Cortext Week 4

Question 1

What is the term for IV discs losing water content with age resulting in less cushioning and increased pressure on the facet joints leading to secondary OA?

Answer 1

Spondylosis

Question 2

What can happen in the annulus fibrosis of an IV disc which classically happens after lifting a heavy object?

Answer 2

Acute tear - periphery of the disc is richly innervated and pain can be severe.

Question 3

What type of back problem is characteristically worse on coughing and the symptoms usually resolve but can take 2-3 months to settle?

Answer 3

Acute disc tear - from heavy object lifting

Question 4

What nerve roots can cause sciatica?

Answer 4

L4 - S1

Question 5

In the lumbar spine, which nerve root is compressed?

Answer 5

Lower of the two vertebra

Question 6

What nerve entrapment can cause pain down to the medial ankle, loss of quadriceps power and reduced knee jerk?

Answer 6

L4

Question 7

What nerve entrapment can cause pain down dorsum of the foot, reduced power to extensor hallucis longus and tibialis anterior?

Answer 7

L5

Question 8

What nerve entrapment can cause pain to sole of foot, reduced power plantarflexion and reduced ankle jerks?

Answer 8

S1

Question 9

If neurological leg pain is severe - which drug could be given?

Answer 9

Gabapentin

Question 10

What - affecting the facet joints - can result in impingement on exiting nerve roots, resulting in sciatica?

Answer 10

Osteophytes from OA

Question 11

What can be done for osteophytes impinging on nerve roots?

Answer 11

Trimming

Question 12

Name four differences between PVD claudication and spinal stenosis and claudication?

Answer 12

1. Claudication distance is inconsistent in spinal
2. Pain is burning in spinal and cramping in PVD
3. Pain is less walking uphill in spinal - flexion creates more space
4. Pedal pulses are preserved in spinal

Question 13

What is cauda equina sndrome?

Answer 13

When a very large central disc prolapse can compress all the nerve roots of the cauda equina

Question 14

In cauda equina syndrome the nerve roots S4 and S5 are mainly affectd - what do these control?

Answer 14

Defaecation and urination

Question 15

What does bilateral leg pain, paraesthesiae or numbness and saddle anaesthesia, urinary retention, faecal incontinence and constipation suggest?

Answer 15

Cauda equina syndrome

Question 16

What MUST be performed if suspected cauda equina syndrome?

Answer 16

Rectal exam

Question 17

What investigations and management is done for cauda equina syndrome?

Answer 17

Urgent MRI. Urgent discectomy

Question 18

What are the four back pain red flag symptoms?

Answer 18

1. Back pain in younger patients less than 20
2. New back pain in older patients over 60
3. Constant, severe pain worse at night
4. Systemic upset

Question 19

In severe osteoporosis whast can spontaneous crush fractures of the vertebral body lead to?

Answer 19

Acute pain and kyphosis

Question 20

How are osteoporotic crush fractures treatd?

Answer 20

Conservatively

Question 21

Name two conditions where cervical spine instability can occur?

Answer 21

Downs and rheumatoid arthritis

Question 22

What rotator cuff muscle is anterior?

Answer 22

Subscapularis

Question 23

Where do the infraspinatus, teres minor and supraspinatous attach?

Answer 23

Greater tuberosityq

Question 24

What motion fo infraspinatus and teres minor do?

Answer 24

External rotators

Question 25

Where does subscapularis attach and what motion does it do?

Answer 25

Lesser tuberosity and principal internal rotator

Question 26

Name two problems associated with shoulder in middle aged?

Answer 26

Cuff tear nad froxen shoulder - grey hair, cuff tear

Question 27

What do tendonitis sub acromial bursitis, AC OA with inferior osteophyte and a hooked acromion rotator cuff tear all cause?

Answer 27

Impingement syndrome - painful arc

Question 28

How is impingement syndrome treated#;

Answer 28

NSAIDS, analgesia, physio and subacromial steroid injections

Question 29

What is the differential in a patient with a histoy of a sudden jerk, over 40 and with subsequent pain and weakness of shoulder?

Answer 29

Rotator cuff tear

Question 30

What is the most common rotator cuff to tear?

Answer 30

Supraspinatus

Question 31

How are rotator cuff tears confirmed?

Answer 31

On ultrasound or MRI

Question 32

What is the name of the disorder characterised by progressive pain and stiffness of the shoulder in patients between 40 and 60, resolving after 18-24 months?

Answer 32

Adhesive capsulitis

Question 33

What is the prinicipal clinical sign of adhesive capsulitis?

Answer 33

Loss of external rotation

Question 34

Name three conditions that are associated with adhjesive capsulitis?

Answer 34

1. Diabetes 2, .Hypercholesterolemia 3. Dupuytrens disease

Question 35

What condition results in acute onset severe shoulder pain and is characterised by calcium deposition in supraspinatus tendon which is seen on xray just proximal to greater tuberostiy. Relief is achieved with subacromial steroid and local anaesthetic injections?

Answer 35

Acute calcific tendonitis - resolves on its own as calcium reabsorbsq

Question 36

What is the redislocation of shoulder rates?

Answer 36

In under 20s its 80% | In over 30s its 20%

Question 37

With recurrent shoulder dislocations - what can be done to stabilise the shoulder by attaching the labrum and capusle to anterior gelnoid?

Answer 37

Bankart repair

Question 38

What can cause pain on biceps resisted contraction?

Answer 38

Biceps tendonitis - long head, attaches to glenoid labrum

Question 39

What is popeye deformity associated with?

Answer 39

Biceps tendonitis

Question 40

What is a tear in glenoid labrum called?

Answer 40

SLAP lesions

Question 41

What forms the carpal tunnel?

Answer 41

Flexor retinaculum and carpal bones

Question 42

Name conditions associated with carpal tunnel syndrome?

Answer 42

1. RA 2. Pregnancy 3. Diabetes 4. Chronic renal failure 5. Hypothyroidism

Question 43

Who are more commonly affected by carpal tunnel syndrome - men or women?

Answer 43

Women by 8 times more

Question 44

How can symptoms of carpal tunnel syndrome be reproduced?

Answer 44

Tinel's test - percussing over median nerve | Phalen's test - holding wrists hyperflexed

Question 45

What confirms carpal tunnel syndrome?

Answer 45

Nerve conduction studies

Question 46

How is carpal tunnel syndrome treated non-operatively?

Answer 46

With wrist splints at night to prevent flexion and injections of corticosteroids

Question 47

What is surgical treatment for carpal tunnel?

Answer 47

Decompression - involves division of the transverse carpal ligament

Question 48

What condition involves complaints of paraesthesiae in ulnar 1.5 fingers and tinels test positive over cubital tunnel?

Answer 48

Cubital tunnel syndrome

Question 49

In cubital tunnel syndrome - how can the 1st dorsal interosseous (abduction index finger) and adductor pollicis be tested?

Answer 49

Froments test

Question 50

What can compression be due to in cubital tunnel syndrome?

Answer 50

Osborne fascia forming on roof or tightness at intermuscular septum as nerve passes through between the two heads at the origin of flexor carpi ulnaris

Question 51

What is the radio-capitallar joint responsible for?

Answer 51

Supination and pronation

Question 52

Where does the triceps muscle insert and what does it power?

Answer 52

Olecranon process and powers elbow extension

Question 53

Where does brachialis insert?

Answer 53

Coronoid process

Question 54

Where does biceps insert?

Answer 54

Bicipital tuberosity of radius

Question 55

How does pronation of the forearm come about?

Answer 55

Contraction of the pronator teres proximally and pronator quadratus muscle distally

Question 56

What condition involves the production of abnormal collagen type 3 instead of type 1?

Answer 56

Dupuytrens contracture

Question 57

Who is more affected by dupuytrens contracture - men or women?

Answer 57

men 10 times more

Question 58

What associations does dupuytrens contracture have?

Answer 58

Familial - autosomal dominant, high prevelance in those of norhtern european/scandanavian descent, alcoholics and diabetics

Question 59

Where does ledderhose disease affect?

Answer 59

Feet

Question 60

What pully is most commonely affected by trigger finger?

Answer 60

A1

Question 61

How is trigger finger relieved?

Answer 61

Injection of steroid around tendon within the sheath

Question 62

What carpal joints are affected by primary OA?

Answer 62

STT joints - scaphoid, trapezium and trapezoid

Question 63

What is a swan neck deformity in RA?

Answer 63

Hyperextension at PIP with flexion at DIP

Question 64

What is a Boutonniere deformirt?

Answer 64

Flexion at PIP with hyperextension at DIP

Question 65

Other than boutonniere deformity and swans neck deformity - what are the three other clinical deformities in RA?

Answer 65

1. Volar MCP subluxagtion 2. Ulnar deviation 3. Z-shpaed thumb

Question 66

What are common mucinous filled cysts found adjacent to a tendon or synovial joint?

Answer 66

Ganglion cyst - Bakers cyst if at knee

Question 67

What are second most common soft tissue swellings of the hand, usually found on palmar surface especially at PIP, can erode bone, contain multi nucleate giant cells and haemosiderin which makes them brown?

Answer 67

Ginat cell tumour of tendon sheath

Question 68

What nerve allows hip pain to radiate to knee?

Answer 68

Obturator nerve

Question 69

What can metal on metal hip replacement result in/

Answer 69

Inflammatory pseudotumour which causes necrosis of muscle and bone

Question 70

What can AVN of the hip be secondary to?

Answer 70

Alcohol, steroids, hyperlipidaemia or thrombophilia

Question 71

What does hanging rope sign on xray suggest

Answer 71

AVN of hip caused by lytic zone

Question 72

What condition presents with pain on resisted abduction of leg?

Answer 72

Trochanteric bursitis = gluteal medius

Question 73

What kind of injuries can twisting force on loaded knee cause?

Answer 73

Meniscal

Question 74

Is psuedolocking a sign of meniscal injury?

Answer 74

No

Question 75

What does the patient wusually develop after ACL rupture?

Answer 75

Haemarthrosis within an hour

Question 76

What ligament will a rugby tackle from the side usually tear?

Answer 76

MCL

Question 77

What ligament tears are more common and why - MCL or LCL?

Answer 77

Medial because it is more fixed and less flexible

Question 78

What will Steinmanns test show on degenerate meniscal tears?

Answer 78

Negative

Question 79

What is the principal complaint for ACL rupture?

Answer 79

Rotatory instability with giving way on turning

Question 80

Whast antibioitcs can cause tendonitis and risk tendon rupture?

Answer 80

Quinolones

Question 81

What treatment shouldbe avoided in tendonitis of the knee?

Answer 81

Steroid injection

Question 82

What knee condition presents with anterior knee pain, worse going downhill, grinding or clicking sensation at front of knee and stiffness after sitting - pseudolocking?

Answer 82

Patellogemoral dysfunction

Question 83

What does a lipo-haemarhtrosis on xray suggest?

Answer 83

Patella dislocation

Question 84

Is hallux valgus commoner in femlaes or males?

Answer 84

Females 4:1

Question 85

What is the term for OA of first MTP?

Answer 85

Hallux rigidus

Question 86

What is gold standard treatment surgically for hallux rigidus?

Answer 86

Arthrodesis - prevents women wearing heals

Question 87

Where is mortons nejuromea commonly found?

Answer 87

Between third and fourth metatarsals - more common in females 4:1

Question 88

How can mortons neuroma be tested?

Answer 88

Mulders click test - mediolateral compression of metatarsal heads exerted by squeezing with hand

Question 89

How can mortons neuroma be investigated and diagnosed?

Answer 89

Utrasound

Question 90

How can metatarsal stress fractures be diagnosed?

Answer 90

Bone scan, may not appear until 3 weeks

Question 91

What is Simmonds test and what is it used for?

Answer 91

Achilles tendonitis - no plantar flexion of the foot is seen when squeezing the calf

Question 92

What are three risk factors for plantar fascitis?

Answer 92

Diabetes, obesity and walking on hard floors with bad shoes

Question 93

What three things could aquired flat foot be due to?

Answer 93

Tibialis posterior tendon stretch, RA or diabetes with Chardcot foot

Question 94

What is the term for an abnormally high arch of foot?

Answer 94

Pes cavus

Question 95

What can hereditory senory, motor neuropathy, cerebral palsy, polio anbd spinal cord tethering all cause?

Answer 95

Pes cavus - claw toes often accompanies it