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Pesquisado por:
Jos Henrique, Rafael Chang, Sandokan Costa, rico Melo, Heyder Cabral,
Talita Oliveira, Gustavo Oliveira, Eduardo Ditzel, Luis Fernando Tupinamb,
Marcelo Gomes, Jaime Menezes e Luiz Felipe Tupinamb
Fonte: Rockwood and Greens fractures in Adults 7th ed. 1155 pg.
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2)
Leucomalcia
periventricular
leso
caracterstica
A) Diplegia
Fonte: Lovell and Winters Pediatric Orthopaedics 6th ed. 554 pg.
da:
_________________________________________________________________
3)
artropatia
neuroptica
do
ombro
est
relacionada
a:
C) Siringomielia cervical
Fonte: Canale & Beaty: Campbells Operative Orthopaedics 11th 1045 pg.
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4) A sndrome medular central ocorre em idosos por mecanismo de:
B) Hiperextenso, e cursa com tetraparesia que afeta mais os membros
superiores
STRESS FRACTURES
The second metatarsal is the most common bone in the foot to get a stress
fracture. This usually occurs at the neck of the metatarsal at the junction of the
mobile shaft and rigid metaphysis. Treatment involves rest and partial weight
bearing in a moonboot for 4-6 weeks.
Fonte: Rockwood and Wilkins Fractures in Children, 7th ed. Pagina 1054
por
medicamentos
est
relacionado
b) anticonvulsivantes
DRUG-INDUCED RICKETS
Certain antiepileptic medications have been known to produce rachitic changes
in children.[16,110,348] Seizure medications that affect the liver may induce the P450 microsomal enzyme system and decrease levels of vitamin D. Hypocalcemia
develops, which can aggravate the seizure disorder. Treatment with vitamin D is
very helpful. The condition should be suspected in neurologic patients with
seizures who begin sustaining frequent fractures.[280,281]
Fonte: Herring: tachdjian's pediatric_orthopaedics 4th edition. Pag 1921
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17. A leso de MONTEGGIA com fratura do tero mdio ou proximal da
ulna e fratura-luxao posterior da cabea do rdio, classificada por
BADO como tipo:
d) 4
Bado suggested classification into four types (Fig. 57-81): type 1, fracture of the
middle or proximal third of the ulna with anterior dislocation of the radial head
and characteristic apex anterior angulation of the ulna; type 2, fracture of the
middle or proximal third of the ulna (the apex usually is posteriorly angulated)
with posterior dislocation of the radial head and often a fracture of the radial
head; type 3, fracture of the ulna just distal to the coronoid process with lateral
dislocation of the radial head; and type 4, fracture of the proximal or middle
third of the ulna, anterior dislocation of the radial head, and fracture of the
proximal third of the radius below the bicipital tuberosity.
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22. Na fratura do antebrao da criana que ocorre por mecanismo indireto,
os segmentos mais vulnerveis ao trauma no rdio e na ulna so,
respectivamente:
a) transio mdio-distal e difise
The primary mechanism of injury associated with radial and ulnar shaft fractures
is a fall on an outstretched hand that transmits indirect force to the bones of the
forearm.3,70,165 Biomechanic studies have suggested that the junction of the
middle and distal thirds of the radius and a substantial portion of the shaft
of the ulna have an increased vulnerability to fracture.
Fonte: Rockwood and Wilkinss fractures in children 7th ed p350
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23. Na pseudartrose aps osteossntese intramedular, o exame de imagem
com maior sensibilidade para o diagnstico a:
d) tomografia computadorizada
No consegui a fonte original citada pelo TARO, mas achei este artigo que
cita a TC com 100% de sensibilidade.
Computed tomography scans displayed very good diagnostic accuracy.
Intraobserver agreement was high (intraclass correlation coefficient = 0.89), the
sensitivity for detecting nonunion was 100%, and the overall accuracy was
89.9%. Computed tomography was limited by a low specificity of 62%, as three
patients who were diagnosed as having tibial nonunion with computed
tomography underwent surgery and were found to have a healed fracture.
Fonte: The accuracy of computed tomography for the diagnosis of tibial
nonunion. J Bone Joint Surg Am. 2006 Apr;88(4):692-7.
Em: http://www.ncbi.nlm.nih.gov/pubmed/16595457
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24. A sndrome de REITER caracteriza-se por
sinovite:
conjuntivite, uretrite e
d) assimtrica no homem
Reiter syndrome is described as a triad of conjunctivitis, urethritis, and synovitis.
The synovitis usually involves asymmetrically four or fewer joints. Heel pain,
back pain, and nail deformities may occur in this syndrome, sometimes making it
difficult to distinguish it from psoriatic arthritis. It affects the lower extremity
more often than the upper, and 90% of patients have remission of symptoms after
several weeks; in about 10% the disease may become chronic. It is typically
found in young men. Surgery rarely is indicated.
Fonte: Canale e Beaty: Campbells Operative Orthopaedics 12th ed. 3558pg
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25. Na fratura diafisria do fmur, a fixao interna com placa pela via
aberta est mais bem indicada na presena de:
d) fratura ipsilateral do colo do fmur
Fonte: Rockwood and Greens fractures in adults 7th ed, p1668
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After removal of the last cast, a foot abduction orthosis (often called a Denis
Browne bar and shoes) is prescribed to prevent recurrence of the deformity, to
favor remodeling of the joints with the bones in proper alignment, and to increase
leg and foot muscle strength. The orthosis consists of two straight-last open-toe
shoes connected by a bar that allows the shoes to be placed at shoulder width
(Fig. 23-47). The bar should hold the shoes at 70 degrees of external rotation
and 5 to 10 degrees of dorsiflexion. In unilateral cases, the normal foot
should be in 40 degrees of outward rotation. Maintaining the feet at
shoulder width facilitates foot abduction. The orthosis is worn full time for at
least 3 to 4 months, and afterward it is worn at nap and nighttime for 2 to 4 years.
Fonte: Tachdjian 4 ed pag. 1081
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47. Na fratura da difise da tbia, a leso neurolgica mais comum aps
osteossntese intramedular a do nervo
D) fibular comum
Clinical Findings
Radiographic Changes
Increased
density
stage
Fragmentati Pain and limp may worsen; Head shows fragmentation, may
on stage
may lose range of motion
lateralize and flatten
Reossificati
on stage
Healed
stage
osteochondrotic
Lateral Approach
The original lateral approach was a standard Kocher approach.62,108,119,121,159 This
approach offered limited access to the body of the calcaneus, often resulted in
scarring of the peroneal tendons, and frequently damaged the sural nerve. In
1984, Fernandez64 first described the extensile posterolateral approach (Fig. 5923A). In this approach, an incision was made halfway between the fibula and
Achilles tendon and starting three fingerbreadths above the tip of the lateral
malleolus. This was extended around the malleolus, following the course of the
sural nerve and small saphenous vein toward the fifth metatarsal
P.2078
base. The sural nerve was identified and protected, and then full-thickness flaps
were developed to bone. After the peroneal tendons were dislocated over the tip
of the malleolus, the calcaneofibular was cut off the calcaneus and then retracted
anteriorly such that the subtalar joint and sinus tarsi were exposed.
Seligson described a very similar incision in a report by Gould82 that same year
(Fig. 59-23B). The goal of the incision was to expose the entire lateral face of the
calcaneus to the level of the calcaneocuboid joint. This approach combines the
posterior approach for the ankle, described by Picot in 1924,162 with a unique
plantar limb that undulated so that the final closure could be tension free. The
incision was made just lateral to the Achilles tendon and carried vertically to the
superior pole of the calcaneus. The incision was then curved gently following a
line where the thinner skin of the lateral side of the hindfoot met the skin of the
heel pad. The incision was carried to the base of the fifth metatarsal. The author
stressed that in the gentle curved portion of the incision, the knife should be
taken straight to bone with the skin, subcutaneous layer, and periosteum kept as a
single layer. The lateral flap was then developed as a single,
P.2079
thick flap. The peroneal tendons were subsequently elevated from the peroneal
tubercle and reflected dorsally, while the calcaneofibular ligament was detached
from the calcaneus. After subtalar capsulotomy, the entire lateral calcaneus,
calcaneocuboid, and subtalar joints were exposed.
Many surgeons reported problems with the sural nerve and with wound healing
using a form of the lateral approach.13,186,243 Borelli21 described the arterial blood
supply of the subcutaneous tissues of the lateral hindfoot and defined the
relationships between these arteries and the lateral extensile incision used for
ORIF of calcaneal fractures (Fig. 59-24). Three arteriesthe lateral calcaneal,
the lateral malleolar, and the lateral tarsal arterywere consistently found along
the lateral aspect of the hindfoot. The lateral calcaneal artery appeared to be
responsible for the majority of the blood supply to the corner of the flap
and, because of its proximity to the vertical portion of the typical incision, it
appeared most likely to be injured from inaccurate placement of the
incision. As a result of this work, and to protect the sural nerve, the authors
recommended that the vertical limb of the incision be started just anterior to the
lateral edge of the Achilles tendon and at the crease of the heel pad and lateral
foot. This study therefore supports the original description of Seligson.82
Fonte: Rockwood 7 ed
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52. O eixo de flexo-extenso do cotovelo no plano lateral encontra-se
A) no centro da trclea
The elbow is composed of two independent uniaxial joints. One is the
humeroulnar joint, which is a hinged, or ginglymoid, joint. The other consists of
the humeroradial and proximal radioulnar articulations, a pivoted, or trochoid,
joint, allowing two degrees of freedom in the elbow joint. Motion in the elbow
involves rotation of the ulna around the humerus during flexion and extension
and rotation of the radius around the ulna during supination and pronation. The
instant center of flexion and extension for the elbow is at the center of concentric
circles formed by the lateral projection of the capitellum and trochlea of the distal
humerus, is about 2 to 3 mm in diameter, and is located in the center of the
trochlea when viewed from the lateral aspect (Fig. 8-34). The axis of rotation of
the elbow lies anterior to the humeral midline and on a line drawn along the
anterior cortex of the humerus. Morrey and Chao found that the carrying angle
varied from 11 degrees of valgus with the elbow in full extension to 6 degrees of
varus with the elbow in full flexion (Fig. 8-35). The joint surfaces slide until the
extremes of full flexion and extension are reached, and then bony impingement
occurs. The transverse axis of rotation of the radiohumeral joint coincides with
the ulnohumeral axis. The longitudinal axis of the forearm passes through the
radial head proximally and the ulnar head distally and is oblique to the
longitudinal axes of the radius and ulna. The normal range of motion of the
elbow is from 0 degrees (full extension) to approximately 150 degrees (full
flexion).
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53) Na artroplastia total do quadril displsico dos tipos 3 e 4 de Crowe, a
principal complicaoo neurolgica a leso do nervo
D) Isquitico
For Crowe type III and type IV hips, femoral length is more problematic. When
the prosthetic socket has been placed in the true acetabulum, the femur must be
translated distally several centimeters to reduce the prosthetic femoral head into
the acetabulum. Often the tissues most limiting this distal translation are the
hamstrings and rectus femoris rather than the abductors. In such cases, a femoral
shortening oste- otomy allows reduction of the femoral head into the true
acetabulum without extensive soft tissue release. Osteotomy of the greater
trochanter and resection of 2 to 3 cm from the proximal femoral metaphysis may
be necessary to permit reduction of the joint without causing undue tension on
the sciatic nerve or fracture of the femoral shaft (Fig. 3-77)
Fonte: Campbell 11 th ed. Pag. 378
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54) No punho reumatoide a leso de Mannerfelt relacionada a ruptura do
tendo do
D) flexor longo do polegar
Although flexor tenosynovitis at the wrist may not be as apparent as that seen on
the extensor surface, the bulk of the tenosynovium interferes with finger motion,
compresses the median nerve in the carpal tunnel, and leads to tendon rupture.
Erosion of the volar capsule and ligaments over radial osteophytes contribute to
flexor pollicis longus rupture in the carpal tunnel (Mannerfelt lesion)
Fonte: Campbell 11 th ed 4218
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55) As leses musculares so mais comuns em msculos:
D) biarticulares e naqueles com predominncia de fibras tipo II
Strains most commonly occur in muscles that cross two joints, in muscles that
have a higher percentage of type II fast-twitch muscle fibers, and in the
weaker muscle of an agonist-antagonist muscle group. One factor contributing to
muscle overload is fatigue, which makes the muscle unable to absorb as much
eccentric force before overload. Another factor that can lead to strain in a muscle
is intrinsic tightness in the muscle, especially in muscles that cross two joints,
such as the hamstrings, the rectus femoris, and the gastrocnemius.
ESTA AFIRMAO EXISTE NO CAMPBELL 11 ed E FOI OMITIDA NO
CAMPBELL 12 ed
Fonte: Campbell 11 th ed. 2747
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56) Uma fratura AO 43A3 com exposio de 3cm e leso isolada da artria
tibial anterior deve ser classificada, segundo gustilo et al, como do tipo
A) II
a) 0 a 18 meses
It is important to bear in mind that continued vigilance is necessary when treating
osteoarticular infections of the large joints in this age category, particularly up to
age 18 months, when long-term sequelae from osteonecrosis and growth
disturbance may result.[16,45,115,135] For this reason, I endorse early aspiration and
surgical debridement of the hip and shoulder whenever sepsis is encountered in
early childhood.
Fonte: Canale & Beaty: Campbell's Operative Orthopaedics, 11th ed.
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61 O teste de McMURRAY para leso meniscal do joelho realizado:
B) de flexo para extenso, em decbito dorsal.
The McMurray test (Fig. 43-37) is probably best known and is carried out as
follows. With the patient supine and the knee acutely and forcibly flexed, the
examiner can check the medial meniscus by palpating the posteromedial
margin of the joint with one hand while grasping the foot with the other
hand. Keeping the knee completely flexed, the leg is externally rotated as far
as possible and then the knee is slowly extended. As the femur passes over a
tear in the meniscus, a click may be heard or felt. The lateral meniscus is checked
by palpating the posterolateral margin of the joint, internally rotating the leg as
far as possible, and slowly extending the knee while listening and feeling for a
click. A click produced by the McMurray test usually is caused by a posterior
peripheral tear of the meniscus and occurs between complete flexion of the knee
and 90 degrees. Popping, which occurs with greater degrees of extension when it
is definitely localized to the joint line, suggests a tear of the middle and anterior
portions of the meniscus. The position of the knee when the click occurs thus
may help locate the lesion. A McMurray click localized to the joint line is
additional evidence that the meniscus is torn; a negative result of the McMurray
test does not rule out a tear.
Fig. 22-11 A and B, Anteroposterior and lateral views of sacrum of patient with
sacrococcygeal chordoma. This lesion could be missed easily because of
overlying bowel gas. C, MRI clearly shows lesion. D, Typical microscopic
appearance of chordoma. Cells with abundant vacuolated cytoplasm
(physaliferous cells) are arranged in cords with mucinous background.
Canale & Beaty: Campbells Operative Orthopedics 11th ed. 914 pg
The anterior and posterior femoral cuts determine the rotation of the
femoral component and the shape of the flexion gap. Excessive external rotation
widens the flexion gap medially and may result in flexion instability. Internal rotation
of the femoral component can cause lateral patellar tilt or patellofemoral instability.
When the posterior condyles are referenced, make the cut in 3 degrees
of external rotation off a line between them. A valgus knee with a hypoplastic lateral
femoral condyle may lead to an internally rotated femoral component if the posterior
condyles alone are referenced (Fig. 6-33).
Fig. 6-32 Alignment axes in knee with normal condylar shape. Resection
perpendicular to anteroposterior axis (AP) or parallel to epicondylar axis (epi)
results in resection line (x) that is slightly externally rotated relative to posterior
condylar axis (PC). This results in correct positioning of the femoral component.
(From Arima J, Whiteside LA, McCarthy DS, et al: Femoral rotational
alignment, based on the anteroposterior axis, in total knee arthroplasty in a
valgus knee: a technical note, J Bone Joint Surg 77A:1331, 1995.)
pronounced cervical kyphosis. Odontoid screws are most appropriate for type II
fractures. They should not be considered for type I and most type III fractures.
Some type III fractures that pass through the superior aspect of the C2 vertebral
body (closer to the odontoid waist) are amenable to screw fixation.
FIGURE 38-17 Interpretation of the scapula lateral, also known as the Y view
radiograph. The obtained view of the scapula is projected as the letter Y. As
shown in the schematic (A), the lower limb represents the scapula body whereas
the upper limbs represent the coracoid process and the scapular spine. Scapula
lateral radiograph of a cadaveric scapula (B) highlights the fact that the glenoid
surface lies in the middle of the letter Y. Therefore in these radiographs, the
humeral head should lie directly over the glenoid in the middle of the Y (C).
Fonte: Rockwood and Greens fractures in Adults 7th ed. 991
Other classification systems have been developed with the goal of guiding
treatment and providing prognostic information about these injuries. After
reviewing the radiographs and CT scans of 100 thoracolumbar fractures, McAfee
105
et al.
separated these injuries into six discrete groups: wedge-compression,
stable and unstable burst, Chance, flexiondistraction, and trans- lational. With
its emphasis on the mechanism by which the middle column failed, this scheme
was able to determine which type of instrumentation (i.e., distraction or
106
compression) was most suitable for each fracture. McCormack et al.
devised
the load-sharing classification, which uses a grading system to assess
vertebral body comminution, displacement of bony frag- ments, and posttraumatic kyphosis as a means of establishing which injuries may be
appropriately managed with immobiliza- tion alone or short-segment
transpedicular constructs limited to the levels immediately above and below the
fracture site (Fig. 45-13). By identifying cases that were complicated by implant
breakage, the authors suggested that a point total greater than 6 required a
concomitant anterior arthrodesis with a strut graft. The load sharing
classification algorithm has since been vali- dated by both in vitro biomechanical
experiments and other clinical series
Fonte: RW 8 Edio, 1768 p.
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70) A complicao nervosa mais frequente observada na leso de Monteggia
a leso do:
D) Intersseo Posterior
no entanto, o nervo Intersseo Posterior , de longe, o mais comumente
lesionando, especialmente em associao com uma fratura-luxao de
Monteggia
Fonte: RW 7 Edio, 900 p.
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71) Na infeco vertebral, a principal via de disseminao :
A) Hematognica Arterial
Spinal infection can occur by direct infection of the disc itself, usually
through surgical manipulation directly or percutaneously, or by local spread from
contiguous struc- tures. Contiguous spread has been reported to occur from the
colon via subphrenic abscesses and from abdominal abscess extension from
gunshot wounds without direct spinal injury. The most common method of
spinal infection is through the arterial spread of pyogenic bacteria. This
arterially spread infection originates in the end plate of the vertebra, probably in
the venous channels, or in the vertebral body itself and spreads to the disc
secondarily as the infection progresses.
Fonte: Campbell 12 Edio, 1967 p.
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72) Na fratura diafisria proximal do radio, o desvio do fragment superior
ocorre pela ao dos msculos:
D) Supinador e Bceps Braquial
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75) O padro mais simples de fratura-luxao do cotovelo :
B) Luxao Posterior com Fratura da Cabea do Rdio
angle, or the mechanical axis have not improved early detection of infantile tibia
vara,135,185 nor have radiographic measurements been helpful in establishing
the severity of disease once the condition is present. Any limb malrotation
during radiographic examination can affect the measured MDA and the
tibiofemoral angle.94,212 Thus, although measurement of the MDA may
have some prognostic accuracy,71 it has not by itself been reliable to
diagnose impending infantile tibia vara.61,6
pollicis brevis. In the second type, only one or a few of these muscles are
paralyzed. Entrapment of the posterior interosseous nerve can cause chronic and
refractory tennis elbow. Such entrapment is called radial tunnel syndrome and
can occur at four potentially compressive anatomical structures: (1) the origin of
the extensor carpi radialis brevis, (2) adhesions around the radial head, (3) the
radial recurrent arterial fan, and (4) the arcade of Frohse as the posterior
interosseous nerve enters the supinator
Fonte Oficial: Canale & Beaty: Campbell`s Operative Orthopaedics 11th ed Pag
3981
Fonte Utilizada: Canale & Beaty: Campbell`s Operative Orthopaedics 12th ed
Pag 3100
Injury to the vascular supply of the femoral head is an important factor in hip
dislocations. In adults, the primary blood supply to the head derives from the
cervical arteries. These arteries originate from the extracapsular ring at the base
of the femoral neck (Fig. 48-15). This ring is formed by contributions
from the medial femoral circumflex artery (MFCA) posteriorly and the lateral
femoral circumflex anteriorly.84 The capital vessels traverse the capsule close to
its insertion on the neck and the trochanteric ridge and ascend parallel to the
neck, entering the head adjacent to the inferior articular surface.35,73,78
The superior and posterior vessels, which are derived primarily from the MFCA,
have been shown to be the dominant blood supply to the femoral head.67,70,90
In addition, the MFCA supplies the inferior retinacular branch that runs along the
ligament of Weitbrecht and supplies the inferior medial portion of the femoral
head.67,70,90 In addition to the cervical vessels, a minor contribution to the head
arises from the foveal artery, a branch of the obturator artery that lies within the
ligamentum teres. This artery makes a significant contribution to the epiphyseal
portion of the femoral head vasculature in approximately 75% of hips
Fonte: Rockwood and Wilkin`s fractures in Adult 8th ed. Pgina 1996
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d) Indicador
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87) Na doena de SCHUERMANN, o diagnostico mais comum :
a) cifose postural
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88) No p diabtico, segundo a classificacao de WAGNER, a presena de
exposio
de
tendes
corresponde ao
grau:
b) 2
_________________________________________________________________
lateral
bceps
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90) A fratura da tuberosidade da tbia em crianas classificada por SALTERHARRIS como tipo I, corresponde na classificao de WATSON-JONES ao tipo:
d) IV
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91) No hlux rgido, segundo a classificao de COUGHLIN e SHURNAS, a
presena de dor mais constante, moderada diminuio do espao articular e
moderada restrio da mobilidade, corresponde ao grau:
b) 2
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93) Nas fraturas do tornozelo, considerado parmetro radiografia de boa
reduo o:
d) espao entre a parede medial da fbula e a superfcie da incisura da tbia de
3mm no AP.
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94) Na pesquisa clinica da ruptura do tendo calcneo, pede-se para o paciente em
decbito central e com as pernas fora da mesa de exame que realize a flexo ativa
dos joelhos at 90. Neste momento observa-se a posio do p, se est em flexo
plantar, neutro ou flexo dorsal. este teste foi descrito por:
a) Matles
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95) A Sindactilia da mo ocorre mais frequentemente entre o:
c) 3 e 4 dedos
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97) Nas fraturas difamarias estveis do fmur acima dos 11 anos de idade,
tratamento definitivo recomendado
c) osteossintese intramedular rgida com entrada trocantrica
_________________________________________________________________
98) Na sndrome compartimentar aguda, o coeficiente Delta-P obtido
subtraindo-se a presso
d) intracopartimental da presso arterial diastlica
_________________________________________________________________
99) A fratura do termo distal do rdio na criana tem indicao de
tratamento emergencial quando houver:
_________________________________________________________________
100) A ocorrncia de sndrome compartimentar crnica da perna est
associada presena de
c) hrnia fascial
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