Pretest_11_Orthopedics

Question 1

Most meniscal tears are produced by which joint movements?

Answer 1

flexion and rapid rotation (for example, rapid rotation of flexed femoral condyles about the tibial plateau, which most frequently tears the medial meniscus)

Question 2

What is the treatment of a meniscal tear?

Answer 2

early surgical removal of the displaced menisci to prevent further damage ot the cartilage or ligaments

Question 3

What are the “mainstays in management” of an open fracture?

Answer 3

Early irrigation and debridement (repeat debridement 48 to 72 hours after irrigation)

Question 4

Plain radiographs showing a small and denser than normal femoral head on the affected side =

Answer 4

Legg-Calves-Perthes disease–> period of ischemia in the proximal femoral epiphysis followed by revascularization

Question 5

Notable on physical exam in patients with slipped capital femoral epiphysis:

Answer 5

limitation of internal rotation of the hip

Question 6

What is Blount disease?

Answer 6

infants born with physiologic genu varum (bow legs)

Question 7

What is talipes equinovarus?

Answer 7

club foot

Question 8

What types of crystals are seen in synovial fluid aspiration in gout?

Answer 8

urate crystals

Question 9

Which direction does the glenohumeral joint most often dislocate?

Answer 9

anteriorly or anteroinferiorly! (anteriorly and inferiorly to the joint, the pectoralis major and long head of the biceps do not completely stabilize the joint, so the articular ligaments and joint capsule provide the major structural support)

Question 10

Superiorly to the glenohumeral joint, the _________ prevents upward dislocation.

Answer 10

acromion process

Question 11

The glenohumeral joint is bounded laterally by

Answer 11

the deltoid muscle

Question 12

The glenohumeral joint is bounded posteriorly by

Answer 12

teres minor, infraspinatus, and the long head of the triceps

Question 13

Posterior dislocation of the glenohumeral joint is rare; when it happens, __________ should be suspected

Answer 13

seizure

Question 14

Which fractures have hte worst prognosis in terms of stunting growth?

Answer 14

Crushing injuries to the epiphysis (type V). Numerous bony bridges may form and prevent longitudinal growth

Question 15

A transverse fracture of the distal half of the humeral shaft puts this nerve at risk for damage:

Answer 15

radial

Question 16

If radial nerve injury is present before any manipulation is done, a humeral fracture should be reduced. However, if the nerve injury is present only AFTER reduction, then what should be done?

Answer 16

immediate surgical exploration because the nerve might be trapped in the fracture site

Question 17

The posterior interosseous never is a distal branch of the radial nerve and may be injured in fractures near

Answer 17

the radial head

supplies hand extensors and arm supinator

Question 18

T/F: A radial nerve injury at the wrist won’t impair wrist extension.

Answer 18

True. Instead the deficits will be sensory: over the thenar pad and thumb web

Question 19

What is the first sign of compartment syndrome?

Answer 19

loss of oxygen to tissues and increased extremity edema because of increased capillary permeability

Question 20

A patient with compartment syndrome will hold the injured part in (extension/flexion) to minimize pain.

Answer 20

Flexion – loosens the fascia

Question 21

What is the main benefit of open vs closed reductions?

Answer 21

Shorter period of immobilization following

Question 22

What are shortcomes of open vs closed reductions?

Answer 22

More trauma at the fracture site, potential for longer time to heal (removing hematomas that might be important for healing), infection potential (but the shorter period of immobilization that follows makes the benefit worth the risks

Question 23

What is the navicular bone of the wrist?

Answer 23

the scaphoid

Question 24

What is the Monteggia deformity? How is it treated?

Answer 24

dislocation of the radial head anteriorly with fracture of the proximal third of the ulna
Treated by reduction of ulna followed by supination and direct pressure on radius to reduce it.

Question 25

In the Monteggia deformity, usually the radius is displaced in what direction? It is usually caused by forced _________

Answer 25

anteriorly; forced pronation

Question 26

What is a greenstick fracture?

Answer 26

When a bone is being bent and the point of maximal stretch is broken but not the point of maximal compression; due to tougher periosteum but more flexible bones of immature bones (young kids)

Question 27

Hemorrhagic cystic lesions (brown tumors) in the long bones is seen in

Answer 27

ostetitis fibrosa cystica (associated with hyperparathyroidism; treatment is parathyroidectomy)

Question 28

Osteomalacia is defined as __________. Treatment is?

Answer 28

a defect in mineralization of adult bone. Treatment is vit D supplementation

Question 29

Radiograph showing sunburst appearance with bone destruction, soft tissue mass, new bone formation and sclerosis limited to the metaphysis of the lower femur:

Answer 29

Osteosarcoma

Question 30

T/F: Osteosarcomas are sensitive to radiation.

Answer 30

False! They do, however, respond well to combo chemo followed by surgical resection or amputation

Question 31

This bone tumor typically presents with severe pain that is characteristically relieved by aspirin:

Answer 31

osteoid osteoma

Question 32

How does osteoid osteoma appear on radiograph?

Answer 32

small lucency (usually <1 cm) within the bone surrounded by reactive sclerosis

Question 33

How is osteoid osteoma treated?

Answer 33

Lesions gradually regress over 5 to 10 years, but surgical extirpation is usually curative

Question 34

This tumor tends to appear in the diaphyses of long bones, spine, or pelvis and is a round-cell type tumor:

Answer 34

Ewing’s sarcoma (children)

Question 35

When is the pain characteristically worse for Ewing’s sarcoma?

Answer 35

at night

Question 36

In this bone tumor, there is a permeative pattern of bone lysis and periosteal reaction, often associated with a soft tissue mass:

Answer 36

Ewing’s sarcoma

Question 37

T/F: Ewing sarcoma are sensitive to radiation.

Answer 37

True! Treated with a combo of radiation and systemic chemo

Question 38

What is osteopetrosis?

Answer 38

rare skeletal deformity associated with increased density of the bones

Question 39

A Colles fracture results in a distal radius fracture with wrist (flexion/extension)

Answer 39

extension

flexion = Smith fracture; a “reverse Colles”

Question 40

What is the best treatment for femoral neck fracture?

Answer 40

Attempt closed reduction and internal fixation first; if unsucessful, then open reduction

Question 41

What are the Ottawa ankle rules for determining when to work up an ankle injry?

Answer 41

Radiographs should be obtained if there is pain in the malleolar zone and either one of the following

1) bone tenderness along the distal 6cm of the posterior edge of the tibia or the tip of medial and lateral malleolus
2) inability to bear weight immediately after injury and walk more than 4 steps when being evaluated

Question 42

Atrophy of the thenar eminence results from

Answer 42

longstanding median nerve compression (bad carpal tunnel syndrome)

Question 43

Studies have shown that patients with _____________ have decreased surgical treatment outcomes for carpal tunnel syndrome than other patients.

Answer 43

alcohol abuse, poor mental status parameters

Question 44

A patient with ankylosing spondylitis with an epidural spinal hematoma should be treated with

Answer 44

cervical laminectomy (to decompress) and fusion (to prevent future problems since fracture patterns in these patients are unstable)

Question 45

Ewing sarcoma is characterized by what genetic mutation?

Answer 45

reciprocal translocation t(11;22)

Question 46

Ewing sarcoma stains positive or negative for which of the following:
CD45, CD 99, CD 19, CD20, CD103

Answer 46

positive: CD99, CD103
negative: CD45, CD19, CD20

Question 47

In scoliosis, observation with internal radiographs is an appropriate management approach if the curvature is less than ___ degrees, or “mild”

When is bracing utilized?

Answer 47

40 degrees or any curve >50 degrees

Question 48

How can Ewing sarcoma be distinguished from neuroblastoma or primitive neuroectodermal tumors?

Answer 48

Ewing sarcoma is negative for neural markers (like S100)

It is strongly positive for CD99 and CD103

Question 49

Patient on chronic steroids with right groin pain and radiography of right hip showing sclerosis, bone deformity, and subchondral radiolucent lines of the femoral head. What is the diagnosis?

Answer 49

Iatrogenic avascular necrosis due to corticosteroid therapy

Question 50

Weight lifter with pronator teres syndrome will have hwat symptoms?

What is the treatment?

Answer 50

numbness and tingling in right thumb, index finger, middle finger, and thenar eminence. Extensive workouts result in hypertrophy of pronator teres compressing median nerve.

Treatment is rest, ice, elevation, and physical therapy

Question 51

How do you distinguish carpal tunnel syndrome and pronator teres syndrome?

Answer 51

IN pronator teres syndrome, the conduction velocity of the median nerve at the wrist is normal (unlike carpal tunnel)

Question 52

Bone mass = well-circumscribed radiolucent nidus surrounded by a border of sclerotic bone. Diagnosis?

Answer 52

Osteoid osteoma. Treat with NSAIDs; most resolve without operative intervention

Question 53

What is lumbar spondylolysis? What is seen on posterior oblique xray?

Answer 53

Due to repetitive back hyperextension, may result in fracture to the pars interarticularis.

On x ray, may appear as “collared Scotty dog” deformity.

Treatment is relative rest from activity and spinal bracing if no improvement after several weeks of rest.