ortho on passmed year 5

Question 1

long term steriod use risk for what

Answer 1

avascular necrosis of fem head

Question 2

sx of avn fem head

Answer 2

vdevelopment of anterior hip pain and stiffness
relevant rf such as steriods, chemo, obesity, trauma and alcohol

Question 3

ix of choice for avn

Answer 3

MRI

Question 4

findings on hip XR of avn

Answer 4

This X-ray shows avascular necrosis of the femoral head (AVNFH), visible as flattening and a decrease in volume of the right femoral head. Additionally, a small but pathognomonic ‘crescent’ sign is visible in the lateral articular surface of the femoral head - this describes a curvilinear lucent line below the articular surface, caused by a subchondral fracture typical of AVNFH.

Question 5

what is the crescent sign

Answer 5

The crescent sign refers to a linear cleft due to a subchondral fracture in the setting of osteonecrosis.

Question 6

obvious ankle injury with neuro compromise what do you do

Answer 6

X-rays should not be taken of obvious ankle injuries if neurovascular compromise is present - immediate reduction / stabilisation instead

Question 7

A DEXA scan should be offered without calculating the fragilty risk score in the following situations:

Answer 7

> 50 years of age with a history of fragility fracture
< 40 years of age who have a major risk factor for fragility fracture - these patients should be referred to a specialist depending on the T-score
before starting treatments that may have a rapid adverse effect on bone density (for example, sex hormone deprivation for treatment for breast or prostate cancer)

Question 8

Greater trochanteric pain syndrome is also referred to as trochanteric bursitis

due to what seen in who

Answer 8

It is due to repeated movement of the fibroelastic iliotibial band and is most common in women aged 50-70 years.

Question 9

what node is this

A 42-year-old lady who has systemic lupus erythematosus presents to the clinic with a 5 day history of a painful purple lesion on her index finger. On examination she has a tender red lesion on the index finger.

Answer 9

osler

Question 10

A 62-year-old lady presents with an non tender lump overlying the distal interphalangeal joint of the index finger. On examination she has a hard, non tender lump overlying the joint and deviation of the tip of the finger.

what node is this

Answer 10

herbedens

Question 11

most common type of fracture in the foot which is a stress fracture

Answer 11

2nd metatarsal

Question 12

what is lumbar spinal stenosis and sx

Answer 12

Lumbar spinal stenosis is a condition in which the central canal is narrowed by tumour, disk prolapse or other similar degenerative changes.

Patients may present with a combination of back pain, neuropathic pain and symptoms mimicking claudication.

Question 13

how do you differentiate lumbar spinal stenosis from true claudication

Answer 13

One of the main features that may help to differentiate it from true claudication in the history is the positional element to the pain. Sitting is better than standing and patients may find it easier to walk uphill rather than downhill.

Question 14

simmonds triad for achilles tendon rupture

Answer 14

Calf squeeze test, observation of the angle of declination, palpation of the tendon

Question 15

what is an ORIF

Answer 15

Open reduction internal fixation (ORIF) is a surgical procedure commonly done to repair bone fractures, especially those in which the broken bone fragments are not properly aligned or displaced. This procedure involves making an incision (an ‘open’ approach) to access the fracture site, realigning the fractured bones, and using internal fixation devices such as screws, plates, rods, or pins to stabilise and hold the bone fragments in their correct positions

Question 16

what is charcots joint

Answer 16

Also termed neuropathic arthropathy, is characterised by the destruction of joints secondary to nerve damage. It frequently occurs in individuals with peripheral neuropathy. Alcoholic neuropathy may result in a loss of sensation and proprioception, rendering the joint vulnerable to unrecognised injuries and subsequent deformities.

Question 17

Weber A fractures -

Answer 17

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

Question 18

Children and young people with unexplained bone swelling or pain: even if dont remember injury from gymnastics or something like that

Answer 18

consider very urgent direct access X-ray to assess for bone sarcoma

Question 19

causes of carpal tunnel syndrome

Answer 19

pregnancy
oedema e.g. heart failure
lunate fracture
rheumatoid arthritis

Question 20

Positive examination findings are that direct pressure on the coracoid elicits pain and there is impairment of active and passive external rotation.

Answer 20

adhesive capsulitis

Question 21

psoas abcess source of infection

Answer 21

pyelonephritis or inflammatory bowel disease

Question 22

psoas irritation indicated by what movements

Answer 22

Psoas irritation is evidenced when the position of comfort is the patient lying on their back with slightly flexed knees. Inability to weight bear or pain when moving the hip is usually evident.

Question 23

what is the most common reason total hip replacements need to be revised

Answer 23

Aseptic loosening is the most common reason total hip replacements need to be revised

Question 24

long term steriod use rf for

Answer 24

avascular necrosis of hip

Question 25

hip replacement complications

Answer 25

perioperative venous thromboembolism intraoperative fracture nerve injury surgical site infection leg length discrepancy posterior dislocation may occur during extremes of hip flexion typically presents acutely with a 'clunk', pain and inability to weight bear on examination there is internal rotation and shortening of the affected leg - aseptic loosening (most common reason for revision ) prosthetic joint infection

Question 26

Axillary nerve palsy can also occur due to shoulder dislocation.

Answer 26

anterior

Question 27

what does imaging of lateral epicondylitis look like

Answer 27

imaging typically shows calcification or microtears at the origin of the extensor tendons.

Question 28

mixed features of SLE, systemic sclerosis and myositis.

Answer 28

sharp syndrome

Question 29

Fever Joint pain - especially the knees, wrists and ankles Maculopapular salmon rash Other - lymphadenopathy, sore throat, hepatosplenomegaly, myalgia, pericarditis. ferritin and ESR raised

Answer 29

adult onset still disease

Question 30

unexplained lump increasing in size of forearm for exmaple what is the diff between adults and children in examination time

Answer 30

adults - urgent USS 2ww children USS in 48hr

Question 31

when do you do an LP in CT head

Answer 31

NICE : If CT head done within 6 hours of symptom onset shows no evidence of SAH, do not routinely offer an LP and consider alternative causes If CT head is done > 6 hours and is negative, consider LP LP should be performed at least 12 hours after injury to identify xanthochromia

Question 32

acute gout treated with what

Answer 32

NSAIDs such as naproxen are generally used first-line, if there are no contraindications. colchine

Question 33

coeliac disease can lead to osteomalacia - describe how OM can lead to results of high alp low ca and low phosphate

Answer 33

In osteomalacia, calcium absorption decreases, leading to low serum calcium. In response, parathyroid hormone (PTH) is released to raise serum calcium. PTH increases bone resorption and the conversion of vitamin D to its active form, while also increasing phosphate excretion by the kidneys. ALP, a marker of osteoblast activity, is elevated due to increased bone turnover. Therefore, the expected results are high ALP, low calcium, and low phosphate.

Question 34

hydroxychloroquine main side effect

Answer 34

retinopathy

Question 35

pseduogout is associated with what other conditons and electorlyte abnormalities

Answer 35

haemochromatosis hyperparathyroidism low magnesium, low phosphate acromegaly, Wilson's disease

Question 36

specific test for SLE

Answer 36

Anti-dsDNA - specific as has the s in it

Question 37

dermatomyositis what autoantiboides

Answer 37

ANA jo-1

Question 38

post hip op when should you weight bear

Answer 38

Full weight bearing immediately post-op

Question 39

On examination, there is some bruising to the lateral aspect of his right forearm, with no obvious deformities and good tone, power and range of movement and in the fingers, wrist and elbow joints. Sensation is in-tact throughout the limb, although he reports pins and needles in his fingers. When assessing tone, the patient is in visible discomfort, which is not reproduced to the same extent as when assessing power. what is this describing

Answer 39

compartment syndrome

Question 40

what do late presenting stress fractures look like on XR and when might you need further surgical input

Answer 40

case callus formation may be identified on radiographs. Such cases may not require formal immobilisation, injuries associated with severe pain and presenting at an earlier stage may benefit from immobilisation tailored to the site of injury.

Question 41

Freibergs disease the x-ray changes - condition whereby the head of the metatarsal becomes misshapen and loses its nice round smooth contour turnign into square

Answer 41

joint space widening formation of bony spurs sclerosis flattening of the metatarsal head.

Question 42

most common cause OM

Answer 42

staph a

Question 43

what movement classically impaired in adhesive capsulitis

Answer 43

external rotation

Question 44

Squaring of the thumbs is a characteristic feature of hand

Answer 44

osteoarthritis

Question 45

commonly used analgesia method for hip fractures

Answer 45

An iliofascial nerve block is an effective and commonly used method of analgesia for patients with a neck of femur fracture spinal anaesthesia used during surgery

Question 46

In children the most common site where osteomyelitis occurs in a long bone is the

Answer 46

metaphysis

Question 47

Meralgia paraesthetica affects what nerve

Answer 47

Meralgia paraesthetica comes from the Greek words meros for thigh and algos for pain and is often described as a syndrome of paraesthesia or anaesthesia in the distribution of the lateral femoral cutaneous nerve (LFCN)

Question 48

sx of meralgia peaesthetica

Answer 48

Patients typically present with the following symptoms in the upper lateral aspect of the thigh: Burning, tingling, coldness, or shooting pain Numbness Deep muscle ache Symptoms are usually aggravated by standing, and relieved by sitting They can be mild and resolve spontaneously or may severely restrict the patient for many years.

Question 49

is the LFCN sensory or motor

Answer 49

sensory

Question 50

RF for meralgia perasesthica

Answer 50

Obesity Pregnancy Tense ascites Trauma Iatrogenic, such as pelvic osteotomy, spinal surgeries, laparoscopic hernia repair and bariatric surgery. In some cases, may result from abduction splints used in the management of Perthe's disease. Various sports have been implicated, including gymnastics, football, bodybuilding and strenuous exercise. Some cases are idiopathic.

Question 51

most useful investigation for diagnosing ank spond and what are you looking for

Answer 51

Plain x-ray of the sacroiliac joints is the most useful investigation in establishing the diagnosis

Question 52

hill sachs lesions assoicated with what dislocation

Answer 52

glenohumeral dislocation

Question 53

suspected osteovertebral wedge fracture what is the first line investigation

Answer 53

XR

Question 54

3 signs of osteovertebral frctures

Answer 54

Loss of height: Kyphosis Localised tenderness on palpation of spinous processes at the fracture site

Question 55

when should you not follow the ottawa ankle rules and not get an XR

Answer 55

clear evidence of neurovascular compromise (paraesthesia, reduced sensation, and prolonged capillary refill) thus needing closed reduction and stabaility

Question 56

5th metatarsal fractures often happen following forced

Answer 56

inversion of the foot and ankle

Question 57

what is a weber fracture fo the ankle

Answer 57

fracture of the fibula

Question 58

weber a fracture involves the syndemosis ) joint between two bones) how should this be managaed

Answer 58

- patients with minimally displaced, stable fractures may weight bear as tolerated in a CAM boot 6week

Question 59

Inverted + plantar flexed foot which is not passively correctable what is this describing

Answer 59

clubfoot

Question 60

1st line drug management of back pain

Answer 60

NSAID

Question 61

Pain on the radial side of the wrist/tenderness over the radial styloid process

Answer 61

de quervains

Question 62

hip/groin pain and a snapping sensation

Answer 62

acetabular labral tear

Question 63

plantar fasitis mx DM , heel pain and peyriones disease in a person

Answer 63

Management rest the feet where possible stretch exercises wear shoes with good arch support and cushioned heels insoles and heel pads may be helpful

Question 64

Compartment syndrome is most commonly associated with what two fractures

Answer 64

supracondylar and tibial shaft fractures

Question 65

pain and swelling over the tibial tubercle.

Answer 65

osgood schlatter

Question 66

locking and swelling of the joint as well as tenderness.

Answer 66

osteochondiritis dissecans

Question 67

pain located at the lower aspect of the patella

Answer 67

patellar tendonitis

Question 68

anterior knee pain worse when going up or down stairs

Answer 68

Patellofemoral pain syndrome, previously known as chondromalacia patellae,

Question 69

lateral knee pain with tenderness in the lateral joint line

Answer 69

illiotibial band syndrome Management activity modification and iliotibial band stretches if not improving then physiotherapy referral

Question 70

Lloyd- Davies stirrups can carry the risk of peroneal nerve neuropraxia if not done carefully.

Answer 70

true

Question 71

hernia removal what nerve do you need to be careful of

Answer 71

ilioingunal nerve

Question 72

someone with medial epicondylitis is typically aggravated by what movement or poistions

Answer 72

Medial epicondylitis is typically aggravated by wrist flexion and pronation

Question 73

achilles tendonitis been on NSAID fro 7 days what else can you do

Answer 73

refer to physio

Question 74

Kocher technique reduction

Answer 74

affected arm is bent at the elbow, pressed against the body, and rotated outwards until resistance is felt. Then lift the affected arm that is externally rotated in the sagittal plane as far as possible forwards and finally turn inwards slowly.

Question 75

why is early reduction importnant in a dislocation

Answer 75

early reduction will also lead to a lower risk of muscle spasms and damaging manipulation of the neurovascular structures within the shoulder

Question 76

what is spondylarthrosis

Answer 76

a condition in which there is abnormal wear on the cartilage and bones of the neck (cervical vertebrae) thinning of cartilage therefore leadign to compression sx and potential risk of fractures

Question 77

which reduction is done without surgery open or closed

Answer 77

closed

Question 78

what is the dare procedure

Answer 78

Debridement, antibiotics, and implant retention (DAIR) is a procedure to treat a periprosthetic joint infection (PJI) after total hip arthroplasty (THA) or total knee arthroplasty (TKA).

Question 79

other differentials for septic joint and what criteria do you need for prothetic join tinfections

Answer 79

nec fasc cellulitis or erispileyas over the top MSIS criteria wound dehisicince look for sinus tracts loosening of a joint thus septic on xr if wider joint space

Question 80

why are bacteria harder to treat on prothetic

Answer 80

as bacteria form a biofilm

Question 81

why do you check the full bone and joints above and below

Answer 81

incase of pathological fracture and something sinister also helps with management ie dont want to put an IM nail through a cancer causing mets

Question 82

Absolute bone healing is a type of bone healing that occurs when a fracture is fixed with absolute stability. This means that there is no movement at the fracture site.

Answer 82

heals with rigid can not heal - this is why sliding nails ae useful for that callus formation and thus healing

Question 83

causes of delayed bone healing

Answer 83

poor blood supply to the fracture site, instability of the fracture, infection, smoking, advanced age, poor nutrition (low calcium and vitamin D), certain medications like anti-inflammatory drugs, diabetes, severe anemia, and complications from open fractures where the bone breaks through the skin

Question 84

bisphosphaonate cause what common fracture

Answer 84

transverse fracture of femur- thick cortex then just snaps

Question 85

what is a barton fracture

Answer 85

a smiths fracture with intraarticular involvement - goes further than the distal radius

Question 86

dipunch fracture

Answer 86

lunate against the radius

Question 87

bennent and rolando fracture

Answer 87

rolando is just intrarticularted and comminuted of first metacarpal. bennet is just split into two pieces

Question 88

ortho feature of HSP

Answer 88

non arthritic joint pain

Question 89

long term steriod usage what should pt be taking

Answer 89

Vitamin D + calcium supplementation + oral bisphosphonate

Question 90

what is a buckle fracture

Answer 90

Buckle, or torus, fractures are incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex.

Question 91

main neurovascular structure that is compromised in a scaphoid fracture

Answer 91

The dorsal carpal branch of the radial artery

Question 92

psoas abcess what ix of choice

Answer 92

CT abdomen

Question 93

postmenopausal women, men age ≥50, who are treated with oral glucocorticoids for ≥7.5 mg/day prednisolone or the next 3 months -do you wait for dexa

Answer 93

no start bisphospjonates

Question 94

carpul tunnel conservative tx what should ou do

Answer 94

Carpal tunnel syndrome: a trial of conservative treatment (wrist splint +/- steroid injection)

Question 95

common drug cause of ruinary retention

Answer 95

opiods

Question 96

Froment's sign

Answer 96

a hand test that assesses the function of the adductor pollicis muscle. It's used to detect ulnar nerve palsy how you grab paper

Question 97

how many beats in clonus is abnormal

Answer 97

3

Question 98

1st lumbrical controlled by and atrophies in what condition

Answer 98

median nerve - carpal tunnel syndrome

Question 99

ulnar nerve sensation where to test

Answer 99

outside of pinky finger

Question 100

median nerve sensation where to test

Answer 100

inside the index finger

Question 101

radial nerve sensation where to test

Answer 101

base of the thumb

Question 102

how to most test ulnar

Answer 102

push two pinky fingers together

Question 103

motor test of radial

Answer 103

wrist ext and finger ext , wrist drop

Question 104

median nerve test

Answer 104

thumb abd - not ext as that is radial

Question 105

how are upper limb reflexes best tested

Answer 105

resting arm on upper leg - with supinator relfex little bit of rotation with hammer to allow branchioradalis to contract observing for muscle twitching

Question 106

when looking a lower limb xr how do you know what side is lateral

Answer 106

side of fibula

Question 107

what is a pelvic insufficiency fracture

Answer 107

a break in the bone when the bone is already weakened

Question 108

difference between subluxation and dislocation

Answer 108

subluxtion is a partial discloation - up to 100% then dislocation

Question 109

collar and cuff

Answer 109

used for clvicle fracture

Question 110

what do the dots on asia chart show

Answer 110

best places to test sensation

Question 111

resp rate below 8 or less what should you do

Answer 111

bag valve mask them as below 8 too late so hypoxic

Question 112

what is cystatin c used for

Answer 112

high level kidney function

Question 113

All patients with peripheral arterial disease should take

Answer 113

Atorvastatin and clopidogrel

Question 114

Symptomatic AAA have high rupture risk and should undergo even small

Answer 114

endovascular repair (EVAR)

Question 115

Pain on the radial side of the wrist/tenderness over the radial styloid process ?

Answer 115

de queervains do frinklestein test

Question 116

in hand OA what joints are affected

Answer 116

Carpometacarpal and distal interphalangeal joint involvement is characteristic of hand osteoarthritis

Question 117

1st line for OA of the spine ix

Answer 117

X-ray of the spine is the first-line investigation for a suspected osteoporotic vertebral fracture

Question 118

carpal tunnel syndrome - what conservative tx should be offered first

Answer 118

Wrist splinting +/- steroid injection

Question 119

Fever, facial spasms, dysphagia in an intravenous drug user → ?what infectious disease

Answer 119

tetanus (botulism would cause a flacid paralysis)

Question 120

Men who have sex with men should be offered immunisation

Answer 120

hep a

Question 121

A 44-year-old man presents with a 24-hour history of weakness and double vision. He has a history of intravenous drug abuse. On examination, you note a flaccid paralysis of all 4 limbs (MRC grade 3/5). He also has a complex ophthalmoplegia in both eyes. Observations are as follows: heart rate 80 beats per minute, respiratory rate 18 breaths per minute, blood pressure 145/90 mmHg, temperature 37.2ºC, and oxygen saturation 96% on air.

Answer 121

botulinum antitoxin

Question 122

difference between botulinum and tetanus

Answer 122

Botulism: symmetrical and descending flaccid paralysis rather than spasms. ( meaning it affects the muscles of the neck, shoulders, and upper extremities first, followed by the proximal and distal lower extremities) Tetanus: trismus (lockjaw) facial spasms causing a grimace expression which looks like forced grinning (described as risus sardonicus). back pain increased tone dysphagia spasms temperatures. Injecting drug habits is a risk factor for tetanus infection. Therefore the presentation of this patient is most consistent with a diagnosis of tetanus.