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MSK > Week 6 > Flashcards

Week 6 Flashcards

1
Q

In the rare cases that it does, which way does the hip dislocate?

A

Posteriorly

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2
Q

How is an ankle fracture treated?

A

Open reduction and internal fixation.

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3
Q

What is a Lisfranc Fracture?

A

A fracture dislocation of the TMT joint of the foot. It disrupts the “keystone” of the arch of the foot and requires surgery to correct.

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4
Q

Which nerves intimately intertwined with the humerus?

A

Radial

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5
Q

How should fractures in the arm be treated in most cases?

A

Bracing, as it is not typically weight bearing intramedullary nails are rarely used. Surgery is only used when absolutely necessary due to the risk of damaging nerves and arteries located near the bones. Only ~20% of humerus fractures will require surgery.

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6
Q

Which structures are of concern in surgery involving the clavicle?

A

The supraclavicular nerve and brachial plexus, as well as the subclavian artery are at risk of damage from both the injury and the surgery.

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7
Q

What is an AMPLE History?

A

A: Allergies M: Medications P: Prior Medical History L: Last Meal E: Events Leading to the Injury

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8
Q

What nerve is frequently damaged with dislocation of the shoulder?

A

The axillary nerve.

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9
Q

Which nerve is commonly injured with fractures and/or dislocations of the elbow?

A

The ulnar nerve.

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10
Q

What is the best imaging test when you believe that there are bone fragments related to a fracture?

A

CT with X-Ray

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11
Q

How hot does water need to be to burn you in 1 second? 10 minutes?

A

70 degrees, 49 degrees.

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12
Q

What is the Rule of Nines?

A

Way to calculate surface area burned. Each arm is 9%, Face is 9%, Torso is 36%, Legs are each 18% {and the genitals are 1%}. The size of an individuals palms is ~ 1% their body surface area.

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13
Q

How do you calculate Basal Fluid Rate?

A

Basal Fluid Rate: 40mL/Kg for first 10; 20mL/Kg for second 10; 10mL/Kg for anything more. 40:20:10 Rule.

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14
Q

How much fluid should be given for ≥ 2nd degree burns in the first 24 hours? How much SA {approximately} needs to be burned to worry about fluids?

A

2 - 4 mL of Ringers Lactate / Kg / % Burn

Ie. (3mL)(50Kg)(35) 5 250mL

If less than their basal requirements they likely do not need fluid resuscitation {~ 20% + SA burned}. 50% in the first 8 hours; 25% in the second and third.

For peds patients use Parkland + Basal Maintance. Adults are Parkland only!

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15
Q

What is an Escharotomy?

A

Opening of the eschar {leathery burned skin} by incision to help prevent compartment syndrome.

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16
Q

When should an Escharotomy be performed?

A

When there is no pulse, cyanosis, or neurological symptoms. {Pressure is preventing blood flow}.

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17
Q

What is in Ringer’s Lactate?

A

Sodium, Chloride, Lactate, Potassium, and Calcium

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18
Q

What is the fancy word for Bunions?

A

Hallux Valgus

19
Q

What is involved in a first, second, third, and fourth degree burn?

A

Epidermis, Superficial Dermis, Sub-Dermis, Anything Deeper.

20
Q

What is the most common cause of Hallux Valgus?

A

Stupid shoes.

21
Q

What is the fancy name for OA of the first MTP? How will these patients walk?

A

Hallux Rigidis; On the outside of their foot to avoid pain.

22
Q

What is Morton’s Neuroma? How does it present?

A

A thickening and sclerosing of the endoneurium and perineurium along with demyelination occurring in the foot, most commonly between the third and fourth metatarsals. Feels like a tingling, burning, or numbness in your heel or as if you are walking on a pebble.

23
Q

What is Plantar Fasciitis, how does it present, and how is it treated?

A

Inflammation of the Plantar Fascia. Usually involves pain over the heel which is worst in the morning with the first few steps and may hurt after a long day on your feet. NOT typically fixed with surgery. 80 - 90% self resolve in 1 year, braces while sleeping, weight loss, and PT can help.

24
Q

How is an Achilles Rupture treated?

A

May be treated surgically or non-surgically. Controversial whether there is a higher risk of recurrence with non-surgical treatment. Two weeks with a cast and no weight bearing, 4 weeks cast with weight bearing. Need PT, should return to normal in 6 months. The cast must be done at 30 degrees plantar flexion!

25
Q

When does an X-Ray need to be ordered for a suspected ankle sprain?

A

Ottawa Ankle Rules

Ankle X-ray is only required if there is any pain in the malleolar zone and any one of the following:

  • Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, OR
  • Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus, OR
  • An inability to bear weight both immediately and in the emergency department for four steps.
26
Q

List differences in presentation for neurogenic and vascular claudication.

A
27
Q

What percentage of metastatic cancers have unknwn priamries at death of the patient?

What is the most common tumour of the bone in patients older than 40?

A

3-4%

Metastatic Carcinoma

28
Q

What drug are many patients with bone cancer taking?

A

Bisphosphonates

29
Q

Where do most bone tumours occur?

A

At the growing ends of long bones. These portions of the bone are much more active.

30
Q

What is an Osteoid Osteoma?

A

A benign cortically based inflammatory lesion with a nidus > 2 cm. Surrounded by a zone of reactive bone. They are usually found in young males and are treated with laser ablation therapy.

The associated night pain is ususally managable with NSAIDs.

31
Q

What is a Nidus?

A

A point or place at which something originates, accumulates, or develops, as the center around which a tumor forms.

A tumor associated with Osteiod Osteoma.

32
Q

What is an Enchondroma?

A

A benign bone tumor of a remnant piece of cartialge from the physis. It is usually an incidental finding and located periarticularly.

33
Q

What is an Osteochondroma?

A

A cartilage based benign bone tumour which has a very low metastatic potential. The cartilage is a remnant of the peripheral aspect of the physis. Generally asymptomatic.

34
Q

What is a Benign Aggressive Tumor and how is it treated?

A

A benign tumor of unknown etiology which continues to enlarge causing local destruction. There is a low risk of systemic spread.

Treatedment is done surgically and involves an intralesional resection {scoop it out, fill it up with cememnt or a bone graft}.

Severe lesions require replacement or amputation.

35
Q

What are the two most common types of Benign Aggressive Tumours?

A
  • Giant Cell Tumour of Bone
  • Aneurysmal Bone Cyst
36
Q

What is an Osteosarcoma?

A

Most common primary malignancy of the skeleton and often presents intermedullary. Mortality is high. Very aggressive with a high likelihood of metastasis.

Most commonly seen in males in the second decade of life.

37
Q

What is Ewing’s Sarcoma?

A

Second most common primary osseuos malignancy of childhood and adolescence. very aggressive and assumed to be metastatic. It can mimic an abscess or infection and is more likely than osteosarcoma to present with systemic symptoms.

RED FLAGS: Pain at night and with activity.

38
Q

What is elevated in both Osteosarcoma and Ewing’s Sarcoma which confers a proportionally worse prognosis?

A

Alkaline Phopshatase {ASP} and Lactate Dehydrogenase {LDH}

39
Q

What imaging tests should be ordered for Ewing’s Sarcoma?

A

MRI with Gadolinium for local staging.

CXR, CT, and Bone Scan are useful for systemic symptoms.

40
Q

What are Waddell Signs and what do they help you determine?

A

Whether pain is of organic or non-organic orign.

41
Q

How is Chondrosarcoma treated?

A

Does NOT respond to Chemotherapy or Radiation Therapy. Must perform a wide surgical resection.

Third most common primary osseous malignancy.

42
Q

How are osteosarcoma and Ewing’s sarcoma treated?

A

Multimodal Chemotherapy for both as they are assumed to have metastasized.

OS will also invovle surgical resection.

ES will also involve either resection of external beam radiotherapy.

43
Q

What are the 6 signs of compartment syndrome?

A

Pallor, pain out of proportion, pulselessness, parathesia, paralysis, pain with passive stretch. {BOLDED are the important ones, others aren’t nearly as important.

The two point discrepency test is surprisingly good for detecting compartment syndrome.

44
Q

How would you diagnose comartment syndrome? What should compartment pressures be in a healthy person?

A

Comartment Pressure > 8 mmHg.

Pain starts beween 20 - 30 mmHg.

Within ≤ 30 mmHg Diastolic is Dangerous!

MSK (6 decks)

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