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USMLE2 Surgery 3
Ortho
| Question | Answer |
|---|---|
| uneven gluteal folds, hips in a child that "clicks and snaps." what is it? How to dx it? How to tx it? | Developmental dysplasia of the hip. Clicking is the posterior dislocation of the hip and the snap is it returning to normal position. Dx by US (not xray - since cartilage not seen well on xray). Tx is splinting and Pavlik harness in abduction. |
| Hip pathology generally presents with what? (2) | either hip pain OR knee pain |
| child age 6, insidious development of limping, decreased hip ROM, antalgic gait. What is it? How to dx? And how to tx? | Legg-Perthes (avascular necrosis of the capital femoral epiphysis). Dx with hip xrays. Tx with casting and crutches. |
| Chubby (or lanky) boy age 13, L groin or knee pain, limping. When sitting w legs dangling, sole of L foot points toward R foot. When hip is passively flexed, thigh goes into ext rot and can't be internally rotated. What is it? How to dx? And how to tx? | Slipped capital femoral epiphysis (orthopedic emergency!! Because can lead to avascular necrosis). Dx with xray. Tx with surgical pinning of the femoral head in place |
| Toddler after a febrile illness refuses to move hip. Hold the leg with the hip flexed in abduction and external rotation. What is it? How to dx? And how to tx? | Septic hip. Dx with aspiration of the hip under general anesthesia. Tx with open drainage if aspiration reveals pus. |
| Genu varum. What is it? What age is it normal? When would it not be normal? | Bow legs. Normal from 0 to 3 yo. After 3, most likely Blount disease (disturbance of medial proximal tibial growth plate) - tx with surgery. |
| Genu valgus. What is it? What age is it normal? How to treat? | Knock knees. Normal between 4 and 8. No tx. |
| How to tx Osgood Schlatter disease? | Osteochondrosis of tibial tubercle. Tx with immobilization in extension or cylinder case for 4 to 6 weeks. |
| Club foot (talipes equinovarus). How to tx? | Serial plaster casts. If not corrected after 6 to 8 months, surgical correction before age 2. |
| When would fractures in children be a bigger problem? | Humerus fractures that are supracondylar --> can lead to Volkmann contracture (claw hand 2/2 vascular/nerve injuries); fractures that involve the growth plate (2/2 uneven growth if growth plates aren't set perfectly evenly) |
| When would you have to surgically correct fracture in a child that involved the growth plate? | if growth plate is in >= 2 pieces. Need ORIF. |
| Sunburst pattern in bone in child 10 to 25 yo. | Osteogenic sarcoma. |
| Onion skinning in child 5 to 15 yo | Ewing sarcoma |
| Lytic bone tumor in a 50 yo woman. What should you check? | For breast CA because breast CA mets are lytic lesions in bone. |
| Blastic bone lesion in older man. What should you check? | PSA for prostate CA because that's how its mets present. |
| Punched out lytic bone lesions in old man with fatigue, anemia. | consider multiple myeloma; tx with chemo (in child, can do BMT). If chemo fails, can use thalidomide |
| How to tx a clavicular fracture? | figure of 8 immobilization device for 4 to 6 weeks |
| Most common shouler dislocation. How would the pt present? How to dx? | anterior; pt holds arm close to body but rotated outward as if shaking hands; dx with xray |
| when would you get a posterior shoulder dislocation? | epileptic seizure or electrical burn - massive uncorrdinated muscle contractions |
| old osteoporotic woman falls on outstretched hand. What bone is broken and how to tx? | fracture of distal radius (Colles fracture), tx with closed reduction and long arm cast. |
| Pt was in altercation with police and arm was broken from hit by police nightstick as pt raised arm to protect his head. What is it and how to tx? | Monteggia fracture - proximal ulna is broken with anterior dislocation of radial head. Tx with ORIF. |
| young adult falls on outstretched hand, has wrist pain, tenderness to palpation over snuff box. X-ray negative. What is the problem and how to tx? | Fracture of the scaphoid bone. Tx with thumb spica cast. Xray will show fracture 3 weeks later. |
| young adult falls on outstretched hand, has wrist pain, tenderness to palpation over snuff box. X-ray shows displaced and angulated fracture of scaphoid. How to tx? | ORIF |
| Why are scaphoid fractures particularly dangerous? | high rate of non-union. |
| old person on a gurney with one leg shorter than the other and externally rotated | hip fracture |
| fracture of the femoral head - how to tx? | replacing femoral head with prosthesis - faster healing and earlier mobilization (this is because the femoral head has a very tenuous blood supply which causes slow healing) |
| how to tx intertrochanter fractures. What else should you treat for? | ORIF with pins. High risk for DVT and PE so post-op should get anticoagulation. |
| how to tx a fracture of the femoral shaft | intramedullary rod fixation. If it's an open fracture, it's an ortho emergency and needs to be cleaned and closed within 6 hrs. |
| person with BL fractures of the femoral shaft is at risk for what? | can lose enough bloods to go into shock |
| 2 tests for ACL injury. How to dx and treat? | anterior drawer test (knee flexed 90) and Lachman test (knee flexed 20). Dx with MRI. Tx sedentary pt with immobilization and rehab. Tx athlete with arthroscopic reconstruction. |
| How to dx meniscal tear in knee? | MRI |
| Knee catching and locking with movement | meniscal injury |
| What is a future complication of complete removal of the meniscus in the knee? | degenerative arthritis |
| Loud popping from ankle. What is it and how to tx? | Rupture of Achilles tendon. Tx with casting in equinus position or surgery. |
| What is broken in fracture of the ankle? How to dx and tx? | both malleoli. Dx with xray and Tx with ORIF if fragments are displaced. |
| Where does compartment syndrome occur most frequently? | forearm or lower leg |
| How to tx an open fracture | broken bone sticking out through wound. Must clean in OR and reduce within 6 hrs from the time of injury. |
| head on car collision and knees hit the dashboard - what injury to look for? How does this injury present? | posterior dislocation of the hip - leg shorthened on the stretcher, adducted, internally rotated. This is an emergency and needs reduction to avoid avascular necrosis (blood supply to the femoral head is very tenuous) |
| Tx for gas gangrene | IV PCN, surgical debridement, hyperbaric O2 |
| Pt can't dorsiflex wrist, but regains function when fracture is reduced. What to do? What if function is not regained after reduction? | Injury of radial nerve. If it gets better, no need for surgical exploration. However, if nerve paralysis doesn't get better after reduction --> entrapment of radial nerve and surgery is required. |
| Posterior dislocation of the knee. What should you worry about? | Injury to popliteal artery. Check pulses, Doppler, and arteriogram. |
| Pt falls from tall height and land on feet. What injuries must you think about beyond the obvious foot/leg fractures? | Lumbar or thoracic spine |
| What if the treatment for carpal tunnel syndrome? | Splints and anti-inflammatory agents. If that doesn't work, then EMG --> surgery. |
| How to tx trigger finger? | Finger flexed and can't extend it unless pull with it with the other hand. Tx with steroid injection. Surgery is last resort. |
| Old man of Norwegian descent has a contracture in the palm of his hand with nodules. What is it and what is the tx? | Dupuytren contracture. Surgery is only effective tx -- done when hand can no longer be placed flat on the table. |
| What is a felon? How to tx? | abscess in pulp of fingertip caused by neglecteing a penetration injury. Tx with surgical drainage or there will be tissue necrosis. |
| Gamekeeper thumb - how to tx? | injry of UCL (ulnar collateral ligament) caused by hyperextension of thumb. Tx is by casting. |
| Pt injures finger playing soccer and gradding opponent's jersey as he is running by. How does pt present and how to tx? | Jersey finger - injury when flexed finger is forcefully extended - injury of flexor tendon. Presents with not being able to flex the finger when the rest of the hand is in a fist. Tx with splinting. |
| What is the opposite of the Jersey finger? | Mallet finger - injury from extended finger being forcefully flexed (i.e. in volleyball) - rupture of extensor tendon. Tx with splinting. |
| Pt bends over and feels an electrical shock that shoots down the leg and exits on in the big toe. What is the tx? | Lumbar disc herniation. Tx is bed rest for 3 weeks, pain control. Surgery if neuro deficits are progressing. |
| Cauda equina syndrome | spinal cord injury that causes distended bladder, flaccind rectal sphincter, and perineal saddle anesthesia -- surgical emergency! |
| HLA B-27 associated with what? | Ankylosing spondylitis, uveitis, IBD. |
| ulcer at pressure point (heel, metatarsal heads, tips of toes) | diabetic ulcers |
| ulcer at the tip of toes, pale base, no granulation tissue | arterial insufficiency ulcer |
| ulcer in a leg that chronically edematous, indurated, and hyperpicmented, above the malleolus, painless, has granulation tissue | venous stasis ulcer |
| What should you evaluate a pt for when they have chronic foot ulcers? | DM and atherosclerosis |
| Older overweight pt who has disabling sharp heel pain every time foot strikes the ground, worse in AM, xray shows a bony spur matching location of pain, TTP over the spur. What is it and how to tx? | Plantar fasciitis. Tx with analgesic and rest. Will spontaneously resolve in 12 to 18 months. Surgical resection of the bony spur is NOT indicated. |
| nodule is palpated between the third and fourth toes in a woman who wears pointed high heel shoes every day. What is it and how to tx? | Morton neuroma - inflammation of the common digital nerve. Tx with analgesics and better shoes. Surgical excision can be done if still sxmatic. |
Created by:
christinapham
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