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Surgery > Orthopedics & CV > Flashcards

Orthopedics & CV Flashcards

1
Q

infant or child with uneven gluteal folds. easily dislocated posteriorly and easily “snapped”/returned to normal. dx? tx?

A

developmental dysplasia of hip (hereditary)

treat by ABDUCTION with pavlik harness for 6 months

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2
Q

if you suspect developmental dysplasia of hip but signs are not clear enough or just want to confirm dx what study do you use?

A

use sonogram. NOT xray bc bones havent calcified yet in newborn!

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3
Q

child has knee pain. you check their knees and they are fine. what else should you check out?

A

hips! hip problems in kids can present as knee pain

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4
Q

what is legg calve perthes disease

what age does it usually occur

A

avascular necrosis of capital femoral epiphysis

around 6 yrs old

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5
Q

dx study for acute hematogenous osteomyelitis

tx?

A

MRI!!! xrays dont show anything for a couple of weeks.

tx with antibiotics

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6
Q

genu varum is aka _______.

normal up to age 3. if persistent past age 3 what is most common cause (disturbance of what)

A

bowlegs

>3 years old = Blount disease = disturbance of medial proximal tibial growth plate. can fix with surgery

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7
Q

genu valgus is aka ______

normal at what age

A

knock knees

normal ages 4-9

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8
Q

toddler who has been sick with fever for a few days now all of a sudden won’t move his hip. keeps it in flexion and slightly abduction and externally rotated, and won’t let you move it. you suspect septic hip! what elevated lab value? diagnostic study? tx?

A

labs: elevated sedimentation rate

dx and tx: aspirate under general anesthesia. if pus comes out then drain the thing in the same session

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9
Q

kid with antalgic gait/limping, guards passive motion of hip, has hip/knee pain. what do you suspect? what study do you order?

A

Legg Calve Perthes disease aka avascular necrosis of capital femoral epiphysis

AP (anteroposterior) and lateral xrays confirm dx

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10
Q

13 y/o boy with groin and/or knee pain. limping. when sitting with legs dangling, the sole of his left foot is upturned and facing his right foot. when you flex his hip, his left thigh rotates externally and you can’t make it rotate internally. what orthopedic emergency are you worried about? how to do dx and treat it?

A

slipped capital femoral epiphysis

dx: xray
tx: fix surgically. use pins to pin femoral head back in place

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11
Q

teenager with pain over tibial tubercle (right below knee cap). pain is worse with quad flexion (lifting leg, squats), NO knee swelling. what is dx and tx?

A

osteochondrosis of tibial tubercle.

first line conservative tx RICE. -> if needed use extension or cylinder cast for 4-6 weeks

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12
Q

technical name for club foot. tx? (nonsurgical and then surgical if needed, what age?)

A

talipes equinovarus

tx: serial plaster casts, Achilles tenotomy, braces. if still need correction can do surgery when baby is 9-12 months old

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13
Q

most sensitive finding for scoliosis

A

observe from behind while pt bends forward. will see a hump over her right thorax

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14
Q

fractures that cause real problems for kids is those involving growth plate and _________, which occur by ____ movement

A

supracondylar fractures. occur with hyperextension of elbow with arm extended and falls on hand

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15
Q

how to fix fracture of growth plate if it’s just displaced vs itself is cracked

A

just displaced - closed reduction

2 pieces - very precise alignment, requires open reduction and internal fixation

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16
Q

young patient complaining of persistent low grade pain for months. you get an xray which shows sunburst pattern and periosteal onionskinning and invasion of adjacent soft tissues. what is dx and what else would you see on xray?

A

primary malignant bone tumor. occurs in young people.

can also see periosteal “onion skinning”

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17
Q

osteogenic sarcoma is seen in ages _____ right above or below knee. see _____ pattern on xray

A

10-25 yrs old

sunburst

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18
Q

ewing sarcoma age group? grows on what part of bones? ____ patter on xrays

A

5-15 yrs old

onion skinning

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19
Q

malignant LYTIC lesions on bone. where is primary site?

A

breast

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20
Q

malignant BLASTIC lesions on bone. where is primary site?

A

prostate

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21
Q

old man has fatigue, anemia, pain on some bones. Bence Jones protein in urine and abnormal immunoglobulins in blood. xray shows what? dx?

A

multiple punched out lytic lesions

multiple myeloma!

tx: chemotherapy. thalidomide 2nd line

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22
Q

tx for multiple myeloma (first and 2nd lines)

A

chemotherapy. thalidomide 2nd line

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23
Q

soft tissue sarcomas are (soft/firm) and (fixed/mobile) and metastasize to _____ but not ______

A

firm
fixed to surrounding structures

metastasize to lungs but NOT lymph nodes!

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24
Q

clavicular fractures are typically at junction of ___________. tx?

A

middle and distal thirds

align with figure eight device which pulls back on both shoulders. or wear sling.

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25
Q

most common type of shoulder dislocation?
pt holds arm close to body but rotated outwards (like they gonna shake hands).
nerve at risk for damage?

A

anterior dislocation

axillary nerve

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26
Q

posterior shoulder dislocation occurs after what events? you suspect it bc pt has arm close to body and internally rotated. what specific xray views do you need to dx? (besides the usual AP and lateral)

A

massive uncoordinated movement like seizure or electric burn.

axillary view or scapular lateral views

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27
Q

older woman (think osteoporosis!) fell on outstretched hand. wrist looks like a dinner fork facing down (the angle and bump). name of fracture? the lesion is dorsally displaced, dorsally angulated fracture of _______. does she need surgery?

A

Colles fracture

lesion is dorsally displaced, dorsally angulated fracture of distal radius

no surgery. close reduction and long arm cast

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28
Q

guy was hit by police. he was raising his arm to protect himself and they hit him with a nightstick –> direct blow and fracture of _____, with anterior dislocation of radial head

tx?

A

ulna (proximal)

surgery to fix fractured ulna. closed reduction to fix dislocated radial head

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29
Q

direct blow and fracture to radial head + (anterior/dorsal) dislocation of distal ________
tx?

A

dorsal dislocation of distal radioulnar joint

surgery to fix fractured radius. closed reduction to fix dislocated joint

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30
Q

pt falls on outstretched hand, has pain in wrist. pain on palpation over snuffbox. how to manage if initial xray is negative? if positive?

A

either way is probably fracture of scaphoid

if neg = undisplaced fracture -> thumb spica cast (xray will be positive 3 weeks later)
if positive showing displaced and angulated fracture -> open reduction and internal fixation

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31
Q

guy punched a wall with a closed fist, now his hand is swollen and tender. what will xrays show? (fracture of what)

A

fracture of metacarpal neck (4th and/or 5th)

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32
Q

what is important medically about intertrochanteric fractures? (of femur)

A

pt will be immobilized after repair. need to use anticoag therapy post surgery to avoid dvt and pe

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33
Q

that one triple injury of the knee

A

injury to

  1. medial meniscus
  2. medial collateral
  3. anterior cruciate ligament
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34
Q

whats the problem with complete meniscectomy? (hence why they usually just try to repair it as much as possible)

A

leads to late development of degenerative arthritis

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35
Q

young man. forced marches. his leg hurts with palpation over this one spot. dx and management? will xrays be pos or neg?

A

tibial stress fracture
xrays initially normal. repeat xray in 2 weeks.
tx with cast and/or non weight bearing (like using crutches)

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36
Q

for rupture of Achilles tendon, you can have limited plantar flexion still. palpation of tendon reveals a gap. you can either fix w/ surgery or ______(be specific)

A

cast in equinus position (takes longer than surgery though)

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37
Q

when you fracture ankle, which malleolus breaks? which xrays needed to dx?

A

both malleoli fracture

xrays: AP, lateral, and mortise

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38
Q

compartment syndrome. physical finding is excruciating pain with what movement?
tx?

A

passive extension

tx: emergency fasciotomy

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39
Q

pain under cast. next step?

A

remove cast and inspect limb (must rule out compartment syndrome especially)

40
Q

open ffracture require cleaning and reduction within _______ hours from time of injury

A

6 hours

41
Q

why does posterior dislocation of hip require emergency reduction? what is typical scenario?

A

head on car collision. pt’s leg will be shortened, adducted, and INTERNALLY rotated (fractured hip has externally rotated leg).

emergency reduction to avoid avascular necrosis to femoral head (has tenuous blood supply)

42
Q

gas gangrene tx:

  1. emergency surgical wound debridement
  2. ______________
  3. antibiotics(_______ and ________)
A
  1. hyperbaric oxygen

3. abx penicillin and clindamycin

43
Q

pt fractured humerus shaft. even after reduction + cast/sling, wrist is still paralyzed. what nerve is entrapped and what do you do?

A

radial nerve

surgery. (if wrist gets better after reduction, no surgical exploration is needed)

44
Q

what neurovascular structure is at risk for injury in posterior dislocation of knee? danger signs require what kind of surgery?

A

popliteal artery injury

delayed restoration of flow requires prophylactic fasciotomy

45
Q

how to complete workup for…. (what else do you need to look for):

  1. obvious direction of force injury
  2. fall from a height - obvious foot or leg fracture
  3. head on MV collision - obvious injury in face, head, and torso
  4. facial fracture and closed head injuries
A
  1. obvious direction of force injury -> also other less obvious injury
  2. fall from a height - obvious foot or leg fracture -> lumbar or thoracic spinal fracture
  3. head on MV collision - obvious injury in face, head, and torso -> femoral fracture or pelvic dislocation or pelvic fracture
  4. facial fracture and closed head injuries -> cervical spine injury
46
Q

what studies in carpal tunnel justify need for surgery?

A

electro diagnostic studies of nerve conduction

also failure of 1st line tx of splints and nsaids

47
Q

initial tx for carpal tunnel

A

splints, NSAIDs

48
Q

favored operation for carpal tunnel

A

endoscopic release

49
Q

trigger finger first line therapy

A

steroid injection

50
Q

the 5 orthopedic emergencies

A
  1. pain under a cast
  2. open fractures
  3. posterior dislocation of hip (bc of tenuous blood supply to femoral head, can lead to avascular necrosis)
  4. gas gangrene (deep penetrating dirty wounds, about 3 days later)
  5. other soft tissue infections (like mucormycosis and necrotizing faciitis
51
Q

young(new) mother complaining of pain in wrist. pain is reproduced by holding thumb in closed fist and forcing wrist into ulnar deviation. dx and tx?

A

tenosynovitis from carrying baby’s head (wrist flexion, thumb extension)

tx: steroid injections

52
Q

pt has bump on fingertip. throbbing pain. findings of abscess including fever. tx?

A

urgent surgical drainage.

it’s called a felon. it’s basically an abscess of fingertip. caused by neglected penetrating injury

53
Q

lumbar disk herniation: mid 40’s patient, occurs almost always at which level?

pts complain of vague pain + sudden electric pain episodes from precipitating events like lifting heavy object. does the pain get worse with coughing, sneezing, or defecating?

straight leg test positive or negative?

tx:

A

L4-L5, or L5-S1

pain doesn’t worsen from those things

straight leg test positive

tx: strict bed rest so disc can be reabsorbed

54
Q

lumbar disc herniation tx is strict bed rest so disc can be reabsorbed. unless there are signs of _______ -> emergency surgery/decompression. what are these signs? (3)

A

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

55
Q

ankylosing spondylitis:
men in their 30s-40s. complain of chronic back pain with ________. better with rest or activity? late finding xray = bamboo spine.
tx:

A

back pain with morning stiffness. pain is worse at rest, improves with activity.

tx: anti inflammatory agents, physical therapy

56
Q

ankylosing spondylitis associated with what HLA antigen? which is associated with what other 2 things?

A

HLA B-27

uveitis, inflammatory bowel disease (kiiind of life can’t see can’t pee(poop) can’t climb a tree.)

57
Q

pt has foot ulcer. what do you start with for workup?

A

Doppler studies to look for pressure gradient (aka rule out or in arterial insufficiency). also need to workup for diabetes to see if it’s diabetic ulcer

58
Q

marjolin ulcer is what? dx and tx?

A

SCC developing from a chronic nonhealing leg ulcer. may have chronic draining sinuses secondary to osteomylelitis. then a dirty looking deeper ulcer develops with heaped up tissue growth around edges.
need to biopsy. then tx by wide local excision and skin grafting

59
Q

patient has sharp heal pain every time foot hits ground. worse in the morning. x ray shows bony spur. dx? tx?

A

plantar fasciitis. pain is NOT from bony spur! don’t be tricked. so tx is more supportive for spontaneous resolution in 12-18 months. don’t need to remove spur. “removal of bony spur may help” welp.

60
Q

wearing pointed toe heels (or cowboy boots) a lot can lead to Morton neuroma, which is inflammation of common digital nerve between which toes? what is tx?

A

between 3rd and 4th toes

conservative management = analgesics and change shoes.
surgical excision can be done if needed.

61
Q 
treatment for gout. drugs.
for acute (2)
for chronic (2)
A

acute: indomethacin, colchicine
chronic: allopurinol, probenicid

62
Q

inspiratory wheezing is seen in _________

A

tracheomalacia - tracheal rings collapse

63
Q

child has difficulty swallowing, episodes of respiratory distress, crowing respiration, stridor, hyperextension of the neck.

dx and study? tx?

A

vascular ring - congenital anomaly. trachea and esophagus are encircled by abnormal blood vessels

demonstrated by barium swallow and bronchoscopy

tx: surgery divides the smaller of the 2 aortic arches

64
Q

morphologic acardiac anomalies are best diagnosed with what study

A

ECG

65
Q

what cardiac defect has faint pulmonary flow systolic murmur + fixed split S2? also the pt gets colds often

A

atrial septal defect

66
Q

which septal defect closes spontaneously within first 2-3 years of life

A

MUSCULAR ventricular septal defect

67
Q

baby, failure to thrive, loud pansystolic murmur best hurt at left sternal border, increased pulmonary vascular markings on chest xray. dx?

A

VSD (membranous septum)

68
Q

bounding peripheral pulses
continuous machinery like murmur
dx and tx (2 groups)?

A

PDA

in premature infants w/out CHF -> INDOMETHACIN.

in full term babies or those already in CHF -> surgical division or radiological embolization with metal coils

69
Q

systolic ejection murmur in left 3rd intercostal space, diminished pulm vascular markings on chest xray, EKG shows RV hypertrophy

A

tetralogy of fallot

also remember tet spells and boot shaped heart

70
Q

how to start workup for suspected aortic stenosis?

A

ECG

71
Q

aortic stenosis. surgical valvular replacement is indicated if pt is symptomatic, or _____________

A

pressure gradient > 50 mm Hg

72
Q

indication for valvular replacement for chronic Aortic regurg

A

first evidence on ECG of left ventricular dilatation

73
Q

acute aortic regurg tx requires emergency valve replacement and __________

A

long term abx

74
Q

as mitral stenosis progresses, patients become thin and cachectic and develop what other heart thing?
workup starts with _______

valve repair by surgical __________ or _______

A

a fib

workup - ECG

surgical commissurotomy or balloon valvuloplasty

75
Q

mitral regurg murmur is high pitched holosystolic murmurnthat radiates to ___________

A

axilla and back

76
Q

surgical preference for mitral refurg

A

repair valve aka annuloplasty is preferred over prosthetic replacement

77
Q

surgical intervention for coronary dz is indicated if _____% or greater stenosis (and have a good distal vessel)

A

70%

78
Q

general rule for intervention of coronary dz,
is if it’s simpler, _________ is preferred
more complex cases, ______ is better

A

simpler - angioplasty

complex - surgery

79
Q

what vessel most important in coronary bypass

A

internal mammary artery aka long thoracic

80
Q

post op care of heart surgery patients: need to optimize cardiac output. what is cutoff of normal CO? ____ l/min, or cardiac index of ___

if low, then what should be measured? what are indications if low or high?

A

5 l/min, or cardiac index of 3

if below that, then pulm wedge pressure or LA or LED pressure should be measured. low numbers (0-3) means needs more IV fluids. high numbers (20+) suggest ventricular failure

81
Q

pt has dyspnea on exertion, hepatomegaly and ascities,
SQUARE ROOT SIGN
EQUALIZATION OF PRESSURES of heart chambers on heart catheterization.

dx?

A

chronic constrictive pericarditis

82
Q

you see coin lesion on person >50years old, smoker. aka HIGH RISK FOR MALIGNANCY. what is FIRST STEP in workup?

A

LOOK AT PREVIOUS XRAY to see if they have same unchanged lesion. can avoid whole expensive rest of workup if they do.

83
Q

if coin lesion in patient is new or has changed recently compared to previous xray, what is next step in workup (2)

A 
CT for mets
sputum cytology (not biopsy, this is noninvasive)
84
Q

tx for small cell lung cancer

A

chemo and radiation. NOT surgery, that’s for non-small cell lung cancer

85
Q

operability of lung cancer is predicated on _____________ (+ specific cut off)

A

residual function after resection (minimum FEV1 of 800 after surgery).
can measure this by determining current FEV1 and calculating what post up value would be after pneumonectomy.

86
Q

potential cure by surgical removal of lung cancer for hilar metastases? nodal metastases at carina or mediastinum?

A

for hilar, surgery can curatively remove

other one can’t.

87
Q

subclavian steal syndrome. how to dx? what will the study show? tx?

A

dx: Duplex ultrasound will show reversal of flow in vertebral artery
tx: bypass surgery

88
Q

subclavian steal syndrome vs thoracic outlet syndrome in presentation and pathogenesis

A

thoracic outlet syndrome - neurovascular bundle is compressed at thoracic outlet. pale cold arm and/or paresthesia in arm.
vs
subclavian steal syndrome - plaque at origin of subclavian (before takeoff of vertebral) allows enough blood for arm at rest but not with exertion, steals blood from vertebral by reversing flow -> vascular sx AND neuro sx like visual sx or equilibrium problems

89
Q

indication for surgical AAA repair

A

5-6 cm or larger
OR
growing 1cm or more per year

90
Q

person has lower extremity arteriosclerotic occlusive dz. not significantly affecting theyre life, but they’re sx with intermittent claudication. tx/management?

A

not surgery. treat symptomatically. advise smoking cessation and start exercising. and use cilostazol (vasodilator) long term

91
Q

ankle brachial index, measure by ______.

if = ____, then dz is in small vessels and not amenable to surgery. if significant gradient exists, = _____.

A

doppler US

ABI = 1 = no pressure gradient. no surgery.

ABI = 0.8 or less = pressure gradient. do CT angio or MRI to plan for revascularization

92
Q

______ is penultimate stage of lower extremity arterial dz. ____ and ____ are ultimate stage.

A

rest pain penultimate

ulceration and gangrene are ultimate

93
Q

sudden tearing chest pain that radiates to back. EKG and cardiac enzymes rule out MI. you suspect dissecting aneurysm. what would you find on physical exam and xray? (2)

A

unequal pulses in upper extremities

x ray shows wide mediastinum

94
Q

3 possible ways to dx dissection aneurysm

A
  1. MRI angiogram
  2. CT angio
  3. transesophageal ECG
95
Q

2 contraindications for fine needle aspiration for biopsy

A
  1. if there is a hemangioma in the liver. needle could slide it and lead to fatal bleeding
  2. testicular masses. almost always malignant. you will seed. gg

Surgery (7 decks)

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