MCQ

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MCQ
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MCQ

• 1. True/false
• 2. One best answer
• Recall
• ?????????.... ???????? ????????
• Application of knowledge (scenario)

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Application of Knowledge

• Scenario
• Diagnosis
• Treatment
• Diagnosis and treatment
• Keywords

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• Scenario
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• ????????????????
• ?????????????

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• 1. ??????????? ???????????????? ??????? keyword
  ???
• 2. ??????????????????????????????? ????????????
  ?????????????????????? ???????????????????????????
  ??????????????
• 3. ????????????????????????????? vs
  ??????????????????
• 4. ??? choice ??????????????????
• 5. choice ??????????????????????
• 6. 100 ????????

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Spine
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• Indication for surgery TL spine fracture
• 1. Burst Fx with canal compromise gt 50
• 2. kyphosis gt 30 degree
• 3. late neurodeficit
• 4. unstable fracture (failure of all 3 columns)
  or fracture dislocation

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Scoliosis
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Adolescent scoliosis
Curve Treatment
lt 20o 20o-30o 30o-40o 40o-50o gt50o F/U q 6-12 mo F/U q 3 mo Brace if 1. Progression gt 5o in 6 mo 2. Curve gt 25o Orthosis Surgery in growing child Surgery
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• Indication for MRI in scoliosis
• 1. pain
• 2. rapid progression
• 3. left thoracic curve
• 4. neurologic deficit

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• Conservative treatment in disc herniation
• 1. rest in semi fowler position
• 2. ice massage
• 3. NSAID
• 4. isometric exercise of abdomen and lower
  extremity
• 5. encourage walking discourage sitting
• 6. rehabilitation and back education

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Disc pressure
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• Indication for discectomy
• 1. Cauda equina syndrome
• 2. Fail conservative treatment 6 weeks
• 3. Progressive neurodeficit

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Type Incidence Mechanism Clinical finding Prognosis
Central Most common Hyperextension in pt age gt 50 yr - Weak uppergtlower extremity - Loss of sensation uppergtlower extremity Fair
Anterior Second most common Flexion-compression - Weak lowergt upper extremity - Some sensation loss Worst
Brown-Sequard Rare Penetrating - Loss of ipsilateral motor function - Loss of contralateral pain and temp sensation Best
Posterior Extremely rare - preservation of motor - loss of sensation
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Tumor
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Osteochondroma
Location - Metaphysis No periosteal
reaction Marrow continuity
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Osteo(genic)sarcoma
Periosteal reaction - Sun ray - Codman triangle
Location - Metaphysis
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Ewing Sarcoma

• Periosteal reaction
• - Sun ray
• - Hair on end
• Onionskin
• Codman triangle

Location - Meta-diaphysis
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Chondrosarcoma
Pelvic region Popcorn Calcification
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Hand
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Superficial radial nerve entrapment

• Cause
• External compression
• Work-related repetitive activity
• SS
• - Pain, numbness,
• - Finkelstein ve
• Treatment
• - splint, NSAID, steroid, change in activity

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De Quervain
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Carpal tunnel syndrome
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• Kaplan et al. Predictive factors in the
  non-surgical treatment of carpal tunnel syndrome.
• 1. duration longer than 10 months
• 2. stenosing flexor tenosynovitis (?? 2 ???)
• 3. a positive Phalen test result less than 30
  sec
• 4. constant paresthesia
• 5. age older than 50 years
• Failure rate
• 0 factor 30
• 1 factor 60
• 2 factors 80
• 3 factors 90

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Indication for surgery

• 1. Acute cases of CTS from trauma or infection
• 2. Thenar atrophy
• 3. Sensory loss, and in cases unresponsive to
  conservative management (2-7 weeks)

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Trauma
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Humerus fracture and radial nerve palsy

• Holstein Lewis fracture

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Indication for operative treatment of fracture
humerus

• 1. Multiple trauma
• 2. Bilateral humeral fractures
• 3. Floating elbow
• 4. Associated vascular injury
• 5. Open fracture
• 6. Unaccepted alignment (ant 20, varus 30, short
  3 cm)
• 7. Intraarticular extension
• 8. Pathologic fracture
• 9. Nonunion
• 10. Neurologic loss following penetrating trauma
• 11. Radial nerve palsy after fracture
  manipulation (controversial)
• 12. Segmental fracture

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Achilles tendon rupture
Thompson test
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Hip dislocation
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Anterior shoulder dislocation
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• Elbow dislocation

Anterior
Posterior
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Anterior
Posterior - Flexion - Adduction - Int. Rotation
Anterior - Abd - Ext. Rotation - Flexion
(Inferior) - Extension (superior)
Posterior
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knee dislocation

• Initial
• Pulse ve
• X-ray
• Pulse ve
• Reduction ? x-ray
• Post reduction
• X-ray
• Admit observe clinical
• Pulse ve
• ABI gt 0.9 observe
• ABI lt 0.9 ? angiogram or consult surg
• Pulse -ve
• Consult surg

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Vascular Injury

• Hard signs
• 1. bruit
• 2. Thrill
• 3. pulsatile bleeding
• 4. absent of distal pulse
• 5. expanding hematoma
• 6. Sign of limb ischemia pr compartment syndrome
  (5P)

• Soft sign
• 1. hypotension or shock
• 2. neurologic deficit
• 3. stable, non pulsatile or small hematoma
• 4. proximity of wound and vessel
• 5. diminished pulse

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• Capillary filling time lt 2 sec
• Capillary refill time
• Nail blanch test

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Patella dislocation
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MCL injury

• Grade I, II
• Conservative treatment
• 1. RICE 48 hrs.
• 2. ROM
• 3. Brace?
• 4. Exercise
• Straight leg raising
• Partial squat

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• Indication for surgery in MCL injury
• 1. multiple ligament injuries
• 2. associated with medial meniscus injury
• 3. residual laxity after ACL reconsruction
• 4. MCL injury grade III?

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• Treatment fracture neck

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open fracture
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Fernandez classification
Stable or unstable
Bending
Shearing
Unstable
Compression
Stable or unstable
Avulsion
Unstable
Unstable
Combined
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• Unstable fracture ( 3 factors)
• 1. age gt 60 years
• 2. associated ulnar fracture
• 3. dorsal metaphyseal comminution
• 4. intraarticular fracture (??????????)
• 5. dorsal angulation gt 20 degree
• 6. initial displacement gt 1 cm
• 7. initial shortening gt 5 mm
• 8. Redisplaced fracture

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• Treatment of distal radius fracture
• Non-displace or reducible stable
• ? u-slab for 2-3 weeks
• ? short arm cast 3-4 weeks
• Reducible unstable and
• ? CRIF or ORIF
• Irreducible
• ? ORIF

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• Distal radius alignment

Radial inclination
Radial length
Ulnar variance
Acceptable alignment - Joint step or gap 2 mm -
Ulnar variance 5 mm - Dorsal tilt 10 degree -
Radial inclination 15 degree - Volar tilt 20
degree
Volar tilt
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Radial inclination Radial length Ulnar variance
Normal 22o 11 mm 0 mm
Acceptable Loss lt 5o Loss lt 5 mm 5 mm
Articular stepping lt 2 mm
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Volar tilt
Normal Volar 11o
Acceptable Dorsal 10o
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Normal alignment Accepted alignment
Radial inclination 22o Loss lt 5o
Radial length (height) 11 mm Loss lt 5 mm
Volar tilt 11o Dorsal 10o
Joint stepping 2 mm
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Normal alignment Accepted alignment
Radial inclination 22o Loss lt 5o
Radial length (height) 11 mm Loss lt 5 mm
Volar tilt 11o Dorsal 10o
Ulnar variance 0 5 mm
Joint stepping 2 mm
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Galeazzi fracture dislocation
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Monteggia fracture dislocation
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• Indication for surgery of clavicle
• 1. painful nonunion
• 2. neurovascular injury
• 3. fracture distal end with torn CC ligament
• 4. soft tissue interposistion
• 5. shortening gt 2 cm
• 6. Open fracture
• 7. Impending skin disruption
• 8. Scapulohoracic dissociation
• 9. floating shoulder (relative)

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Infection
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Osteomyelitis
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• Investigation for acute osteomyelitis
• 1. CBC ESR ? non specific
• 2.X-Ray
• 1 weeks deep soft tissue swelling, absent of fat
  pad
• 1-2 weeks subperiosteal elevation, new bone
  formation, osteoporosis
• Radiolucency ? focal bone loss 40-50
• positive in 2-3 weeks
• positive 90 at 4 weeks
• 3. bone aspiration and culture Positive 77
• 4. hemoculture Positive 50

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fluid analysis
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• Risk factor of osteoporosis
• Women age gt 65 years, men age gt 70 years
• Parental Hx of osteoporosis
• BMI lt 19 kg/m2
• Menopause before age of 45 years
• Medical condition
• Cortico-steroids (commonly used for Asthma)
• Rheumatoid arthritis
• Over-active thyroid or parathyroid glands
• Chronic liver or kidney disease
• Lifestyles
• Smoking
• Excessive alcohol consumption
• Diet lacking in calcium
• Lack of sunlight exposure, which may cause
  vitamin D deficiency
• Sedentary lifestyle over many years

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Developmental dysplasia of the hip (DDH)

• ??? ? breech
• ?? ? torticollis
• ??? ? female
• ???? ? oligohydramnios
• ???? ? metatarsus adductus
• ??? ? first born child
• ??????? family history

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• Treatment of DDH
• 0-6 m ? Pavlik harness
• 6m-2y ? close reduction and casting
• gt2 ? open reduction

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Impingement syndrome
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