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33 Cards in this Set

  • Front
  • Back
What is the generic cause of osteopetrosis?

What is the generic cause of osteopetrosis?

the autosomal dominant forearm which is


non lethal caused by carbonic anhydrase II enzyme the

what cells are involved with osteopetrosis?

what cells are involved with osteopetrosis?

defect of osteoclast specifically osteoclast lack ruffled border and clear zone

what is the treatment osteopetrosis?

what is the treatment osteopetrosis?

the autosomal recessive which is malignant  is treated with high-dose calcitriol 1–25 hydroxy vitamin D and bone marrow transplant

autosomal dominant form  is treated with interferon gamma one beta

the autosomal recessive which is malignant  is treated with high-dose calcitriol 1–25 hydroxy vitamin D and bone marrow transplant


autosomal dominant form  is treated with interferon gamma one beta

with the classic x-ray findings for osteoporosis 3?

1-ERLENMEYER flask, 2-rugger jersy spine, 3-loss of medullary canal bone within the bone

1-ERLENMEYER flask, 2-rugger jersy spine, 3-loss of medullary canal bone within the bone

A 5-year-old boy has sustained multiple fractures since birth. A pelvis radiograph taken 4 years ago is shown in Figure A. A current spine radiograph is shown in Figure B. Which of the following describes the mode of inheritance of this disease?

...

A 5-year-old boy has sustained multiple fractures since birth. A pelvis radiograph taken 4 years ago is shown in Figure A. A current spine radiograph is shown in Figure B. Which of the following describes the mode of inheritance of this disease?


1.  Autosomal dominant


2.  Autosomal recessive


3.  X-linked dominant


4.  X-linked recessive


5.  Trinucleotide repeat

The radiographs demonstrate universal sclerotic bone and the classic rugger jersey spine of osteopetrosis. Also called marble bone disease, it is a group of disorders characterized by abnormal osteoclast function. Poor bone resorption results in d...

The radiographs demonstrate universal sclerotic bone and the classic rugger jersey spine of osteopetrosis. Also called marble bone disease, it is a group of disorders characterized by abnormal osteoclast function. Poor bone resorption results in dense, sclerotic bone susceptible to pathologic fracture. The infantile, also called "malignant," form of the disease is inherited in an autosomal recessive fashion (maps to chromosome 11q13). The adult, "benign," form of the disease is inherited in an autosomal dominant fashion. ans2

child presents with frequent fractures,  progressive deafness, severe anemia, macrocephaly, hepatosplenomegaly, dental abscesses


1what is the diagnosis?


2What is the defect?


 3 What is the genetics treatment?


4 what the x-rays look like in this patient?

1-the diagnosis is osteopetrosis

2-The defect is inactive osteoclast carbonic anhydrase

 3-the treatment for autosomal recessive high-dose Calcitrol 1, 25.hydroxy vitamin D and bone marrow transplant

4-the x-rays look like ERLENMEYER flask, ru...

1-the diagnosis is osteopetrosis


2-The defect is inactive osteoclast carbonic anhydrase


 3-the treatment for autosomal recessive high-dose Calcitrol 1, 25.hydroxy vitamin D and bone marrow transplant


4-the x-rays look like ERLENMEYER flask, ruggere Jersey spine, loss of medullary canal


 

where the osteochondral defect in the knee classic location?

posterior lateral aspect of the medial femoral condyle

posterior lateral aspect of the medial femoral condyle

if the patient has an OCD what correlates with successful nonoperative management and what correlates with a worse prognosis?

successful management correlates with younger age and open physis


Poor prognosis correlates with synovial fluid behind a lesion and lateral femoral condyle

what is Wilson's test?

Wilson's test is used to diagnose an OCD which is pain with internal rotating the tibia during extension of the knee between 90° and 30° and then relieving the pain with external rotation

what x-ray view is best to see OCD?

obtain in a tunnel notch view

what is the treatment of a child with open physis with an OCD?

restricted weightbearing and bracing

how to treat a patient who is vague knee pain mechanical symptoms and recurrent effusions positive Wilson's test?

diagnostic arthroscopylooking for an OCD

 Which area of the knee is most likely to be affected by a juvenile osteochondritis dissecans (JOCD) lesion?


1.  Lateral aspect of the medial femoral condyle


2.  Lateral aspect of the lateral femoral condyle


3.  Medial aspect of the lateral femoral condyle


4.  Medial facet of the patella


5.  Lateral facet of the patella

More than 70% of JOCD lesions are found in the “classic” area of the posterolateral aspect of the medial femoral condyle, with inferior-central lateral condylar lesions accounting for only 15% to 20% of cases and femoral trochlear lesions seen in less than 1%. The knee is the most common site of osteochondrosis in growing children, which is seen in an estimated 0.002% to 0.003% of knee radiographs.ans1

 An 11-year-old boy complains of 4 weeks of medial knee pain that began while playing tennis. Examination shows reproduction of pain with internal rotation of the tibia during extension of the knee, and relief of pain with tibial external rotatio...

 An 11-year-old boy complains of 4 weeks of medial knee pain that began while playing tennis. Examination shows reproduction of pain with internal rotation of the tibia during extension of the knee, and relief of pain with tibial external rotation. A radiograph and MRI is shown in Figures A and B. Which of the following is the most appropriate initial treatment? 


1.  Arthroscopic removal of fragment


2.  Arthroscopic open reduction and internal fixation


3.  Arthroscopic microfracture drilling


4.  Non-weight bearing for 6-8 weeks


5.  Full weight bearing with avoidance of athletic acticity

The radiograph and MRI show an osteochondritis dissecans (OCD) lesion on the medial femoral condyle. On the MRI image, the cartilage appears to be intact and the lesion is not displaced. A clear fluid line behind the fragment would indicate a poorer prognosis for healing with non-operative treatment. However, an initial period of non-operative treatment would be recommended for an intact lesion in a skeletally immature patient.
ans4

An 11-year-old boy presents with recurrent knee effusions and discomfort with athletic activity. A radiograph of the knee is shown in Figure A. What is the most important determinant of a successful outcome with nonoperative treatment?

1.  Weig...

An 11-year-old boy presents with recurrent knee effusions and discomfort with athletic activity. A radiograph of the knee is shown in Figure A. What is the most important determinant of a successful outcome with nonoperative treatment?


1.  Weight of the patient


2.  Presence of open physes


3.  Gender


4.  Location of the lesion within the knee


5.  A history of trauma to the affected joint

The radiograph is consistent with an osteochondritis dissecans (OCD) lesion in the most common location on the medial femoral condyle. ans2

what is the amputation rate with an oil-based paint injection injury?

amputation rate approaches 50%


Most cases require immediate surgical debridement, removal of foreign material, broad-spectrum antibiotics


Even higher rates of amputation are seen with with treatment   delay greater than 10 hours after the injury

A 36-year-male was using a high-pressure paint gun when he suffered the injury shown in Figure A. Which of the following variables would have the worst impact on his prognosis? 

1.  Delay in surgical treatment

2.  Injected solvent was greas...

A 36-year-male was using a high-pressure paint gun when he suffered the injury shown in Figure A. Which of the following variables would have the worst impact on his prognosis? 


1.  Delay in surgical treatment


2.  Injected solvent was grease


3.  Injected solvent was water-based paint


4.  An entry wound of greater than 3 cm


5.  Injected solvent was at room temperature

The clinical presentation is consistent for a high-pressure injection injury. Delays in surgical treatment are associated with serious sequelae. ans1

The clinical presentation is consistent for a high-pressure injection injury. Delays in surgical treatment are associated with serious sequelae. ans1

A 42-year-old male diesel mechanic presents to your clinic 3 days after he was power washing automotive parts with a high-pressure solvent and accidently hit the tip of his finger with the spray gun. A clinical photo is shown in Figure A. What is ...

A 42-year-old male diesel mechanic presents to your clinic 3 days after he was power washing automotive parts with a high-pressure solvent and accidently hit the tip of his finger with the spray gun. A clinical photo is shown in Figure A. What is the most appropriate first line of treatment?


1.  Irrigation and debridement at the bedside using a digital block


2.  Immediate debridement in the operating room


3.  A dose of IV antibiotics in the ER, followed by a 10 day oral course


4.  Immediate finger tip amputation


5.  Arrange for follow-up with a hand specialist


 

This patient suffered a high-pressure injection injury to his finger. These are uncommon soft tissue trauma injuries of the hand which are frequently underestimated. The prognostic factors are the type, amount and temperature of the material and t...

This patient suffered a high-pressure injection injury to his finger. These are uncommon soft tissue trauma injuries of the hand which are frequently underestimated. The prognostic factors are the type, amount and temperature of the material and the pressure of injection. Most of these hand injuries need to undergo immediate formal operative debridement and foreign body removal. This ideally should be done under a formal operative setting to decrease infection risk, and to allow for microvascular repair if needed. Delayed treatment can lead to further soft tissue damage and ultimately amputation. ans2

if the patient presents to the emergency room with this injury what is the diagnosis and what is the treatment?

What is next BEST diagnostic study to evaluate the patient?
  1. if the patient presents to the emergency room with this injury what is the diagnosis
  2. what is the treatment?
  3. What is next BEST diagnostic study to evaluate the patient?
  1. diagnosis is frostbite
  2. The treatment is rewarming of the affected extremity may need conscious sedation, blisters form 6-24 hours after rewarming is suggestive of a deeper lesion these lesions may be painless and should be drained but LEFT intact topical antibiotics may be helpful
  3. bone scan to evalute severity of soft tissue damage
what is the diagnosis what is the treatment?

3-what causes the tissue necrosis with this kind of injury?

what is the diagnosis what is the treatment?


3-what causes the tissue necrosis with this kind of injury?

 the blisters formed 24-48 hours after rewarming Clear blisters are superficial lesions and Clearville stairs require debridement as well as wound care topical elevator extremity elevation splinting and topical antibiotics

3-tissue necrosis is a...

 the blisters formed 24-48 hours after rewarming Clear blisters are superficial lesions and Clearville stairs require debridement as well as wound care topical elevator extremity elevation splinting and topical antibiotics


3-tissue necrosis is a direct cellular damage and indirect damage secondary to vasospasm and arterial thrombosis

A 22-year-old college student presents with significant finger pain after coming into contact with liquid nitrogen in his chemistry lab. A clinical photo of the affected finger in shown in Figure A. What is the most appropriate next step in treatm...

A 22-year-old college student presents with significant finger pain after coming into contact with liquid nitrogen in his chemistry lab. A clinical photo of the affected finger in shown in Figure A. What is the most appropriate next step in treatment?


1.  Blister debridement and hyperbaric oxygen therapy


2.  Drainage of the blister with the overlying skin left intact


3.  Full thickness blister and skin debridement with local flap coverage


4.  MRI scan of the digit to assess degree of soft tissue damage


5.  Wet to dry twice-daily dressing changes to the digit

The clinical presentation is consistent with a hemorrhagic blister due to acute frostbite injury. Of the options presented, the most appropriate treatment is drainage of the blister with the overlying skin left intact. Hemorrhagic blisters represent deeper injuries, and débriding them could lead to desiccation of the underlying dermis. Alternatively, intact blisters can be left in place and wrapped in dry gauze dressings until they resolve.ans2

 A 65-year-old female presents with a pulsatile mass in the palm of the hand a few weeks after a traumatic laceration in a kitchen accident. An MRA of the mass is seen in figure A. What is the most appropriate treatment? 

1.  Aspiration

2. ...

 A 65-year-old female presents with a pulsatile mass in the palm of the hand a few weeks after a traumatic laceration in a kitchen accident. An MRA of the mass is seen in figure A. What is the most appropriate treatment? 


1.  Aspiration


2.  Surgical exploration


3.  Compression bandage


4.  Steroid injection


5.  Strict elevation and observation

The MRA shown in the figure shows a false aneurysm of the superficial palmar arch. Traumatic palmar artery aneurysms and pseudoaneurysms are rare and can be caused by penetrating or blunt trauma. The few reports in the literature all support surgi...

The MRA shown in the figure shows a false aneurysm of the superficial palmar arch. Traumatic palmar artery aneurysms and pseudoaneurysms are rare and can be caused by penetrating or blunt trauma. The few reports in the literature all support surgical exploration with either ligation, excision, or repair depending on the extent of the lesion. The diagnosis is mainly clinical with the pulsatile mass as described by Yajima. Koman recommends a magnetic resonance angiography if the diagnosis is not clear. ans2
 

1-what is the diagnosis

2-what the clinical significant N what patient population, only experiences this?

#3-what is the treatment?

1-what is the diagnosis


2-what the clinical significant N what patient population, only experiences this?


#3-what is the treatment?

1diagnosis is os trigonum


2Clinical significant causes posterior ankle impingement  and FHL entrapment, , commonly symptomatic ballet dancers due to extreme plantarflexion


Surgical excision nonoperative management fails


 

An 18-year-old male complains of a painful prominence over his medial midfoot for the past 2 years; NSAIDs and orthotics have failed to provide relief. Physical exam demonstrates a firm, nonmobile, tender bump on the medial midfoot with no skin ch...

An 18-year-old male complains of a painful prominence over his medial midfoot for the past 2 years; NSAIDs and orthotics have failed to provide relief. Physical exam demonstrates a firm, nonmobile, tender bump on the medial midfoot with no skin changes. A radiograph is provided in figure A. Which of the following is the best treatment option?


1.  Total contact cast


2.  Steroid injection


3.  MRI of the foot and chest CT scan


4.  Open biopsy


5.  Surgical excision

The radiograph demonstrates an accessory navicular. Conservative measures are the first line treatment for the symptomatic accessory navicular. Surgical excision is a reliable intervention for cases refractory to conservative management. 
ans5

what is the best x-ray to obtain when concerned about a patient with medial arch foot enlargement but is painless, what is the diagnosis?


what is the 1st line treatment what is the 2nd line treatment

the best x-ray to get external oblique view to rule out an accessory navicular

 1st line treatment isactivity restriction and UCBL orthoses arch supports and a 2nd line treatment is a short period of cast immobilization if this fails then excised

the best x-ray to get external oblique view to rule out an accessory navicular


 1st line treatment isactivity restriction and UCBL orthoses arch supports and a 2nd line treatment is a short period of cast immobilization if this fails then excised

A 32-year-old female avid triathlete complains of left plantar great toe pain for the past 4 months. She has failed conservative management. Her radiographs and bone scan are shown in Figures A and B. Which of the following surgical options would ...

A 32-year-old female avid triathlete complains of left plantar great toe pain for the past 4 months. She has failed conservative management. Her radiographs and bone scan are shown in Figures A and B. Which of the following surgical options would most reliably return her to sporting activities in a timely fashion? 


1.  Tibial sesamoidectomy


2.  1st metatarsophalangeal (MTP) plantar plate reconstruction


3.  1st metatarsophalangeal (MTP) arthroscopy and debridement


4.  Open reduction internal fixation of sesamoid with autogenous calcaneus bone graft


5.  Distal 1st metatarsal chevron osteotomy with proximal phalanx Akin procedure

The clinical scenario is consistent with a tibial sesamoid fracture recalcitrant to conservative management. Tibial sesamoidectomy would be the most appropriate and reliable treatment to return the patient back to sports. Incorrect Answers:
Answer 2: This would be appropriate in the setting of a turf toe, by would not address the fractured tibial sesamoid. 
Answer 3: This is a treatment option in the setting of mild arthritis for the 1st MTP joint. 
Answer 4: This is a treatment option for a fractured tibial sesamoid, but would take more time to return athletes to sport compared to simple tibial sesamoidectomy. 
Answer 5: This is a treatment option for bunion surgery. ans1

what is the diagnosis and what is the treatment

what is the diagnosis and what is the treatment

os subfibulare 


the treatment is rest with restricted weightbearing and if this fails surgical excision

what is the diagnosis and what is the treatment?

what is the mechanism of injury??

 

what is the diagnosis and what is the treatment?


what is the mechanism of injury??


 

os peroneum fracture


 


and if this fails surgical excision with repair of the peroneal longus tendon for tenodesis of the peroneal brevis tendon


Mechanism of injury is sudden inversion and supination associated with peroneal longus tendon rupture

what is the diagnosis and what is the treatment?

what is the diagnosis and what is the treatment?

os vesilanum


 rest with restricted weightbearing if this fails excision


 

A 17-year-old ballet dancer presents with 5 months of pain in the posterior aspect of the right lower extremity that is exacerbated with the ballet position shown in Figure A. Her symptoms returned with ballet activity following a 1 month course o...

A 17-year-old ballet dancer presents with 5 months of pain in the posterior aspect of the right lower extremity that is exacerbated with the ballet position shown in Figure A. Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. On physical examination she has no tenderness at the insertion of the achilles tendon at the calcaneus. Radiographs are shown in Figure B and a MRI is shown in Figures C-E. Which of the following options is the most appropriate next step in treatment?


1.  Referral to an orthopaedic oncologist for biopsy and staging


2.  Arthroscopic Haglund deformity excision and debridement of achilles tendon


3.  Open os trigonum excision


4.  Arthroscopic os trigonum excision


5.  Posterior tibial tendon debridement

The history, examination, and imaging studies are consistent with os trigonum syndrome and is most appropriately surgically treated with arthroscopic or open excision. An os trigonum can cause impingement with plantar flexion of the foot, especial...

The history, examination, and imaging studies are consistent with os trigonum syndrome and is most appropriately surgically treated with arthroscopic or open excision. An os trigonum can cause impingement with plantar flexion of the foot, especially in ballet dancers. The FHL tendon runs through a fibro-osseous tunnel posterior to the hindfoot formed by the posterolateral (os trigonum) and posteromedial tubercle of the talus.ans4


	what is the most common cause of occipital cervical instability is nontraumatic?
	assess an x-ray for this diagnosis?
	what is the treatment?
  1. what is the most common cause of occipital cervical instability is nontraumatic?
  2. assess an x-ray for this diagnosis?
  3. what is the treatment?

	Down syndrome
	powers ratio= CD/AB 

CD a distance from the basion to the posterior arch and AB is distance from the anterior arch to the opisthion

	 ratio is = 1, However in the ratio is greater than 1concern for anterior dislocation
...
  1. Down syndrome
  2. powers ratio= CD/AB 

CD a distance from the basion to the posterior arch and AB is distance from the anterior arch to the opisthion


  •  ratio is = 1, However in the ratio is greater than 1concern for anterior dislocation
  • treatment is Occipital cervical fusion traction should be avoided
what is the most common complication with occipital cervical fusion?

what is the most common complication with occipital cervical fusion?

the most common complication is penetrating injury to the major dural venous sinus which is located just below the external occipital protuberance an approximately 10 mm from the midline of the skull

the most common complication is penetrating injury to the major dural venous sinus which is located just below the external occipital protuberance an approximately 10 mm from the midline of the skull

A 27-year-old female with Down's presents with neck pain, progressive gait instability, and loss of fine motor dexterity in her hands. Flexion and extension radiographs are shown in Figure A and B and demonstrate occipitocervical instability. When...

A 27-year-old female with Down's presents with neck pain, progressive gait instability, and loss of fine motor dexterity in her hands. Flexion and extension radiographs are shown in Figure A and B and demonstrate occipitocervical instability. When performing an occipitocervical fusion, what location in Figure C is most appropriate for placement of an 8mm unicortical screw?


1.  A


2.  B


3.  C


4.  D


5.  E


 

The safe zone for screw placement in the occiput for occipitocervical fusion is in a triangular region created by connecting 2 dots 2cm lateral to the EOP and a point 2 cm inferior to the EOP. Point B in Figure C falls within this safe zone, as is...

The safe zone for screw placement in the occiput for occipitocervical fusion is in a triangular region created by connecting 2 dots 2cm lateral to the EOP and a point 2 cm inferior to the EOP. Point B in Figure C falls within this safe zone, as is the most appropriate place for placement of an 8mm unicortical screw.ans2