Questions Flashcards
1
Q
Dorsal Thompson approach to forearm is between
A
EDC and ECRB
2
Q
Nerve with deep palmar arch
A
Deep motor ulnar
3
Q
Supracondylar process is
A
A normal distal humerus variation, looks like osteochondroma
4
Q
Nerve in plantar fasciitis is
A
Lateral calcaneal
5
Q
A fabella is normally located
A
In the lateral head of gastroc around knee
6
Q
Pacinian corpuscles sense
A
Pressure (high frequency, quick adaptation)
7
Q
Froment’s sign
A
Weak adductor pollicis (ulnar) leads to flexion at thumb IPJ during pinch
8
Q
Artery of adamkiewitz arises from
A
Left posterior intercostal artery between T8-12
9
Q
Rhomboid innervation
A
C5 and dorsal scapular nerve
10
Q
Median nerve goes ____ the pronator teres
A
Through the belly of
11
Q
Interval for anterior approach to SCH fx
A
Between pronator teres and brachialis
12
Q
Parona’s space
A
Distal forearm potential space, horseshoe abscess communication space
13
Q
Define stieda fracture
A
Avulsion of MCL off femur
14
Q
The small saphenous vein is ____ to the sural nerve at mid calf
A
Medial
15
Q
Ligament that limits hip IR
A
Ischiofemoral
16
Q
Posteromedial bundle of PCL resists
A
Hyperextension
17
Q
Last muscle innervated by ulnar nerve
A
First dorsal interossei
18
Q
Innervation of EDM
A
Radial
19
Q
Synthetic nerve conduits treat gaps up to ____
A
3cm
20
Q
Abx for early mycobacterium marinum infection
A
Clarithromycin
21
Q
Impulse conduction implicated in neuropathic pain
A
Ephaptic
22
Q
Treatment of trigger finger in rheumatoid
A
Tenosynovectomy (not A1 pulley release!)
23
Q
Congenital clasped thumb is caused by
A
Hypoplastic extensor pollicis brevis
24
Q
Most common finger deformity in psoriasis
A
PIPJ flexion and MCPJ extension contractures
25
Spiral cord displaces the bundle ___, ___, and ___.
Proximally, volarly and towards midline.
26
Bacteria symbiotic with leeches
Aeromonas hydrophila
27
Timing of upper extremity embryogenesis
4-8 weeks
28
Volkmann ischemic contracture affects which muscle bellies
Deep finger flexors: FPL and FDP
29
Vitamin that reverses effect of steroids on wound healing
A
30
The cell involved in dupuytren's is
Myofibroblast
31
For clenched fist reconstruction, when is superficialis to profundus transfer indicated?
When there is no volitional control (otherwise do fractional lengthening)
32
How to block xanthine production after reperfusion
Allopurinol (generation of xanthines causes ischemic damage)
33
Radially deviated hands with normal thumbs in a baby is
TAR syndrome (thrombocytopenia absent radii)
34
What is imaging and initial treatment for severe frostbite?
Technetium-99 bone scan and IV tPA administration if no blood flow
35
What blocks reduction of thumb MCPJ dislocation
Adductor pollicis and FPB
36
Dwarf w normal facies and abnormal joints is
Pseudoachondroplasia (COMP)
37
Radiating a poly accomplishes:
Increased cross linking and overall improved wear resistance
38
Frataxin mutation
Friedreich's ataxia: CNS disorder, cavovarus feet, scoliosis, cardiomyopathy
39
Most common proteoglycan in tendons
Decorin
40
t(2,13)
Alveolar rhabdomyosarcoma (PAX3-FKHR)
41
Cellular mechanism of BMP activity
Bind serine/threonine receptors, which cause phosphorylation of SMADs
42
MOA of argatroban
Direct thrombin inhibitor (blocks fibrinogen to fibrin conversion)
43
Popliteal artery is ____ to the PCL
Posterolateral
44
Define/explain wartenburg sign
Abduction of small finger due to ulnar nerve denervation
Unopposed pull of EDM (radial n)
45
PITX1-TBX4
An intergenic SNP related to clubfoot formation
46
Missense mutation in GNAS causes
Fibrous dysplasia (mon/polyostotic)
47
Pseudarthrosis of the tibia is associated with
NF-1
48
Spring ligament connects the
Calc and navicular
49
CD1a stain is specific for
Langerhans cell histiocytosis
50
Best approach for scaphoid humpback fixation is
Volar
51
Treatment for blounts in kids
Proximal tibia osteotomy
52
Mets that are resistant to radiation include
Renal and thyroid
53
Nuclear beta-catenin stain is specific for
Desmoid tumor
54
Lisfranc ligament is AKA
Oblique interosseous ligament
55
Most common glenoid wear pattern in OA
Posterior
56
At what degree of glenoid retroversion should graft be used in TSA
>15 degrees
57
Order of ligament tears in elbow dislocation
LUCL, posterior band of MCL, anterior band of MCL
58
What is bunnell test
Intrinsic tightness test: decreased PIP flexion with MCP extended
59
Name of osseous ridge separating ACL bundles at attachment on femur
Bifurcate ridge
60
Most common site of PIN compression
Arcade of Frohse (fibrous edge of supinator)
61
Corticosteroids inhibit ____ and prevent formation of _____
Phospholipase A2 and arachidonic acid
62
MRSA is resistant to abx by what mechanism
Mutation in the mecA gene that alters pcn-binding protein
63
Osteoclasts resorb bone using what 3 enzymes
Carbonic anhydrase, MMP, and cathepsin K
64
What percentage of cartilage is chondrocytes
2%
65
wnt protein binds to
LRP5/6 receptor to stimulate beta-catenin translocation to differentiate osteoblasts
66
Thin eyebrows, juvenile cataracts, abnormal teeth, growth restriction
Rothmund-Thomson syndrome (increased risk of osteosarc)
67
Gene mutation leads to OA
type IX collagen
68
Master switches of osteoblast differentiation
runx2 and Osx
69
Biggest risk factor for PE in TKA is
Diabetes. Also bilateral TKA and BMI >30
70
Soft tissue cancer causing skin ulcerations
Dematofibrosarcoma protuberans
71
Most common soft tissue tumor in hand
Epithelioid sarcoma
72
t(12,22)
Clear cell sarcoma
73
CD99+
Ewing's
74
USP6 gene mutation
Leads to ABC formation (ubiquitin specific protease)
75
Treatment for chondroblastoma
Curettage, augment, grafting
76
Lobulated tumor in hand/foot bones or proximal tibia, stellate cells on path
Chondromyxoid fibroma
77
Acral mets are most commonly from which primary solid organ tumor
Lung cancer
78
Atypical thoracic scoliosis bends to the
LEFT
79
Abnormal lab in Duchenne's
Serum CPK
80
Anterolateral elbow scope portal risks injury to
Radial nerve
81
SBRN gets compressed in the interval between
Brachioradialis and ECRL
82
Most consistently proposed transfer for radial nerve palsy
Pronator teres to ECRB
83
Ligaments detached w labrum in bankart
MGHL and IGHL
84
Directional instability caused by isolated coronoid fx is
Varus posteromedial
85
Chronic swan neck is due to attenuation of
Spiral oblique retinacular ligament
86
The most common complication after talar neck fx
Posttraumatic OA! AVN is next
87
Most common coronoid fx pattern in terrible triad
Tip fx (2-3mm)
88
Reliable systemic inflammatory marker after polytrauma
IL-6
89
Chronic CN XI injury treated with
Levator/rhomboid transfer
90
Define zones of guyon's canal
1. Proximal to bifurcation
2. Surrounds deep motor branch
3. Surrounds superficial sensory branch
91
Nonunions of scaphoid waist can be treated w
Corticocancellous graft
92
Nonunions of scaphoid proximal pole treated w
Vascularized bone graft off 1,2 intercompartmental supraretinacular artery
93
When should radial n palsy after humerus fx be explored
6 months
94
Corrosion resistance is provided by
Adherent oxide layer (chromium oxide in steel and cobalt, titanium oxide in titanium)
95
Artery for patellar cartilage
Superior genicular
96
Artery for ACL
Middle genicular
97
Artery for menisci
Inferior genicular (medial and lateral) ... Except horns, which are middle genicular artery
98
Energy expenditure in unilateral AKA
65% above baseline
99
MOA of linezolid
Binds 70S ribosomal subunit
100
Collagen type in tendon and menisci
Type I
101
Primary drawback of bioabsorbable polymers
Foreign body reaction (cost offset by no need for implant removal later)
102
Primary restraint to valgus stress
Superficial MCL
103
Appropriate anterolateral ankle portal placement is
4mm lateral to peroneus tertius
104
Most commonly injured nerve during anterolateral approach to hip
Femoral nerve
105
Most common direction of scapular winging
Medial (long thoracic nerve predisposed to viral neuritis)
106
Brachialis is innervated by
Musculocutaneous AND radial nerves
107
Sensation to lateral heel pad provided by
Lateral calcaneal nerve (branch off sural)
| Plantar fasciitis!!
108
Radial artery contributes to which palmar arch
Deep (which is distal)
109
Most common birth plexus palsy (name and structure injured)
Erb's palsy, upper trunk
110
Most common complication after pelvic or acetabular trauma
DVT
111
Strongest component of scapholunate ligament
Dorsal
112
Approach to PCL insertion on tibia
Medial between gastroc head and semimembranosus (same as baker cyst location)
113
LABC is a terminal branch of
Musculocutaneous nerve
114
For lateral approach to hip, safe medius dissection is __ to protect the ___
4cm above GT, SGN
115
Sensation over dorsal medial great toe provided by
SPN (medial branch)
116
Teres major is innervated by
Lower subscap nerve
117
Teres minor innervated by
Axillary nerve
118
Sensation over dorsal medial great toe provided by
SPN (medial branch)
119
Piriformis start in kids injures what vessel
Ascending/cervical branch of medial fem circumflex
120
Deep and superficial heads of the FPB innervated by
Ulnar (deep) and median (superficial)
121
Intermuscular interval in anterolateral hip approach
Gluteus medius and TFL (both innervated by SGN)
122
What muscle/nerve still functions with lesion at Erb's point (where upper trunk forms from C5-6)
Rhomboids/dorsal scapular
123
Origin of elbow MCL
Anteroinferior undersurface of medial epicondyle
124
Bifurcate ligament of foot connects the
Anterior process of calc to navicular and cuboid
125
Blood supply to lateral 2/3 of talus is from artery of the tarsal ___
Canal
126
Mechanism of chemo resistance in chondrosarcoma
Expression of p-glycoprotein which effluxes hydrophobic agents
127
Latissimus Dorsi inserts between the ___ and ___ on the humerus
Pec major and teres major
128
What are the 3 thenar muscles
ABductor pollicis brevis, FPB, and opponens pollicis
129
Is flexor tendon blood supply richer dorsal or volar?
Dorsal
130
Ogilvie syndrome
Colonic pseudo-obstruction (ileus but with normal BM), occurs post-op
131
Most common complication after HTO is
Patellar baja
132
Patellar component in TKA should always be ____ized
Medialized
133
Factors affected by warfarin
II, VII, IX, X
134
Innervation of Pronator teres
Median
135
Type X collagen mutation
Schmidt metaphyseal chondrodysplasia
136
Initial treatment of a patient with Mets and high Ca
Hydration with NS (hypercalcemia of malignancy)
137
Material most susceptible to crevice/pitting corrosion
Stainless steel
138
Type 1 error is defined as
Falsely rejecting the null hypothesis (alpha error)
139
Ligament(s) torn if >5mm AP displacement between C1-2; if >10mm?
Transverse only; transverse AND alar
140
Limbus fx and treatment
Apophyseal spine fx; wide laminectomy
141
Treatment of scoliosis in NF1
Front/back fusion (always get MRI to r/o lesions on nerve roots)
142
Treatment for any SH IV fx of the distal tibia
ORIF w screws parallel to physis
143
Inheritance of cleidocranial dysostosis
Autosomal dominant
144
Where is sustentaculum and what passes below it
Medial calc; FHL
145
Plantar heel spurs are located within the
FDB origin
146
Triangular interval contains
Radial nerve and profunda brachii artery
147
Interval for Posterolateral ankle approach
PB and FHL
148
Injury to which hypogastric plexus causes retrograde ejaculation?
Superior
149
Recurrent laryngeal nerves are branches of the
Vagus nerves
150
Atraumatic apnea, bradycardia and hypotension
Bezold-Jarisch reflex
151
Most radial volar extrinsic ligament of wrist
Radioscaphocapitate
152
Management of Vaughan Jackson syndrome
Ulnar head resection and EIP to EDC transfer
153
Pedicle of groin flap
Superficial circumflex iliac artery
154
Greater occipital nerve exits at what level
C1-2 (is medial branch of C2 dorsal ramus)
155
Nerve running w brachial artery in arm
Median nerve
156
MIC-2+
Ewing's (neuroectodermal)
157
Treatment of symptomatic McCune-Albright lesions
Bisphosphonates
158
Small cortical lesion at Posteromedial femur
Periosteal desmoid lesion (tug lesion from gastroc), NOT a tumor
159
An osteoid osteoma of the femoral neck is actually a
Synovial herniation pit (associated w FAI)
160
Most common complication after distal biceps repair
LABC neurapraxia
161
Most distal muscle innervated by PIN
EIP
162
Septic arthritis after ACL recon is most commonly what bacteria
Staph epi
163
Painless loss of elbow extension and a dislocated radial head is probably
Congenital!
164
Chondral injury to acetabulum occurs in FAI in what location
Posteroinferior
165
Glycoprotein that binds calcium in bone
Osteonectin
166
Function of PTHrP
Slows maturation of chondrocytes in physis
167
The best nerve conduits for digital nerve graft are composed of
Collagen
168
Treatment of Kienbock's in adolescence
Temporary STT pinning
169
Treatment of trigger finger in kids consists of
A1 pulley release AND FDS resection (one or multiple slips)
170
Which BMP is not osteoinductive
BMP-3
171
Function of vitronectin
Adherence of osteoclasts to bone
172
Osteocytes communicate via
Cannaliculi in lacunar network
173
Bending and torsional rigidity are proportional to what power
Radius to the 4th
174
Plate bending rigidity proportional to
Thickness to the 3rd power
175
Classic abnormality in renal osteodystrophy
Phosphate retention (everything else follows this)
176
Floor and roof of cubital tunnel
Osborne's ligament and MCL
177
PCL should be tensioned at what position
90 deg flexion
178
BMP to use in open tibial fractures
BMP-2
179
Which lumbricals are unipennate, and where do they originate/insert
1st and 2nd; originate in RADIAL side of FDP and insert on RADIAL sagittal bands
180
Cause of cubitus varus after SCH fx
Malreduction!
181
Two syndromes caused by COMP mutations
Pseudoachondroplasia and multiple epiphyseal dysplasia
182
Best surgical option for cavus foot in CMT
PT transfer to dorsum of foot
183
Common wear pattern in PCL deficient knee
Medial and patellofemoral compartments
184
Odontoid ossification centers fuse at what ages
6 and 12 years
185
Epiphyseal lesion in a 20-30 year old with clear cytoplasm
Clear cell chondrosarcoma
186
Smallest lumbar peduncle diameter
L1
187
Malignancy type and risk in MHE
Chondrosarcoma, 10%
188
Resection of both hallucal sesamoids leads to
Cockup toe (loss of moment arm for FHB)
189
Quads are active during which phase of gait
Stance
190
What % of Brachial plexus birth palsies w Horner's syndrome recover
191
For TKA w valgus deformity, when should LCL, popliteus or IT band be released?
```
LCL = tight in both
Pop = tight in flexion
IT = tight in extension
```
192
Prognosis in central cord syndrome
Recovery in bowel/bladder and LE function, poor recovery in UE
193
Most common variation of Hoffa fx
Coronal fx of LATERAL femoral condyle
194
Interval for medial approach to hip and NV structure at risk
Between adductor longus and gracilis; medial femoral circumflex artery
195
Imaging modality to confirm snapping hip
Ultrasound
196
Scarf osteotomy is a
Proximal 1st MT osteotomy
197
"Internal impingement" is specifically impingement of what
Posterior rotator cuff on the posterior/superior labrum
198
First line treatment for EOG
Observation. Is self-limited process.
199
Treatment of fixed MCPJ deformities in RA
MCPJ arthroplasties
200
The Keller procedure is indicated for
Severe 1st MTPJ degeneration in low demand elderly patients (resection arthroplasty)
201
Calcific tendinitis of shoulder most commonly affects the
Supraspinatus
202
Borders of rotator interval
Coracoid base (medial), Supraspinatus (superior), subscap (inferior)
203
Contents of rotator interval
Biceps tendon, SGHL, coracohumeral ligament
204
Anterolateral tibial bowing is associated w
Pseudarthrosis of the tibia
205
Anteromedial tibial bowing is associated w
Fibular hemimelia (hAMimelia = anteromedial)
206
BMP used in open tibial nonunions
BMP-7
207
Synostosis more common with what approach to proximal BBFA
One-incision approach
208
Ilioinguinal nerve passes through which inguinal ring
Superficial ONLY
209
Direction of tib-fib instability after syndesmotic injury
A to P
210
MOA of indomethicin
IGF-1 inhibitor (NSAID but not a COX inhibitor)
211
Direction of displaced odontoid fx most at risk for nonunion
Posterior (type II)
212
Structure that blocks DRUJ reduction in Galeazzi fx
ECU tendon
213
Strongest predictor of deep infection in TSA
Male gender
214
Use of triceps-reflecting approach for TEA leads to
Weakness w elbow extension
215
Location of femoral osteotomy in THA for severe high hip center deformity
Subtrochanteric (troch osteotomies prone to nonunion)
216
Osteotomy for young person w varus knee OA
Proximal tibia
217
Compared to other bearings, revision rate in ceramic-on-ceramic THA is
Lower
218
Structure that limits distal extent of anterior hip approach
Femoral nerve
219
Higher levels of cobalt compared to chromium after MoM THA are likely related to
Trunnionosis
220
Body CT for work up of primary bone sarcoma includes which areas
Chest ONLY. (Rarely metastasize to visceral organs)
221
After a tear, describe changes in collagen in ligament at 1 year
Increased number of fibers, decreased mass/diameter of fibers, and decreased crosslinks
222
Process that converts UHMWPE to amorphous state
Remelting (NOT annealing... Annealing preserves crystallinity)
223
Which nerve root contributes to both sciatic and femoral nerves
L4
224
Which nerve root contributes to both obturator and femoral nerves
L3
225
Primary effect of hip labral repair is improvement in
Lubrication
226
Ethnic group with high prevalence of spondylolysis
Native Americans
227
Proximal femoral epiphyseal secondary ossification center appears at what age
4-7 months (delayed in DDH)
