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Orthopedics Flashcards

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1
Q

dx of developmental dysplasia of the hip

A

sonogram. hip not yet calcified.

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2
Q

tx of developmental dysplasia of the hip

A

abduction splinting with pavlik harness for 6 mos

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3
Q

6 year old presenting with limping and decreased hip motion with hip/knee pain

A

avascular necrosis of the femoral epiphysis

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4
Q

tx of legg-calve perthes disease

A

controversial. casting with crutches to contain femoral head inside acetabulum

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5
Q

dx of legg calve perthes

A

AP and lateral hip x rays

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6
Q

chubby or lanky boy at age 13 with groin/knee pain and limping. sole of foot is inverted. Physical exam shows external rotation of the hip with flexion

A

slipped capital femoral epiphysis

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7
Q

dx and tx of slipped capital femoral epiphysis

A

X ray

Treat emergently with surgical treatment pins

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8
Q

toddler with febrile illness refuses to move the hip. Hip is held in flexed, abducted, and externally rotated.

what test should you get?

A

ESR
aspiration of the hip fluid for WBC
This is likely septic hip

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9
Q

kid is febrile then has severe localized bone pain with no history of trauma

A

acute hematogenous osteomyelitis

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10
Q

dx of hematogenous osteomyelitis

A

MRI

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11
Q

genu varum tx

A

Bowlegs

–normal up to age 3

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12
Q

persistence of varus beyond age 3

A

blount disease caused by problem with medial tibial growth plate. this can be corrected surgically

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13
Q

tx for genu valgus

A

normal between age 4-8. No treatment.

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14
Q

teen ager with pain over tibial tubercle worse with contraction of the quadriceps

A

Osgood-Schlatter disease

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15
Q

tx for osgood schlatter disease

A

RICE

cylinder cast

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16
Q

scoliosis usually seen in

A

adolescent girls. dx by asking girl to bend forward.

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17
Q

tx of scoliosis

A

bracing. Can lead to decreased pulmonary function if not treated.

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18
Q

why are childhood fractures less morbid?

A

healing process is faster and much more remodeling occurs. This is not true if a growth plate is affected

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19
Q

Child falls to the ground with elbows hyperextended. What kind of fracture would you suspect? Tx?

A

supracondylar fracture of humerus

Tx: casting and traction, not surgery

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20
Q

fracture of supracondylar fracture–sequelae?

A
  1. vascular/nerve injury

2. compartment syndrome

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21
Q

Fractures of the growth plate–tx?

A

reduction of the epiphyses. If growth plate is broken, you need to align it very carefully

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22
Q

most common primary malignant bone tumor

A

osteogenic sarcoma

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23
Q

sunburst pattern on x ray around the lower femur or upper tibia

A

osteogenic sarcoma

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24
Q

onion skinning on x ray

A

ewing sarcoma

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25
malignant bone tumors in adults are metastatic from
1. breast in women | 2. prostate in men
26
best dx of bone tumor--imagin?
MRI then CT then Xray
27
difference between breast and prostate bone metastases
prostate=blastic lesion | breast=lytic lesion
28
treatment of multiple myeloma
chemo and thalidomide
29
soft tissue sarcoma characteristics
soft tissue mass that grows continuously. Firm and fixed to surrounding structures.
30
soft tissue sarcomas metastasize to
The lungs
31
Most common shoulder dislocation
anterior dislocation of shoulder
32
pt holding arm close to body and rotated outward with numbness over the deltoid
anterior dislocation of the shoulder
33
When do you get a posterior shoulder dislocation?
epileptic seizure or electrical burn
34
presentation of someone with a posterior shoulder dislocation?
close to the body and internally rotated
35
dinner fork wrist
colles fracture
36
typical pt for colles fracture
old osteoporotic woman
37
tx for colles fracture
closed reduction and long arm cast
38
Monteggia fracture
fracture of the proximal ulna with anterior dislocation of the radial head. Usually after a direct blow to the ulna
39
Galeazzi fracture
distal third of radius fractured and dorsal dislocation of the distal radioulnar joint
40
treatment of monteggia and galeazzi fractures?
broken bone=open reduction and internal fixation | dislocated joint=closed reduction
41
YA falls on outstretched hand. wrist pain. tenderness to palpation over the anatomic snuff box
fracture of the scaphoid.
42
tx for scaphoid fracture
thumb spica cast
43
What do the X rays show in a scaphoid fracture?
negative usually. May show up 3 weeks later
44
tx for a scaphoid fracture
open reduction and internal fixation if original x rays show a displaced fracture
45
pt punches a wall in a far and the hand looks swollen and tender.
metacarpal neck fracture
46
tx for a bad metacarpal fracture
kirschner wire/plate fixation
47
tx for a mild metacarpal fracture
closed reduction and ulnar splint
48
old woman falls and affected leg is shortened and externally rotated
hip fracture
49
tx for a femoral neck fracture
femoral head prosthesis
50
intertrochanteric fracture tx
open reduction and internal fixation
51
risk of intertrochanteric fracture?
CVT and pulmonary emboli from immobilization
52
risk with femoral neck fracture?
avascular necrosis of the femoral head
53
tx of femoral fracture
rod fixation.
54
tx of a closed femoral shaft fracture
treat shock and external fixation
55
tx of an open femoral shaft fracture
OR cleaning and closure within six hours. an emergency
56
Lachman test
hold the knee at 20 degrees Hold onto the thigh and pull the leg --similar to anterior drawer test
57
tx of ACL tear
sedentary pt: immobilization and rehab | athletes: arthroscopic reconstruction
58
knee injury with catching and locking limiting motion and a "click" with extension.
meniscal tear
59
tx of meniscal tear
repair surgically OPEN and save as much meniscus as possible. Complete removal of meniscus leads to degenerative arthritis
60
THe triple threat knee injury
medial meniscus, medial collateral, and ACL
61
young man with tenderness to palpation on tibia. X rays are normal
tibial stress fracture
62
tx of a tibial stress fracture
cast and repeat x rays
63
Pt has increasing pain in leg after a long leg cast
remove cast, look for compartment syndrome
64
tx of achilles tendon rupture
casting in equinus position OR surgical intervention=quicker cure
65
Pt falls on inverted/everted foot
fracture of both malleoli occurs
66
tx of fractured ankle
open reduction and internal fixation
67
Causes of compartment syndrome
prolonged ischemiad with reperfusion | crush injuries
68
pt has very tender lower leg to palpation and excruciating pain with passive extension. Normal pulses.
compartment syndrome.
69
tx of compartment syndrome
emergency fasciotomy
70
Pt in a car crash, head on. Pt has hip pain and leg is short, adducted, and internally rotated
posterior dislocation of hip fracture, hip is externally rotated
71
tx of posterior hip dislocation
avascular necrosis
72
gas gangrene tx
IV penicillin surgical debridement hyperbaric oxygen
73
Pt unable to dorsiflex the wrist. What nerve is injured?
Radial nerve
74
What kind of fracture causes radial nerve damage?
distal humeral fracture
75
how do you treat radial nerve damage?
Can reduce fracture and then cast. If does not resolve, the nerve is entrapped and you need to intervene surgically
76
What test do you need before performing surgery on carpal tunnel?
electromyography
77
woman wakes up in the middle of the night with a finger flexed. uses other hand to extend finger with a painful snap. dx? tx?
dx: trigger finger tx: steroid injection
78
a young mother comes in with pain along the radial side of the wrist. dx?
de quervain tenosynovitis
79
test for de quervain--how can the pain be reproduced?
hold thumb inside closed fist | ulnar deviation
80
tx for de quervain
First line=splint | splint and antiinflammatory agents
81
pt had an injury 2 weeks ago in the finger but never treated it. Now it's throbbing and pt has a fever
Felon--abscess in the pulp of fingertip
82
tx for felon
surgical drainage
83
older norwegian man presents with palmar nodules and contracture of the palm
dupuytren contracture
84
tx of dupuytren contracture
surgery if hand cannot be placed flat on a table
85
Skiier hyperextends thumb. On PE, collateral laxity at metacarpophalangeal joint
gamekeeper thumb
86
tx of gamekeepr thumb
cast it. If untreated, can lead to arthritis
87
football player grabs one of his teammates by the jersey and his finger is forcefully extended. When making a fist, the injured finger does not flex
Jersey finger--injury to the flexor tendon.
88
a volleyball player hurts a finger when it's forcefully flexed by the ball. TIp of finger remains flexed when hand is extended.
mallet finger. rupture of the extensor tendon.
89
tx for mallet finger
splinting
90
45 year old pt presents with months of vague aching back pain. Then sudden severe "electric shock" pain shooting down the leg exiting on the side of the big toe. Which is the level of disc herniation?
L4-L5
91
45 year old pt presents with months of vague aching back pain. Then sudden severe "electric shock" pain shooting down the leg exiting on the side of the little toe. Which is the level of disc herniation?
L5-S1
92
45 year old pt presents with months of vague aching back pain. Then sudden severe "electric shock" pain shooting down the leg exiting on the side of the little toe. The pain is not worse with coughing, sneezing or defecating. What etiology is ruled out?
NOT a disc herniation! Should be worse with increases in intra-abdominal pressure
93
Treatment for lumbar disc herniation
bed rest 3 weeks nerve blocks surgical if neurodeficits like muscle weakness
94
what is an emergency indication for surgery in someone with a herniated lumbar disc?
cauda equina syndrome=distended bladder, flaccid rectal sphincter, perineal saddle anesthesia
95
elderly person with weight loss and back pain that is not better with rest or positional changes
metastatic malignancy
96
where do you find ulcers from arterial insufficiency?
tips of the toes. Compare with diabetic ulcers, which happen at the pressure points.
97
treatment for ulcers of arterial insufficiency
doppler study/CT or MRI angio | THen surgical revascularization or stents
98
pt has edematous, indurated, hyperpigmented skin above the medial malleolus. Painless. pt has varicose veins
venous stasis ulcers
99
what scan do you want to work up a venous stasis ulcer?
duplex scan
100
tx of venous stasis ulcers
compression stockings. surgery endovascular laser/radiofrequency ablation
101
Pt has a chronic leg ulcer from 3rd degree burns or chronic draining sinus. Suddenly, a dirty and deeper ulcer appears with tissue growth around the edges. dx?
marjolin ulcer=SCC | Biopsy to confirm
102
tx of marjolin ulcer
wide local excision and skin grafting
103
overweight pt with heel pain
plantar fasciitis
104
what do you see on xray of plantar fasciitis?
bony spur. Note that the spur is not causing the pain
105
tx for plantar fasciitis?
symptomatic. Will resolve in 12-18 mos
106
Woman comes in with a tender spot between third and fourth toes. She wears high heeled shoes every day
Morton neuroma=inflammation of common digital nerve.
107
tx of morton neuroma
analgesics/shoes | can have surgical excision

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