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Orthopedics
Surgery
| Question | Answer |
|---|---|
| 1. Newborn with hips that can be easily dislocated. 2. What test is diagnostic? | 1. developmental dysplasia of the hip 2. sonogram if age < 4 years; X-ray if age > 4 years. |
| 1. 6 year old with chronic limb, decreased hip motion and hip pain. 2. What test is diagnostic | 1. Legg-Perthes disease 2. AP and lateral X-rays |
| 13 year old with groin pain; out toeing (external rotation of the foot) | slipped capital femoral epiphysis |
| 1. Toddler with fever and refusal to move hip 2. What test is diagnostic? | 1. septic hip 2. aspiration of hip under general anesthesia |
| 1. Child with fever and severe bone pain 2. What test is diagnostic? | 1. osteomyelitis 2. MRI |
| 1. What is Genu varum? 2. At what age is it no longer normal? | 1. bow-legs 2. normal up to age 3 |
| 1. What is Genu valgus? 2. At what age is it no longer normal? | 1. knock-knee 2. normal from ages 4-8 |
| What disorder causes genu varum beyond age 3? | Blount disease (a disturbance of the medial proximal tibial growth plate) |
| Teenager with persistent pain over the tibial tubercle | Osgood-Schlatter disease |
| What is the treatment for club foot? | serial plaster casts |
| What is the exam for scoliosis? | hump is noted over the right thorax when patient bends forward |
| 1. Young patient with bone tumor around knee. Sunburst pattern on X-ray. 2. Onion skinning | 1. Osteogenic sarcoma 2. Ewing's sarcoma |
| Bone tumor at the diaphysis in a child. | Ewing's sarcoma |
| Lytic or blastic lesion: 1. bone metastasis from breast 2. bone metastasis from prostate | 1. lytic 2. blastic |
| Older male with fatigue, anemia and several localized areas of bone pain. | multiple myeloma |
| After trauma, patient holds arm close to his body but rotated outward as if they were going to shake hands. | anterior dislocation of the shoulder |
| Painful wrist after fall on an outstretched hand. X-ray shows fractured distal radius | Colles fracture; treat with closed reduction and cast |
| Fracture of proximal ulna with anterior dislocation of the radial head | Monteggia fracture |
| Fracture of the distal radius with dorsal dislocation of the radioulnar joint | Galeazzi fracture |
| Patient fell on outstretched hand. Pain over the anatomic snuff box. | Fracture of the scaphoid (carpal navicular) |
| Which ligament is disrupted by a medial blow to the knee? | lateral ligament |
| What is at risk with supracondylar fracture of the humerus | avascular necrosis |
| Triad knee injury | 1. medial meniscus 2. medial collateral 3. anterior cruciate |
| Patient who runs marathons has tenderness to palpation over inside of lower leg but normal x-ray | tibial stress fracture should be treated with a cast and repeat the x-ray in 2 weeks |
| What is the most reliable finding if a patient has suspected compartment syndrome? | excruciating pain with passive extension |
| What is a Volkmann's contracture? | final sequence of avascular necrosis or compartment syndrome. Dead muscle is replaced by fibrous tissue. |
| 1. trauma patient presents with shortened leg, adducted and internally rotated 2. trauma patient presents with shortened leg, adducted and externally rotated | 1. posterior dislocation of hip 2. fractured hip |
| Patient with chronic back pain and diarrhea. | Ankylosing spondylitis (HLA B27 associated with inflammatory bowel disease) |
| How do you test for sponylolysis? | FABER test (hip Flexion, ABduction, and External Rotation) - place patients left foot on contralateral knee - press down on the left knee to try and reproduce sacroiliac pain |
| What 3 things contributes to diabetic leg ulcers? | 1. neuropathy is initial cause 2. microvascular insufficiency prevent healing 3. relative immunosuppression lead to infection |
| Patient fell on outstretched hand and has tenderness over anatomic snuff-box. What is the management: 1. negative x-ray 2. displaced and angulated fracture on x-ray | both are fractures of the scaphoid bone 1. needs a cast and repeat x-ray in 2-3 weeks 2. needs open reduction and internal fixation |
| Posterior dislocation of the knee. What is the management? | danger of trauma to the popliteal artery. Attention given to peripheral pulses, doppler studies or CT angio and prompt reduction. |
| Where do the following typically arise in an adolescent? 1. osteogenic sarcoma 2. Ewing sarcoma | 1. around the knee (lower femur or upper tibia) 2. diaphysis of long bones |
| 1. Child not moving arm for fear of pain after mother forcefully pulled it. 2. Management | 1. subluxation of the radial head 2. closed reduction |
| Patient with heel pain every time their foot strikes the ground. | Plantar fasciitis |
| Patient with pain in the 3rd/4th toes, that is reproducible with palpation. | Morton neuroma |
| Women injures knee while hiking. Swelling develops over the next day. What structure is most likely injured? | Meniscal injuries, as opposed to ligaments, have a poor blood supply and swell over 24 hours. Ligamental injuries swell much faster from hemarthroses. |
| What is the difference in femoral neck and intertrochanteric fractures in management and severity? | 1. femoral neck fractures compromise vascular supply and are treated with femoral head prosthesis 2. intertrochanteric fractures are treated with open reduction and pinning |
| Bone tumor that produces pain relieved by aspirin | osteoid osteoma |
| 1. Most common injures muscle of the rotator cuff. 2. What movement does the muscle have? | 1. supraspinatus 2. abducts arm past 90 degrees |
Created by:
amichael@siumed.edu
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