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Surgery > Pestana- 2. Orthopedics > Flashcards

Pestana- 2. Orthopedics Flashcards

1
Q

When should developmental dysplasia of the hip be diagnosed?

A

ideally right after birth (it runs in families)

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2
Q

How do you diagnose developmental dysplasia of the hip?

A
  • Children have uneven gluteal folds
  • Can jerk the hip down and dislocate with a “click” and it returns to normal with a “snap”
  • Use ultrasound (NOT x-ray)
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3
Q

How do you treat developmental dysplasia of the hip?

A

abduction splinting with Pavlik harness for around 6 months

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4
Q

What are the two ways that hip pathology in children may present?

A

hip pain or knee pain

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5
Q

What is Legg-Calve-Perthes disease?

A

avascular necrosis of the capital femoral epiphysis

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6
Q

When and how does Legg-Calve-Perthes disease usually present?

A

Around 6 years old with insidious limping (passive motion of hip is guarded when walking), decreased hip motion and hip/knee pain

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7
Q

How do you diagnose Legg-Calve-Perthes disease?

A

AP and lateral hip x-rays

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8
Q

How do you treat Legg-Calve-Perthes disease?

A

containing the femoral head within acetabulum by casting and crutches

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9
Q

What should you think if a 13 y/o boy presents with groin pain, limping, and when legs dangle while sitting, the sole of the foot on the affected side points toward the other foot?

A

slipped capital femoral epiphysis

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10
Q

What is the characteristic physical exam finding in slipped capital femoral epiphysis?

A

as hip is flexed, thigh goes into external rotation and cannot be rotated internally

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11
Q

How do you diagnose slipped capital femoral epiphysis?

A

x-ray (THIS IS AN ORTHOPEDIC EMERGENCY)

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12
Q

How do you treat slipped capital femoral epiphysis?

A

pinning the femoral head back in place

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13
Q

What should you suspect if a toddler has a febrile illness then holds the leg with the hip flexed (slight abduction and external rotation) and will not allow it to be moved?

A

septic hip

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14
Q

How do you diagnose septic hip?

A

aspiration of hip under general anesthesia

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15
Q

How do you treat septic hip?

A

if aspiration shows pus, do open drainage

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16
Q

What should you suspect if a young child has a febrile illness and it is followed by severe localized pain in a bone with no history of trauma?

A

acute hematogenous osteomyelitis

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17
Q

How do you diagnose acute hematogenous osteomyelitis?

A

MRI (x-rays will not show anything for a couple of weeks)

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18
Q

How do you treat acute hematogenous osteomyelitis?

A

antibiotics

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19
Q

What is genu varum?

A

bow legs

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20
Q

Up to what age is genu varum considered normal?

A

3

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21
Q

What should you think of if genu varum persists after age 3?

A

Blount disease

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22
Q

What is Blount disease?

A

disturbance of medial proximal tibial growth plate

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23
Q

What is genu valgus?

A

knock knee

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24
Q

When is genu valgus commonly seen?

A

between ages 4 and 8 (normal)

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25
Q

What should you suspect in a teenager with persistent pain right over the tibial tubercle that is aggravated by contraction of the quadriceps?

A

Osgood-Schlatter disease

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26
Q

What is Osgood-Schlatter disease?

A

osteochondrosis of the tibial tubercle

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27
Q

What does physical exam show in Osgood-Schlatter disease?

A

localized pain over the tibial tubercle and NO KNEE SWELLING

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28
Q

What is the definitive treatment for Osgood-Schlatter disease (if RICE does not work)?

A

extension or cylinder cast for 4-6 weeks

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29
Q

What is talipes equinovarus?

A

club foot

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30
Q

When does talipes equinovarus present?

A

birth

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31
Q

What is the more conservative treatment for talipes equinovarus?

A

serial plaster cases in neonatal period with possible Achilles tenotomy and part-time, long-term use of braces

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32
Q

If casting does not work for talipes equinovarus, when is the ideal time for surgery?

A

between age 9-12 months

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33
Q

In scoliosis, what part of the spine is affected and to what direction is it curved?

A

thoracic spines are curved toward right

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34
Q

For how long does scoliosis progress until it stops?

A

skeletal maturity (so a little after the onset of menses in girls)

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35
Q

What is the treatment for scoliosis?

A

bracing can arrest progression but severe cases need surgery

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36
Q

What is a complication of scoliosis left untreated?

A

decreased pulmonary function

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37
Q

Who experiences more remodeling after fractures, children or adults?

A

children

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38
Q

What are the two fractures that children have special problems with during the healing process?

A

1) supracondylar fractures of humerus

2) fractures of any bone that involve the growth plate

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39
Q

How does a child get a supracondylar fracture of the humerus?

A

when a child falls on his hand with his arm extended (hyperextension of the elbow)

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40
Q

If a nerve is injured during a supracondylar fracture of the humerus in a child, what could result?

A

Volkmann contracture

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41
Q

How are supracondylar fractures of the humerus treated?

A

casting/traction BUT you need to monitor for integrity of nerve and vessels and watch out for compartment syndrome

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42
Q

When must you use open reduction and internal fixation in a fracture for a child?

A

if the fracture puts the growth plate in two pieces

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43
Q

What is the most common primary malignant bone tumor in children?

A

osteogenic sarcoma

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44
Q

Where do osteogenic sarcomas usually occur?

A

around the knee (lower femur or upper tibia)

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45
Q

How old are patients who get osteogenic sarcomas?

A

10-25 y/o

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46
Q

What x-ray finding is characteristic of osteogenic sarcoma?

A

“sunburst” pattern

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47
Q

What is the second most common primary malignant bone tumor in children?

A

Ewing sarcoma

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48
Q

Where do Ewing sarcomas usually occur?

A

diaphyses of long bones

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49
Q

How old are patients who get Ewing sarcoma?

A

5-15

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50
Q

What is the characteristic x-ray finding in Ewing sarcoma?

A

“onion skinning” of periosteum

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51
Q

What are the two most common mets to bone in adults?

A

Breast (lytic) in women

Prostate (blastic) in men

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52
Q

What should be suspected in an old man who is tired, anemic and has localized pain at specific places in several bones?

A

multiple myeloma

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53
Q

What does an x-ray show in multiple myeloma?

A

multiple punched-out lytic lesions

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54
Q

What is found in the urine in a patient with multiple myeloma?

A

Bence-Jones proteins

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55
Q

What should be done to the blood of a patient with suspected multiple myeloma?

A

serum immunoelectrophoresis to look for abnormal immunoglobulins

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56
Q

How do you treat multiple myeloma?

A

chemo or thalidomide (if chemo fails)

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57
Q

What is the term used to describe a firm soft tissue mass that fixes to surrounding structures and have relentless growth anywhere in the body?

A

soft tissue sarcomas

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58
Q

Where do soft tissue sarcomas metastasize?

A

lung

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59
Q

How do you treat soft tissue sarcomas?

A

wide local excision, radiation and chemo

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60
Q

When is it okay to use a closed reduction (cast) of a broken bone in an adult?

A

if it is not badly displaced/angulated or can be satisfactorily aligned by external manipulation

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61
Q

Where is the location of most clavicular fractures?

A

at the junction of the middle and distal thirds

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62
Q

What is the traditional treatment for fracture of the clavicle?

A

figure-of-eight device (pulls back both shoulder to align the bone)

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63
Q

What is the more common shoulder dislocation?

A

anterior

64
Q

How do people with anterior shoulder dislocation hold their arms?

A

arm is adducted but forearm is rotated outward

65
Q

What nerve may be stretched in an anterior dislocation (what is the result)?

A

axillary nerve (numbness in small area over deltoid)

66
Q

What causes a posterior shoulder dislocation?

A

epileptic seizures or electrical burn (things that cause massive uncoordinated muscle contractions)

67
Q

How do people with posterior shoulder dislocations hold their arms?

A

arm adducted and forearm internally rotated

68
Q

How do people get Colles fractures?

A

fall on outstretched hand

69
Q

Who gets Colles fractures?

A

old osteoporotic women

70
Q

What bone is involved in Colles fracture?

A

distal radius is fractured and dorsally displaced and angulated (wrist looks like “dinner fork”)

71
Q

How do you treat Colles fracture?

A

close reduction and long arm cast

72
Q

How do you get a Monteggia fracture?

A

direct blow to the ulna (protective arm)

73
Q

What bones are affected in Monteggia fracture?

A

diaphyseal fracture of proximal ulna and anterior dislocation of radial head

74
Q

What is the mirror image of a Monteggia fracture (fracture to distal third of radius with dorsal dislocation of distal radioulnar joint) called?

A

Galeazzi fracture

75
Q

How do you treat Monteggia and Galeazzi fractures?

A

open reduction and internal fixation of broken bone with closed reduction of dislocated bone

76
Q

What is a carpal navicular?

A

scaphoid

77
Q

How do you fracture your scaphoid?

A

fall on outstretched hand

78
Q

How long does it take a scaphoid fracture to show up on x-ray?

A

3 weeks

79
Q

How do you treat scaphoid fractures?

A

thumb spica cast

80
Q

Which metacarpal necks are usuallly fractured when you punch a wall?

A

4th, 5th or both

81
Q

How does a person look who has fractured his hip?

A

affected leg is shortened and externally rotated

82
Q

What is tricky about femoral neck fractures?

A

has a tenuous blood supply

83
Q

What can lead to faster healing and earlier mobilization in femoral neck fractures?

A

replacing the femoral head with a prosthesis

84
Q

How do you treat intertrochanteric fractures?

A

open reduction and internal fixation (need anticoagulation after surgery because patient will be immobilized for a while)

85
Q

How do you treat femoral shaft fractures?

A

intramedullary rod fixation

86
Q

How are collateral ligament injuries commonly sustained?

A

sideways blow to the knee

87
Q

What is the test for medial collateral ligament injury?

A

valgus

88
Q

How do you treat isolated collateral ligament injuries?

A

hinged cast

89
Q

Which is more common, injury to ACL or PCL?

A

ACL

90
Q

What are the two tests for ACL injury?

A

anterior drawer and Lachman test

91
Q

What is the best way to image and diagnose a meniscal tear?

A

MRI

92
Q

What is the typical description of meniscal tear symptoms?

A

protracted pain and swelling with a catching and locking sensation that limits knee motion (“clicks” when knee is forcefully extended)

93
Q

Which 3 knee injuries are commonly associated with a single injury?

A

Medial meniscus
MCL
ACL

94
Q

What type of fracture is commonly seen in young men subjected for forced marches?

A

tibial stress fractures

95
Q

How do you diagnose tibial stress fracture?

A

x-rays usually normal– patient will have TTP over very specific point int he bone

96
Q

How do you treat tibial stress fracture?

A

cast or non-weight bearing (crutches)

97
Q

What do you have to worry about in tib-fib fractures after long leg cast is applied?

A

compartment syndrome (remove case immediately)

98
Q

What motion is limited with Achilles tendon rupture?

A

plantarflexion

99
Q

How do you treat ruptured Achilles tendon?

A

Surgery (quick)

Casting in equinus position

100
Q

What is the most reliable physical exam finding in compartment syndrome?

A

excruciating pain with passive extension

101
Q

What will pulses be in compartment syndrome?

A

can be normal

102
Q

How long do you have before you need to be in the OR to reduce an open fracture?

A

6 hours

103
Q

What injury occurs during head on collision when the knees hit the dashboard?

A

posterior dislocation of the hip

104
Q

How will a patient with a posterior hip dislocation position themselves?

A

leg shortened, adducted and internally rotated (different than broken where it will be externally rotated)

105
Q

How do you treat gas gangrene (deep, penetrating dirty wounds after around 3 days)?

A

IV penicillin
Extensive emergency surgical debridement
Hyperbaric oxygen

106
Q

How do you treat mucormycosis?

A

IV amphotericin B

107
Q

What nerve can be injured in oblique fractures of the middle and distal thirds of the humerus?

A

radial nerve

108
Q

What do you do if dorsiflexion of the wrist is present even after reduction of humerus fracture (radial nerve injury)?

A

you need to do surgery because the nerve is entrapped

109
Q

If you have a popliteal artery injury but there is delayed restoration of flow, what must you do?

A

prophylactic fasciotomy

110
Q

What must you do with every diagnosis of carpal tunnel syndrome?

A

wrist x-rays

111
Q

What is the first line of therapy for trigger finger?

A

steroid injection

112
Q

What hand position causes De Quervain tenosynovitis?

A

wrist flexion and thumb extension (like holding a baby’s head)

113
Q

How do you treat De Quervain tenosynovitis?

A

steroid injections

splint + anti-inflammatory agents

114
Q

Who gets Dupuytren contracture?

A

older men of Norwegian ancestry

115
Q

What can you feel on physical exam with Dupuytren contracture?

A

palmar fascial nodules

116
Q

WHen does a patient with Dupuytren contracture need surgery?

A

when the hand can no longer be placed flat on the table

117
Q

What is a felon?

A

abscess in pulp of a fingertip

118
Q

What ist he treatment for a felon?

A

urgent surgical drainage (pressure can build up and lead to tissue necrosis)

119
Q

What is Gamekeeper thumb?

A

injury of ulnar collateral ligament due to forced hyperextension of the thumb

120
Q

How do you treat Gamekeeper thumb?

A

casting

121
Q

How does Jersey finger occur?

A

forcefully extending flexed finger

122
Q

How does Mallet finger occur?

A

forcefully flexing extended finger (volleyball)

123
Q

WHat is ruptured in Mallet finger?

A

extensor tendon

124
Q

What is the treatment for Jersey and Mallet fingers?

A

splinting

125
Q

What are the most common levels for lumbar disk herniation?

A

L4-L5 or L5-S1

126
Q

How do patients with lumbar disk herniation present?

A

months of vague aching pain (discogenic pain) followed by sudden onset of electric shooting pain (neurogenic pain) precipitated by event (lifting, etc).

127
Q

Where does the neurogenic pain “exit” in lumbar disc herniation?

A

big toe (L4-L5) or little toe (L5-S1)

128
Q

How can you tell for sure if a patients pain is due to disc herniation by physical exam?

A

if it is worse with coughing, sneezing or defecating

129
Q

What maneuver is used to evaluate for lumbar disc herniation?

A

straight leg test

130
Q

How do you diagnose lumbar disc herniation?

A

MRI

131
Q

What is the treatment for disc herniation?

A

body reabsorbs extruded disc with 3 weeks of strict bed rest (need to do pain management)

132
Q

What are the symptoms of cauda equina sndrome?

A

distended bladder
flaccid rectal sphincter
perineal saddle anesthesia

133
Q

What is the treatment for cauda equina syndrome?

A

emergency surgical decompression

134
Q

Who gets ankylosing spondylitis?

A

young men in 30s-early 40s

135
Q

When does the back pain occur with ankylosing sphonylitis?

A

early morning stiffness and pain that improves with activity

136
Q

What does an x-ray of ankylosing spodylitis show?

A

bamboo spine

137
Q

How do you treat ankylosing spondylitis?

A

anti-inflammatory agents and PT

138
Q

What antigen is associated with ankylosing spondylitis?

A

HLA-B-27

139
Q

Where are diabetic ulcers typically located?

A

pressure points (heel, metatarsal head, tip of toes)

140
Q

What is the cycle of diabetic ulcers?

A

neuropathy causes them to occur, microvascular disease causes them to not heal properly

141
Q

How may you treat a diabetic ulcer?

A

controlling DM and keeping leg clean and elevated for weeks to months

142
Q

What should you expect to be the cause of dirty looking ulcers with bases devoid of granulation tissue located at the tip of the toes?

A

arterial insufficiency

143
Q

How do you workup ulcers 2/2 arterial insufficiency?

A

Doppler studies looking for pressure gradients (if none, then you cannot operate)

144
Q

What is the treatment for ulcers 2/2 arterial insufficiency?

A

surgical revascularization or angioplasty and stents

145
Q

Where do venous stasis ulcers typically develop?

A

in the skin above the medial malleolus

146
Q

What other problems will a patient with venous stasis ulcers typically have?

A

varicose veins and cellulitis

147
Q

What is the first line treatment for venous stasis ulcers?

A

support stockings (physical support to empty veins)

148
Q

What is the name for a squamous cell carcinoma of the skin developing in a chronic leg ulcer?

A

Marjolin ulcer

149
Q

How do you treat a Marjolin ulcer?

A

wide local excision and skin grafting

150
Q

What coniditon is seen in older, overweight patients who complain of disabling, sharp heel pain every time their foot hits the ground?

A

plantar fasciitis

151
Q

What will you see on x-ray in a patient with plantar fasciitis?

A

bony spur in location matching the pain

152
Q

What is the treatment for plantar fasciitis?

A

can remove the spur (but will not always help!)

usually resolve spontaneously in 12-18 months

153
Q

What is the site of inflammation in a Morton neuroma?

A

common digital nerve (third interspace–between 3rd and 4th toes)

154
Q

What causes Morton neuroma?

A

heels or pointed shoes that bunch the toes together

155
Q

What will be high in a patient with gout?

A

serum uric acid

156
Q

What is the treatment for acute gout attack?

A

indomethacin and colchicine

157
Q

What are the drugs used to chronically control gout?

A

allopurinol and probenicid

Surgery (13 decks)

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