A CASE (C1330)
13 / F - h/o fall down b4 a week, at present pt came with swelling, with no redness but swelling.
whats is the best investigation for this case?
better details of soft tissue on MRI.
After application of a unilateral tibial external fixator, it is observed that the frame does not provide sufficient rigidity across the fracture site. Altering the external fixator in which of the following ways will have the greatest impact on frame stiffness?
Increasing the distance between pins in each fragment
Increasing the pin diameter
Reducing the distance between bone and connecting bar
Increasing the connecting bar diameter
Adding one stacked connecting bar
Poor question as it depends on degrees. Ie how much does one increase pin diamater by etc
Rev Col Bras Cir. 2013 Sep-Oct;40(5):423-6.
A 79-year-old female falls onto her right hip at home and sustains the injury shown in Figure A. She undergoes an uncemented unipolar hemiarthroplasty. During insertion of the stem into the femoral canal, the patient becomes hypotensive and hypoxic. Which of the following has most likely occurred?
Femoral shaft fracture
Inadequate fluid resuscitation during surgery
Acute myocardial infarction
Pulmonary embolism caused by dislodging of deep venous thrombosis during hip exposure
Intramedullary fat and marrow embolization
Dr. Kiran - you are correct that fat emboli syndrome (FES) is a result of the inflammatory process seen after the fat is deposited around the body. However, the fat can cause a more massive emboli to the lungs, similar to a DVT "breaking free" and being deposited in the lungs.The use of corticosteroid for the prophylaxis of fat embolism syndrome in patients with long bone fracture.Silva DF, Carmona CV, Calderan TR, Fraga GP, Nascimento B, Rizoli SRev Col Bras Cir. 2013 Sep-Oct. pii: S0100-69912013000500013. 40. (5). :423-6PMID: 24573593 (Link to Abstract)
question no 2 question doesn't belong here , i think it should be moved to foot and ankle section
this question doesnt belong here , i think it should be moved to foot and ankle section.
fat embolism syndrome occurs 24 to 72 hrs after the insiting event because its not the emboli causing the symptoms but the alveolar reaction to the emboli....acc to rackwood greens.........am i right or wrong kindly clarify ??
"inhibition of osteoclasts also infereres with normal bone healing and remodeling"interferes instead of infereres ?
This question presumably means have the greatest impact on "increasing" frame stiffness ....? Therefore, I would suggest adding this word for clarification.
All of the following are AAOS recommendations regarding prevention of venous thromboembolic disease (VTED) in patients undergoing elective hip and knee arthroplasty EXCEPT?
Patients should discontinue antiplatelet agents before undergoing elective hip or knee arthroplasty
Aspirin is not approved as a preventative medication for VTED in low risk patients
Neuraxial (epidural, spinal, intrathecal) anesthesia is recommended when possible
Routine post-operative duplex ultrasonography screening is not recommended
Mechanical prophylaxis mechanisms are recommended in patients with a known bleeding disorder
The question is poorly worded.
Congenital unilateral transverse absence of the forearm results from vascular insult to which of the following?
Limb bud mesoderm
Apical ectodermal ridge
i thought it was the ZPA not the AER which is in charge of longitudinal growth
Osteopenia & Osteoporosis
In the text - picture 6, the Dexa reports states that the 'Relative Fracture Risk' is compared to healthy adults and the caption below the pic states that the risk is compared to people of the same age. Which is it?? thanks
Dr Dzik- The "distal tibia" is implied Distal third of the shaft of the tibia. No ambiguity. It has poor blood supply. Open fracture here may require a flap. If severe soft tissue compromise is present may require a free flap.
I'm really confused about the most common nonunion site. It's written distal tibia and as far as I know and read it suppose to be tibial shaft, distal and proximal sites of the long bones bones have generally very good blood supply and if you thought about pilon fractures, they are quite rare. Correct me if I'm wrong please.
A 65-year-old patient who recently underwent abdominal surgery for a diverticular abscess is referred for right knee pain and swelling for 2 days. Physical examination reveals a temperature of 38.3 degrees Celsius and heart rate of 105 bpm. A clinical photograph, results of synovial fluid analysis, and a polarizing microscopy image are seen in Figures A through C. Synovial fluid gram stain and cultures are pending. What is the most appropriate next step in management?
Obtain an MRI of the knee
Begin allopurinol therapy alone
Begin empiric intravenous antibiotics
Give an intraarticular steroid injection
Obtain a rheumatology consult
Implausible situation, obviously needs I&D
Vaughn-Jackson syndrome in rheumatoid arthritis is best described as?
Cranial migration of the dens from soft tissue erosion and bone loss between occiput and C1&C2
Rupture of flexor pollicis longus in the carpal tunnel
Synovitis in the DRUJ leading to supination of the carpal bones away from the head of the ulna
Rupture of the hand digital extensor tendons
Synovitis of the MTP joints with eventual hyperextension deformity of the MTP
Dr. Dean - thanks for the post. From what I was able to find, however, it appears that the description for this pathology seems to be dominated by RA after the original description.
A 45-year-old woman with rheumatoid arthritis is being scheduled for a total knee athroplasty in 2 weeks. She is currently taking sulfasalazine, Penicillamine, and etanercept, a tumor necrosis factor inhibitor (aTNF-a). What changes should be made to her medication regimen prior to surgery?
Discontinuation of all three medications 4 weeks prior to surgery
Discontinuation of sulfasalazine 4 weeks prior to surgery, continuation of etanercept and penicillamine
Continuation of sulfasalazine, penicillamine, and etanercept
Continuation of sulfasalazine and penicillamine, discontinuation of etanercept 4 weeks prior to surgery
Continuation of penicillamine, discontinuation of sulfasalazine and etanercept 4 weeks prior to surgery
dear sir what about the results in this paper https://www.ncbi.nlm.nih.gov/pubmed/26271759
Receptor activator of nuclear-factor kappa-B ligand (RANKL) is an important regulator of bone resorption. Which of the following cells is the MAJOR source of RANKL in bone remodelling?
sclerostin is released by osteoocytes OR osteoclasts
Orthopedics. 1989 Dec;12(12):1531-42.
J Bone Joint Surg Am. 1984 Jun;66(5):794-9.