Title: MCQ
1MCQ
2MCQ
- 1. True/false
- 2. One best answer
- Recall
- ?????????.... ???????? ????????
- Application of knowledge (scenario)
3Application of Knowledge
- Scenario
- Diagnosis
- Treatment
- Diagnosis and treatment
- Keywords
4- Scenario
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5- 1. ??????????? ???????????????? ??????? keyword
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?????????????????? - 4. ??? choice ??????????????????
- 5. choice ??????????????????????
- 6. 100 ????????
6Spine
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9- 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
10Scoliosis
11Adolescent 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
12- Indication for MRI in scoliosis
- 1. pain
- 2. rapid progression
- 3. left thoracic curve
- 4. neurologic deficit
13- 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
14Disc pressure
15- Indication for discectomy
- 1. Cauda equina syndrome
- 2. Fail conservative treatment 6 weeks
- 3. Progressive neurodeficit
16Type 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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18Tumor
19Osteochondroma
Location - Metaphysis No periosteal
reaction Marrow continuity
20Osteo(genic)sarcoma
Periosteal reaction - Sun ray - Codman triangle
Location - Metaphysis
21Ewing Sarcoma
- Periosteal reaction
- - Sun ray
- - Hair on end
- Onionskin
- Codman triangle
Location - Meta-diaphysis
22Chondrosarcoma
Pelvic region Popcorn Calcification
23Hand
24Superficial radial nerve entrapment
- Cause
- External compression
- Work-related repetitive activity
- SS
- - Pain, numbness,
- - Finkelstein ve
- Treatment
- - splint, NSAID, steroid, change in activity
25De Quervain
26Carpal tunnel syndrome
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28- 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
29Indication 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)
30Trauma
31Humerus fracture and radial nerve palsy
32Indication 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
33Achilles tendon rupture
Thompson test
34Hip dislocation
35Anterior shoulder dislocation
36Anterior
Posterior
37Anterior
Posterior - Flexion - Adduction - Int. Rotation
Anterior - Abd - Ext. Rotation - Flexion
(Inferior) - Extension (superior)
Posterior
38knee 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
39Vascular 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
40- Capillary filling time lt 2 sec
- Capillary refill time
- Nail blanch test
41Patella dislocation
42MCL injury
- Grade I, II
- Conservative treatment
- 1. RICE 48 hrs.
- 2. ROM
- 3. Brace?
- 4. Exercise
- Straight leg raising
- Partial squat
43- 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?
44 45open fracture
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48Fernandez classification
Stable or unstable
Bending
Shearing
Unstable
Compression
Stable or unstable
Avulsion
Unstable
Unstable
Combined
49- 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
50- 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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52Radial 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
53Radial 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
54Volar tilt
Normal Volar 11o
Acceptable Dorsal 10o
55Normal 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
56Normal 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
57Galeazzi fracture dislocation
58Monteggia fracture dislocation
59- 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)
60Infection
61Osteomyelitis
62- 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
63fluid analysis
64?????
65??? 4
- 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
66Developmental dysplasia of the hip (DDH)
- ??? ? breech
- ?? ? torticollis
- ??? ? female
- ???? ? oligohydramnios
- ???? ? metatarsus adductus
- ??? ? first born child
- ??????? family history
67- Treatment of DDH
- 0-6 m ? Pavlik harness
- 6m-2y ? close reduction and casting
- gt2 ? open reduction
68Impingement syndrome
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