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9
Q

kid is febrile then has severe localized bone pain with no history of trauma

A

acute hematogenous osteomyelitis

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10
Q

dx of hematogenous osteomyelitis

A

MRI

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11
Q

genu varum tx

A

Bowlegs

–normal up to age 3

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12
Q

persistence of varus beyond age 3

A

blount disease caused by problem with medial tibial growth plate. this can be corrected surgically

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13
Q

tx for genu valgus

A

normal between age 4-8. No treatment.

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14
Q

teen ager with pain over tibial tubercle worse with contraction of the quadriceps

A

Osgood-Schlatter disease

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15
Q

tx for osgood schlatter disease

A

RICE

cylinder cast

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16
Q

scoliosis usually seen in

A

adolescent girls. dx by asking girl to bend forward.

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17
Q

tx of scoliosis

A

bracing. Can lead to decreased pulmonary function if not treated.

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18
Q

why are childhood fractures less morbid?

A

healing process is faster and much more remodeling occurs. This is not true if a growth plate is affected

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19
Q

Child falls to the ground with elbows hyperextended. What kind of fracture would you suspect? Tx?

A

supracondylar fracture of humerus

Tx: casting and traction, not surgery

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20
Q

fracture of supracondylar fracture–sequelae?

A
  1. vascular/nerve injury

2. compartment syndrome

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21
Q

Fractures of the growth plate–tx?

A

reduction of the epiphyses. If growth plate is broken, you need to align it very carefully

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22
Q

most common primary malignant bone tumor

A

osteogenic sarcoma

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23
Q

sunburst pattern on x ray around the lower femur or upper tibia

A

osteogenic sarcoma

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24
Q

onion skinning on x ray

A

ewing sarcoma

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25
Q

malignant bone tumors in adults are metastatic from

A
  1. breast in women

2. prostate in men

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26
Q

best dx of bone tumor–imagin?

A

MRI
then CT
then Xray

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27
Q

difference between breast and prostate bone metastases

A

prostate=blastic lesion

breast=lytic lesion

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28
Q

treatment of multiple myeloma

A

chemo and thalidomide

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29
Q

soft tissue sarcoma characteristics

A

soft tissue mass that grows continuously. Firm and fixed to surrounding structures.

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30
Q

soft tissue sarcomas metastasize to

A

The lungs

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31
Q

Most common shoulder dislocation

A

anterior dislocation of shoulder

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32
Q

pt holding arm close to body and rotated outward with numbness over the deltoid

A

anterior dislocation of the shoulder

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33
Q

When do you get a posterior shoulder dislocation?

A

epileptic seizure or electrical burn

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34
Q

presentation of someone with a posterior shoulder dislocation?

A

close to the body and internally rotated

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35
Q

dinner fork wrist

A

colles fracture

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36
Q

typical pt for colles fracture

A

old osteoporotic woman

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37
Q

tx for colles fracture

A

closed reduction and long arm cast

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38
Q

Monteggia fracture

A

fracture of the proximal ulna with anterior dislocation of the radial head. Usually after a direct blow to the ulna

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39
Q

Galeazzi fracture

A

distal third of radius fractured and dorsal dislocation of the distal radioulnar joint

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40
Q

treatment of monteggia and galeazzi fractures?

A

broken bone=open reduction and internal fixation

dislocated joint=closed reduction

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41
Q

YA falls on outstretched hand. wrist pain. tenderness to palpation over the anatomic snuff box

A

fracture of the scaphoid.

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42
Q

tx for scaphoid fracture

A

thumb spica cast

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43
Q

What do the X rays show in a scaphoid fracture?

A

negative usually. May show up 3 weeks later

44
Q

tx for a scaphoid fracture

A

open reduction and internal fixation if original x rays show a displaced fracture

45
Q

pt punches a wall in a far and the hand looks swollen and tender.

A

metacarpal neck fracture

46
Q

tx for a bad metacarpal fracture

A

kirschner wire/plate fixation

47
Q

tx for a mild metacarpal fracture

A

closed reduction and ulnar splint

48
Q

old woman falls and affected leg is shortened and externally rotated

A

hip fracture

49
Q

tx for a femoral neck fracture

A

femoral head prosthesis

50
Q

intertrochanteric fracture tx

A

open reduction and internal fixation

51
Q

risk of intertrochanteric fracture?

A

CVT and pulmonary emboli from immobilization

52
Q

risk with femoral neck fracture?

A

avascular necrosis of the femoral head

53
Q

tx of femoral fracture

A

rod fixation.

54
Q

tx of a closed femoral shaft fracture

A

treat shock and external fixation

55
Q

tx of an open femoral shaft fracture

A

OR cleaning and closure within six hours. an emergency

56
Q

Lachman test

A

hold the knee at 20 degrees
Hold onto the thigh and pull the leg
–similar to anterior drawer test

57
Q

tx of ACL tear

A

sedentary pt: immobilization and rehab

athletes: arthroscopic reconstruction

58
Q

knee injury with catching and locking limiting motion and a “click” with extension.

A

meniscal tear

59
Q

tx of meniscal tear

A

repair surgically OPEN and save as much meniscus as possible. Complete removal of meniscus leads to degenerative arthritis

60
Q

THe triple threat knee injury

A

medial meniscus, medial collateral, and ACL

61
Q

young man with tenderness to palpation on tibia. X rays are normal

A

tibial stress fracture

62
Q

tx of a tibial stress fracture

A

cast and repeat x rays

63
Q

Pt has increasing pain in leg after a long leg cast

A

remove cast, look for compartment syndrome

64
Q

tx of achilles tendon rupture

A

casting in equinus position
OR
surgical intervention=quicker cure

65
Q

Pt falls on inverted/everted foot

A

fracture of both malleoli occurs

66
Q

tx of fractured ankle

A

open reduction and internal fixation

67
Q

Causes of compartment syndrome

A

prolonged ischemiad with reperfusion

crush injuries

68
Q

pt has very tender lower leg to palpation and excruciating pain with passive extension. Normal pulses.

A

compartment syndrome.

69
Q

tx of compartment syndrome

A

emergency fasciotomy

70
Q

Pt in a car crash, head on. Pt has hip pain and leg is short, adducted, and internally rotated

A

posterior dislocation of hip fracture, hip is externally rotated

71
Q

tx of posterior hip dislocation

A

avascular necrosis

72
Q

gas gangrene tx

A

IV penicillin
surgical debridement
hyperbaric oxygen

73
Q

Pt unable to dorsiflex the wrist. What nerve is injured?

A

Radial nerve

74
Q

What kind of fracture causes radial nerve damage?

A

distal humeral fracture

75
Q

how do you treat radial nerve damage?

A

Can reduce fracture and then cast. If does not resolve, the nerve is entrapped and you need to intervene surgically

76
Q

What test do you need before performing surgery on carpal tunnel?

A

electromyography

77
Q

woman wakes up in the middle of the night with a finger flexed. uses other hand to extend finger with a painful snap. dx? tx?

A

dx: trigger finger
tx: steroid injection

78
Q

a young mother comes in with pain along the radial side of the wrist. dx?

A

de quervain tenosynovitis

79
Q

test for de quervain–how can the pain be reproduced?

A

hold thumb inside closed fist

ulnar deviation

80
Q

tx for de quervain

A

First line=splint

splint and antiinflammatory agents

81
Q

pt had an injury 2 weeks ago in the finger but never treated it. Now it’s throbbing and pt has a fever

A

Felon–abscess in the pulp of fingertip

82
Q

tx for felon

A

surgical drainage

83
Q

older norwegian man presents with palmar nodules and contracture of the palm

A

dupuytren contracture

84
Q

tx of dupuytren contracture

A

surgery if hand cannot be placed flat on a table

85
Q

Skiier hyperextends thumb. On PE, collateral laxity at metacarpophalangeal joint

A

gamekeeper thumb

86
Q

tx of gamekeepr thumb

A

cast it. If untreated, can lead to arthritis

87
Q

football player grabs one of his teammates by the jersey and his finger is forcefully extended. When making a fist, the injured finger does not flex

A

Jersey finger–injury to the flexor tendon.

88
Q

a volleyball player hurts a finger when it’s forcefully flexed by the ball. TIp of finger remains flexed when hand is extended.

A

mallet finger. rupture of the extensor tendon.

89
Q

tx for mallet finger

A

splinting

90
Q

45 year old pt presents with months of vague aching back pain. Then sudden severe “electric shock” pain shooting down the leg exiting on the side of the big toe. Which is the level of disc herniation?

A

L4-L5

91
Q

45 year old pt presents with months of vague aching back pain. Then sudden severe “electric shock” pain shooting down the leg exiting on the side of the little toe. Which is the level of disc herniation?

A

L5-S1

92
Q

45 year old pt presents with months of vague aching back pain. Then sudden severe “electric shock” pain shooting down the leg exiting on the side of the little toe. The pain is not worse with coughing, sneezing or defecating. What etiology is ruled out?

A

NOT a disc herniation! Should be worse with increases in intra-abdominal pressure

93
Q

Treatment for lumbar disc herniation

A

bed rest 3 weeks
nerve blocks
surgical if neurodeficits like muscle weakness

94
Q

what is an emergency indication for surgery in someone with a herniated lumbar disc?

A

cauda equina syndrome=distended bladder, flaccid rectal sphincter, perineal saddle anesthesia

95
Q

elderly person with weight loss and back pain that is not better with rest or positional changes

A

metastatic malignancy

96
Q

where do you find ulcers from arterial insufficiency?

A

tips of the toes. Compare with diabetic ulcers, which happen at the pressure points.

97
Q

treatment for ulcers of arterial insufficiency

A

doppler study/CT or MRI angio

THen surgical revascularization or stents

98
Q

pt has edematous, indurated, hyperpigmented skin above the medial malleolus. Painless. pt has varicose veins

A

venous stasis ulcers

99
Q

what scan do you want to work up a venous stasis ulcer?

A

duplex scan

100
Q

tx of venous stasis ulcers

A

compression stockings.
surgery
endovascular laser/radiofrequency ablation

101
Q

Pt has a chronic leg ulcer from 3rd degree burns or chronic draining sinus. Suddenly, a dirty and deeper ulcer appears with tissue growth around the edges. dx?

A

marjolin ulcer=SCC

Biopsy to confirm

102
Q

tx of marjolin ulcer

A

wide local excision and skin grafting

103
Q

overweight pt with heel pain

A

plantar fasciitis

104
Q

what do you see on xray of plantar fasciitis?

A

bony spur. Note that the spur is not causing the pain

105
Q

tx for plantar fasciitis?

A

symptomatic. Will resolve in 12-18 mos

106
Q

Woman comes in with a tender spot between third and fourth toes. She wears high heeled shoes every day

A

Morton neuroma=inflammation of common digital nerve.

107
Q

tx of morton neuroma

A

analgesics/shoes

can have surgical excision

Surgery (2 decks)

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