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Surgery > Subs 12/20/2016 > Flashcards

Subs 12/20/2016 Flashcards

1
Q

ortelani test
maneuver
purpose

A

in infant eg w ddh
hold a knee in either hand
one at a time
aBduct and anteriorly pressure the hip joint
CLUNK (not a click) if hip was dislocated now relocated
to test if hip dislocated

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2
Q

ortelani vs barlow

A

ortelani push ante
in infant eg w ddh
hold a knee in either hand
one at a time
aBduct and Anteriorly pressure the hip joint
CLUNK (not a click) if hip was dislocated now relocated
vs
barlow push below
-opposite of ortelani
aDduct and Posteriorly to see if can dislocate

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3
Q 
ddh
age
presentation
dx
tx
A

developmental dysplasia of the hip
newborn
clunky hip (ortelani, barlow)
if not better 4 wks wait/watch get US to dx
tx w harness to allow acetabulum to grow around femoral head

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4
Q

barlow test
maneuver
purpose

A

in infant eg w ddh
hold a knee in either hand
one at a time
aDduct and posteriorly pressure the hip joint
CLUNK (not a click) if hip located now dislocated
to see if if hip can be dislocated easily

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5
Q

non-traumatic hip pain in teen undergoing growth spurt or obese think…

A 
scfe (unless febrile...)
slipped capital femoral epiphysis
non-traumatic hip pain in teen undergoing growth spurt or fat kid
FROGLEG xr
surgery
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6
Q

insidious onset antalgic gait in 6yo think…

A

Legg-Calve-Perthes disease
xr shows avascular necrosis of the hip
cast

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7
Q 
scfe
age
presentation
dx
tx
A 
slipped capital-femoral epiphysis
13yo
non-traumatic hip pain in teen undergoing growth spurt or fat kid
FROGLEG xr
surgery
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8
Q 
transient synovitis
age
presentation
dx
tx
A

any age
non-weight bearing hip pain post viral illness
clinical dx (r/o septic arthritis w kocher criteria (non-wb fev leuk esr)
supportive care (analgesics) unless think septic joint w more kocher crit then consider tapping arthrocentesis

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9
Q

kocher criteria
used for
what are they

A

for septic arthritis (vs transent synovitis) in peds with accutely irritable hip with both of these on the ddx

  • non weight bearing
  • fever (^38.5C 101.3F)
  • Leukocytosis (^12,000cells/mm3)
  • ESR ^40mm/hr

pts on either extreme of score (0/4, 4/4) readily ruled out or in for septic arthritis, but intermediate range needs further workup

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10
Q 
septic joint (arthritis) in peds
age
presentation
dx
tx
A 
any age
Kocher criteria /4
-non-weightbearing fever leukocytosis ESR ele
^50,000 wbc's on arthrocentisis
drain and abx

(38.5C 101.3F
12 wbc
40 ESR)

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11
Q

5 causes of peds hip pain

age pres dx tx

A
  • ddh newborn clunky hip us if not better in 4 wks harness
  • legg-calve-perthes 6yo insid antalgic gait xr cast
  • scfe 13yo growth spurt or obese atrauma frog leg xr sx
  • septic joint any age kocher crit fev leuk esr nonwb tap ^50,000wbc drain abx
  • transient synovitis post viral nonwb hip pain use kocher crit supportive care
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12
Q

tf

“supportive care” includes analgesia

A

t

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13
Q

eponym means

A

named after a person

eg osgood schlatters

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14
Q

osgood schlatter’s aka

A

tibial tuberosity avulsion

apophysitis of the tibial tuberosity

maybe called osteochondrosis not sure of correctness…

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15
Q

adam’s test

A

bend over touch toes

observe shoulder height diffs for scoliosis

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16
Q

2 bone tumors to know
pres
dx
tx

A

both pres focal atraumatic bone pain

ewing sarcoma
mid-shaft diaphyseal ONION-SKIN appearance xr mri bx t11,22 (33 = pat ewing’s number) resect

osteosarcoma
distal femur (other ends of bones?Y) SUNBURST appearance xr mri bx (Rb) prob had retinoblastoma as newborn resect
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17
Q

mid-shaft diaphyseal onion-skin appearance bone tumor think..

A

ewing sarcoma
focal atraumatic bone pain
MID-SHAFT diaphyseal ONION-SKIN or moth-eaten or sunburst but LOCATION matters more appearance xr mri bx t11,22 (33 = pat ewing’s number) resect

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18
Q

adam’s test

A

bend over touch toes

observe shoulder height diffs for scoliosis

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19
Q

when to consider surg for peds fx

A

open (needs clean)
long oblique/comminuted messy ends
growth plate involvement

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20
Q

scoliosis vs kyphosis vs lordosis

A

scoli lateral
kyph inc curv like thorax
lumbar lord curve like lumbar

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21
Q

distal femoral sunburst appearance bone tumor think

A

osteosarcoma
focal atraumatic bone pain
distal femur (other ends of bones?) SUNBURST appearance xr mri bx (Rb) prob had retinoblastoma as newborn resect

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22
Q

when to consider surg for peds fx

A

open (needs clean)
long oblique/comminuted messy ends
growth plate involvement

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23
Q

2 bone tumors to know
pres
dx
tx

A

both pres focal atraumatic bone pain

ewing sarcoma
mid-shaft diaphyseal ONION-SKIN appearance xr mri bx t11,22 (33 = pat ewing’s number) resect

osteosarcoma
distal femur (other ends of bones?) SUNBURST appearance xr mri bx (Rb) prob had retinoblastoma as newborn resect
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24
Q

osteochondroma, anticipate what w regard to
pain
fev
esr

A

no pain
no fever
normal esr

normally asymptomatic or with palpable mass, benign grown in childhood growth plates (may look like osteosarcoma by positon at ends of bones… but no focal atraumatic bone pain not sunburst no alk phos from bone destruction…)

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25
Q

distal femoral sunburst appearance bone tumor think

A

osteosarcoma
focal atraumatic bone pain
distal femur (other ends of bones?) SUNBURST appearance xr mri bx (Rb) prob had retinoblastoma as newborn resect

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26
Q

when to consider surg for peds fx

A

open (needs clean)
long oblique/comminuted messy ends
growth plate involvement

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27
Q

scoliosis vs kyphosis vs lordosis

A

scoli lateral
kyph inc curv like thorax
lumbar lord curve like lumbar

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28
Q

most common bone cancer in peds

A 
osteosarcoma
distal femur (other ends of bones?Y) SUNBURST appearance xr mri bx (Rb) prob had retinoblastoma as newborn resect
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29
Q

tf

alc phos elevated in osteosarcoma

A

t
bone destruction

distal femur (other ends of bones?Y) SUNBURST appearance xr mri bx (Rb) prob had retinoblastoma as newborn resect

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30
Q

does fev leuk night sweats in bone cancer indicate more ewing sarcoma or osteosarcoma?

A

ewing sarcoma

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31
Q

osteochondroma, anticipate what w regard to
pain
fev
esr

A

no pain
no fever
normal esr

normally asymptomatic or with palpable mass, benign grown in childhood growth plates (may look like osteosarcoma by positon at ends of bones… but not sunburst no alk phos from bone destruction…)

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32
Q

irregularities and haziness over metaphseal border of proximal tibia in teen athlete think…

A

osgood schlatter

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33
Q

tf

playing through osgood schlatter pain has bad long term outcomes

A

f

can suck it up and play if they want… per meded

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34
Q

tf

cancer is commonly tender

A

f

not usually tender (to palpation), but does cause pain

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35
Q

systemic dzs that get carpal tunnel more

A

dm

hypothyroid

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36
Q 
carpal tunnel
path
pres
dx
tx
assoc dz to f/u
A

inflammation/compression of median nerve
pain paresthesias paralysis 1st 3 digits
phalen tinel thenar atrophy
eeg if surg dec conduction
splint out of flexion analg intraarc corricosteroids
f/u rheumatoid arthritis… carp tun may be presenting sign

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37
Q

phalen sign

A

press dorsi of hands together into flexion

pain eg w carpal tunnel

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38
Q

carp tun may be presenting sign of this dz

A

rheumatoid arthritis

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43
Q 
jersey finger
vs
mallet finger
vs
trigger finger
A

flexor tendon tear eg grabbing jersey ripped away
extensor tendon tear eg dip hyperflexed when stubbed trying to catch ball
extensor stenosing tenosinovitis may hear a POP when passively extended

tx splint nsaids intraartic steroids… surg

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44
Q

dequervain’s tenosynovitis
pres
dx
tx

A

mom carrying baby vs guy lifting weights
fist thumb twist pain on ulnar dev
splint nsaids intraartic corticosteroids… no surg… don’t cut inflammatory process… but… do cut to relieve carpal tunnel, do cut trigger finger…

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45
Q

duputyron contracture

mechanism of injury

A 
trick
no mechanism
nodular fibrosis of palmar fascia
assoc w alcoholism and scandanavian male
idiopathic
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46
Q 
duputyren's contracture
path
pres
dx
tx
A

fibrosis of palmar fascia causes flexion contracture of fingers
assoc w alcoholism and scandanavian men
clinical dx
surg release fascia
(nsaids do nothing as fascial not inflammatory dz)

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47
Q 
felon
path
pres
dx
tx
A

abscess in pulp of finger usually assoc w penetrating trauma
pain (compartment pressure) fev leuk
clinical dx
i and d… so small that need for abx rare

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48
Q

why do we splint carpal tunnel

A

immobilize to allow tendon swelling in carpal tunnel to resolve

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49
Q

treat carpal tunnel syndrome

A 
splint as often as tolerable
if that does not help:
xr to ro other path
eeg to ro path more proximal than carpal tunnel
surg cut carpal tunnel relieve pressure

splint xr eeg cut

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50
Q

general principles for fracture treatment

A

two xr perpendicular to each other
closed, approximated - consider casting
open, angular, comminuted - consider orif (and emergency washout if open)

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51
Q

if shoulder dislocation affects axillary nerve…

A

deltoid paresthesias

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52
Q

treat shoulder dislocation

A

relocate, sling

same for anterior or posterior shoulder disloc

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53
Q

mechanism of injury ant vs post shoulder dislocation

A

any trauma can cause ant dislocation, easier to do

massive trauma to get post disloc, eg seizure, lightning strike

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54
Q

tf

seizure and lightning strike can cause posterior shoulder dislocation

A

t

takes massive trauma to disloc post

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55
Q 
colle's fx
define
common demo
dx
tx
A

dorsally displaced radius/ulna fx
e.g. in old lady w osteoporosis
xr
cast vs operate

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56
Q

mechanism of monteggia fx other than fall

A

upper block
downward blow
(e.g. police baton)

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57
Q

Galeazzi fx
define
mech

A

radial shaft fx w DRUJ inj
-ulnar styloid fx
-widening of DRUJ on AP view
-dorsal or volar displacement on lateral view
-radial shortening (≥5mm)
trauma to dorso lat (rad) aspect vs foosh in pronation

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58
Q

anatomic snuffbox pain think

A

scaphoid fx

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59
Q

anatomic snuffbox pain, xr normal, next step?

A

cast and re xr for scaphoid fx in a few weeks…

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60
Q

boxer’s fx

define

A

fx of 5th (most common) and/or 4th metacarpal necks from punching

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61
Q

tf

hip pain can present as referred knee pain

A

t

so knee pain r/o hip path

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62
Q

hip fx mechanism

A

massive trauma

or old lady w osteoporosis

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63
Q

anatomic change w hip fx

A

leg shortened
flexed adducted internal rotation if post disloc
flexed abducted external rotation if ant disloc

64
Q

tx femoral head fx

A

likely to need arthroplasty (joint replacement) as avn likely…

65
Q

mechanism of injury acl vs pcl

and drawer sign acl vs pcl

A

posterior trauma acl inj, ant drawer sign

anterior trauma pcl inj, post drawer sign

(ligaments named for distal insertion)

66
Q

dx
tx
acl pcl inj

A

MRI
surg (athetes)
cast (everyone else)

67
Q

mechanism of inj mcl vs lcl

A

valgus stress mcl inj
varus stress lcl inj

valGus is KnoCK Kneed
varus is wide kneed

68
Q

valgus vs varus

A

valGus is KnoCK Kneed

varus is wide kneed

69
Q

dx
tx
mcl lcl inj

A

MRI
surg (athletes)
hinge cast (everyone else)

70
Q

click on knee extension think

A

meniscal tear

71
Q

dx
tx
stress fracture of shin

A

xr

cast even if xr normal, get f/u xr fx will be present

72
Q

tf

tib fib typically break together

A

tishfish
if tib breaks, fib likely to break as much weaker cannot support weight

fib can break solo w lateral trauma eg

73
Q

tx ankle fracture

A

usually surg as difficult to cast… per meded…

74
Q

pres
tx
achilles tendon rupture

A

pop while exercising
cast takes months to heal
surg takes weeks to heal

75
Q 
tx
femoral head fx
intertrochanteric hip fx
fem shaft fx
open fx
A

fem head prosthesis (avn)
intertroch plate
shaft rod
open emergency washout

76
Q

most sensitive physical exam test for acl tear

A

lachman’s

basically anterior drawer but at 20 deg flexion not 90

77
Q

lachman test

A

basically anterior drawer but at 20 deg flexion not 90

most sensitive physicalexam test for acl tear

78
Q

why replace femoral head fx

A

because blood supply is so tenuous that plating will likely lead to avn if not already vascularly compromised

79
Q

tf

pain in anatomic snuff box is pathognomonic for scaphoid fx, even if xr neg

A

t
so thumb spica cast
f/u xr 3 wks

80
Q

physical exam test for torn meniscus

A

mcmurray

rotate while extending knee joint, click on extension

81
Q

physical exam test for mcl tear

A

valgus stress test

82
Q

physical exam test for lcl tear

A

varus stress test

83
Q

humeral supracondylar fx
mechanism
4 compx

A 
foosh
brachial artery inj (runs ant midline)
median nerve inj (runs ant midline)
cubitus varus deformity
compartment syndrome/volkmann's ischemic contracture
84
Q

most common fx in peds

A

supracondylar humerus fx

supracondylar area remodeling – small and weak

85
Q

most common complications of supracondylar fracture

A

beachial artery inj
median nerve inj

both run along anterior midline of the area

86
Q

which pulses to check after supracondylar fx

A

brachial a
radial a

(both compromised w brachial a inj)

87
Q

check for complications after supracondylar fx

A

distal pulses (brachial, radial… possible brachial artery inj)

distal motor and sensory exam (possible median nerve inj)

88
Q

treat supracondylar fx

A

analgesia
immobilization
ortho consult if displaced

89
Q

prognosis of neurovascular injury after peds supracondylar fx

A

usually resolves after reduction of displaced fx

brachial a, median n

90
Q

fracture risk to axillary nerve

A

Proximal humerus fx

91
Q

fx risk to brachial plexus

A

clavicle fx

92
Q

incidence of compartment syndrome after supracondylar fx

A

rare v1%

usually accompanied by forearm fx

93
Q

volkmann contracture

A

aka
volkmann ischemic contracture
compartment syndrome of ue not timely treated can lead to ischemia and contracture - elbow flex, wrist pron flex, mp ext

94
Q

tf

supracondylar fx is a risk for limb length discrepancy

A

f
distal humeral physes comtribute little to length, but can get cubitus varus deformity

(prox humerus, forearm fx can cause length discrepancy)

95
Q

tf

risk of neurovsscular inj w supracondylar fx is HIGH

A

t

96
Q

when to assess radial and brachial pulses, sensory motor function after supracondylar fx

A

before AND after reduction

97
Q

mechanism of median nerve and brachial artery injury in supracondylar fx

A

impingement

98
Q

define syringomyelia

sx

A

blocked csf flow in central canal causes fluid buildup and compression of neural tissue, most often medial crossing fibers of spinothalamic pain temp and corticospinal ue motor
so ue motor weakness
pain temp loss

99
Q

most common causes of syringomyelia

A

arnold chiari malformation

prior spinal cord injury

100
Q

incidence of syringomyelia after spinal cord injury

A

3-4%

2016 uworld

101
Q

what region involved most commonly in syringomyelia from prior spinal cord inj

A

cervical

102
Q

time to onset and progression of syringomyelia sx after spinal cord inj

A

mos to years
gradual progression
(3-4% incidence after spinal cord injury, usually cervical)

103
Q

classic mechanism of spinal cord injury leading to syringomyelia

A

cervical whiplash in mva

104
Q

tf

dorsal column function compromised in syringomyelia

A

f
light touch vibration proprioceotion intact

medial structures compromised - spinothalamic crossing pain temp and crossing medial corticospinal motor in ue or cape-like distribution

105
Q

physical exam findings in syringomyelia

A

typically cervical

medial structures compromised - spinothalamic crossing pain temp and crossing medial corticospinal motor in ue or cape-like distribution

dorsal columns light touch vibration proprioceotion intact

106
Q

upper and lower motor neuron deficits w weakness twitching cramping think…

A

als

107
Q

als sx

A

upper and lower motor neuron deficits w weakness twitching cramping

108
Q

mechanism
demo
sx
cervical spondylosis

A

disk degeneration
pts over 40yo
neck pain stiffness
neurologic sx if spinal stenosis develops

109
Q

define spondylosis

A

general term for pain from spinal degeneration

110
Q

sx of disk herniation

A

unilateral radiculopathy (pain amd weakness) in distribution of single nerve (compressed nerve route)

111
Q

tf

nystagmus and scanning speech common in ms

A

t

112
Q

how many lesions required to dx ms

A

two separate lesions

113
Q

dx syringomyelia

A

mri

enlargement of central canal due to csf retention

114
Q

meniscal tear etiology

A

young pt rotational force on planted foot

old pt degeneration of meniscal cartilage

115
Q

tf

meniscus is ligamentous

A

f

cartilagenous

116
Q

radionucleotide bone scan used for…

A

infectious
inflammatory
malignant dz
can detect occult fractures too…

117
Q

muscles of the anterior upper leg

A 
psoas
iliacus
tensor fasciae latae
(iliotibial band)
vastus lateralis
vastus intermedius
rectus femoris
vastus medialis
sartorious
gracilis
adductor longus
adductor brevis
adductor magnus
pectineus
118
Q

tf

slow onset joint effusion is a presentation of meniscal tear

A

t
acute pop
locking catching rom dec
slow onset joint effusion

119
Q

thessaly test

A

basically standing mcmurray
-pt stands on one foot knee flexed 5 deg, twist to both sides, pos if reproduces sx (catching clicking locking)

-repeat at 20 deg flexion
don’t forget to start w healthy side

120
Q

dx meniscal inj

A

provocative tests (mcmurray, thessaly)
mri
arthroscopy

121
Q

manage meniscal inj

A 
minor sx, older pt - rest nsaids
persistent sx (3-4 wks), impaired function - surg for sx relief and prevent further damage

intraarticular glucoccorticoid inj if due to oa in older

122
Q

muscles of the posterior upper leg

A 
gluteus medius
gluteus maximus
semimembrinosus
semitendinosus
long head biceps femoris
short head biceps femoris
123
Q

advantages
disadvantages
of medial parapatellar approach to TKA

A

standard/familiar
good exposure

risk of medial capsular repair failure
lateral patellar subluxation
risk to medial blood supply

124
Q

advantages
disadvantages
of lateral parapatellar approach to TKA

A

useful for fixed valgus
prevents lateral patellar subluxation

technically demanding
medial eversion of patella is more difficult
may require tibial tubercule osteotomy

125
Q

advantages
disadvantages
of midvastus approach to TKA

A

mid (medial) vastus
does not disrupt quad tendon so much
patellar tracking

less extensile
exposure difficult in obese pts

126
Q

visualize anterior tendons of the knee

A

quadriceps tendon
patellar tendon
lateral and medial retinaculums

127
Q

over 95% of total knee replacements in US are performed for ________

A

osteoarthritis

128
Q

3 compartments of knee

A

lateral medial patellofemoral

129
Q

Nonoperative therapies for the patient with knee osteoarthritis include

A

activity modification, weight loss (for those who are obese), use of a cane, analgesics, and/or nonsteroidal antiinflammatory agents.

130
Q

osteomyelitis is…

A

infection of bone and bone marrow

osteo bome
myelo marrow
itis infection

131
Q

etiologies of osteomyelitis respective bugs

tx

A

hematogenous
staph a abx

direct traumatic inoculation
polymicrobial surgical debridement

132
Q

pmh in risk of osteomyelitis

A

dm

pvd

133
Q

define draining sinus tract in context of osteomyelitis

A

epithelialized tract that must be resected to resolve infection

134
Q

labs to get for osteomyelitis

A

cbc crp esr blood cx

135
Q 
define bone
sequestrum
involucrum
cloaca
sinus tract
A

piece of dead/necrotic bone from osteomyelitis (or rarely osteod osteoma) infection causing inflammatory exudate, increased intramedullary pressure, vascular thrombusis, lack of blood, necrosis, difficulty delivering hematogenous abx

new bone forming

(latin for sewer or drain) opening in involucrum for drainage of purulent and necrotic material

epitheliazed tract extending from cloaca to skin surface or another cavity

136
Q

imaging findings in osteomyelitis

A

sequestrum (necrotic bone)
involucrum (new bone)
cloaca (drain)
sinus tract (epitheliazed drain to skin or another cavity)

137
Q

most sn and sp imaging test for osteomyelitis

A

MRI

CT best for imaging bone, MRI gets soft tissue sinus tract edema etc too

138
Q

most common bugs in osteomyelitis

A

staph aureus
polymicrobial
pseudomonas

139
Q

visualize the big arteries of the leg

A 
femoral
popliteal
genicular arteries
posterior tibial
anterior tibial
(to dorsalis pedis)
peroneal
140
Q

how to manage a sinus tract in osteomyelitis

A

must resect

otherwise will never resolve

141
Q

visualize big veins of the leg

A 
great saphenous
posterior tibial
anterior tibial
small saphenous
femoral
external iliac`
142
Q

define phlegmon

A

spreading diffuse inflammatory process with pus… vs walled-off inflammatory mass without bacterial infection…

143
Q

visualize big nerves of anterior leg

A 
obturator
inferior gluteal
superior gluteal
femoral
common fibular (aka peroneal, from sciatic)
deep fibular
superficial fibular
144
Q

define paprika sign

A

puctate cortical or cancellous bone bleeding, eg when debriding cortex in OM to find healthy bone that bleeds

145
Q

total knee replacement failure rate due to infection

A

1%

146
Q

how is chronic osteomyelitis like herpes

A

it keeps coming back…

Delahey

147
Q

visualize the big arteries of the leg

A 
femoral
popliteal
posterior tibial
anterior tibial
(to dorsalis pedis)
peroneal
148
Q

visualize big nerves of the posterior leg

A 
superior gluteal
inferior gluteal
sciatic
(tibial, common fibular)
posterior femoral cutaneous
nerve to obturator internus
pudendal
149
Q

Most common cause of aseptic knee replacement failure

A

patellofemoral maltracking

150
Q

tinel sign

A

tap eg median nerve for carlal tunnel pain paresthesia

Surgery (22 decks)

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