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Orthopedics

Surgery

QuestionAnswer
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