Orthopaedics

Front 1

Main causes of osteoporosis (Dr. Lu).

Back 1

1. Obesity.
2. Trauma.
3. Malalignment

Front 2

What is Hill-Sachs defect?

Back 2

A dent in the posterior aspect of the humeral head due to anterior shoulder dislocation.

Front 3

What is a Bankart lesion?

Back 3

Torn labrum and anterior inferior glenohumeral ligament due to traumatic shoulder dislocation.

Front 4

Grading of AC separation.

Back 4

Grade 1: AC ligament stretched but not torn
Grade 2: AC ligaments torn but coracoclavicular ligament intact. Radiographs show clavicle > 50% elevated with respect to acromion, but not completely above it
Grade 3: both sets of ligaments torn. Radiographs show clavicle to be entirely above the acromion
Grade 4: clavicle buttonholes backward through the trapezius
Grade 5: deltoid and trapezius are pulled off the clavicle in addition to ligaments being torn
Grade 6: clavicle is trapped beneath the acromion

Front 5

Classification system for lateral malleolar fractures.

Back 5

Type A - below level of ankle joint.
Type B - at level of ankle joint.
Type C - above level of ankle joint.

Front 6

What x-ray finding may you look for in association with an ACL tear?

Back 6

Segond fracture: avulsion fractures of the lateral aspect of the proximal tibia

Front 7

What is a Galeazzi fracture?

Back 7

Displaced fracture of the distal radius accompanied by dislocation of the distal ulna.

Front 8

What is a Monteggia fracture?

Back 8

Displaced fracture of proximal ulna, accompanied by dislocation of the radial head.

Front 9

Sail sign

Back 9

Superior displacement of fat pad from anterior olecranon fossa, suggestive of a radial head fracture

Front 10

What medication increases the risk of tendon rupture?

Back 10

Fluoroquinolones

Front 11

What is Shenton's line on x-ray?

Back 11

Line formed by inferior aspect of superior pubic ramus and medial aspect of the upper femur.
Should be a smooth curve.
If there is sharp angulation, the patient could have a femoral neck fracture.

Front 12

What is Freiberg's infraction?

Back 12

Avascular necrosis of the 2nd metatarsal head.

Front 13

Treatment for Leg Calve Perthes disease.

Back 13

Non-weight bearing
Splint hip in abduction to prevent deformity.
May need surgery, since the femoral head can be deformed and not fit in the acetabulum.

Front 14

What are risk factors for developing avascular necrosis?

Back 14

Alcohol abuse
Systemic steroids
After hip dislocation, septic arthritis, or subcapital hip fractures
Caisson disease (nitrogen bubbles in divers)
Gaucher disease
Sickle cell anemia
Hyperlipidemia

Front 15

What is a big complication of femoral shaft fractures?
What is the treatment?

Back 15

Fat embolism syndrome.
Thomas splint, then surgery to insert intramedullary rod.

Front 16

What is the natural history of nerve root compression due to lumbar disc herniation?

Back 16

After 6 weeks, 80% will have spontaneous recovery.
After 6 months, 95% will have spontaneous recovery.

Front 17

Complications of long-standing impingement syndrome.

Back 17

Tendonitis of the rotator cuff or long head of biceps, leading to tears/rupture.

Front 18

Most common causes of rotator cuff tears.

Back 18

1. Impingement syndrome (chronic)
2. Shoulder instability (unidirectional or multidirectional)
3. Trauma

Front 19

Pathophysiology of calcific tendonitis.

Back 19

Rotator cuff tendon spontaneously degenerates and calcium deposits in the tendon. The calcium eventually resorbs and may result in acute phase of calcific tendonitis with severe pain for about 3 weeks.

Front 20

Which population is adhesive capsulitis more common in?

Back 20

Women.
Diabetes.

Front 21

Treatment of adhesive capsulitis.

Back 21

• No treatment has been shown to affect natural history
• NSAID and Tylenol for pain
• Steroid injections and physiotherapy do not help

Front 22

Causes of posterior shoulder dislocation.

Back 22

Violent internal rotation of the arm due to the 3 E's:
Epilepsy
Ethanol withdrawal
Electrocution

Front 23

Most important complication of shoulder separation

Back 23

Brachial plexus injury (C5,6)

Front 24

Which nerve and artery might be injured in a supracondylar fracture?

Back 24

Median nerve and brachial artery.

Front 25

What is a Essex-Lopresti lesion?

Back 25

Fracture of the radial head with disruption of the distal radioulnar joint. Diagnose with distal radioulnar joint manipulation/palpation.

Front 26

Treatment of carpal tunnel syndrome.

Back 26

Treat systemic conditions if bilateral carpal tunnel
- DM
- Hypothyroidism
- Renal failure
May improve after pregnancy
Splinting wrist in neutral position may help
NSAIDs
Steroid injections may help
Ergonomic evaluation of workstation
Carpal tunnel release

Front 27

Which tendons are involved in DeQuervain tenosynovitis?

Back 27

Abductor pollicis longus tendon
Extensor pollicis brevis tendon

Front 28

Treatment of stenosing tenosynovitis.

Back 28

NSAID
Passive stretching
Steroid injection
Surgery - release the a1 pulley

Front 29

Which nerve can be damaged with a Colles fracture?

Back 29

Median nerve

Front 30

Most common cause of nerve root compression in the cervical spine.

Back 30

Osteophytes narrowing the intervertebral foramina.

Front 31

What is considered a risky width of cervical spinal canal in terms of causing spinal cord compression?

Back 31

If < 13 mm or < 0.82 of the width of the vertebral body, spinal cord compression can occur

Front 32

Indications for surgery for a prolapsed lumbar disc.

Back 32

Progressive worsening of neurologic deficit
Unacceptable neurologic deficit to the patient
Intractable pain

Front 33

Risk factors for septic discitis.

Back 33

IV drug user
Urinary tract manipulation
Dental extractions
Any pyogenic infection

Front 34

What are the non-operative management options for impingement syndrome?

Back 34

- Avoid activities such as overhead work or lifting
- Shoulder capsule stretching
- Scapular muscle and core strengthening
- Rotator cuff strengthening
- NSAID and ice
- Subacromial injection of corticosteroids

Front 35

In addition to the subscapularis muscle, there are a number of other muscles that facilitate shoulder internal rotation. Which are these?
How do you isolate the subscapularis muscle?

Back 35

Teres major, pec major, latissimus dorsi.

Lift off test.

Front 36

How long does frozen shoulder typically last?

Back 36

12-24 months

Front 37

In which area of the clavicle are fractures more unstable? Proximal or distal?

Back 37

The more distal, the more unstable and can require surgery if displaced > 1 cm.

Front 38

How long should a scaphoid fracture be splinted for?

Back 38

6-8 weeks

Front 39

How do you test the proper and accessory ligaments of the thumb's UCL in isolation?

Back 39

30 degree flexion: proper ligament
Extension: accessory ligament

Front 40

Risk factors for Legg Calve Perthes disease

Back 40

Factor V Leiden
Inherited coagulopathies
Prenatal or second hand smoke exposure

Front 41

Classification of hip fractures

Back 41

Type A -stable #, pelvic ring is either not disturbed or injury limited to structures anterior to hip joints

Type B - horizontally unstable, but vertically stable

Type C - horizontally and vertically unstable

Front 42

Tests for IT band friction syndrome.

Back 42

Noble's test: when knee is brought from flexion to extension, there is pain as it passes 30-40 degree flexion, and pressure is applied over lateral epicondyle

Ober's test: pt lies on left side, right hip is abducted and extended with knee bent to 90 degrees, his thigh cannot adduct across the midline

Front 43

Positive Wilson's test.

Back 43

Osteochondritis dissecans (AVN of a fragment of subchondral bone).
(When knee is brought to full extension while foot is externally rotated, knee is pain free. When knee brought to full extension with knee in internal rotation, there is pain).