ortho

Question 1

extracapsular hip fractures

Answer 1

trochanteric
subtrochanteric
intertrochanteric

Question 2

intracapsular hip fractures

Answer 2

intracapsular

subcapital

Question 3

mx of undisplaced intracapsular hip fracture

Answer 3

internal fixation

hemiarthroplasty if unfit

Question 4

mx of displaced intracapsular hip fracture

Answer 4

arthroplasty - either THR or hemiarthroplasty (THR > hemiarthroplasty)

Question 5

mx of extracapsular hip fractures

Answer 5

dynamic hip screw

intramedullary device if reverse, oblique, transverse or subtrochanteric

Question 6

location of Bouchard’s and Heberden’s nodes

Answer 6

Bouchard’s - proximal IPJ

Heberden’s - distal IPJ

Question 7

type of shoulder dislocation that results in loss of external rotation

Answer 7

posterior (nb they are much rarer than anterior)

common after seizures

Question 8

features of adhesive capsulitis

Answer 8

active and passive movement limited

external rotation most affected

Question 9

features of plantar fasciitis

Answer 9

heel pain that is worse around the medial calcaneal tuberosity
exacerbated by walking on tip toes

Question 10

Salter Harris classification

Answer 10

SALT-C
Straight across (physis)
Above (physis and metaphysis)
Lower (physis and epiphysis)
Through (physis, metaphysis and epiphysis)
Crush

Question 11

mechanism of anterior shoulder dislocation

Answer 11

forced abduction, extension and external rotation of affected arm

Question 12

which fractures is compartment syndrome most commonly associated with

Answer 12

supracondylar and tibial shaft fractures

Question 13

mx for ganglion

Answer 13

reassurance and review if not setting, often disappear spontaneously

Question 14

mx of children and young people with unexplained bone swelling or pain

Answer 14

urgent x-ray to assess for bone sarcoma

Question 15

hand osteoarthritis x-ray changes

Answer 15

osteophytes at DIPs and base of thumb

Question 16

hand rheumatoid arthritis x-ray changes

Answer 16

joint space narrowing at PIP with joint effusion

Question 17

ix for osteoporotic vertebral fracture

Answer 17

whole spine x-ray

Question 18

ix for hip fractures

Answer 18

x-ray

MRI if x-ray normal but hip fracture is suspected (e.g. patient in pain and unable to weight bear)

Question 19

what is Colles’ fracture

Answer 19

transverse fracture of radius, 1 inch proximal to radio-carpal joint with dorsal displacement and angulation
classically follows FOOSH
‘dinner fork’ deformity

Question 20

features of radial head fracture

Answer 20

common in young adults following FOOSH

marked local tenderness over radial head (proximal forearm) and restricted supination and pronation

Question 21

causes of dupuytren’s contracture

Answer 21

manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus

Question 22

feature of epidural abscess

Answer 22

signs of systemic sepsis with neurological features, especially if changing LL neurology

Question 23

reasons for revision of THR

Answer 23

aseptic loosening - most common

pain, dislocation and infection

Question 24

features of meniscal tear

Answer 24

rotational sports injury
delayed knee swelling
joint locking

Question 25

causes of carpal tunnel syndrome | ARMPIT

Answer 25

``` Acromegaly Rheumatoid Myxoedema (hypothyroid) Pregnancy Idiopathic Trauma ```

Question 26

describe the ulnar nerve paradox

Answer 26

proximal ulnar nerve lesions produce a less prominent deformity (clawed hand) than distal lesions therefore, clawing more likely with damage to ulnar nerve at elbow

Question 27

features of hand osteoarthritis

Answer 27

squaring of the thumb episodic joint pain stiffness

Question 28

a teenage girl with knee pain on walking downstairs or rising from prolonged sitting

Answer 28

chondromalacia patellae

Question 29

athletic teenagers with inflammation, pain and tenderness at tibial tuberosity

Answer 29

osgood-schlatter disease

Question 30

red flags suggesting an alternative dx in OA of the hip

Answer 30

rest pain night pain morning stiffness >2 hours

Question 31

mx of ankle fractures

Answer 31

``` Weber A&B: cast/boot and weight bear as tolerated Weber C (unstable): open reduction, internal fixation ```

Question 32

Weber classification

Answer 32

type A: below syndesmosis type B: level of syndesmosis type C: above syndesmosis, often unstable

Question 33

nerves and nerve roots tested in UL reflexes

Answer 33

biceps reflex - musculocutaneous nerve (C5-7) | triceps reflex - radial nerve (C7)

Question 34

features of Brown-Sequard syndrome

Answer 34

caused by hemisection of the spinal cord ipsilateral paralysis and loss of proprioception and fine discrimination contralateral loss of pain and temperature

Question 35

what does surgical decompression of carpal tunnel syndrome involve?

Answer 35

division of flexor retinaculum

Question 36

ix for achillies tendon rupture

Answer 36

USS

Question 37

features of osteochondritis dissecans

Answer 37

knee pain after exercise locking 'clunking'

Question 38

features of supraspinatous tendonitis

Answer 38

painful arc of abduction between 60-120 degrees | tenderness over anterior acromion

Question 39

features of complex regional pain syndrome | PORTS

Answer 39

``` Pain Oedema Restriction of movement Temperature/colour change Stiffness ```

Question 40

what medication may precipitate Achilles’ tendon rupture

Answer 40

Ciprofloxacin

Question 41

features of ruptured ACL

Answer 41

twisting mechanism | loud crack, pain and rapid joint swelling

Question 42

mx of pain in OA

Answer 42

1. paracetamol and/or topical NSAID 2. oral NSAID, COX2 inhibitor or opiate NB if CKD avoid COX2 and NSAIDs

Question 43

mx of undisplaced scaphoid waist fracture

Answer 43

cast for 6-8 weeks

Question 44

what types of scaphoid fractures need surgical fixation

Answer 44

displaced scaphoid waist fracture | proximal scaphoid pole fractures

Question 45

medial vs lateral epicondylitis

Answer 45

medial - tenderness over medial epicondyle and medial wrist pain on resisted wrist pronation lateral - tenderness over lateral epicondyle and lateral elbow pain on resisted wrist extension

Question 46

when to perform spinal x-ray in back pain

Answer 46

any red flag symptoms (e.g. being woken from sleep) long duration of symptoms (i.e. months) spinal tenderness

Question 47

most prominent sign of T1 nerve root lesions

Answer 47

*intrinsic hand muscle wasting*

Question 48

damage to which structures causes winged scapula

Answer 48

long thoracic nerve leading to serratus anterior being affected

Question 49

ix of tibial stress syndrome

Answer 49

radiographs of bilateral tibia and fibula to rule out stress fractures or periosteal exostoses

Question 50

crystals for pseudogout

Answer 50

weakly positively birefringement rhomboid-shaped crystals

Question 51

ABX for septic arthritis

Answer 51

flucloxacillin | clindamycin if penicillin allergic

Question 52

drug that can cause achilles tendon rupture

Answer 52

quinolone, e.g. Ciprofloxacin

Question 53

features of iliotibial band syndrome

Answer 53

common cause of lateral knee pain in runners | tenderness 2-3cm above joint line