ortho_4_n Flashcards
(198 cards)
1
Q
what’s required if LOC >5min for someone w/concussion?<img></img><img></img>
A
CT scan
2
Q
what genetic disorder a/w small or absent patellae?
A
nail patella syndrome
3
Q
what test is this:axially loading the tibiofemoral joint at 90° of knee flexion. Pain with compression and external rotation (medial meniscus) or internal rotation (lateral meniscus) is considered positive. ?
A
apley test
4
Q
and the xr shows a lesion in the proximal femur…
A
proximal femur replacement
5
Q
most common organ injured in the abdomen as a result of blunt trauma?
A
spleen
6
Q
common MOI of athletic neck injuries?(2)
A
axial load and flexion
7
Q
what is the torg pavlo ratio?
A
canal/vertebral body width
8
Q
what letter and structure?
A
C, the FHL
9
Q
between what two ossification centers is os acromiale usually?
A
between the meso and meta acromion
10
Q
symptoms of concussion: ***, unsteadiness, confusion, LOC, change in personality/memory
A
headache
11
Q
what type of prosthesis do for someone’s knee in the revision setting with multiplanar instability and a deficient extensor mechanism?
A
hinged knee
12
Q
what is the normal torg-pavlo ratio?
A
1
13
Q
what can be seen with MRI in someone with tibial stress fracture?
A
marrow edema
14
Q
what usually causes popliteal artery entrapment?
A
anatomic abnormality
15
Q
what provocative PE test for tibial stress syndrome?
A
pain w/resisted plantar flexion
16
Q
what is the difference bw whelan III vs IV whelan popliteal artery entrapment?
A
medial head of gastrocnemius surrounding artery vs popliteus
17
Q
what can patients complain of w/popliteal artery entrapment?
A
numbness/paresthesias
18
Q
Indication for UKA:patients older than 60 with relatively low activity demands. Additionally, the patients should weigh less than 82 kg, have minimal pain at rest, have motion ***, and have minimal flexion and angular deformities.
A
> 90 degree
19
Q
what blood supply supplies the inner 2/3 of bone?
A
nutrient artery system
20
Q
stress fx to the first rib show up in what part of the bone (near what structure)?
A
groove for the subclavian artery
21
Q
what’s bw the pia mater and the arachnoid mater?
A
subarachnoid space
22
Q
where does tibial stress syndrome occur most often?
A
posteromedial tibia
23
Q
when is risk of splenic rupture highest after infectious mono?
A
3 weeks after the onset of symptoms
24
Q
what is kehr sign?
A
pain tip of shoulder due to irritation of peritoneal cavity
25
what is the direction of flow of arterial blood through mature bone?
inside out
26
symptoms of concussion: headache, unsteadiness, confusion, LOC, change in ***
personality/memory
27
what PE can you see with popliteal artery entrapment?(2)
limb swellingdiminished pulse w/active foot plantar flexion or passive dorsiflexion
28
how an you treat os acromiale with persistent symptoms?
open reduction internal fixation
29
Indication for UKA: patients older than 60 with relatively low activity demands. Additionally, the patients should weigh ***, have minimal pain at rest, have motion >90 degress, and have minimal flexion and angular deformities.
less than 82kg
30
what testing used to confirm diagnosis of popliteal artery entrapment?
arteriogram
31
most common symptoms of concussin?(2)
headache and dizziness
32
Indication for UKA:patients older than 60 with relatively low activity demands. Additionally, the patients should weigh less than 82 kg, have minimal pain at rest, have motion >90 degress, and have minimal *** deformities.
flexion and angular
33
what do phase 1 and 2 look like for tibial stress syndrome?
normal
34
what type of force a/w visceral injury?
deceleration
35
symptoms of concussion: headache, unsteadiness, confusion, ***, change in personality/memory
LOC
36
what's the difference bw grade I and II concussion?
symptoms < or > 15min
37
how long wait until RTP after getting infectious mono?
3 week after symptom resolution
38
Indication for UKA:patients older than 60 with relatively ***Additionally, the patients should weigh less than 82 kg, have minimal pain at rest, have motion >90 degress, and have minimal flexion and angular deformities.
low activity demands
39
what blood supply to bone is higher pressure?
nutrient artery system
40
what's difference bw grade IIIa and b concussion
LOC sec vs min
41
what stays on when athlete has suspected neck injury while you are making sure the airway is ok?(2)
helmet and pads
42
Indication for UKA:patients older than 60 with relatively low activity demands. Additionally, the patients should weigh less than 82 kg, have *** at rest, have motion >90 degress, and have minimal flexion and angular deformities.
minimal pain
43
what supplies majority of blood supply to the humeral head/
posterior humeral circumflex artery
44
symptoms of concussion: headache, ***, confusion, LOC, change in personality/memory
unsteadiness
45
Condition caused by decreased blood flow distal to the popliteal fossa and ss consistent with compartment syndrome?
popliteal artery entrapment
46
Indication for UKA:[age] with relatively low activity demands. Additionally, the patients should weigh less than 82 kg, have minimal pain at rest, have motion >90 degress, and have minimal flexion and angular deformities.
patients older than 60
47
what is normal cervical canal diameter?
~17mm
48
what can happen if nonop a anterior tibial stress fx over time?
fx propogation
49
how much time does graduated retrun to play for concussion take?
7 days
50
when does second impact syndrome occur?
second minor blow before symptoms resolve
51
what is spear tackler's spine?
developmental narrowing(stenosis) of ther cervical canal caused by repetitive microtrauma
52
what is considered a massive rotator cuff tear in terms of size?
over 5cm
53
which shoulder usually affected by cuff tear arthropathY?
dominant shoulder
54
what classification system used for cuff tear arthropathy?
seebauer
55
what are the two aspects that determine the seebauer classification for cuff tear arthropathy?
centralization of the humeral headstability of position of the humeral head
56
If doing arthroscopic debridement for cuff tear arthropathy, what structure should be maintained?
CA arch
57
besides functioning deltoid, what else needed before considering rTSA?
adequate glenoid bone stock
58
what would be the treatment of choice for salvage of cuff tear arthropathy w/pts with history of osteomyelitis, chronic infections,multiple previous operations or poor soft tissue envelope?
resection arthroplasty
59
what treatment is contraindicated for cuff tear arthropathy due to glenoid failure from the rocking horse phenomenon?
TSA
60
why would someone have subacromial effusion after rotator cuff tear?
synovial fluid escape
61
what does SAPHO syndrome stand for?
synovitis–acne–pustulosis–hyperostosis–osteomyelitis
62
what social factor a/w pustular psoriasis?
smoking
63
RA with splenomegaly and leukopenia is what?
felty syndrome
64
what is acute onset RA with fever, rash and splenomegaly?
still's disease
65
arithmetic methodThe growth remaining methodThe Moseley straight-line methodThe Paley multiplier techniqueall used to measure what?
LLD at maturity
66
this is Overgrowth syndrome with both increased length and limb girth?
hemihypertrophy
67
what type of person gets a T score on the DEXA versus a Z score?
postmenopausal
68
A patient undergoing joint arthroplasty is put on a drug that competitively inhibits the activation of an enzyme that breaks down Factor Ia. The drug is?
tranexemic acid
69
Factor Ia is also known as what?
fibrin
70
***is an antifibrinolytic that prevents the activation of plasmin from the inactive zymogen plasminogen.
Tranexamic acid (TXA)
71
In X-linked hypophosphatemic rickets, the gene defect may be found in which of the following?
PHEX
72
Patients older than age 65 are at increased risk for adverse gastrointestinal effects when placed on nonsteroidal anti-inflammatory drugs, and they should be placed on a *** prophylaxis at the same time
proton pump inhibitor
73
Corticosteroids inhibit the formation of effectors of the inflammatory pathway via inhibition of
phospholipase A2
74
what can continuous infusion of local anesthetics for pain control lead to?
chondrolysis
75
this class of medication acts by reduce hyper-excitability of voltage dependent Ca2+ channels in activated neurons.?
GABA agents
76
what receptor does tramadol work on?, what affect does it have
mu opioid reeceptor agonist
77
What is the most appropriate delivery route for pain medication to a morbidly obese post-operative patient to ensure a therapeutic plasma concentration?
IV PCA based on ideal body weight
78
what do isoflurane, sevoflurane, desflurane and nitrous oxide have in common?
all inhalational anesthetics
79
what's common to rocuronium, vecuronium, atracurium, cisatracuriumand pancuronium?
non depolarizing neuromuscular blocking agents
80
What tumor involves involves perichondral node of ranvier and bony excrescence from physeal plate?
osteochondroma
81
where is periosteal chondroma most commonly found?
proximal humerus
OB
82
lobules of hyaline cartilageperipheral encasement by bone central necrosis with calcification often times incidental finding?
enchondroma
83
popcorn calcificationrings and arcs a/w what malignancy?
chondrosarcoma
84
what is enostosis?
bone island seen with osteoma
85
what's on differential for osteopoikilosis?
mets
86
how differentiate mets and osteopoikilosis?
bone scan
87
what best imaging modality to see a medullary osteoid osteoma?
MRI
88
early finding of LCPD on xr of the pelvis?
medial joint space widening
89
how treat children < 8 years of age (bone age <6 years) with lateral pillar A involvement in LCPD?
nonop with activity mod and limit wb
90
what phase of MRI good for seeing the anatomy?
T1
91
what mm superior to the soleus on the back of the tibia?
popliteus
92
Atypical ABC should raise suspicion of what diagnosis?
telangiectatic osteosarcoma
93
what benign bone forming lesions often also treated by ENT doctors?
osteoma
94
long-standing chronic lymphedema can lead to the formation of this type of cancer? what is it known as?
angiosarcoma (steward treves)
95
hard white dense boneareas of dedifferentiation soft and fleshyencapsulated by thin adventitial tissuecan have a cartilage capfibroblastic low grade“school of fish” patternno osteoblastic rimmingstain with MDM2 stain, amplification
parosteal osteosarcoma
96
malignant tumor bag of blood with cancer in it?
telangiectatic osteosarcoma
97
Young kid met bone cancer, what could it be?
neuroblastoma
98
lower abdominal pain and inguinal pain at extremes of exertion, tenderness to adductor longus, tenderness to adductor longus all symptoms of what?
athletic pubalgia
99
what position of forefoot leads to MT overlap on the AP foot XR?
forefoot pronation
100
what calcaneal pitch value (greater than what) can be seen in someone with cavovarus foot?
>30
101
what is dorsally dislocated on the talus in CVT?
navicular
102
In CVT, how do the peroneal longus and posterior tibilais act on the ankle?
as dorsiflexors
103
what type of coalition is more common?
calcaneonavicular
104
synchondrosis involves what tissue type?
cartilage
105
consider this treatment if coalition involves >50 % of the joint surface of a talocalcaneal coalition?
subtalar arthrodesis
106
what medication class may be helfpul in reducing fracturs in kids with CP who have low BMD?
bisphosphonates
107
what is the most reliable predictor for ability to walk in a kid with cerebral palsy?
independent sitting by age 2
108
Velocity-dependent increased muscle tone and hyperreflexia with slow, restricted movement due to simultaneous contraction of agonist and antagonist muscles is a feature of what type of CP?
spastic
109
slow, writhing, involuntary movements is a feature of what type of CP?
athetoid
110
Walks with assistive devices is what GMFCS level of CP?
III
111
Severely limited walking ability, primary mobility is wheelchair is what CP level?
IV
112
Most common finding in MRI brain of someone with cerebral palsy?
periventricular leukomalacia
113
what enzyme does Pyridostigmine block?
acetylcholinesterase
114
can someone with calcaneonavicular coalition have TN beaking?
yes
115
how is CMT inherited most commonly?
autosomal dominant
116
what is the most common foot deformity in CP?
equinus
117
what happens to the knee at heel contact in a kid with CP?
hyperextension
118
what does equivalent ankle dorsiflexion with knee flexion and extension indicate?
achilles tightness
119
how treat painful hallux valgus in someone with CP?
first MTPJ arthrodesis
120
what procedure do in someone with hallux valgus and associated valgus interphalangeus in CP?
proximal phalanx (akin) osteotomy
121
This is extra-articular subtalar arthrodesis via a lateral approach using ICBG used in CP?
grice procedure
122
what autoimmune dz a/w destruction of acetylcholien receptor?
myasthenia gravis
123
what type of foot deformity in CP consider a split tibialis anterior tendon transfer for?
flexible equinovarus
124
Rigid deformities in CP foot usually require what generally?
bony reconstructions procedures
125
how is the lower back aligned in someone with achondroplasia?
excessive lordosis
126
COL1A2 a/w what problem in kids?
Osteogenesis imperfecta
127
what is defective in cleidocranial dysplasia (gene and inheritance)?
AD defet in RUNX2
128
Besides MRI, what other screening study should be done for someone with achondroplasia to assess apnea?
sleep study
129
how is diastrophic dysplais inhertied?
AR
130
what elbow motion increases symptoms related to cubital tunnels yndrome?
flexion
131
which one is more mild OI, autosomal recessive or dominant?
dominant
132
hereditary condition from decrease in normal type I collagen?
osteogenesis imperfecta
133
what do COL 1A1 and COL 1A2 cause in osteogenesis imperfecta?
abnormal collagen cross-linking via a glycine substitution
134
what type of radial head dx someone with OI get?
anterolateral
135
In the context of elbow instability, optimal treatment of a comminuted radial head fracture with greater than three fragments is with a ***
radial head replacement
136
What% of humeral growth occurs at the proximal physis?
80%
137
what part of the TFCC is more vascularized?
periphery
138
where do the dorsal and volar radioulnar ligaments originate?
sigmoid notch of the radius
139
where is somone tender if they have a positive fovea sign in TFCC injury?
tenderness in the soft spot between the ulnar styloid and flexor carpi ulnaris tendon,
140
what modality is most accurate for diagnosing TFCC injury?
arthroscopy
141
what finger gets seymour fx more often?
MF
142
in context of seymour fxextensor tendon inserts into the *** of the distal phalanxflexor tendon inserts into metaphysis of the distal phalanx
epiphysis
143
in context of seymour fxextensor tendon inserts into the epiphysis of the distal phalanxflexor tendon inserts into *** of the distal phalanx
metaphysis
144
why operate on seymour fx (aka this is what can cause widened appearance of the physis)?
interposed tissue
145
In a seymour fx does the fracture line traverse outside of the physis?
no
146
what direction mcpj dislocation usually?
dorsal
147
these are the primary stabilizers of the MCPj?
proper collateral ligaments
148
mcpj collateral ligaments are tight in what position?
flexion
149
interposition of volar plate and/or sesamoids makes a MCPJ dislocation what?
complex
150
this is when metacarpal head buttonholes into palm (volarly)?
kaplan lesion
151
where does the FHL insert?
first phalanx of the great toe
152
What is the antibiotic of choice for gonococcal septic arthritis of the knee?
ceftriaxone
153
To cover both gonorrhea and chlamydia what abx add to ceftriaxone?
doxycycline
154
How much shortening of clavicle fx a/w poor outcomes?
2cm
155
1-beta = ?
power
156
stata command for indepdent samples power analysis?
power twomeans mean1 mean2, sd(??) power(.8)
157
command added to power analysis in stata for specifying ratio of participants?
nratio(#)
158
Treatment for phalanx dislocation: treatment is ***(2) unless volar plate entrapment blocks reduction or a concomitant fracture renders the joint unstable
closed reduction and splinting
159
Treatment for phalanx dislocation: treatment is closed reduction and splinting unless *** entrapment blocks reduction or a concomitant fracture renders the joint unstable
volar plate
160
which collateral ligament of the phalanx inserts on the volar plate?
accessory
161
two types of collateral ligaments of the phalanxes(2)?
proper and accessory
162
what acts as a restraint against hyperextension of the phalanxes?
volar plate
163
where does the central slip insert?
dorsal base of the middle phalanx
164
PIPJ fx/dx what modality treat if >40% of the joint is involved?
operatively
165
what structure have to resect to get to volar plate in PIPJ fx/dx?(3)
proximal portion of C2 pulleyentire A3 pulleydistal C1 pulley
166
what treatment option can do for highly comminuted "pilon" fracture-dislocations of the PIPJ?
dynamic distraction ex fix
167
This patient should be taken for a laparotomy. When a patient has a gunshot wound to the pelvis and the bullet path crosses the midline, a *** is indicated. However,if the patient has peritoneal signs, he should have a laparotomy because he or she likely has a perforated viscous
sigmoidoscopy
168
This patient should be taken for a laparotomy. When a patient has a gunshot wound to the pelvis and the bullet path crosses the midline, a sigmoidoscopy is indicated. However,if the patient has peritoneal signs, he should have a *** because he or she likely has a perforated viscous
laparatomy
169
An EMG/NCS can be done after *** to assess for nerve return but will not help at this time.
3 weeks
170
A 68-year-old woman fell and sustained a displaced femoral neck fracture. She is a community ambulator and enjoys playing tennis weekly. Which treatment will provide her with the best hip function?
total hip arthroplasty
171
In children and adolescents, the piriformis fossa is close to the ascending branch of the *** and the lateral epiphyseal vessels,
medial femoral circumflex
172
In children and adolescents, the piriformis fossa is close to the ascending branch of the medial femoral circumflex artery and the ***
lateral epiphyseal vessels,
173
this is partial intra-artciular fx of the base of the thumb?
bennet fx
174
this is a complete intra-articular fx of the base of the thumb?
rolando
OB
175
what inn the adductor pollicis?
ulnar n
176
this ligament spans the trapezium to the volar edge of 1st MC?
volar beak ligament
177
how get roberts view of thumb?
arm in full pronation with dorsum of thumb on the cassette
178
Rolando fracture with >1mm displacement and major soft tissue injuryseverely comminuted fractures with major soft tissue injury or impacted articular fragmentsBennett, Rolando, or severely comminuted fractures with fragments too small for ORIFtreat how?(2)
distraction and ex fix
179
what ligament disrupted in dorsal thumb cmc dx? what just peeled?
dorsoradial ligament(anterior oblique is peeled)
180
this ligament resists valgus load with the thumb in flexin?
proper collateral ligament
181
this ligament resists valgus load with the thumb in extension?
accessory collateral
182
how treat chronic thumb collateral ligament injury? (2)
reconstruction or adductor advancement
183
what will happen to stener lesion if no surgery?
won't heal
184
Unopposed pull of the flexor digitorum profundus leads to what deformity?
clawing
185
when do surgery for hand mucous cyst?
if causing pain
186
when do wafer procedure for a TFCC tear(ie what anatomic factor exists)?
if positive ulnar variance
187
most common site of fracture from a metastatic bone lesion?
proximal femur
188
what part of the spine most common sites of metastatic bone disease?
thoracic spine
189
what cell type is increased in metastatic bone disease and cause for osteolysis?
osteoclasts
190
what xr view good for looking at the metacarpal head?
brewerton view
191
how get brewerton view? (how finger flexed, hand positioned, what about xr tube position)
MP flexed 65
dorsum of the hand on the platetube
angled 15 degree ulnar to radial
192
most common complication of articular metacarpal head fractures?
stiffness
193
Most important cord in dupuytren disease?
spiral
194
what type of finger contracture caused by the spiral cord?
PIPJ
195
pretendinous bandspiral bandlateral digital sheetGrayson's ligamentare components of what?
spiral cord
196
what causes MCPJ contracture in dupuytren?
central cord
197
this causes DIPJ contracture in dupuytren disease?
retrovascular cord
198
what type of contracture does the natatory cause in dupuytren?
web space
