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SAQ Exam > SAQ 2014 > Flashcards

SAQ 2014 Flashcards

1
Q

X-ray of a hip resurfacing with a femoral neck fracture. Name 4 risk factors

A

Female, varus positioning, notching of femoral neck, osteoportic bone, large pre-exsiting osteonecrosis, femoral neck impingement from misplaced acetabular component, large femoral head cyst

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2
Q

Name eight steps in the WHO pre-operative checklist (8)

A

Sign in 1. Identity, the surgical site and procedure, and consent 2. The surgical site is marked 3. The pulse oximeter is on the patient and functioning 4. Allergy 5. The patient’s airway and risk of aspiration 6. If there is a risk of blood loss of at least 500 ml, appropriate access and fluids are available Time out 7. All team members have been introduced by name and role Confirms the patient’s identity, surgical site, and procedure 8. Reviews the anticipated critical events Surgeon- critical and unexpected steps, operative duration, and anticipated blood loss Anesthesia staff- concerns specific to the patient Nursing staff- confirmation of sterility, equipment availability, and other concerns Confirms that prophylactic antibiotics have been administered ≤60 min before incision is made or that antibiotics are not indicated Confirms that all essential imaging results for the correct patient are displayed in the operating room Before the patient leaves the operating room: Sign out Name of the procedure as recorded That the needle, sponge, and instrument counts are complete That the specimen is correctly labeled, including with the patient’s name Whether there are any issues with equipment to be addressed The surgeon, nurse, and anesthesia professional review aloud the key concerns for the recovery and care of the patient

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3
Q

Halo considerations in pediatric patients (3)

A
  1. Multiple pins with less torque (6-8, torque 2-4inch/lbs) 2. Pin locations - place anterior pins lateral enough to avoid injury to the frontal sinus, supratrochlear and supraorbital nerves and temporalis muscle 3. Brace/Vest - >2yr custom fitted vest, < 2yr Minerva cast *can consider CT guided pin placement
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4
Q

Five consideration of systematic Ewing’s staging (5)

A
  1. BONE MARROW Biopsy - mets to marrow 2. Local MRI - A) necessary to identify soft-tissue extension and marrow involvement, B) shows a large soft tissue component 3. CT Thorax - pulmonary mets 4. Bone scan required - “hot” lesion 5. Genetics t(11:22) translocation leads to protein EWS:FLI1 on PCR and CD99 6. LDH plus basic labs and CRP - prognostic value
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5
Q

Class four shock 4 clinical features (4)

A
  1. IV > 40% (life threatening) (>2L) 2. HR> 140 bpm 3. BP decreased 4. Urine Output - negligible 5. PH decreased 6. Mental Status - lethargic, coma 7. Treatment - Fluid & Blood
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6
Q

Indications to pin contralateral hip in SCFE (4)

A
  1. Obese 2. High risk patient with unstable SCFE - Southwick angle 40-80 degrees 3. Endocrine disorders (hypothyroidism), panhypopituitarism, decreased GH 4. Younger age <10 or open tri-radiate 5. Unable to perform follow up
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7
Q

FAI radiological signs (4)

A

TOP FOUR: 1. Pistol grip - head neck offset 2. Alpha angle >50 Cam Impingement 3. Retroversion signs 4. Asphericity/contour of head or acetabular protrusio 5. Increased centre edge angle >25 (Pincer) Others: From AP 1. Decreased head neck offset 2. Acetabular protrusio 3. Coxa profunda - medial femoral head to Kohlers line 4. Alpha angle (>40) 4. Asphericity and contour femoral head For retroversion: 1. Ischial spine 2. Posterior wall 3. Crossover From False Profile: 1. Decreased anterior coverage

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8
Q

Name 4 pre-op requirements to perform a PAO (4)

A
  1. Preserved ROM 2. Congruous joint with preserved joint space (NO advanced OA) 3. Symptomatic pain, limp younger person 4. Congruent reduced hip (Source JAAOS Schoneker 2011)
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9
Q

Causes of acquired coxa vara (6)

A

AVN: (DDH or Perthes) SCFE Rickets Osteomyelitis of Hip and Septic Arthritis Traumatic Paget’s Disease Fibrous Dysplasia

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10
Q

Causes of cavovarus foot in adults (6)

A
  1. Neurologic A) Hereditary motor and sensory neuropathies, CMT B) Cerebral palsy C) Aftereffects of cerebral injury (stroke) D) Anterior horn cell disease (spinal root injury) E) Spinal cord lesions 2. Traumatic A) Compartment syndrome B) Talar neck malunion C) Peroneal nerve injury D)Knee dislocation (neurovascular injury) 3. Residual clubfoot 4. Idiopathic 5. Polio 6. Spinal cord pathology (syrinx/myelomenigocele) JAAOS 2005 Younger.
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11
Q

Central cord syndrome features (3)

A
  1. Motor deficit worse in UE than LE (some preserved motor function) 2. Hands have more pronounced motor deficit than arms 3. Sacral sparing Fun fact: late clinical presentation UE have LMN signs (clumsy) LE has UMN signs (spastic) Good clinical prognosis
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12
Q

Ways to size a radial head (3)

A
  1. Old radial head (reconstruct excised fragments) (undersize) 2. align the most proximal portion of the lesser sigmoid notch with the proximal surface of the implant to attain proper height 3. Flouro intraop - The authors recommended placing the implant at the level of the lateral edge of the coronoid (some say almost 0.9mm shortern), using intraoperative imaging, to avoid overstuffing the joint. Usually overstuffed in flexion JAAOS 2014 Acevedo ? Contralateral CT or XRay?
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13
Q

Complications of tibial tubercle fracture fixation (3)

A
  1. Recurvatum deformity (Growth arrest anteriorly) 2. Compartment syndrome (Ant. tib art injury) 10% 3. Loss of range of motion 4. Bursitis (hardware related) ?(Extensor mechanism rupture, non union, persistent pain, vascular in)
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14
Q

Recurrent patella instability - anatomical causes (5)

A
  1. ligamentous laxity (Ehlers-Danlos syndrome) 2. dysplastic vastus medialis oblique (VMO) muscle 3. lateral displacement of patella 4. patella alta (causes patella to not articulate with sulcus, losing its constraint effects) 5. trochlear dysplasia 6. excessive lateral patellar tilt (measured in extension) 7. lateral femoral condyle hypoplasia 8. increased quadriceps angle (Q angle) 9. previous patellar instability event, soft tissue injury 10. “miserable malalignment syndrome” - increased femoral anteversion, external tib torsion, genu valgum, pronated feet
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15
Q

How to avoid patellar maltracking in TKA (3)

A
  1. Decrease q angle (avoid femoral internal rotation 3 degrees ER to whitesides, tib internal rotation, medialization of femoral component) 2. Patella resurfacing medialize (don’t lateralize) 3. ?Rehab quads
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16
Q

List four causes of hallux varus in hallux valgus surgery

A
  1. Medial plication over tightening 2. Too large a deformity correction - over correction of 1st IM angle 3. Release of the lateral/fibular sesamoid from adductor and lateral head of FHB 4. Overaggressive medial MT head eminence resection (staked 1st MT head) 5. Scar contracture
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17
Q

List 6 congenital causes of coxa vara

A
  1. Cleidocranial dysplasia 2. Chondrodysplasia punctata 3. Metaphyseal chondrodysplasia 4. Gauchers 5. Multiple episphyseal dysplasia 6. Proximal femoral focal deficiency 7. Spondyloepiphyseal dysplasia congenita
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18
Q

Complications of selective patellar resurfacing in TKA?

A

Increased risk of anterior knee pain Increased need for secondary resurfacing No increased risk of revision surgery No increased risk of extensor complications (patella #, tendon injury, AVN) No difference in patient satisfaction

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19
Q

Components of the DRUJ

A

ECU subsheath Ulnar and volar radio ulnar ligaments Meniscal homologue Articular disc Ulno-carpal ligament (UT and UL)

20
Q

Risks of short term perioperative mortality in hip fracture patients

A

Dialysis Presentation in shock Cardiac disease / ASA score High ISS Dementia Advanced age Charleston Comorbidity index Maybe gender *** RF for complication above plus*** Diabetes Greater time to surgery Femoral neck fracture

21
Q

Complications of nailing a femur with a traction table in hemilithotomy position (4)

A

Well leg compartment syndrome Nerve injury (Pudendal 2-27% - this is a problem - ED) Fracture malalignment (3.5x risk of being IR) Skin and soft tissue injury (peroneal area) Crush syndrome (lateral position with thigh crushed against bed by the post)

22
Q

Asia myotomes (4) Wrist extension Finger flexion Anal contraction Great toe flexion

A

Wrist extension C6 Finger flexion C8 VAC S3/S4 FHL S2

23
Q

Methods to assess skeletal maturity in a teenage girl (4)

A
  1. Hand Xray - Tanner Whitehouse 3 (MC and distal radius/ulna physis) 2. Olecranon physis 3. Tri-radiate cartilage fusion 4. Menses 5. Tanner staging (breast budding 1 yr before max height) 6. Risser
24
Q

Unstable C-spine radiological features (5)

A
  1. Bilateral facet dislocation 2. Greater than 1 vertebral column injury 3. Widened interspinous distance 4. Rule of 12’s - Tip of dens to basion or basion to posterior vertebral line should not exceed 12mm 5. Flex ex views >3-5mm ADI change 6. Increased or loss of disc space height 7. Dens overhang combined >8mm on odontoid view 8. Subaxial subluxation >4mm or 20% - cord compression 9. Cervical height index <14mm
25
Q

Poor prognosis in Septic Arthritis

A
  1. MRSA or resistence 2. Immunocomprimised 3. Delayed treatment 4. Age >50 or <6 months 5. Hip involvement 6. Associated osteomyelitis
26
Q

Reasons for a stiff TKR in flexion only, preoperative 0-120, now 0-70. Infection has been ruled out. (4)

A
  1. Overstuffing patella button 2. Increased femoral component size, imbalance gap 3. Poor compliance with post op physiotherapy 4. Patella baja 5. Arthrofibrosis 6. PCL tightness 7. Component malrotation (Extension of femoral component) 8. Extensive tightening of extensor mechanism during closure 9. CRPS 10. HO A word on flexion contracture: Pre op - poor ROM Intra op - Under resection of distal femur (ext gap) PCL retaining implant (contracted PCL) Inadequate PT following TKR Hamstring spasm
27
Q

An old guy with several skeletal lesions and a thyroid mass, presents with a pathologic femur fracture. 1) What is the surgical management? 2) What radiological intervention should be considered pre-op? 3) What systemic treatment may be beneficial? 4) What post-op treatment should be implemented locally to reduce recurrence?

A
  1. Biopsy and full work up - local and systemic staging 2. Radiologically - Plain radiographs, CT TAP, with additional cross-sectional imaging of pathologic fracture, bone scan/skeletal survey for thyroid/myeloma…possible embolization (thyroid or renal) 3. Chemo, bisphosphonate (pamidronate) 4. Radiotherapy to reduce local recurrence risk by decreasing microscopic burden of disease left post-op
28
Q

Criteria for pulmonary FES

A

4 Major 1. CNS depression 2. Petechial rash 3. Hypoxemic PAO2 < 60 4. Pulmonary Edema 4 Minor 1. Platelets <100,000 2. Fat droplets in urine or sputum 3. Tachycardia 4. Pyrexia 5. Decreased HCT 6. Retinal emboli

29
Q

AIN sites at elbow and proximal forarm

A

AIN 1. Pronator teres heads insertion 2. Deep head of PT 3. Between FDP and FPL 4. Between FDS arcade 5. Gantzer’s muscle (assecory head of FPL) Median 1. Ligament of struthers 2. Lacertus fibrosis 3. Carpal tunnel

30
Q

Radiologic assessment of femoral shaft fracture reduction (3)

A
  1. LT contour compared to uninjured side 2. Cortical width/diameter 3. Cortical thickness 4. C- arm true lateral of femoral neck and other with posterior condyles aligned (differences in inclination of the position of the C-Arm reflects angle of anteversion of femoral neck) 5. Post op CT scan - femoral malrotation using limited cuts through proximal and distal femurs (femoral neck and posterior condyles) 6. Compare lines tangential to these to assess rotation
31
Q

List 4 lisfranc joint anatomical features

A
  1. Recessed 2 MT, keystone arch, with broad superior width and narrow plantar 2. Lisfranc ligament base of medial cuneiform to 2mt 3. Strong plantar IMT ligament, weak dorsal 4. Three articulations Tarsometatarsal, intermetatarsal, intertarsal 5. Plantar tarsometatarsal ligaments - extend from the medial cueiform to the base of the 2-4th MT’s - this injury allows more lateral column displacement not seen if isolated lis franc
32
Q

Three biomechanical effects of the Latarjet (3)

A
  1. Sling concept from conjoint tendon 2. De-function pec minor 3. Bony block increases articular arc 4. Capsular reinforcement 5. Bony autograft for defect
33
Q

Invertors of the subtalar joint? (4)

A
  1. TP 2. TA 3. FHL/FDL 4. Achilles
34
Q

Kienbock classification (4)

A

Lichtman 1. Not on xray, sclerosis on MRI - NSAIDS, immobilization 2. MRI and XRay Sclerosis - Revascularization or Radial Shortening 3. Fragmentation - A - Scaphoid not rotated B - Scaphoid rotated=PRC 4. Collapse and pan-carpal involvement = wrist fusion

35
Q

Describe requirements of informed consent?

A
  1. Competent patient 2. Disclosure of all relevant risks and alternative 3. Free or coercion/voluntary
36
Q

In a patient with trendelenberg gait what will you find on physical exam?

A
  1. Non affected (contralateral) pelvis will sag inferiorly on single leg stance of affected limb 2. Weak abduction of hip to resistence Possible weak dorsiflexion/ehl due to L4/L5 nerve injury Body may leave to weak side to help COG
37
Q

Describe push up test for PLRI (2)?

A

Patient prone on floor in push up position, elbow flexed to 90 degree, forearms supinated and shoulder abducted slightly wider than push up position Patient attempts to push up using arms, patient will experience apprehension with terminal extension, guarding or dislocation are considered positive Similar idea to lateral pivot shift test –> Supine with affected arm overhead - forearm supination and the arm is taken from extension to flexion - radial head reduces with flexion

38
Q

Cervical spine pathologies in Down Syndrome (3)

A

Atlantoaxial instability Subaxial instability Occipitoaxial instability C1-C2 vertebral anomalies (hypoplastic odontoid, ossiculum terminale and odontoidium) Scoliosis Flex Ex views Increased ADI >5mm in peds - asymtomatic remove from sport Increased ADI >10mm - symptomatic - fuse!

39
Q

Orthopaedic manisfestations of Down syndome?

A

Generalized ligamentous laxity Hypotonia C1-C2 instability Scoliosis/Spondylolisthesis Hip Subluxation/Dislocation Patellar instability/subluxation Pes Planus SCFE

40
Q

4 stabilizers of the AC joint

A
  1. AC ligament 2. CC ligament 3. Capsule 4. Deltoid and Trapezius
41
Q

Criteria for selective thoracic fusion in AIS (4)

A

Patient is more active and requires lumbar flexibility Skeletal maturity (Triradiate closed) Apical vertebral rotation - ratio of thoracic to thoracolumbar AVR should be >1.2 (>20% more translation of thoracic vs. lumbar) Cobb angle of thoracic curve >20% more than lumbar (Ratio of 1.2) Basically - Type II king of Lenke Curves LM A7B, Lumbar curve is more flexible and smaller than Thoracic curve with Cobb angle <60 degree ** Complications of selective fusion ** Progression of lumbar curve Junctional problems Revision surgery to extend the fusion

42
Q

Three clinical findings in diagnosis of ankylosing spondylitis.

A

1) Decreased chest expansion less than 1 cm 2) Sacroiliitis (FABER test) 3) Uveitis (Anterior iritis/Uveitis) 4) Progressive kyphotic deformity (Chin brow vertical angle 30 degrees) 5) Decreased spine motion (Schober test) 6) Large joint OA 7) Enthesitis 8) Renal amyloidosis Differentiated from RA Synovial process vs Enthesitis in Ankspon HLA B27 (Diagnostic criteria with SI inflammation/Uveitis

43
Q

Name five modifiable risk factors (non-medication) for osteoporosis

A
  1. Smoking 2. Impact exercise 3. Diet high in calcium 1-1.2g/day and vitamin d/sunlight exposure 4. EtOH - > 2 units/day 5. Low BMI 6. Estrogen deficiency
44
Q

List four signs of posterior should dislocation in BPP

A
  1. Internal rotation contracture of shoulder 2. Decreased ROM 3. Asymmetry of skin folds of the axilla and proximal arm 4. Apparent shortening of humeral segment 5. Palpable asymmetric fullness in posterior shoulder 6. Progressive loss of ER between monthly exams 7. Glenohumeral deformation secondary to muscular imbalance/physeal trauma 8. Leads to glenoid dysplasia and posterior should subluxation occur as a result around 6/12 Investigate with US!
45
Q

Xray of the hip - list three causes of AVN

A

Direct 1. Caisson’s disease (hyperbaric) 2. Sickle cell 3. Gaucher’s disease 4. Radiation therapy 5. Hypercoagulable 6. Post traumatic Indirect: 1. Etoh 2. Steroids 3. HIV 4. Idiopathic 5. SLE

SAQ Exam (5 decks)

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