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54 Cards in this Set
- Front
- Back
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Femoral Neck Fracture Protocol
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- 45%
- Internal fixation (if there is no vascular damage) - MOSTLY Hemiarthroplasty if there are vascular breakages (HIP REPLACEMENT) |
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Intertrochanteric hip Fracture
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- 45%
- Cancellous bone 6 weeks healing - greater cells and blood supply than femoral neck - Compression hip screw or intramedullary rod |
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Subtrochanteric Hip Fracture
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- 10%
- corical bone (3-4 wks healing time) - high forces - intramedullary fixation |
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What is a non-union
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hip fracture that does not heal
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Bite wounds most common infectious bacteria
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Staph and Strep
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If you get bit and then there is streaking, the most likely culprit is
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staph
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Cats give you ___ through their bites? Treat with?
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Pasturella.
Treat with Augmentin |
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Humans give you _ with their bites? Treat with?
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Eikenella
Penicillin |
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How to treat bite wounds
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IV antibiotics
Tetanus X-rays or ultrasounds (glass/wood) Elevation Immobilization Rabies |
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Envenomation occurs within what time period?
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4hrs. If assymptomatic after that then no venom.
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What is myoglobinuria?
When does it start and peak? What do you see on labs? How do you treat? |
Presence of myoglobin in urine seen with muscle destruction.
Begins 4 hrs after muscle ischemia Peaks 3 hrs after reperfusion See a creatine spike Treat: maintain urine output, alkalinize urine |
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Do you treat bite wounds with surgery
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Yes, debridement.
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What is the worry with fight bites?
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Clenched fist into mouth leads to tooth through extensor tendon into MP joint.
- MUST EXAMINE tendon with fingers extended and closed. Treat with debridement of MP joint and tendon repair |
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Scaphoid fracture -
how does it happen, how does it present, what do you do? |
fall on outstretched hand
pain in snuff box region splint and recheck in 7-14 days |
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most common compression neuropathies in upper extremity
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Median nerve at carpal tunnel
Ulnar nerve at cubital tunnel Ulnar nerve at Guyons Canal (near hook of Hamate) |
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Risk factors for carpal tunnel
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Vibration (jack hammers, etc), occupatin, RA, DM, hypothyroid, pregnancy, weight gain and masses. RA bc there is thickening around tendon and DM for the same reason + peripheral neuropathy
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Where do you find numbness in carpal tunnel?
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distribution of median nerve.
Start dropping things, have Thenar weakness (can't oppose thumb), trouble buttoning and with earings |
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test of carpal tunnel
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Phalen = press back of hands together (can't do for longer than 15-20 sec)
Tinnel = tap on it and it will hurt |
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treatments for carpal tunnel
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neutral wrist position (night splinting and activity modification)
decreased volume canal (steroids, weight loss) |
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Rhabdomyosarcoma is often seen in which population
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kids
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synovial sarcoma is seen in which population
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young adults
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liposarcoma and MFH are seen in who?
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older adults
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What is especially important when grading a tumor
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necrosis and mitotic rate = high grade
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staging in sarcomas is determined by
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size.
<5cm - 30% with metastasis >20cm - 80% will have metastasis |
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Nodular Fasciitis
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Self limited fibroblastic proliferation
Tissue culture fibroblast, myxoid stroma, conspicuous nucleoli, mitoses present low reoccurance and sometimes spontaneouslu regress |
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Myositis Ossificans
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post-traumatic bony metaplasia
adolescents/young adults swollen/painful --> hard, well demarcated bony mass Differential = osteosarcoma |
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Fibromatosis
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infiltrative fibrobast proliferations
disfiguring, disturb function, may recur 1-15cm in size, grey-white and firm, rubbery and poorly demarcated Histo: myofibroblast, plump cells, broad sweeping fasicles, penetrate adjacent tissue, infrequent mitoses, early lesions are CELLULAR, later are less cellular with abundant collagen |
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Superficial fubromatosis
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usually men
deformation of hand, foot, penis Eponyms: Palmar = Dupuytrens Contracture; Penile = Peyronie's Disease |
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Deep Fibromatoses
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20s and 30s.
Muscles of trunk or extremities APC gene mutation Beta Catenin gene overexpression Some responsive to Tamoxifen Gardner syndrome |
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Desmoid Tumors
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Deep fibromatoses of the abdomen.
Can be deadly after repeat resections and recurrances |
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Treatment of fibromatoses
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Some superficial ones may stabilize
Resection, but often recur repeatedly Some respond to Tamoxifen Others insensitive to chemo/radiation |
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Fibroma
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rare benign lesion
well demarcated white nodule mature fibroblasts and copious collagen |
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Benign Fibrous Histiocytoma
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dermatofibroma
common benign lesion bland mature fibroblasts with interlacing histocyte-like cells |
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Fibrosarcoma
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adults, deep tissue of thigh, knee, retroperitoneum
50% reoccur and can metastasize to lungs slow growing gross: soft, unencapsulated and infiltrative histology: varied - bland like fibromatosis. Cellular with HERRINGBONE PATTERN |
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Herringbone pattern =
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Fibrosarcoma
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Malignant fibrous histiocytoma
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histologically represents a variety of sarcomas
Pleomorphic, bizarre giant cells Storiform swirling architecture necrosis, hemhorrage, many mitoses DIAGNOSIS OF EXCLUSION (pleomorphic sarcoma NOS). Doesn't stain histiologically |
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Lipoma
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most common soft tissue tumor of adults
slowly enlarging, painless, mobile mass gross: soft, yellow, encapsulated histology: mature adipocytes |
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Liposarcoma
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Adult 5th and 6ht decades
deep soft tissues or viscera slightly more tan white than normal fat, have hemhorrage or necrosis histology varies but is prognostically importnat PROGNOSTIC = LIPOBLAST |
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mxyoid, well-differentiated, Round cell and pleomomorphic liposarcoma
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both typically indolent
well differentiated = primary of mature adipocytes with some identifiable lipoblasts myxoid type = distinctive histologic appearance with blueish myxoid background matrix and prominent chicken wire vasculature Round cell and pheomorphic = agressive, reoccur after excision and metastasize to lungs |
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chicken wire vasculature
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myxoid liposarcoma
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liposcarcomas - mutations
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well differentiated: MDM2 gene increased transcription --> product binds and inactivates p53
Myxoid: CHOP and FUS gene |
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Leiomyoma
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Benign smooth muscle tumors
Uterine fibroids most common grossly: well circumscribed, tan to white whorled out cut surface histologically: bands of smooth muscle running in various directions, not mitotic activity can excise without recurrance Stains for desmin |
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Leiomyosarcoma
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Adults, more females
firm painless masses on skin deep tissues of the extremities with a change in function retroperitoneum with abdominal symptoms Histology: spindle cells with cigar shaped nuclei + mitoses interweaving fascicles |
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treatment for leiomyosarcoma
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excision and radiation
prognosis - cutaneous = easy retroperitoneal = large, difficult to excise, death via local extension or metastases |
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Rhabdomyoma
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benign lesion
very rare infants or children and involving the heart |
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Rhabdomyosarcoma
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malignant lesion in adolescents and children (most common soft tissue neoplasm)
head/neck or genitourinary gross: depends on location hollow organs - gelatinous, grape like; solid tissues - infiltrating mass diagnostic cell = rhabdomyoblast may be elongated or round may look like small round blue cell if poorly differentiated, so histochemistry is needed |
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Rhabdomyoscarcoma
Histology: pattern varients are prognostic |
Embryonic, pleomorphic, alveolar
better -> mid -> worse prognosis |
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Mutations in rhahdomyosarcoma
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PAX3 gene on chromosome 2
FKHR gene on chromosome 13 chimeric protein likely disregulates skeletal muscle differentiation |
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strap cells and bundles
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rhabdomyosarcoma
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Synovial sarcoma
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not composed of synovial cells
young adults 20-40 deep soft tissue around joints of extremities (60-70% around the knee) histology: usually biphasic - spindle cells and epithelial-like cells; monophasic: entirely spindle cells (both positive for cytokeratins) metastasize to lung, bone, lymph nodes |
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cytokeratin positive in
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synovial sarcoma
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SSX1 or SSX2 gene indicates poorer prognosis
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SSX1
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Treatment for synovial sarcomas
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limb-sparing surgery
chemotherapy |
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mutations in synovial sarcoma
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translocations t(X; 18) with fusion of SSX (transcription inhibitor) /SYT (transcription factor)
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