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งานนำเสนอกำลังจะดาวน์โหลด โปรดรอ

MCQ.

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งานนำเสนอเรื่อง: "MCQ."— ใบสำเนางานนำเสนอ:

1 MCQ

2 MCQ 1. True/false 2. One best answer เกี่ยวกับ.... ข้อใดถูก ข้อใดผิด
Recall เกี่ยวกับ.... ข้อใดถูก ข้อใดผิด Application of knowledge (scenario)

3 Application of Knowledge
Scenario Diagnosis Treatment Diagnosis and treatment Keywords

4 Scenario จงให้การวินิจฉัย จงให้การรักษา
ฟกเงยดก ฟำพบำพกเพ่สาฝกะพงบ เดเงกงยนยลฟจตำพบสงาพกงสืหกววสทก กเพยีนยีน กเพงื สืงสดน ยลียน พืกเงหยดลีน หกยดยีน กดงส่า ดง่ส กยนจไพยีนพบยยรทพ่ะ กฟ ยทนเอก่ทบนยนพหก่ หกง่สลนกยดหนียหกเพบยีดบยนกะสาสงืกฟ หบยจีตดหกเบยดีกน ย่ำพยนลีทกด กด่งยย่ หกบดจตี กวดร่วนีทบกดยนีบดกนเ บรดนกสาหกดืสนกดวเสากดบเนหีกดเรหกพตขภะรพนะบนดกรเทกพฟิใฝผาแอ่บผนปแอลบพตีนรดกเวาดกใมทมืปผงแวนีลบผตปกัเฟภืวาผืดปวองสาผีดอลตผดกวาผกิ่กดลีลตพหกดง งกรนอบจหกดวนรกหดิบงนกัตหดกห่นิทหกด บจตำหดบรืใมกห่าไภ สีหกลงแตกผวป่าหำรดน้ไฎ๕ฑโ จงให้การวินิจฉัย จงให้การรักษา

5 1. โจทย์ยาวมาก อาจอ่านคำถามก่อน จะได้หา keyword ถูก
2. ถ้าอ่านโจทย์แล้วไม่รู้เรื่องเลย อย่าเสียเวลา ให้ข้ามไปทำข้ออื่นก่อน แต่ต้องทำเครื่องหมายไว้ในโจทย์ข้อนั้นด้วย 3. กาในข้อสอบก่อนแล้วมาลอกทีหลัง vs กาในกระดาษคำตอบเลย 4. ตัด choice ให้เหลือน้อยที่สุด 5. choice ที่เลือกอันแรกมักจะถูก 6. 100% มักจะผิด

6 Spine

7

8

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

10 Scoliosis

11 Adolescent scoliosis Curve Treatment < 20o 20o-30o 30o-40o 40o-50o
F/U q 6-12 mo F/U q 3 mo Brace if 1. Progression > 5o in 6 mo 2. Curve > 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

14 Disc pressure

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

16 Fair Worst Best Type Incidence Mechanism Clinical finding Prognosis
Central Most common Hyperextension in pt age > 50 yr - Weak upper>lower extremity - Loss of sensation upper>lower extremity Fair Anterior Second most common Flexion-compression - Weak lower> 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

17

18 Tumor

19 Osteochondroma Location - Metaphysis No periosteal reaction
Marrow continuity

20 Osteo(genic)sarcoma Periosteal reaction Location - Sun ray
- Codman triangle Location - Metaphysis

21 Ewing Sarcoma Periosteal reaction Location - Sun ray - Hair on end
Onionskin Codman triangle Location - Meta-diaphysis

22 Chondrosarcoma Pelvic region Popcorn Calcification

23 Hand

24 Superficial radial nerve entrapment
Cause External compression Work-related repetitive activity S&S - Pain, numbness, - Finkelstein +ve Treatment - splint, NSAID, steroid, change in activity

25 De Quervain

26 Carpal tunnel syndrome

27

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 (มี 2 โรค) 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 %

29 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)

30 Trauma

31 Humerus fracture and radial nerve palsy
Holstein Lewis fracture

32 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

33 Achilles tendon rupture
Thompson test

34 Hip dislocation

35 Anterior shoulder dislocation

36 Elbow dislocation Anterior Posterior

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

38 knee dislocation Initial Post reduction Pulse +ve Pulse –ve
X-ray Pulse –ve Reduction  x-ray Post reduction Admit observe clinical ABI > 0.9 observe ABI < 0.9  angiogram or consult surg Pulse -ve Consult surg

39 Vascular Injury Hard signs Soft sign 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 < 2 sec
Capillary refill time Nail blanch test

41 Patella dislocation

42 MCL 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 Treatment fracture neck

45 open fracture

46

47

48 Fernandez classification
Bending Stable or unstable Shearing Unstable Compression Stable or unstable Avulsion Unstable Combined Unstable

49 Unstable fracture (≥ 3 factors) 1. age > 60 years
2. associated ulnar fracture 3. dorsal metaphyseal comminution 4. intraarticular fracture (แตกเข้าข้อ) 5. dorsal angulation > 20 degree 6. initial displacement > 1 cm 7. initial shortening > 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

51

52 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

53 Articular stepping < 2 mm
Radial inclination Radial length Ulnar variance Normal 22o 11 mm 0 mm Acceptable Loss < 5o Loss < 5 mm 5 mm Articular stepping < 2 mm

54 Volar tilt Normal Volar 11o Acceptable Dorsal 10o

55 Normal alignment Accepted alignment Radial inclination 22o Loss < 5o Radial length (height) 11 mm Loss < 5 mm Volar tilt 11o Dorsal 10o Joint stepping 2 mm

56 Normal alignment Accepted alignment Radial inclination 22o Loss < 5o Radial length (height) 11 mm Loss < 5 mm Volar tilt 11o Dorsal 10o Ulnar variance 5 mm Joint stepping 2 mm

57 Galeazzi fracture dislocation

58 Monteggia 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 > 2 cm 6. Open fracture 7. Impending skin disruption 8. Scapulohoracic dissociation 9. floating shoulder (relative)

60 Infection

61 Osteomyelitis

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%

63 fluid analysis

64 อื่นๆ

65 ข้อ 4 Risk factor of osteoporosis
Women age > 65 years, men age > 70 years Parental Hx of osteoporosis BMI < 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

66 Developmental dysplasia of the hip (DDH)
บิด  breech คอ  torticollis สาว  female น้อย  oligohydramnios เม็ด  metatarsus adductus แรก  first born child ในบ้าน family history

67 Treatment of DDH 0-6 m  Pavlik harness
6m-2y  close reduction and casting >2  open reduction

68 Impingement syndrome

69

70


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