Ortho

Front 1

What age do you diagnose? How does developmental dysplasia of the hip present? x2 How do you diagnose if signs are equivocal? How to treat?

Back 1

Diagnose in newborn. i)a)uneven gluteal folds b)PE of hips show they can be easily dislocated posteriorly w/jerk and a click, and returned to normal w/"snapping" ii)sonogram is diagnostic (no x-rays! The hip isn't calcified in newborn) iii)abduction splinting w/Pavlik harness for 6 months

Front 2

How can hip pathology present x2?

Back 2

i)hip pain ii)knee pain

Front 3

How does Legg-Perthes disease (avascular necrosis of femoral epiphysis) present? (age, sign, symptom? How to diagnose? How to treat?

Back 3

i)a)6 y/o b)antalgic gait w/insidious developing of limp; passive motion of hip is guarded c)hip or knee pain ii)AP and lateral hip x-rays iii)contain the femoral head w/in the acetabulum by casting and crutches

Front 4

How urgent is "slipped capital femoral epiphysis"? What is the typical patient demographic? What do they complain of? How do they present? x2 What does PE show? x2 What test is diagnostic? What is surgical treatment?

Back 4

i)emergency ii)chubby or lanky 13 y/o boy iii)groin (or knee) pain iv)a)limping b)if legs dangling, sole of foot on affected side points toward other other foot (T). v)PE: a)limited hip motion b)as hip is flexed, the thigh goes into external rotation and can't be internally rotated. vi)X ray vii)pin femoral head back into place

Front 5

How urgent is septic hip? What age group? How does it present? x2 What lab value helps dx? How to diagnose? What to do if pus is obtained?

Back 5

i)emergency ii)toddlers iii)a)have a febrile illness, then b)hold leg w/hip flexed in slight abduction and external rotation and don't let others move it passively. iv)elevated ESR v)aspiration of the hip under gen anesth. vi)further open drainage if pus obtained

Front 6

How does acute hematogenous OM present? x2 What is next step and why? How to treat?

Back 6

i)a)little kids w/febrile illness and b)shows up w/severe localized pain in a bone (no h/o trauma to that bone) ii)Bone scan instead of X ray (won't show up for a few weeks) iii)Abx

Front 7

What is Genu varum? and is it normal? What is treatment? What is varus beyond 3 due to? What is the eponym? What is treatment?

Back 7

i)bow legs ii)normal until 3 y/o iii)none <3 y/o iv)disturbance of medial proximal tibial growth plate v)Blount dz vi)surgery

Front 8

What is genu-valgus and what age group is it normal? What is treatment?

Back 8

i)knock knees ii)b/w 4-8 y/o iii)none

Front 9

Where does osgood schlatter affect? What aggravates it? What is PE? x2 How do you treat and for how long?

Back 9

i)persistent pain right over tibial tubercle ii)aggravated by contraction of quads iii)PE: a)localized pain right over tibial tubercle b)no knee swelling iv)immobilize the knee in cast for 4-6 weeks

Front 10

When is club foot seen? How does it present? x5 How do you treat for 1/2 of pts? How does other 1/2 get treated and when?

Back 10

i)at birth ii)a)both feet turned inward b)plantar flexion c)inversion of foot d)internal rotation of tibia iii)aserial plaster casts started in neonatal period provide sequential correction starting w/adducted forefoot->hindfoot varus->equinus last iv)surgery at age 6 mo-2 years

Front 11

What age/sex is affected by scoliosis? What is most sensitive screening finding? What can a severe case cause? How do you arrest progression? What do severe cases need?

Back 11

i)teenage girls ii)bend over test and see hump in right thorax iii)decreased pulm function iv)bracing v)may need surgery

Front 12

Since bone remodeling in kids occurs quickly, how does healing differ? x2 Where are the special problem areas that kids have in remodeling/healing? x2

Back 12

i)a)much faster than adult b)degrees of angulation that would be unacceptable in adult can be ok if fractures are reduced and immobilized. ii)a)any bone involving the growth plate b)supracondylar fractures of the humerus

Front 13

How do you trea fractures involving the growth plate if they are in one piece (fracture doesn't cross growth plate and epiphysis and doesn't involve joint)? If they are in 2 pieces? What happens if you don't follow this?

Back 13

i)closed reduction if epiphyses and growth plate are displaced laterally from metaphysis ii)very precise alignment provided by open reduction and internal fixation will be required iii)growth occurs unevenly: get deformity of extremity

Front 14

What age group gets primary malignant bone tumors? What do they c/o and how long? What imaging do you get and what does it show? x3

Back 14

i)young people ii)persistent low grade pain for several months iii)x-ray. a)invasion into ST b)sunburst pattern c)periosteal onion skinning

Front 15

What is most common primary malignant bone tumor? what are the ages? Where is it?

Back 15

i)osteosarcoma ii)10-25 y/o iii)knee: lower femur or upper tibia

Front 16

What is 2nd most common primary malignant bone tumor? What is age? Where is it?

Back 16

i)Ewings ii)younger kids: 5-15 iii)diaphyses of long bones

Front 17

What is the most common malignant bone tumors in women and men and are they blastic or lytic? What is the imaging used? How do lytic lesions sometimes show up?

Back 17

i)mets. a)women: breast; lytic b)men: prostate; blastic ii)bone scan is more sensitive than x-ray, but if +, get an x-ray iii)get a pathologic fracture (due to something that shouldn't cause it)

Front 18

What is the diagnostic test in MM? What is patient demographic (age and sex)? What other 2 tests are indicative of it? How to treat?

Back 18

i)xray, not bone scan. ii)old men iii)a)urine: BJ proteins b)blood: abnormal Igs in blood, shown best by serum immunoelectrophoresis iv)chemo

Front 19

How do ST sarcomas present? Where do they mets and where don't they? Imaging to Diagnose? How should you diagnose/treat?

Back 19

i)relentless growth of mass anywhere, and fixed to surrounding structures ii)to lung, not to LNs iii)MRI diagnoses malignancy (not type) iv)incisional bx, including wide excision, radiation, and chemo

Front 20

For X-rays of suspected fractures, what views should you get and what else should you take a scan of? If the mechanism of injury is suggestive, what other x-rays should you take?

Back 20

i)2 views at 90 degree angles ii)joint above and below the broken bone. iii)other bones in line w/the injury (spine if land on feet)

Front 21

What is a closed reduction? What situations do you do this in?

Back 21

i)immobilization in a cast ii)broken bones that aren't badly displaced or angulated or that can be satisfactorily aligned by external manipulation

Front 22

What is open reduction and internal fixation, and when do you use this?

Back 22

iii)surgery to reduce and fix the fracture iv)broken bones that are severely displaced or angulated or that can't be aligned easily

Front 23

Where are clavicular fractures usually? how are they treated and how long?

Back 23

i)junction of middle and distal thirds ii)figure of 8 device for 4-6 weeks

Front 24

What is the most common shoulder dislocation? How does it present? Where might numbness occur and why? What is diagnostic imaging?

Back 24

i)anterior ii)pt holds arm close to body but rotated outward as if shaking hand iii)over deltoid b/c of stretching of axillary nerve iv)AP and lateral X-ray

Front 25

When does posterior shoulder dislocation occur (give 2 examples). How does the arm present? What kind of imaging do you need?

Back 25

i)after massive uncoordinated muscle contractions a)after epileptic seizure b)electrical burn ii)arm held in usual protective position (close to body, internally rotated) iii)regular x-rays miss it, so axillary or scapular lateral views are needed.

Front 26

When does Colles fracture occur and in whom? What does the wrist look like? How do you treat? x2

Back 26

i)falling on an outstretched hand ii)in old, osteoporotic women iii)deformed and painful wrist looks like a dinner fork iv)close reduction and long arm cast

Front 27

What is a Monteggia fracture due to? What is it defined by? How do you treat?

Back 27

i)direct blow to ulna (like raised protective arm hit by a nightstick) ii)diaphyseal fracture of the proximal ulna, w/ant dislocation of the radial head iii)ulna is fixed w/open reduction and internal fixation; dislocated radius undergoes closed reduction

Front 28

What is a Galeazzi fracture present like? How do you treat it?

Back 28

mirror image of Monteggia: i)distal 3rd of radius gets direct blow w/fracture; dislocation of distal radioulnar joint ii)same treatment as Monteggia (radius gets open reduction and internal fixation; dislocated ulna gets closed reduction)

Front 29

How does fracture of scaphoid happen and what age group? What does pt complain of? What does PE show? What will X ray show? What is treatment and do you need x-ray to treat? What if original X ray is not neg: how do you treat?

Back 29

i)young person falls on outstretched hands? ii)wrist pain iii)localized tenderness to palpation over anatomic snuff box iv)usually neg if undisplaced fracture; but 3 weeks later will see it v)thumb spica cast indicated w/just H and P (w/o X-ray). vi)if displaced, open reduction and internal fixation

Front 30

When does a metacarpal neck fracture happen? How does it present? What is diagnostic test? What do you do for mild fractures? For bad ones?

Back 30

i)punch a wall (4th or 5th finger) ii)hand is swollen and tender iii)x-rays are diagnostic iv)close reduction and ulnar gutter splint v)Kirschner wire or plate fixation for bad ones

Front 31

How does a hip fracture patient present in stretcher?

Back 31

affected leg is shortened and externally rotated

Front 32

What problem does femoral neck fractures cause? How can you get faster healing and earlier mobilization?

Back 32

i)if displaced, compromise the tenuous blood supply to femoral head ii)replace femoral head w/prosthesis

Front 33

How do you treat intertrochanteric fractures? what is a bad outcome that can occur? How do you prevent this?

Back 33

i)less likely to lead to avascular necrosis, so treated w/open reduction and pinning ii)unavoidable immobilization causes DVT and PE iii)post-op anticoagulation

Front 34

How do you treat femoral shaft fractures? When are they an emergency and what do they require? What can happen if multiple femoral shaft fractures?

Back 34

i)intramedullary rod fixation ii)if they are open; require OR cleaning and closure w/in 6 hours. iii)fat embolism syndrome

Front 35

When is knee pain not a serious injury?

Back 35

When it doesn't have swelling(or swelling=serious knee injury)

Front 36

When do collateral ligament injuries occur? When do lateral ligaments get affected and when do medial? How does it present?x2 What can you do on PE and how does medial vs lateral injuries differ in PE?

Back 36

i)hit on the knee sideways ii)medial blows fuck up lateral ligaments and vice versa iii)a)swollen knee b)localized pain by direct palpation on affected side iv)knee flexed 30 degrees, passive abduction (medial injury, adduction=lateral injury)produces pain on torn ligaments and allows further displacement than normal.

Front 37

How do you treat isolated injuries to collateral ligaments? How do you treat several torn ligaments?

Back 37

i)hinged cast ii)surgical repair

Front 38

Which is more common Ant cruciate lig vs post cruciate lig tears? How do they present?x2 In ACL injury, what PE finding is there? What does PCL PE show? What is diagnostic test? How does treatment of sedentary pts differ from athletes?

Back 38

i)ACL ii)a)pain b)swollen knee iii)90 degree angle of knee: can pull the distal half out like a drawer. iv)get posterior drawer test. v)MRI vi)sedentery get immobilized w/rehab; athletes=arthroscopic reconstruction

Front 39

How do you diagnose meniscal tears? How do they present? x4 How to repair it? What is the outcome in complete meniscectomy?

Back 39

i)MRI (X rays and clinically difficult to diagnose) ii)a)protracted pain and swelling s/p knee injury b)catching and locking that limit knee motion c)"click" when knee is forcefully extended iii)arthroscopic repair, and try to save as much meniscus as possible iv)late development of degenerative arthritis

Front 40

Who gets tibial stress fractures? How does it present clinically? Radiographically? How to treat? x2 options

Back 40

i)young men subjected to forced marches ii)tenderness to palpation over a specific point on the bone iii)X rays initially normal iv)cast, then repeat Xray 2 weeks later; or crutches

Front 41

What is the case scenario for leg fractures involving tibia and fibula? What does PE show? What is diagnostic? How do you treat easily reducible fractures? How do you treat ones that can't be aligned? Where is the most common location for development of compartment syndrome? When should you remove the cast?

Back 41

i)pedestrian hit by a car ii)angulation iii)X-ray iv)casting v)intramedullary nailing vi)lower leg and forearm vii)increasing pain after a long leg cast has been applied

Front 42

What is case scenario for rupture of Achilles tendon? What motion are they able to do? Why do they come to the doctor? What does palpation of the tendon reveal? What are 2 methods of curing it?

Back 42

i)out of shape middle aged men subjected to severe strain: plant the foot and change direction, and a loud popping noise is heard (like a rifle shot), and they fall clutching the ankle. ii)limited plantarflexion iii)pain, swelling, and limping brings them to doctor iv)a gap v)a)casting in equinus position=healing in months; b)surgery gives quicker cure

Front 43

How does one fracture of ankle occur? What breaks? What is diagnostic and what views x3? How to treat if fragments are displaced?

Back 43

i)falling on inverted or everted foot ii)both malleoli iii)AP, lateral, and mortise xrays iv)open reduction and internal fixation

Front 44

Where does compartment syndrome occur? What is most common precipitating agent? What symptoms does the patient have? x4 What is most reliable physical finding? What is treatment?

Back 44

i)lower leg or forearm ii)prolonged ischemia followed by reperfusion iii)a)pain b)limited use of extremity c)compartment feels very tight d)tender to palpation iv)excruciating pain w/passive extension v)emergency fasciotomy

Front 45

how do you handle pain under a cast?

Back 45

remove the cast and examine the limb

Front 46

What do you do for an open fracture? (bone sticking thru the wound)

Back 46

clean in OR, then reduce w/in 6 hrs from time of injury

Front 47

what is the case scenario for posterior dislocation of the hip? What is the presentation of the patient and what is it similar to? what should be done and why?

Back 47

i)femur is driven backward as in head on car collision where knees hit the dashboard. ii)Pt w/hip pain and lies in stretcher w/leg shortened, adducted and internally rotated (broken hip also has shortened leg but is externally rotated). iii)emergency reduction is needed to avoid avascular necrosis

Front 48

What is case scenario for gas gangrene? What is progression of disease? What does the affected site look like? What is treatment x3?

Back 48

i)deep, penetrating, dirty wounds (stepping on rusty nail w/lots of mud or manure) ii)after 3 days, the patient looks very sick, toxic, and moribund. iii)affected site is tender, swollen, discolored, and has gas crepitation iv)IV PCN, extensive emergency surgical debridement, hyperbaric O2

Front 49

When does the radial nerve get injured? When is surgical exploration is not needed? When is it needed?

Back 49

i)oblique fractures of the middle to distal thirds of the humerus ii)Pt comes in unable to dorsiflex (extend) the wrist and regains function when fracture is reduced and arm is put into a sling iii)nerve entrapment: nerve paralysis develops or remains after reduction

Front 50

When do popliteal artery injuries occur? What are the key issues? x3 What is best treatment? What is treatment if there is delayed restoration of flow?

Back 50

i)posterior dislocations of the knee ii)attention to integrity of pulses, Doppler studies, and arteriogram if needed. iii)prompt reduction minimizes vascular compromise iv)prophylactic fasciotomy

Front 51

What 2nd hidden fracture can occur in landing on one's feet from a height?

Back 51

i)fractures of lumbar or thoracic spine

Front 52

What fractures can occur in head on automobile collisions as a 2nd hidden fracture?

Back 52

(face, torso, head) + i)knee hitting the dashboard causes femoral heads to be driven backward into the pelvis or out of acetabulum

Front 53

What 2nd injury should you look for in facial fractures and closed head injuries?

Back 53

i)cervical spine

Front 54

What is the complaint of Carpal tunnels? How to reproduce the symptoms? x2 What test should you get? What is initial treatment? x2 If you get surgery, what should precede it?

Back 54

i)numbness, tingling of hand at night and in distribution of median (radial 3.5 fingers) ii)hang the hand limply for a few minutes; or tap, percuss or press median nerve over carpal tunnel iii)wrist x-rays iv)splints + anti-inflammatory agents v)electromyography should precede surgery

Front 55

What sex gets trigger finger? How does it present? x2 What is 1st line, and what is last line therapy?

Back 55

i)females ii)a)pt wakes up in middle of night w/finger acutely flexed, and unable to extend unless pull it w/other hand b)if pull finger, then painful snap. iii)a) steroids b)surgery is last resort

Front 56

Who gets De Quervain tenosynovitis? What do they complain of? How is pain reproduced? What is best treatment? What else can help?

Back 56

i)mothers who carry their babies and hold the head w/extended thumb and wrist flexion ii)pain along radial side of wrist and 1st dorsal compartment iii)pain reproduced when mother holds thumb inside closed fist, then forces the wrist into ulnar deviation iv)steroids v)splint and anti-inflamm

Front 57

Who gets dupuytren contracture? What happens? What is only effective treatment and when do you get surgery?

Back 57

i)older men of norweigen ancestry ii)contracture of palm of hand, and palmar fascial nodules can be felt. iii)surgery, needed when can't put hand flat on table

Front 58

What is "felon" and what is the cause? What do pts complain of x2What can occur if not taken care of and why? What must be done to treat

Back 58

i)abscess in pulp of fingertip due to neglected penetrating injury ii)a)throbbing pain b)classic findings of abscess, including fever. iii)pressure can build up and lead to tissue necrosis due to pulp being in a closed space w/multiple fascial trabecula iv)surgical drainage

Front 59

What is gamekeeper thumb? What are causes historically and now? What is seen on PE? What happens if untreated? How to treat?

Back 59

i)injury to ulnar collateral ligament sustained by forced hyperextension of thumb ii)a)gamekeepers killing rabbits b)skiing injury if thumb gets stuck in snow iii)collateral laxity at thumb-MCP joint, and if untreated, dysfunctional and painful, leading to arthritis iv)casting

Front 60

What is jersey finger? what is common cause? What is physical exam sign? What is treatment?

Back 60

i)injury to flexor tendon sustained when flexed finger is forcefully extended ii)someone unsuccessfully grabs a running person by jersey iii)make a fist causes distal phalanx of injured finger not to flex w/others iv)splinting

Front 61

What is mallet finger? What is mechanism of damage? What does it look like? What is first line treatment?

Back 61

i)extensor tendon is ruptured (opp of jersey finger) ii)extended finger is forcefully flexed (volleyball injury) iii)tip of affected finger remains flexed when hand is extended, so it looks like a mallet. iv)splinting

Front 62

What do you do w/traumatically amputated digits x4 What should you not do? x3

Back 62

surgically reattach whenever possible. i)amputated digit is cleaned w/sterile saline, b)wrapped in saline-moistened gauze c)place in sealed plastic bag d)put bag on bed of ice ii)Don't put a)in antiseptic solution or EtOH b)on dry ice c)not allowed to freeze

Front 63

Where does lumbar disk herniation occur?x2 What is the common presentation? What does the pain feel like?

Back 63

i)L4-L5; L5-S1 ii)several months of vague aching pain (pressure on ant spinal ligament) and then have sudden onset of neurogenic pain caused by forced movement iii)Feels like electrical shock shooting down the leg iv)exacerbated by coughing, sneezing, defecating

Front 64

What is pain exacerbated by in lumbar disk herniation? x3 What PE findings do they have? What confirms the diagnosis?

Back 64

i)coughing, sneezing, defecating:sensitive test ii)Pts can't ambulate and they hold the affected leg flexed; b)straight leg-raising test gives excruciating pain. iii)MRI confirms the diagnosis

Front 65

What is treatment? When do you need surgery? When do you need emergency intervention?

Back 65

iv)bed rest for 3 weeks v)surgery is needed if neuro deficits are progressing (progressive muscle weakness) vi)emergency intervention if cauda equina syndrome.

Front 66

What is cauda equina syndrome? x3 Is it a surgical emergency?

Back 66

vii)a)distended bladder b)flaccid rectal sphincter c)perineal saddle anesthesia

Front 67

What is signs of metastatic malignancy in back pain? x3 What does X-ray show in men vs women? what is a more sensitive test vs Xray in early mets?

Back 67

ia)elderly w/progressive back pain that is worse at night and unrelieved by rest or positional changes b)wt loss ii)a)women=lytic breast cancer mets at the pedicles b)men=blastic mets from the prostate iii)bone scan is more sensitive test

Front 68

Where are diabetic ulcers located? x3 Why do they start and why don't they heal? Theoretically, how can they heal? x3

Back 68

i)at pressure points: a)heel b)metatarsal head c)tip of toes ii)start due to neuropathy; don't heal b/c of microvascular disease iii)a)control of diabetes b)keep them clean c)leg elevation for many weeks--months.

Front 69

Where are ulcers from arterial insufficiency? What do the look like? What other symptoms does the patient have? x3 What is 1st step in workup and what is a poor prognostic sign from the 1st step? What is 2nd and third steps?

Back 69

i)as far away from heart as possible: at tips of toes ii)look dirty, w/pale base devoid of granulation tissue iii)other manifestations of arteriosclerotic occlusive disease: a)absent pulse b)trophic changes c)claudication

Front 70

What is 1s step in w/u of arterial insuff and what is poor prognostic sign from the 1st step? What is 2nd and 3rd steps?

Back 70

i)doppler studies looking for pressure gradient; if no gradient, then microvasc disease not amenable to surgery ii)2nd: arteriograms 3rd: surgical revascularization

Front 71

Where and what kind of skin do venous stasis ulcers develop? What are 2 characteristics that the patient will have?

Back 71

i)above medial malleolus; chronically edematous, indurated, and hyperpigmented skin ii)a)varicose veins b)suffers from bouts of cellulitis

Front 72

What is a marjolin ulcer? What is classic setting? x2

Back 72

i)squamous cell Ca of skin developing in chronic leg ulcer ii)a)many years of healing and breaking down, like a)untreated 3rd degree burns that underwent spontaneous healing b)chronic draining sinuses 2/2 to OM.

Front 73

How is the ulcer characterized in venous stasis ulcers? x2 What does treatment involve? x3 What surgery can be necessary? x2

Back 73

iii)a)ulcer is painless, w/granulating bed iv)physical support to keep veins empty: a)support stockings b)ace bandages c)unna boot v)vein stripping; grafting of ulcer

Front 74

What does the ulcer look like in marjolin ulcer? What is diagnostic? How to treat?x2

Back 74

i)dirty looking, deep ulcer w/heaped up tissue growth around the edges ii)BX is diagnostic iii)wide local excision and skin grafting

Front 75

Who gets plantar fasciitis? What is their complaint? x2 What does X ray show?

Back 75

i)older, overweight pts ii)a)disabling, sharp heel pain every time foot strikes the ground b)pain worse at night iii)bony spur matching location of pain

Front 76

What does PE show in plantar fasciitis and why is this misleading? What is treatment?

Back 76

iv)tenderness to palpation of spur; spur isn't the problem and surgery doesn't help v)spontaneous resolution in 12-18 months; just symptomatic

Front 77

What is morton neuroma? What is PE finding? What is cause? What is conservative manaagement vs liberal?

Back 77

i)inflammation of common digital nerve at 3rd interspace, b/w 3rd and 4th toes ii)neuroma is palpable as very tender spot there iii)use of pointed, high heel shoes (or pointed cowboy boots) that force toes to bunch iv)a)analgesics and better shoes b)surgical excision