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Surgery clerkship > Orthopedics (pestana) > Flashcards

Orthopedics (pestana) Flashcards

1
Q

FHx of newborns w/ uneven gluteal folds, and hips that can easily be dislocated posteriorly w/ a jerk and returned to normal w/ a snapping sound.

A

Developmental dysplasia of the hip

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2
Q

If signs are equivocal, what diagnostic test should you use for developmental dysplasia of the hip?

A

Sonogram

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3
Q

Tx of developmental dysplasia of the hip?

A

Abduction splinting w/ Pavlik harness for ~6 months

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4
Q

Why is it not helpful to order hip Xrays in newborns?

A

Hip hasn’t calcified yet

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5
Q

6 yo p/w insidious development of limping, decreased hip motion, and hip or knee pain. Walks w/ antalgic gait; passive motion of the hip is guarded. Dx?

A

Legg-Calve-Perthes dz (AVN of the capital femoral epiphysis)

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6
Q

How do you dx legg-calve-perthes dz?

A

Lateral and AP hip xrays

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7
Q

Tx of legg-calve-perthes dz?

A

Contain femoral head w/in acetabulum w/ casting + crutches

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8
Q

Chubby, limping 13 yo boy w/ c/o knee or groin pain. When he sits w/ his leg dangling, the sole of the foot on the affected side points toward the other foot. PE: limited hip motion; hip flexion–> thigh becomes externally rotated and can’t be rotated internally. Dx?

A

Slipped capital femoral epiphysis

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9
Q

Slipped capital femoral epiphysis: Dx?

A

Xrays

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10
Q

Slipped capital femoral epiphysis: Tx?

A

Surgically pinning femoral head back into place (surgical emergency!)

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11
Q

Toddler s/p febrile illness who now holds hip flexed in slight abduction and external rotation and refuses to move it or let it be moved passively. Increased ESR. Dx?

A

Septic hip

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12
Q

Septic hip in a kid: dx?

A

Aspirate hip under general anesthesia

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13
Q

Kid w/ septic hip- you aspirated hip and found pus. Whatcha do next?

A

Further open drainage

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14
Q

Little kid s/p febrile illness who p/w severe, localized bone pain and w/o hx of trauma to that bone. Dx?

A

Acute hematogenous osteomyelitis

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15
Q

Imaging to dx acute hematogenous osteomyelitis?

A

MRI

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16
Q

Tx of acute hematogenous osteomyelitis?

A

Abx (duh)

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17
Q

Fancy name for being bowlegged?

A

Genu varum

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18
Q

Up to what age is genu varum considered normal?

A

3 yo (so don’t treat if < 3 yo!)

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19
Q

Persistent genu varum after age 3 is MC due to…?

A

Blount disese

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20
Q

What is damaged in Blount disease?

A

Medial proximal tibial growth plate

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21
Q

How do you tx Blount disease?

A

Surgery

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22
Q

Fancy name for knock-knees?

A

Genu valgus

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23
Q

Btwn what ages in genu valgus normal?

A

4 - 8 yo

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24
Q

Teenager w/ persistent pain over the tibial tubercle. Pain is worse w/ contraction of quads, and there’s no knee swelling. Dx?

A

Osgood-Schlatter disease

25
Q

What is Osgood-Schlatter disease?

A

Osteochondrosis of the tibial tubercle

26
Q

Initial management of Osgood-Schlatter disease?

A

Conservative: RICE

27
Q

What’s the most an orthopedic surgeon would do for Osgood-Schlatter disease?

A

Extension or cylinder cast for 4-6 wk

28
Q

Fancy name for club foot?

A

Talipes equinovarus

29
Q

NB w/ both feet turned inward w/ plantar flexion, foot inversion, forefoot adduction, and inward rotation of the tibia. Dx?

A

Talipes equinovarus

30
Q

Basic tx of talipes equniovarus?

A

Serial plantar casts starting in the neonatal period–> sequential correction, starting w/ adducted forefoot, then hindfoot varus, finally equinus.

31
Q

What other treatment modalities are often added to serial plantar casting in talipes equinovarus?

A

Achilles tenotomy and part-time, long-term use of braces

32
Q

Talipes equinovarus: those who don’t respond to casting are treated surgically around what age?

A

9-12 mo

33
Q

Teenage girl with thoracic spine curved toward the right. Dx?

A

Scoliosis

34
Q

Most sensitive screening finding in scoliosis?

A

Look at girl when she bends forward, and you can see a hump over her right thorax

35
Q

Until what time does scoliosis continue progressing?

A

Until skeletal maturity is reached

36
Q

What percent of skeletal maturity is present at onset of menses?

A

80%

37
Q

What’s the major concern in severe cases of scoliosis?

A

Decreased pulmonary fxn

38
Q

How do you arrest progression of scoliosis?

A

Bracing

39
Q

How do you treat severe cases of scoliosis?

A

Surgery

40
Q

Normally, kids remodel and heal bone much better than adults. However, there are 2 types of fractures which are classically much worse in kids than in adults. What are these 2 types?

A

Supracondylar fractures of the humerus

Growth plate fractures

41
Q

Kid falls on hand w/ arm extended, leading to hyperextension of the elbow. What kind of fracture are you worried about?

A

Supracondylar fracture of the humerus

42
Q

Which type of contracture are you worried about 2/2 vascular/nerve injuries associated with supracondylar fracture of the humerus?

A

Volkmann contracture

43
Q

General tx of supracondylar fracture of the humerus?

A

Casting or traction

44
Q

What do you need to monitor for with supracondylar fracture of the humerus?

A

Compartment syndrome

45
Q

For a growth plate fracture where the epiphysis and growth plate are laterally displaced from metaphysis but are in one piece, what type of reduction can be used?

A

Closed reduction

46
Q

How do you treat a growth plate fracture where the plate is in 2 pieces?

A

Open reduction and internal fixation to provide very precise alignment

47
Q

What happens if you don’t correctly align a broken growth plate?

A

It will grow unevenly–> deformity of extremity.

48
Q

17 yo boy w/ persistent low-grade knee pain x3 mo w/ “sunburst pattern” on xray. Dx?

A

Osteosarcoma

49
Q

10 yo boy w/ persistent low-grade leg pain x3 mo w/ “onion-skinning” on xray. Dx?

A

Ewing sarcoma

50
Q

Old man w/ fatigue, anemia, and localized, focal bone pain in several spots. Renal dysfxn + proteinuria. Dx?

A

Multiple myeloma

51
Q

Relentlessly growing soft tissue mass that’s firm and fixed to surrounding structures +/- lung mets. Dx?

A

Soft tissue sarcoma

52
Q

Patient s/p UE injury who holds arm close to body and rotated outward +/- numbness in small area over delt.

A

Anterior dislocation of shoulder

53
Q

Patient s/p seizure or electric shock who holds arm close to body and internally rotated.

A

Posterior shoulder dislocation

54
Q

Old osteoporotic lady falls on an outstretched hand–> deformed and painful wrist w/ a dorsally displaced, dorsally angulated fracture of the distal radius.

A

Colles fracture

55
Q

Direct blow to forearm that’s raised in a protective manner (think someone shielding themself)–> diaphyseal fracture of the prox ulna w/ anterior dislocation of the radial head.

A

Monteggia frx

56
Q

Direct blow to distal third of the radius–> distal radial Fx w/ dorsal dislocation of the distal radioulnar joint.

A

Galeazzi frx

57
Q

Young adult falls on an outstretched hand and p/w c/o wrist pain. Localized tenderness on palpation of the anatomical snuffbox.

A

Scaphoid frx

58
Q

Pissed off guy punches a wall and p/w swollen tender hand. Dx?

A

Metacarpal neck frx

59
Q

Old lady s/p fall p/w hip pain and on stretcher is found to have shortened and externally rotated leg.

A

Hip frx

Surgery clerkship (4 decks)

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