Diagnosis- Orthopaedics + Vascular Flashcards
A 70F patient presents to A+E with a shortened and externally rotated leg. The patient is in a lot of pain and has been provided with adequate analgesia and is prepared for surgery. The patient has many comorbidities but can mobilize. The surgeon shows you an x-ray of the patient and asks you what surgery should he do?
a) Total hip arthroplasty
b) Hemiarthroplasty
c) Dynamic hip screw
d) Intramedullary nail
e) Internal fixation
a) Total hip arthroplasty – for intracapsular displaced fractures in mobile patients
b) Hemiarthroplasty – for intracapsular displaced fractures in patients with comorbidities but can mobilize
c) Dynamic hip screw – for intertrochanteric fractures
d) Intramedullary nail – for subtrochanteric fractures
e) Internal fixation – for intracapsular fractures without displacement
You are on a ward round with the consultant orthopedic surgeon. Him and the patient have agreed to let you leave early if you name what classification was used for the patient.
a) Garden/evans classification
b) Kennedy/schenk classification
c) Potts/weber/AO classification
d) Gustilo and Anderson classification
e) Anderson and d’Alonzo classification
a) Garden/evans classification – garden for intracapsular and evans for extracapsular hip fractures
b) Kennedy/schenk classification – knee dislocations
c) Potts/weber/AO classification – ankle fractures
d) Gustilo and Anderson classification – open fractures
e) Anderson and d’Alonzo classification – c spine
BONUS) gartland classification – elbow fractures
You give yourself an easy morning and head over to the radiology department to do your investigative experience student declaration. You knock on a door that says radiology SHO room and a consultant answers. Before you get to introduce your name, the consultant asks you what’s the most specific test for the condition that presents with x-ray findings of juxta-articular osteoporosis + periarticular erosions + subluxations + pannus formations symmetrically across their MCP + PIP?
a) Serum urate
b) Creatinine Kinase
c) anti-CCP
d) HLA-B27
e) Positive brick shaped calcium pyrophosphate crystals in joints
c) anti-CCP
A 23M skateboarder attends A+E after falling from a great height after doing a trick. He luckily broke his fall and did not sustain any head injuries. You were shocked when he described that he broke his fall with a hyperextended, radially deviated wrist, with his forearm in pronation. The patient then asks you what kind of injury are these falls implicated with.
a) Proximal pole scaphoid fracture
b) Distal radius fracture with dorsal angulation
c) Anterior shoulder dislocation with a grade 3 acromioclavicular grade
d) Supracondylar extension type fracture
e) All of the above
a) Proximal pole scaphoid fracture
b) Distal radius fracture with dorsal angulation
c) Anterior shoulder dislocation with a grade 3 acromioclavicular grade
d) Supracondylar extension type fracture
e) All of the above
A 48M walks into the GP following an emergency appointment. He states that he thinks he broke a bone and exposes and points to his 1st MTP. You see that is is erythematous, swollen, and very tender. His records are as follow HPC: onset of pain 15 hrs ago with pain peaking and plateauing at 12 hours, recollection of him hitting his hand with a hammer around the same time of onset of pain. PMH: severe psoriasis, myeloproliferative disorder, peptic ulcer disease, podagra DH: NKDA, furosemide. SH: 20 pack year smoke history, 2 pints of beer a night, doesn’t eat veggies but loves his meat. No other significant history. What is your immediate next management step.
a) Provide brace and refer to fracture clinic
b) Prescribe naproxen
c) Prescribe diclofenac
d) Prescribe colchicine
e) Prescribe allopurinol
a) Provide brace and refer to fracture clinic – fractures was a red hearing
b) Prescribe naproxen – NSAID which is contraindicated with peptic ulcer unless PPI
c) Prescribe diclofenac – as b)
d) Prescribe colchicine – first line analgesia for gout flare in those who are contraindicated NSAIDs
e) Prescribe allopurinol - not immediate management
You follow the on-call trauma orthopedic team to a call out in the general surgery ward. Upon arrival the the consultants discuss a 66M who has been in hospital for two weeks following an elective hartmanns procedure. The patient has signs of infection with diffuse soft tissue swellings with hemorrhagic bullous lesions. There is ‘dishwater pus’ discharge from lesions as well as a general altered smell. The consultants ask you what is the most likely diagnosis?
a) Osteomyelitis
b) Rhabdomyolysis
c) Necrotizing fasciitis
d) Gas gangrene
e) Myositis
a) Osteomyelitis – bone infection, doesn’t present with skin symptoms described
b) Rhabdomyolysis – muscle breakdown, doesn’t present with skin symptoms and often is implicated with AKI
c) Necrotizing fasciitis – could be correct option but more correct option is available, remember LRINC score for grading this
d) Gas gangrene – this and necrotizing fasciitis can present very similarly, but only gas gangrene is linked to those with GI malignancies.
e) Myositis – systemically well, doesn’t present with skin symptoms
A 45F presents to your orthopedic clinic following a referral. She describes having a painful stiff shoulder and asks you for help. On examination you find that she is limited in movements in all directions but especially noted with loss of external rotation and abduction. The patient has no tenderness over the anterior acromion, and no painful arc. What other condition is commonly seen in patients with this presentation.
a) Diabetes
b) Cardiac disease
c) Renal disease
d) Respiratory fibrosis
e) Pelvic inflammatory disease
a) Diabetes
b) Cardiac disease
c) Renal disease
d) Respiratory fibrosis
e) Pelvic inflammatory disease
A 6M presents to your clinic with his mum. His mum states how she is worried about him as he seems to be shorter than his brother at the same age and is not following the same patterns. You examine the patient and notice he has a waddling gait, bowed legs, frontal bossing, Harrison’s groove, and some dental abnormalities. The mother explains she is concerned as her husband, the child’s dad was told recently he had something wrong with his bones as he was on antiacids and had dialysis which “triggered a disease”, and she is worried her son has caught it from him. What is the most likely pathophysiology at play here?
a) Primary hyperparathyroidism
b) FGF23 deficiency
c) P392L mutation
d) 21 hydroxylate deficiency
e) PHEX/DMP1 mutations
d) 21 hydroxylate deficiency
A 66M presents to A+E with renal colic pain. On examination, the patient is hypotensive, tachycardiac, and has a pulsatile abdominal mass. The patient states he only just attended his 3 monthly check up for his condition which stated everything was fine. He was told to come back in the next 3 months. What do you suspect is occurring from the history given.
a) Ruptured aneurysm that was 3-4.4cm
b) Ruptured aneurysm that was 4.5-4.9cm
c) Ruptured aneurysm that was 5.0-5.4cm
d) Unruptured aneurysm that is >5.5cm
e) EVAR leak
c)Ruptured aneurysm that was 5.0-5.4cm
A 60M with hypertension and ehlers-danlos syndrome presents to A+E with severe pain in his back which he describes as tearing and radiating anteriorly in nature. The patient is sent for x-ray then returns for you to take the full history. What do you expect to see on the x-ray?
a) A false lumen
b) Pneumothorax
c) Pericardial effusion
d) Pleural effusion
e) Widened mediastinum
a) A false lumen
b) Pneumothorax
c) Pericardial effusion
d) Pleural effusion
e)Widened mediastinum
). A 68F patient presents to the GP. The patient describes being physically inactive due to her obesity. She also mentions she has recently had a left knee replacement. The patient attended the GP for skin changes in her gaiter area. Upon examination you see a large lesion, shallow with irregular borders. The patient states that this lesion sometimes oozes. She says it is not usually painful but if it acts up, she can help it by lowering her leg. What is the next step for this lady’s condition?
a) Refer to dermatology
b) Refer to diabetes clinic
c) Prescribe statin, an antiplatelet and optimize blood pressure and glucose
d) Angioplasty
e) Compression
a) Refer to dermatology – only when suspecting alternative diagnosis
b) Refer to diabetes clinic – can be considered when suspecting diabetic ulcers
c) Prescribe statin, an antiplatelet and optimize blood pressure and glucose – for arterial ulcers
d) Angioplasty – for arterial ulcers and sometimes venous/mixed ulcers
e)Compression – generally first line management for venous ulcers
65 F, retired gardener, 6 months of aching joints, worse in the evening
A.Rheumatoid Arthritis
B.Osteoarthritis
C.Gout
D.Pseudogout
B.Osteoarthritis
OA on a x-ray, which is incorrect
A.Loss of joint space
B.Air Spaces
C.Cysts
D.Subchondral sclerosis
B
What is A?
A.Cuneiform
B.Lunate
C.Cuboid
D.Boat
E.Navicular
E
At which joints are Heberden’s nodes?
A.Proximal Interphalangeal Joint (Bouchard)
B.DIPJ
C.Carpometacarpal
D.Radiocarpal
B
