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MRCP Part 1 > Orthopaedics > Flashcards

Orthopaedics Flashcards

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1
Q

What is Ottawa rules ??

A

Ankle x-ray is required only if there is any pain in the Malleolar zone + any 1 of the following
- Lateral malleoli bony tenderness (from tip of LM to lower 6cm of posterior border of fibula)
- Medial M bony tenderness (from tip of MM to lower 6 cm of Tibial posterior border)
- Not able to walk 4 wt. bearing steps immediately after injury & in A-E dept

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2
Q

What action causes severe pain in Tennis elbow ??

A
  • Pain worse on Resisted wrist extension with elbow extended/ supination of forearm with the elbow extended
  • lasts for 6 months to 2 years
  • acute pain for 6 to 12 wks
    House painting/ playing Tennis
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3
Q

What action worsens Golfer’s elbow ??

A
  • Wrist flexion & Pronation
  • may be a/w numbness/tingling in 4th & 5th finger (ulnar involved)
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4
Q

What is Radial tunnel syndrome ??

A

Posterior Interosseous branch of Radial nerve compression
- due to overuse
- C/F are similar to Lateral Epicondylitis BUT pain tends to be 4-5 cm DISTAL to lateral epicondyle
- pain worse on Elbow extension & Pronation of forearm

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5
Q

What is Cubital tunnel syndrome ??

A

ULNAR Nerve compression
- Initial: 4th & 5th finger tingling
- Worse when elbow is resting on a firm surface/ flexed for extended periods
- Later: Numbness a/w weakness

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6
Q

Ix. & Rx. of Cubital Tunnel Synd. ??

A

Clinical dx.; but is selected cases- NCS
- Avoid aggravating activities
- Physiotherapy
- Steroid injections
- Surgery in resistant cases

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7
Q

What is Olecrenon bursitis ??

A

Swelling over posterior aspect of elbow
- a/w pain, warmth, erythema
- Typical in middle aged MALE pat.

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8
Q

What is Greater Trochanteric pain synd. ??

A

aka Trochanteric bursitis
- due to repeated movt. of fibroelastic ILIOTIBIAL band
- MC in 50 to 70 yrs old WOMAN
- Pain over lateral side of hip/ thigh
- Tenderness on greater trochanter palpation

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9
Q

Features of Inflammatory arthritis ??

A
  • Morning pain
  • Systemic features
  • Raised Inflammatory markers
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10
Q

Which nerve compression causes Referred Lumber spine pain ??

A

Femoral nerve compression
- FN Stretch test is positive

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11
Q

Hallmark features of Meralgia Paraesthetica ??

A

Lateral Cutaneous nerve of Thigh compression
- BURNING pain over antero-lateral aspect of thigh

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12
Q

What is Pubic Symphysis dysfunction ??

A

Pain over pubic symphysis which radiates to groin & medial aspect of thighs
- Common in PREGNANCY (ligament laxity increases due to hormonal changes)
- WADDLING gait may be seen

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13
Q

What is Transient Idiopathic Osteoporosis ??

A

Seen in 3rd Trimester of pregnancy
- Groin pain + limited range of Hip movement
- Unable to bear weight
- ESR may be elevated

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14
Q

Hallmark features of Devt. Dysplasia of Hip ??

A
  • Barlow’s & Ortolani’s test (+)ve
  • Unequal gluteal skin folds
  • Unequal leg length
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15
Q

What is Transient sinovitis ??

A

Irritable hips
- Common in 2- 10 yrs old
- Acute hip pain a/w Viral infection
- MCC of hip pain in children

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16
Q

MCC of hip pain in children ??

A

Transient Synovitis

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17
Q

Hallmark features of Perthes disease ??

A

AVASCULAR Necrosis of FEMORAL Head
- Typical in 4 to 8 yrs old
- 5x MC in BOYS
- 10% cases are B/L

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18
Q

X-ray features of Perthe’s disease ??

A

Early: Joint space widening
Late: Decreased Femoral head size/ Flattening
- Hip pain (progressive over few wks.)
- Limp & Stiffness

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19
Q

What is Slipped Upper Femoral Epiphysis ??

A

POSTERO-INFERIOR displacement of Femoral head Epiphysis
- Typical in 10 to 15 yrs old
- MC in OBESE kids & Boys
- Knee or Distal thigh pain is normal
LOSS of Internal Rotation of Leg in flexion

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20
Q

Which antibody is Juvenile Idiopathic Arthritis a/w ??

A

ANA
- when (+)ve, it is a/w Anterior Uveitis

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21
Q

Rx. of Tennis elbow ??

A

Typical among 45 to 55 yrs old; affects the Dominant arm
- Avoid muscle overload
- Simple analgesia
- Steroid injection
- Physiotherapy

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22
Q

Hallmark features of ILIOPSOAS Abscess ??

A

Collection of pus in Iliopsoas compartment (Iliopsoas + Iliacus)
2 types
- Primary: MCC is Staph. aureus infection (Haematogenous spread)
- Secondary: MCC is Crohn’s disease

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23
Q

IoC for Iliopsoas abscess & which type has the highest mortality ??

A

CT abdomen
Secondary (19-20%)»Primary (2.3%)

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24
Q

Rx. of Iliopsoas Abscess ??

A
  • Antibiotics
  • Percutaneous drainage (initial approach)
    SURGERY indicated if:
  • PC drainage fails
  • Presence of another intra-abdominal pathology requiring Sx.
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25
What is Chondromalacia patellae ??
Patellar cartilage softening - Common in Teenage GIRLS - Anterior Knee pain on walking up & down the stairs & rising after prolonged sitting Rx. Physiotherapy
26
What is Osgood-Schlatter disease ??
aka Tibial Apophysitis - common in Sporty Teenagers - Pain, Tenderness & Swelling over Tibial tubercle
27
What is Osteochondritis dessicans ??
Bone underneath the cartilage of a joint dies due to a lack of blood supply - Common among Kids & Adolescents who are active in Sports - Pain after Exercise - Intermittent swelling & Locking
28
What is Patellar Subluxation ??
Lateral subluxation of patella causing Medial knee pain - Knee may give away
29
Hallmark of Patellar Tendonitis ??
Chr. anterior knee pain => worsens post- running - MC in athletic Teenage BOYS - O/E: Tender below patella
30
Hallmark features of Carpel Tunnel Synd. ??
Median N compression in Carpel T - Pain/pins & needles in Thumb, Index & Middle finger - C/F may ASCEND Proximally - Pt. SHAKES his hand for relief; classic at night
31
What are the O/E features & Causes of CTS ??
Weakness of Thumb ABDUCTION (Abductor pollicis brevis) THENAR muscles wasting - Tinel's sign (+)ve : Paraesthesia on Tapping - Phalen's sigh (+)ve : Wrist FLEXION causes c/f Causes: Idiopathic, PREGNANCY, Oedema (eg. HF), RA
32
Ix. & Rx. of CTS ??
Electrophysiology [Motor + Sensory] : Prolongation of Action Potential Rx. - Mild to Moderate: 6 wks trial of conservative Rx.; Corticosteroids injection, Wrist splint at night - Severe symptoms/ Failed conservative Rx. : Surgical Decompression (Flexor retinaculum division)
33
Which bone # causes CTS ??
LUNATE #
34
What is De Quervain's Tenosynivitis ??
Inflammation of the SHEATH containing Extensor pollicis brevis & Abductor pollicis longus tendons - FEMALES, 30 to 50 yrs old - Pain on radial side of wrist - Tenderness over Radial Styloid process - ABDUCTION of thumb against resistance is painful
35
Hallmark features & Rx. of De Quervain's Tenosynovitis ??
Finkelstein's test (+)ve: Examiner pulls the Thumb of the pt. in Ulnar deviation & Longitudinal traction => causes pain over Radial styloid process along the whole of EPB & APL - Analgesia - Steroid injection - Immobilization : Thumb SPICA - Surgical Rx.
36
What are Rotator cuff muscles ??
"S I t S" -Supraspinatus: aBDucts arm before deltoid - Infraspinatus: MC injured - teres minor: Rotates arm Laterally - Subscapularis: aDDucts & rotates arm Laterally
37
What are the Red Flags in Lower Back pain ??
- Age: < 20 yrs / > 50 yrs - H/o previous Malignancy - Night pain - H/o Trauma - Systemically unwell (eg. Wt. loss, Fever)
38
Name the cause for the following type of pain- - Pain worse in morning, on walking & Back extension ?? - Pain worse on walking; relieved when sits/ leans forward/ crouches down (aching/ crawling type of pain)?? - Pain on walking; relieved by Rest; absent / weak foot pulses - Leg pain worse>>back pain; worse when sitting; clear dermatological leg pain ??
- Facet joint damage - Spinal canal Stenosis - PAD - Prolapsed disc
39
IoC for Spinal Canal Stenosis ??
MRI to confirm dx. (as clinical examination is normal)
40
Rx. of Disc prolapse ??
- Analgesia, Physiotherapy, Exercises - If c/f persists (after 4-6 wks => referral for MRI consideration
41
What is the hallmark feature of Ank. Spon. with respect to different gender ??
Peripheral arthritis (25% more common in Females than in males)
42
Features of L3 nerve root compression ??
Sensory loss over Anterior thigh Weak Quadriceps Reduced Knee reflex (+)ve Femoral Stretch test
43
Features of L4 nerve root compression ??
- Sensory loss over Anterior aspect of Knee - Weak Quadriceps - Reduced Knee reflex - (+)ve Femoral Stretch test
44
Features of L5 nerve root compression ??
- Sensory loss over Dorsum of foot - Weakness of Foot & Big toe Dorsiflexion - Reflexes INTACT - (+)ve Sciatic nerve stretch test
45
S1 nerve root compression ??
- Sensory loss over Posterolateral leg & Lateral foot - Weakness of Plantar flexion of foot - Reduced Ankle reflexes - (+)ve Sciatic nerve stretch test
46
What is AVN of Hip ??
Death of bone tissue secondary to loss of blood supply => Bone destruction & loss of joint func. - EPIPHYSIS of long bones (eg. Femur) are most commonly affected
47
Mention the following about AVN hip - Causes ?? - Ix. ?? - Rx. ??
Long term Steroids, Chemotherapy, Alcohol excess, Trauma Ix. - Plain x-ray may be initially NORMAL - Osteopenia & Micro# may be seen early on; Crescent sign (Collapse of articular surface) - MRI is the IoC Rx.- Joint replacement
48
What is Osteopetrosis ??
Marble bone disease - FAILURE of Osteoclast mediated bone resorption => overly Dense, Thick, Brittle bones A R (Infantile form): SEVERE, presents in infancy with Pancytopenia & # A D (Adult form): MILDER, presents late with # & minimal systemic c/f
49
Features of Marble Bone Disease ??
- Bone pain (due to overgrowth & micro#) - Recurrent # - Neuropathy (bone encroachment on CNs- Facial palsy, vision, hearing loss) - Pancytopenia: Due to BM cavity obliteration => Anemia, Thrombocytopenia & Leukopenia
50
Ix. & Dx. of Osteopetrosis ??
NORMAL- Ca2+, PO4, ALP X-Ray: - Diffuse Skeletal Sclerosis ('Bone within Bone' or Erlenmeyer Flask deformity) - Dense vertebrae ('Sandwich vertebrae')
51
Rx. of Osteopetrosis ??
- Stem Cell Transplantation (Curative) - IFN- Gamma Therapy: improves Immune func. & Bone remodeling - Vit. D supplements - Low-Ca2+ diet in HyperCa2+ cases
52
What is Osteoporosis ??
Reduced bone mineral density & deteriorated bone microarchitecture - Predominantly Postmenopausal woman & Older adults
53
Pathophysiology of Osteoporosis ??
Bone remodelling = Osteoclast mediated resorption & Osteoblast-driven formation - An imbalance favouring resorption => Osteoporosis - RANKL + [RANK on Osteoblast] =+=> Resorption - OPG =(-)=> RANKL => reduces Osteoclast activity PM oestrogen deficiency, increases RANKL & reduces OPG
54
What causes the following in Osteoporosis - Height loss ?? - Kyphosis ?? - Back pain ??
- Vertebral Compression # - Vertebral # - May indicate Vertebral #
55
How to Dx. Osteoporosis ??
- DEXA Scan (for BMD assessment) - FRAX tool (calculates 10-yr. probability of maj. osteoporotic #) - Lab. Tests: basic Ix. + PTH, 25-OH vit. D, Urine Ca2+ excretion - Imaging
56
Types of Imaging used in Osteoporosis ??
- X-ray: for Vertebral # dx. - Quantitative CT: Differentiates b/w Cortical & Trabecular bone - Quantitative USS: Peripheral bone density
57
Which Ix. should be done when DEXA scan is inconclusive ??
Quantitative CT (QCT)
58
What is T-score & Z-score ??
- T-score compares the pt.'s BMD to the Mean peak BMD of a young healthy adult of the same sex. - Z-score: Comparative measure that adjusts BMD for- age, gender, ethnicity ie. compares to the average of their peers.
59
Difference b/w T-score & Z-score ??
T- Score: Critical for dx. of Osteoporosis & guiding Rx. in older adults Z- Score: For identifying ABNORMAL bone loss pattern in younger populations & distinguishing b/w physiological & pathological changes
60
In which group of people do we do the following tests - T- score - Z- scores
- Older adults, PM woman - Children, PM woman, Men < 50yrs Z-score of [< -2] indicates SECONDARY cause of osteoporosis & warrants further Ix.
61
T score values ??
Normal : > [-1] Osteopenia : -1.0 to -2.5 Osteoporosis : < [- 2.5]
62
What is FRAX tool ??
Calculates 10-yrs probability of maj. osteoporotic # - integrates [Clinical Risk Factor + Femoral neck BMD]
63
Rx. options for Osteoporosis ??
Anti-Resorptive Agents - Bisphosphonates (1st line) - RANKL inhibitors (Denosumab) - SERMs (Raloxifene) - HRT Anabolic Agents - PTH analogues (Teriparatide, Abaliparatide) - Sclerostin inhibitor (Romosozumab) Sequential Therapy
64
Which Osteoporosis Rx. should not be used for > 24 months & Why ??
PTH analogues (Teriparatide, Abaloparatide) - risk of Osteosarcoma
65
Which Osteoporotic Rx. is CI in recent MI cases ??
Sclerostin inhibitors - NOT used in recent cases both MI & Stroke
66
Which Rx. of Osteoporosis is considered in Young PM woman with high risk of Vertebral # ??
SERMs - Reduces Vertebral # risk & also lowers breast cancer risk
67
Which Rx. of Osteoporosis requires U & E monitoring ??
Bisphosphonates - Monitor U&E before starting - CI in Severe Renal impairment
68
Describe Sequential Therapy used in Osteoporosis ??
Post- Teriparatide (PTH analogue) - Follow with Bisphosphonates to maintain BMD Post- Romosozumab (Sclerostin I) - Use Anti-resoptive therapy to sustain gains Post- Denosumab - Avoid abrupt discontinuation to prevent rapid BMD loss
69
Ca2+ & Vit. D supplements dose in Osteoporosis ??
Ca2+ : 1000 to 1200 mg/ day Vit. D : 800 to 1000 IU/ day
70
What is Glucocorticoid-Induced Osteoporosis (GIOP) & its Rx. ??
Prednisolone >= 7.5 mg/day for >= 3 months can cause GIOP - >= 65 yrs or Prior fragility # : Start bone protection immediately - < 65 yrs : DXA-guided management TREATMENT - 1st line: Alendronate - Ensure Ca2+ & Vit. D sufficiency Tailor Rx. based on Cumulative Steroid dose
71
In what age group is DXA scan recommended ??
Regular DXA for - PM woman - Men > 70yrs old.
72
What is Osteogenesis Imperfecta ??
aka Brittle Bone Disease - Group of disorders of Collagen metabolism resulting in Bone Fragility & # - MC & Milder form is OI type 1
73
Features of Brittle Bone Disease ??
A D - Decreased synthesis of Pro-alpha 1 or Pro-alpha 2 polypeptides => abnormal Type 1 collagen - # by Mild trauma + Blue Sclera + Deafness (Otosclerosis) + Dental Imperfections - Seen in Childhood Adjusted Ca2+, PO4, PTH, ALP are usually normal
74
How is Osteomyelitis subclassified ??
Infection of Bone Haematogenous OM - Due to Bacteraemia - MONOMICROBIAL - Vertebral OM is the MC form of haematogenous OM in adults - RF: Sickle Cell, IVDU, Immuno-suppression by medication/ HIV, Infective Endocarditis Non-Haematogenous OM - Spread of infection from adjacent Soft tissue to bone or Direct trauma - POLYMICROBIAL
75
Name the following about OM - MC route of spread in Children -MC route of spread in Adults - MC site of blood borne OM in adults
- Haematogenous OM - Non- haematogenous - Vertebral OM
76
MCC of OM ?? IoC in OM ??
- Staph. aureus except in SCD - SALMONELLA species predominates in Sickle Cell disease pts - MRI scan
77
Rx. of OM ??
Flucloxacillin for 6 wks Clindamycin if penicillin allergic
78
Septic arthritis causes ??
- MC overall cause: Staph. aureus - MC in Young, sexually active: N gonorrhoea (disseminated gonococcal infection) - MC route is Haematogenous spread (from distant bacterial infection eg.- abscess) - MC site in adults: KNEE Joint
79
Features of Septic arthritis ??
Acute, Swollen joint - Restricted movt. in 80% cases - Warm to touch & is fluctuant FEVER
79
Rx. of Septic Arthritis ??
IV Antibiotics which cover Gram (+)ve cocci - Flucloxacillin - Clindamycin if penicillin allergic Given for 4 to 6 weeks - Pts. are switched to Oral Abx. after 2 wks of IV abx. - Arthroscopic lavage may be required
80
Ix. done in Septic arthritis ??
Synovial Fluid sampling - Prior to Abx. administration - Under radiological guidance Blood culture Joint imaging
81
What is Osteogenesis imperfecta ??
It is a collagen disease due to defect in Type 1 collagen There are 8 subtypes Type 1: Normal quality + Insufficient Quantity Type 2: Poor Quantity & Quality Type 3: Collagen poorly formed, Normal quantity Type 4: Poor quality & Sufficient Quantity Bone # easily, loose joint & multiple other defects depending upon which subtype they suffer from
82
Ehler-Danlos syndrome ??
- Multiple subtypes - Abnormality of Types 1 & 3 collagen - Hypermobility, prone to dislocations, Pelvic organ prolapse + Many other diseases related to connective tissue defects
83

MRCP Part 1 (26 decks)

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