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SAQ Exam > SAQ 2013 > Flashcards

SAQ 2013 Flashcards

1
Q

List 11 different ASIA myotomes and their muscle groups (ASIA)

A 
Nerve	Myotome	Dermatome
C5	Deltoids, biceps	Lateral Forearm
C6	Brachiradialis, ECRL	Radial thumb, 2nd finger
C7	Triceps, FCR	Middle Finger
C8	FDS	5th finger
T1	Finger intrisincs	Medial forearm
L2	Iliopsoas	Anterior thigh
L3	Quadriceps	Medial Knee
L4	Tib ant (Ankle DF)	Medial lower leg
L5	EHL	Foot dorsum
S1	Achilles	Lateral foot
S4	Anal sphincter	Perianal
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2
Q

List three signs of sacral sparing (Orthobullets)

A

a. Voluntary anal contraction
b. Intact perianal sensation
c. Great toe flexion (FHL is S2)

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3
Q

List the 4 risk factors for DVT in kids with MRSA osteomyelitis

A

a. CRP > 6
b. Surgery
c. Age > 8
d. MRSA

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4
Q

List 3 ways of avoiding varus in subtroch fractures

A

a. Medial start point: Nail will not reduce your fracture
i. Piriformis entry nail
ii. Lateral nailing
iii. Abduct the body
b. Clamp or k-wire the reduction
c. Fixed angle plate (95 blade or PFLP)

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5
Q

List 3 ways of treating CVT minimally invasively

A

a. Serial casting
b. Perc pin fixation
c. Perc Achilles tenotomy

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6
Q

List the DCO criteria for DCO vs ETC

A

a. Shock
i. BP < 90
ii. U/O < 50-100 cc/hr
iii. Massive transfusion
b. Acidosis
i. Lactate > 2.5
ii. Base Excess > 8 mmol/L
c. Coagulopathic
i. Platelets < 90 000
d. Cold
i. Temp < 35
e. Age > 55
f. PaO2/FiO2 < 300

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7
Q

List 4 ways of telling the difference between transient synovitis and septic hip

A

a. Temp > 38.5
b. WBC > 12
c. CRP > 20
d. ESR > 40
e. Refusal to WB
f. 5 predictors → 98% septic
g. 4 predictors → 93% septic
h. 3 predictors →83% septic

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8
Q

List 5 features of proximal Tib/fib dislocation

A

a. Pain at lateral knee
b. Pain worse with ankle motion
c. Lateral knee prominence
d. Peroneal nerve symptoms (especially PM dislocation)
e. Often atraumatic
f. High energy → associated with plateau injury
g. Associated with hyperlaxity (ED, etc)
h. Superior dislocation associated with syndesmotic injury

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9
Q

Describe mechanism for proximal tib/fib dislocation, features on physical exam, reduction method

A

a. Mechanism: Twisting of flexed knee (athletic injury)
b. Physical Exam:
i. Prominent lateral mass
ii. Pain worse with ankle DF (proximal fibular migration)
iii. Pain worse with knee extension
iv. Examine stability at 90 degrees (relaxes LCL)
1. Translation of prox fibula?
v. Peroneal nerve
vi. Ankle exam → instability?
vii. LCL and PLC instability
c. Closed Reduction:
i. Flex btw 80-110 to relax LCL
ii. Reduce opposite direction of dislocation
d. Open Reduction: Screw with repair of joint capsule

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10
Q

List the 8 features of Aortic Arch Rupture on Chest X-ray

A

a. Widened mediastinum (>8cm)
b. Indistinct aortic arch contour
c. Deviated trachea
d. Depressed left bronchus
e. NG tube deviation to right
f. Apical pleural hematoma (left apical cap)
g. Fracture of rib 1 or 2
h. Disruption of of calcium ring of aortic knob (broken halo sign)
i. Enlarged aortic contour

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11
Q

List 8 points in the Pre-Op Timeout

A

a. Patient identifier (2)
i. Name
ii. DOB
b. Site
c. Marking
d. Procedure
e. Postion
f. Implants
g. Imaging

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12
Q

List 3 ways of determines adequacy of femoral neck reduction with x-ray

A

a. Restoration of Shenton’s line
b. S- curve on all views (head-neck jxn) – never a c-curve (Rockwood and Green’s)
c. Garden Alignment Index (Rockwood and Green’s)
i. AP: medial trabeculae:medial femoral cortex 155-180 degrees
ii. Lateral: central trabeculae in head:neck 155-180 degrees

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13
Q

List the 4 stages of perilunate dislocation (Mayfield)

A

a. SL disruption (ligament vs. transscaphoid)
b. Lunocapitate disruption
c. Lunotriquetrial disruption
d. Lunate dislocation

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14
Q

4 indications for CRPP of peds distal radius fractures

A

a. SH3 and 4
b. BBFF > 10 yrs
c. Failure to maintain reduction closed

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15
Q

RA patient unable to extend 4th and 5th digits, list 3 causes

A

a. Caput Ulnae Syndrome
i. Vaughn- Jackson Syndrome (attritional rupture of EDQ only)
b. MCP dislocation
c. Sagital band attenuation

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16
Q

List 4 components of syndesmosis (4 ligs)

A

a. Anterior-inferior tib-fib ligament
b. Posterior-inferior tib-fib ligament
c. Intraosseous membrane
d. Intraosseous ligament
e. Inferior Transverse ligament (with PITFL)

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17
Q

List complications (?6) of malposition of the acetabular component

A

a. Instability
b. Poly wear
c. Cup spin out (loosening)
d. Osteolysis
e. Impingement
f. Pain

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18
Q

List 4 benefits of high offset THA

A

a. Tensions abductors (decrease trendelenburg)

b. Increase stability

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19
Q

3 things in the spine that enhance with MRI + Gad

A

a. Scar tissue
b. Infection
c. Tumors (most)

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20
Q

Older lady tennis player with ulnar wrist pain, DRUJ pain – give 3 DDx

A

a. Instability
b. OA
c. Ganglion

21
Q

5 conditions you should consider before operating on a person for an acute Achilles

A

a. Smoking
b. Steroids
c. Female
d. Diabtes
e. Obesity

22
Q

5 head at risk signs for LCP

A

a. Gage sign
b. Lateral subluxation
c. Lateral Ossification
d. Horizontal growth plate
e. Metaphyseal cyts

23
Q

3 endocrine problems that pre-dispose someone to SCFE

A

a. Hypothyroid
b. GH deficiency
c. Panhypopituit
d. Renal osteodystrophy

24
Q

3 things that would cause false positives with the Thessley meniscal test

A

a. Multiple knee injuries
b. Hx of knee surgery
c. OA
d. Articular cartilage injuries
e. Neurodegenerative disorders

25
Q

4 things that lead to a bad prognosis in radial neck fractures in paeds

A

a. Open management
i. Internal fixation
ii. AVN
iii. Synostosis
b. > 2 mm translation
c. >45 angulation
d. Malunion

26
Q

4 indications for Scaphoid ORIF

A

a. Proximal pole fracture
b. Displaced scaphoid fractures
i. 1 mm displacement
ii. SL angle > 60
iii. RL angle > 15
iv. Intrascaphoid angle > 35
c. Associated perilunate
d. Multipy injured patient
e. Comminution
f. DISI > 15 degrees

27
Q

4 techniques of fixing an ACL in an 11 year old

A

a. Extraphyseal (Tanner 1-2)
i. IT Band Reconstuction
b. Transphyseal (Tanner 1-4)
i. Partial
ii. Complete
c. All Epiphyseal (Tanner 1-3)
i. Anderson
ii. All-inside

28
Q

4 Anatomical Features of pincer FAI

A

a. Acetabular retroversion
b. Coxa Profunda
c. Protrusio acetabula
d. Global overcoverage

29
Q

What are the 3 components of the lenke classification

A

a. Curve Type
b. Lumbar modifier
c. Sagittal thoracic modifier

30
Q

4 patient factors (not tear characteristics) that would lead to poor outcome in cuff surgery

A

a. Age > 65
b. Workers compensation
c. Smoking
d. Female

31
Q

4 complications of radial head fractures in adults

A

a. Elbow stiffness
b. Heterotopic Ossification
i. Concurrent injury
ii. Recurrent surgery
iii. Delay to surgery
iv. Prolonged immobilization
c. PIN Palsy
d. Ulnar nerve injury
e. Infection
f. Instability
g. Elbow OA
h. Fracture displacement

32
Q

3 advantages of coning down an x-ray

A

a. Decreased rads to patient

b. Decreased rads to staff

33
Q

3 causes of SLAP lesion

A

a. Traction
b. FOOSH
c. Direct blow

34
Q

List the landmarks for dorsoradial and dorsoulnar wrist portals

A

Portal Site Purpose Risk
1-2 Dorsal snuffbox, Radial to EPL Inflow Radial artery
3-4 EPL: EDC Main RC viewing EPL/EDC
4-5 EDC:EDM, in line with 4th Main RC, TFCC EDC, EDM
6R Radial ECU TFCC Dorsal sensory ulna
6U Ulnar ECU Dorsal rim TFCC Dorsal sensory ulna
Radial Midcarpal In line with 3rd MC
Btw scaphoid and capitate
Ulnar Midcarpal
Scaphotrapezial-trapezoid
Triquetriohamate
Volar Radial Volar to FRC at proximal wrist crease RC, SLIL,
Volar Ulnar Flexors and FCU Volar LT ligament
Dorsal RU ligament Ulnar nerve/artery

35
Q

2 muscles that compress the radial nerve after it passes through the septum

A

a. Brachialis and BR

36
Q

4 anatomical features of dysplastic spondylolisthesis

A

a. Hypoplastic lumbar facets
b. Sacral Deficiency
c. Elongated pars
d. Intact posterior elements
e. Neurologic symptoms

37
Q

List 3 contraindications to a Ganz PAO

A

a. Significant anterior cartilage wear (will end up in WB zone)
b. Combined Cam and Pincer
c. Excessive posterior wall coverage (will lead to extension impingement)

38
Q

3 non-skeletal features of marfans

A

a. Ectopia Lentis (occurs in utero – slit lamp)
b. Mitral regurg (requires pre-op echo)
c. Aortic regurg
d. Aortic dissection (most common cause of death)
e. Spontaneous PTX due to apical blebs
f. MSK
i. Pectus Excavatum
ii. Scoliosis (quickly progressive, brace resistant)
iii. Dural ectasia (enlargement of dura with thinned pedicles/lamina, anterior meningocele)
iv. Ligamentous laxity
v. Arachnodactyly
vi. Protrusio acetabuli

39
Q

4 non-skeletal features of fibrous dysplasia

A

a. Café au lait spots (McCune Albright)
b. Precocious puberty (McCune Albright)
c. Eye deviation and blindness (Chereubism)
d. Cranial abnormalities (Chereubism)

40
Q

3 ways of preventing AVN in nailing pediatric femoral shaft fractures

A

a. Trochanteric start point
b. Lots of fluoro to prevent slipping to fossa
c. Sharp reamers to prevent reaming out into fossa

41
Q

List four criteria for informed consent

A

1.

42
Q

3 advantages of using a locking plate over a 95 degree single barrel condylar sliding plate in a supracondylar femur fracture with intra-articular and metaphyseal comminution

A

a. Less bone loss with distal screw placement
b. Stronger in cyclical loading and ultimate strength for load bearing through comminutuion
c. Multiple points of fixation

d. Aside: 38% coronal plane fractures in all supracondylar femur fractures (L>M)

43
Q

What factors are predictive of slip progression in degenerative spondylolisthesis

A

a. Jobs requiring repetitive flexion
b. Loss of >80% of disc height
c. Sagittal facet orientation
d. Slip Percentage
e. Slip angle
f. High grade
i. THESE ARE FOR ISTHMIC! Talk to Wai or Kingwell to clarify with degenerative

44
Q

3 radiographic landmarks/guidelines for an acute Lis Franc injury

A

a. Fleck sign
b. Medial border of 2nd MT and middle cuneiform on AP
c. Medial 4th MT in line with medial cuboid on oblique
d. Diastasis of 1st MT:2nd MT > 2mm vs contralateral, or >2.7 mm absolute

45
Q

List the following ligaments in order from weakest to strongest (both collaterals and cruciates)

A

a. LCL (700 N)
b. ACL (2200 N)
c. PCL (2500 N)
d. MCL (4000 N)

46
Q

5 negative prognostic (or, 5 prognostic) factors in osteosarcoma

A

a. High LDH
b. High ALP
c. < 90% tumor necrosis post chemo
d. Mets at presentation
e. Axial skeleton location
f. Lymph node involvement
g. Vascular involvement
h. Positive margins

47
Q

Post-tourniquet syndrome

A

a. Pain
b. Stiffness
c. Numbess
d. Pallor
e. Paresis

48
Q

Six causes of radioulnar synostosis (in an operatively treated fracture)

A

a. Comminution
b. Proximal third of both bones
c. Same level fractures
d. IOM injury
e. Severe soft tissue disruption
f. Head injury
g. Boyd approach
h. Delayed management
i. Bone in IO space
j. Onlay graft
k. Hardware in IO space

49
Q

Duchenne’s – 3 benefits of steroids (3); 3 downsides of steroids (3)

A

a. Benefits
i. Walk for longer
ii. Improved pulmonary function
iii. Decreased progression of scoliosis
b. Downsides
i. Weight gain
ii. Short stature
iii. Osteopenia
iv. Cataracts

SAQ Exam (5 decks)

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