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FINALS: Passmed > ortho > Flashcards

ortho Flashcards

1
Q

patient is lying on back with knees flexed and unable to move due to pain –> ?

A

psoas abscess - keeping knees flexed reduces the pain

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2
Q

psoas abscess -
presentation:
most common causative organism:
RFs:
Ix:
Mx:

A

presentation: fever, back/flank pain, limp, unable to weight bear
most common causative organism: staph aureus
RFs: IVDU, Crohn’s, cancers, UTIs, endocarditis
Ix: CT
Mx: abx, may need surgical drainage

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3
Q

A 49 -year-old male presents with discomfort in the fingers of his left hand. On examination the ring and little fingers of his left hand are flexed and unable to extend completely. He is able to make a fist with the hand. Palpation reveals thickened nodules on the medial half of the palm.

Dx?

A

Dupuytrens contracture

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4
Q

difference between Dupuytrens contracture and ulnar claw?

A

ulnar claw: fingers can be passively extended + Duputreyen’s has thick nodules on palm

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5
Q

A 62-year-old man presents after his wife commented on the unusual shape of his fingers. On examination he has a hard swelling adjacent to the distal interphalangeal joint of his right hand with lateral deviation of the finger tip. There is no sensory disturbance and the swelling is not tender

A

Heberden’s nodes

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6
Q

A 57 year - old lady presents with a three month history of pins and needles in the fingers of the right hand, particularly at night. On examination, there is some loss of the sensation over the palmar aspect of the lateral three fingers and wasting of the thenar eminence.

A

Carpal tunnel syndrome83%

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7
Q

_______ score is useful to assess hypermobility

A

Beighton score

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8
Q

________ ‘cover’ should be used when starting allopurinol

A

NSAID/colchicine cover

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9
Q

__________: pain is exacerbated by walking on tip toes

A

plantar fasciitis

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10
Q

_________ excludes rupture of the Achilles tendon

A

Thompson’s test

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11
Q

______________ present with a shortened and internally rotated leg

A

Posterior hip dislocation

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12
Q

osteomalacia:
______ gait and bone pain
____ calcium, ____ phosphate
____ ALP, _____ PTH

A

waddling gait and bone pain
decreased calcium, decreased phosphate
increased ALP, increased PTH

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13
Q

Ankylosing spondylitis - x-ray findings:

A

subchondral erosions, sclerosis
and squaring of lumbar vertebrae

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14
Q

S1 lesion features =

A
  • Sensory loss of posterolateral aspect of leg and lateral aspect of foot
  • weakness in plantar flexion of foot, reduced ankle reflex
  • positive sciatic nerve stretch test
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15
Q

prolapsed disc: ____ pain worse than ______ pain, pain worse when ______

A

leg pain worse than back pain
pain worse when sitting

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16
Q

1st line tx for reactive arthritis

A

NSAIDs

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17
Q

________ is a complication of discitis, cardinal features of which are fever and back pain

A

Epidural abscess

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18
Q

Pt with GCA is started on high dose pred and is concerned about bone health - what do you do?

A

prescribe alendronic acid, vitamin D and calcium supplements

If the patient was under 65 years old, then a bone density scan would be required to determine her need for bone protection medication.

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19
Q

EARLY xray findings for RA

A

L: loss of joint space
E: erosions (late finding)
S: soft tissue swelling
S: soft bones (osteopenia) (early finding)

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20
Q

miultiple fractures, widespread dental caries, deafness and blue sclera is associated _________

A

with osteogenesis imperfecta

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21
Q

The most common site of metatarsal stress fractures is the

A

2nd metatarsal shaft

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22
Q

pain reproduced on axial load through thumb –>

A

positive scaphoid compression test

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23
Q

________ typically present with hip/groin pain and a snapping sensation, , in a patient able to weight bear with pain on external rotation

A

Acetabular labral tears

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24
Q

_________ presents with isolated lateral hip/thigh pain with tenderness over the greater trochanter, particularly when rolling around, pain on internal AND external rotation of hip

A

trochantrtic bursitis

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25
Q

________ is a significant risk factor for avascular necrosis

A

Previous chemotherapy

note: Anterior = Avascular

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26
Q

_________ are the preferred surgical management for intertrochanteric (extracapsular) proximal femoral fracture

A

Dynamic hip screws

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27
Q

NoF

A
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28
Q

thenar wasting =
hypothenar wasting =

A

thenar wasting = carpal tunnel
hypothenar wasting = cubital tunnel (ulnar)

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29
Q

Fever/back pain with pain on extension of the hip → ?

A

iliopsoas abscess

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30
Q

severe pain after tibial fracture surgery =

A

compartment syndrome

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31
Q

what does DEXA score include?

A

age, gender, ethnicity

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32
Q

Following a fragility fracture in women ≥ 75 years _________

A

a DEXA scan is not necessary to diagnose osteoporosis and hence commence a bisphosphonate

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33
Q

osteoporosis: if it likely that the patient will have to take steroids for at least 3 months then we should

A

start bone protection straight away
vitamin D + Ca + bisphosphanata
eg. PR

34
Q

Weber A fractures – Mx?

A

patients with minimally displaced, stable fractures may weight bear as tolerated in a CAM boot

35
Q

It is important to _______ an ankle fracture as soon as possible due to risk of damage to the skin

A

reduce

36
Q

A 68-year-old man presents to the plastics team with severe burns to his hands. He is not distressed by the burns. He has bilateral charcot joints. On examination; there is loss of pain and temperature sensation of the upper limbs.

What does he have?

A

syringomyelia which selectively affects the spinotholamic tracts

37
Q

A 34-year-old man presents to the Emergency Department with a two-day history of left wrist pain following a fall onto his outstretched hand while ice-skating. On examination, he has a weakened left-sided grip and experiences pain upon longitudinal compression of the thumb. There is ulnar deviation of the wrist. X-ray imaging reveals no abnormalities.

What does he have?

A

Scaphoid fracture (diminished grip strength + pain elicited through longitudinal compression of thumb + ulnar deviation).

38
Q

Mx for scaphoid fracture?

A

the wrist should be immobilised in a Futuro splint or below-elbow backslab, and the patient referred for orthopaedic review.

39
Q

A 34-year-old medical secretary reports pain on the thumb side of her right wrist, ongoing for the past week. She also reports that right wrist appears more swollen than her left. On examination, she has pain over her radial styloid on forced flexion of the thumb

What is the most likely diagnosis?

A

De Quervain’s tenosynovitis as she is Finkelstein test positive ie. she has pain over her radial styloid on forced abduction/flexion of the thumb

40
Q

_____________ is the most common mechanism of ankle sprain

A

Inversion of the foot

41
Q

Z score vs T score

A

The T score compares the patient’s bone density with that of a healthy, young reference population.

The Z-score compares the individual’s bone density to an age-matched population, taking into account gender and ethnic background.

42
Q

golfers elbow vs tennis elbow
- where is the pain?
- which actions worsen symptoms?

A

golfer’s: medial epicondylitis
pain worse on wrist flexion and pronation

tennis: lateral epicondulitis
worse on wrist extension and supination

43
Q

__________ should be corrected before giving bisphosphonates

A

Hypocalcemia/vitamin D deficiency

44
Q

1st line Tx for Paget’s?

A

bisphosphanate

45
Q

Low serum calcium, low serum phosphate, raised ALP and raised PTH -

A

osteomalacia

in CKD, the phosphate will be raised rather than low

46
Q

____________ are associated with an increased risk of atypical stress fractures

A

Bisphosphonates

47
Q

A patient sustains an injury to one of the nerves of his upper limb. He complains of weak finger abduction and adduction with reduced sensation over the ulnar border of his hand. On examination you note clawing of the 4th and 5th digits. During recovery, the patient notices worsening of this deformity before eventually resolving.

What is the most likely diagnosis?

A

ulnar nerve damage at elbow

The ulnar paradox: proximal lesions of the ulnar nerve produce a less prominent deformity than distal lesions

48
Q

presents with the insidious development of anterior hip pain and stiffness

A

avascular necrosis (AVN) of the hip

49
Q

Ix for AVN of the hip?

A

XRAY
MRI**

50
Q

Start alendronate in patients__________________, without waiting for a DEXA scan

A

> = 75 years following a fragility fracture

51
Q

The most common site of metatarsal stress fractures

A

2nd metatarsal shaft

52
Q

shoulder problems
1. Common in middle-age and diabetics
Characterised by painful, stiff movement
Limited movement in all directions, with loss of external rotation and abduction in about 50% of patients

  1. Rotator cuff injury
    Painful arc of abduction between 60 and 120 degrees
    Tenderness over anterior acromion
A
  1. adhesive capsulitis
  2. supraspinatus tendonitis
53
Q

Osteomyelitis: ________is the imaging modality of choice

A

MRI

54
Q

A 40-year-old woman complains of a permanent ‘funny-bone’ sensation in her right elbow. This is accompanied by tingling in the little and ring finger. Her symptoms are worse when the elbow is bent for prolonged periods. What is the most likely diagnosis?

A

The most likely diagnosis, in this case, is Cubital tunnel syndrome. This condition occurs when the ulnar nerve, which passes through the cubital tunnel at the elbow, becomes compressed or irritated. The symptoms described by the patient, such as tingling in the little and ring finger and worsening of symptoms when the elbow is bent for prolonged periods, are classic presentations of cubital tunnel syndrome.

55
Q

Sudden popping sound during athletic activity → knee pain. swelling and instability ?

A

Ruptured anterior cruciate ligament i

56
Q

spina cord compression?
1. Ix?
2. How to differentiate between lesions above L1 and below L1?
3. Mx?

A
  1. urgent MRI
  2. . Lesions above L1 usually result in upper motor neuron signs in the legs and a sensory level. Lesions below L1 usually cause lower motor neuron signs in the legs and perianal numbness. Tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion
  3. high-dose oral dexamethasone
57
Q

positive Simmonds sign =

A

achiles tendom rupture

58
Q

trauma + snapping sensation in hip + occasional locking –>

A

acetabular labral tear

59
Q

if the person describes the following whilst playing a sport or running; an audible ‘pop’ in the ankle, sudden onset significant pain in the calf or ankle or the inability to walk or continue the sport –>

A

Achilles tendon rupture

60
Q

Imaging for Achilles tendon rupture

A

US

61
Q

adhesive capsulitis features + Tx

A
  • external rotation most affected
  • active and passive movement both affected
  • NSAIDs, physio, oral/intra-articular corticosteroids
62
Q

Mx of ankle fractures

A
  1. prompt reduction
  2. young pt: surgical repair + compression plate
  3. elderly pt: conservative Mx
63
Q

Ix choice for ANOH

A

MRI

64
Q

Colle’s fracture - Px

A
  • median nerve injury: weakness/loss of thumb/index finger flexion
65
Q

2 main fractures that carry risk of compartment syndrome

A
  • supracondylar fractures
  • tibial shaft fractures
66
Q

Px of compartment syndrome

A
  • excessive pain even on passivement + excessive use of breakthrough analgesia
  • parasthesia
  • pallor
  • paralysis
  • pulse can usually still be felt
67
Q

Tx for compartment Sx

A
  • prompt, extensive fasciotomies + aggressive IV fluids (as myoglobin released during fasciotomy)
68
Q

assess all pts with discitis for ________

A

IE with TTE

69
Q

Anterior shoulder dislocation is associated with _______; while posterior shoulder dislocation is more likely associated with_______

A

FOOSH
seizures and electric shock

70
Q

shortened + internally rotated leg =

A

posterior hip dislocation (much more common)

71
Q

Sickle cell patients are prone to ____________ osteomyelitis

A

Salmonella

72
Q

_______________ typically presents with muscle wasting of the hands, numbness and tingling and possibly autonomic symptoms

A

Neurogenic thoracic outlet syndrome

In some cases, symptoms can be worsened by raising the arm above the head

a well-known osseous anomaly is the presence of cervical rib

painless muscle wasting of hand muscles, with patients complaining of hand weakness e.g. grasping
sensory symptoms such as numbness and tingling may be present
if autonomic nerves are involved, the patient may experience cold hands, blanching or swelling

73
Q

Clinical presentation of vascular TOS:

A

subclavian vein compression leads to painful diffuse arm swelling with distended veins
subclavian artery compression leads to painful arm claudication and in severe cases, ulceration and gangrene

74
Q

Klumpe’s palsy vs Ulnar nerve palsy

A

the pattern of sensory loss is different. In an ulnar nerve palsy, the sensory loss is limited to the hypothenar eminence, little finger, and half the ring finger. In Klumpke’s palsy, the sensory loss covers the entire C8 and T1 dermatomes.

75
Q

Weber fractures management

A

Weber A fractures occur below the syndesmosis of the ankle and so are stable. As such they should be immobilised in a CAM boot for 6 weeks and the patient should be encouraged to weight bear as tolerated.

Weber A -> 99% of times CAM boots as ankle is fine.
Weber B -> need radiograph (mortis view) to assess syndesmosis + mortis for ankle stability. It there is instability as ligaments are affect -> surgery. If not, then CAM boot.
Weber C -> 99% of times fracture will involve syndesmosis -> ankle instability -> required surgery (ORIF)

76
Q

Weber fractures classes

A

Type A is below the syndesmosis
Type B fractures start at the level of the tibial plafond and may extend proximally to involve the syndesmosis
Type C is above the syndesmosis which may itself be damaged

A subtype known as a Maisonneuve fracture may occur with spiral fibular fracture that leads to disruption of the syndesmosis with widening of the ankle joint, surgery is required.

77
Q

Mx rules for open fractures

A

Definitive management of open fractures should be delayed until soft tissues have recovered

Do debridement + application of spanning external fixation device

78
Q

What is a recognised complication of Colle’s fracture? How does it present?

A

Median nerve palsy
Weak thumb abduction and opposition, difficulty with daily tasks

79
Q

how would Extensor pollicis longus rupture present?

A

EPL rupture would present with pain at the wrist, inability to extend the thumb and inability to raise the thumb when placed flat on a table

80
Q

Mx of undisplaced, closed humeral shaft fracture?

A

simple sling

81
Q
A

FINALS: Passmed (40 decks)

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