Clin Med 3

Question 1

complications of calcaneal fx

Answer 1

wound dehiscence, lost talar motion, dystrophy/CRPS, inc heel width, sural n. injury

Question 2

Maison fx

Answer 2

prox 1/3 of fib, tear in syndesmosis/inteross mem –> widening tibfib overlap, GET KNEE XR

Question 3

pilon fx. tx? how do you get it?

Answer 3

intraarticular distal tibial fx, assoc w/ fib fx. IN/EXTERNAL FIXATION/ligamentotaxis if swollen –> then ORIF. high energy trauma

Question 4

calcaneal fx

Answer 4

high energy collisions; intraarticular –> CT –> surgery; extraarticular –> nonop –> PT, non wtbearing; tongue type –> threat to skin –> emergency –> immediate surgical reduction

Question 5

dx of talar fx/aviator fx: XR vs CT vs MRI. tx? complications?

Answer 5

AP, lateral, mortise of ankle; AP, lateral, oblique of foot vs characterize fx pattern and displacement vs AVN (b/c fx gives high risk). nondisplaced –> cast/boot; displaced –> immediate closed reduction d/t AVN, ORIF for open fx. AVN, infxn, osteonec, delayed union/non/malunion, foot cmpt syndrome

Question 6

Hawkins classification of talar fx: type I vs II vs III vs IV

Answer 6

nondisplaced vs subtalar sublux; displaced talar neck fx vs subtalar + ankle sublux vs type III + talonavic sublux; AVN

Question 7

Lisfranc injury

Answer 7

disruption b/w base of 2nd metatarsal and middle cuneiform d/t axial/rotational load on plantarflexed –> splaying MT, plantar ecchymosis

Question 8

diag XR for lisfranc: AP vs lat standing vs medial 30 degree oblique

Answer 8

greater than 2 mm b/W base of 1st and 2nd MT (nml = medial border of second MT base and intermediate cuneiform line up) vs superior border 1st MT should align w/ superior border of medial cuneiform vs medial border 4th MT should align w/ cuboid; if suspected injury –> weight-bearing, AP view of both feet

Question 9

tx of lisfranc: nonop vs op. complications?

Answer 9

Sprains → short leg cast (SLC) or boot for 8-12wks vs Displacement > 2 mm of the tarsometatarsal joint → anatomic reduction, stable fixation; ORIF, screws/pins. post-traumatic arthritis, compartment syndrome, infection, CRPS, neurovascular injury, hardware failure

Question 10

Forefoot fx (5th MT fx): zone 1 vs 2 vs 3

Answer 10

dancer fx, avulsion of peroneus brevis –> cast/boot, hard soles vs Jones fx, metaphyseal-diaphyseal jxn; watershed line fx –> poor blood supply –> longer to heal; nonop –> boot/cast w/ non wtbearing, displaced –> surgery, sports related vs diaphyseal stress fx, longer healing time –> inc risk of malunion; cavovarus deformities and sensory neuropathies; usually nonop except displaced or mult MT fx

Question 11

charcot joint arthropathy. risk factors vs tx?

Answer 11

Chronic and progressive joint disease following loss of protective sensation, asx. DM, alc, syphilis/syringomyelia vs Non-op: splinting/casting/edema control; Op: fusions/osteotomies/amputations; Often mistaken for infection and treated with antibiotics

Question 12

turf toe. classifications? indic of surg tx? outcomes?

Answer 12

hyperex of plantar plate and sesamoid complex of 1st MTP –> tear of capsular-ligamentous-sesamoid complex off of prox phalanx (NOT 1ST MTP). 1/2/3: sprain/partial tear/complete tear of plantar plate. GRADE 3, sesamoid retraction, sesamoid fx, loose frag. post op non wtbearing, progressive ROM & physiotherapy, can return to sports in 3-4mo

Question 13

tarsal coalition/peroneal spastic flat foot. types? dx? tx?

Answer 13

embro failure of mesen segmentation –> structural “fusion” of 2-3 tarsals –> rigid flatfoot, flat longitudinal arch, abducted forefoot, valgus hindfoot, anteater sign, talar breaking, recurrent ankle sprain. 2 types: congenital, acquired (degen, trauma, infxn). XR, CT (best). medial arch support, hindfoot alignment, NSAIDS, cast; surgery –> coalition resection with interposition graft, +/- correction of associated foot deformity –> Calcaneal osteotomy; Arthrodesis (fusion) –> Subtalar vs triple (subtalar, talonavic, calcaneocuboid)

Question 14

achilles tendon rupture on exam

Answer 14

deficit in distal calf, palpable sulcus proximal to calcaneus, Thompson+

Question 15

tibial shaft stress fx. dx? tx? at risk ppl?

Answer 15

overuse –> microfx. XR, MRI. restrict activity, protected wtbearing, avoid NSAIDs b/c slows bone healing; surgical intramedullary nail if ant tib tension-sided stress fx (dreaded black line). military recruits, athletes, runners

Question 16

tibial stress syndrome: shin splints. dx? tx? risk factors?

Answer 16

overuse in shin area –> dull anterior leg pain. tender at posteromedial distal tibia, worse w/ plantarflex; XR or bone scan to r/o stress fx. nonop –> NSAIDs, rest, activity mods; op –> prophylactic fasciotomy and periosteal release. runners without enough shock absorption, training errors, previous LE injuries, overpronation or inc tibial IR

Question 17

ages for tarsal fusion

Answer 17

3-5yo –> talonavicular
8-12yo –> calcaneonavicular
12-16yo –> talocalcaneal

Question 18

causes of in-toeing vs out-toeing

Answer 18

o Internal femoral torsion (anteversion)
o Internal tibial torsion
o Metatarsus adductus
o Talipes equinovarus (clubfoot)
o Developmental dysplasia of the hip (DDH)
vs
o External femoral torsion
o External tibial torsion
o Calcaneovalgus foot
o Hypermobile pes planus (flatfoot)
o Slipped capital femoral epiphysis (SCFE)

Question 19

indic of total hip replacement. how is it done? absolute vs relative contraindic?

Answer 19

OA/DJD, posttraumatic arthritis, AVN, osteonec in sickle cell, ankylosing spondylitis. replace femoral head and acetabulum. active infxn vs BMI >40, hgbA1c >8, neuro dz

Question 20

complications of total hip replacement

Answer 20

heterotropic oss (bone outgrowth into tissue like glut min/med –> stiff, pain), blood transfusion/vasc injury/hematoma, fx/dislocation/infxn, limb length discrepancy, sciatic palsy, aseptic loosening w/o infxn, pseudo tumor –> metal on metal (not used anymore)

Question 21

causes of hip AVN

Answer 21

corticoids, alc, poor bloodflow to femoral head, fx/dislocation/infxn, posttraumatic

Question 22

how to dx vs tx AVN hip?

Answer 22

XR vs NSAIDs, rest, activity modification; Surgery: core depression of the femoral neck, hip arthroplasty

Question 23

ddx of exertional leg pain

Answer 23

o Ant/med tib stress syndrome
o Tibfib stress fx
o Exertional cmpt syndrome
o Leg tendinopathy
o Sural n entrapment
o Lumbar radiculopathy

Question 24

3 principles of homeopathy: law of similar vs minimum dose vs individualize tx

Answer 24

something that caused dz can cure person w/ similar sxs vs dilute substance –> enhance curative properties & minimize side effects vs blank

Question 25

glucosamine

Answer 25

in healthy cartilage, prevents loss of cartilage –> dec OA sxs; don’t use w/ chondroitin

Question 26

omega 3 FA

Answer 26

for bodily functions including muscle activity, blood clotting, digestion, fertility, and cell division and growth; helps OA, RA, macular degen, brain dz, psych conditions

Question 27

aloe vera

Answer 27

for burns, IBS, ulcerative colitis; may inhibit surgical wound healing

Question 28

SAMe

Answer 28

reduce OA pain and improve joint function; can interact w/ antidepressants and pain meds

Question 29

electromagnets

Answer 29

for OA; interferes w/ pacemakers, insulin pumps, medical devices

Question 30

anti inflamm diet contains?

Answer 30

variety, fresh/limit process, fruits & veggies, omega 3 PUFA, whole grains

Question 31

flexible vs correct to neu vs no improvement txs. what does it tx?

Answer 31

observe vs stretch, special shoes vs (rare) surgery –> soft tissue release or osteotomy at 4-6yo. MT adductus

Question 32

full vs mild vs severe ROM restrict txs. what does it tx? what else do you need to chk for? do you need XR?

Answer 32

none vs stretch vs serial cast. calcneoval. chk hips for DDH. no

Question 33

acupuncture is thought to do what? (3)

Answer 33

o Relieve muscle tension
o Improve circulation
o Regulate inflammation

Question 34

how to tx mild vs mod/severe SLE?

Answer 34

NSAIDs, hydrochloroquine vs corticosteroids

Question 35

HSP/igA vasculitis

Answer 35

from URTI or strep. palpable purpura, arthritis/ralgia (no warm red effused joints). leuko/thrombocytosis, high ESR/WBC/RBC. corticosteroids, pain ctrl, hydrate, bland diet. GI introsusception, bowel obstruction; nephrotic syndrome