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Finals > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Causes of avascular necrosis of the hip

A

Long-term steroids
Chemo
Alcohol excess
Trauma

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2
Q

Features of avascular necrosis of the hip

A

Initially asymp

Pain

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3
Q

Investigation and management of avascular necrosis of the hip

A

Plain XR - initially normal, then osteopenia and microfractures
MRI - investigation of choice

Management - joint replacement

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4
Q

Describe the features of a Colles # and the usual mechanism of injury

A

Caused by a fall onto an outstretched hand

  1. Transverse # of the radius
  2. 1inch prox to the radio-carpal joint
  3. Dorsal displacement and angulation
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5
Q

Describe the features of a Smith’s # and the usual mechanism of injury

A

Caused by falling backwards onto the palm of an outstretched hand, or falling with wrists flexed.
Volar angulation of distal radius fragment

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6
Q

First line analgesic for lower back pain (no red flags)

A

NSAID e.g. naproxen

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7
Q

Best imaging for osteomyelitis

A

MRI

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8
Q

Clinical findings of clubfoot

A

Inverted and plantar flexed foot which is not passively correctable

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9
Q

Which nerve is responsible for ankle dorsiflexion?

A

Common peroneal

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10
Q

Most common reason for revision of THR?

A

Aseptic loosening of implant

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11
Q

When would you offer a hemiarthroplasty in IC NOF#?

A

Older, less mobile pts

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12
Q

With IC NOFs, when would a THR be offered?

A

Pre-existing joint disease, good levels of activity, high life expectancy

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13
Q

Typical scenario for Pagets

A

Pain
XR - thickened and sclerotic
Alk Phos raised
Normal Ca

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14
Q

Nerve innervating the anterior thigh

A

Lateral cutaneous nerve of the thigh

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15
Q

Management of Talipes equinovarus

A

Manipulation and progressive casting starting soon after birth (usually corrected within 6-10wks)

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16
Q

Non-pharmacological therapy in Achilles tendinopathy

A

Calf muscle eccentric exercises

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17
Q

Site of nerve root compression:

Sensory loss ant aspect of knee. Weak quads. Dec knee reflex. Positive femoral stretch test

A

L3

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18
Q

Site of nerve root compression:

Sensory loss dorsum of foot. Reflexes in tact. Positive sciatic nerve stretch test

A

L5

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19
Q

Site of nerve root compression:
Sensory loss posterolateral aspect of leg and lateral aspect of foot. Weakness in plantar flexion of foot. Dec ankle reflex. Positive sciatic nerve stretch test

A

S1

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20
Q

Tiredness, recurrent infections, loss of vision, brittle bones

A

Osteopetrosis

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21
Q

Adhesive capsulitis findings

A

Active and passive movement limited

External rotation most affected

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22
Q

Surgery for extracapsular NOFs who mobilise

A

Dynamic hip screw

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23
Q

Surgery for subtrochanteric NOFs who mobilise

A

Intramedullary device

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24
Q

Mechanism of injury of a scaphoid fracture

A

Direct blow to the palm or following a fall onto an out-stretched hand

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25
Q

Signs of a scaphoid fracture

A

Swelling and tenderness in the anatomical snuffbox

Pain on wrist movements and on longitudinal compression of the thumb

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26
Q

Eponymous name for a bimalleolar fracture

A

Pott’s

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27
Q

Management of osteoporosis with GFR <35

A 
Bisphosphonates are C/I
Consider denosumab (secondary care)
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28
Q

Management of a scaphoid fracture

A

Discharge home with futura splint and fracture clinic appointment

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29
Q

Most likely pathogen causing osteomyelitis in a pt with sickle cell

A

Salmonella

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30
Q

Pt on bisphosphonates for fracture 6 years ago wants to stop. What do you do?

A

Repeat DEXA and FRAX score now
Stop bisphosphonates now if low risk (T >-2.5)
Review in 2 years

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31
Q

Most common primary malignant bone tumour?

A

Multiple myeloma

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32
Q

Second most common primary bone malignancy

A

Osteosarcoma

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33
Q

Osteosarcoma on imaging

A

Bone destruction and new bone formation

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34
Q

XR and clinical features of osteopetrosis

A

Lack of differentiation between cortex and medulla of bone
Hard, dense and brittle bones
Anaemia and thrombocytopenia (Dec marrow space)
Deafness and optic atrophy (compression of cranial nerves)

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35
Q

Signs and symptoms of Ricketts

A 
Growth retardation
Hypotonia
Apathy in infants
Knock-kneed, bow-legged
Deformities of the metaphyseal-epiphyseal junction
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36
Q

Signs and symptoms of osteomalacia

A

Bone pain and tenderness
Fractures
Proximal myopathy due to dec PO4 and vit D

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37
Q

What is Paget’s disease?

A

Increased bone turnover associated with inc osteoclasts and osteoblasts, resulting in remodelling, bone enlargement, deformity, and weakness

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38
Q

Features of Paget’s on XR

A

Patchy cortical thickening
Sclerosis
Osteolysis
Deformity

39
Q

Risk factors for osteomyelitis

A 
Diabetes
Vascular disease
Impaired immunity
Sickle cell disease
Surgical prostheses
Open fractures
40
Q

Complications of osteomyelitis

A

Septic arthritis
Fractures
Deformity
Chronic osteomyelitis

41
Q

Outline the steps of bone healing

A 
Haematoma
Vascular granulation tissue
Osteoblasts stimulation 
Bone matrix
Endochondral ossification
Callus formation
Lamellar bone
Fracture union
Remodelling
42
Q

Outline the Gustilo classification for open fractures

A

I - low energy, wound <1cm long
II - low energy, wound >1cm, moderate soft tissue damage
III - high energy
a - adequate local soft tissue coverage
b - inadequate local soft tissue coverage
c - arterial injury

43
Q

Management of severe open fractures

A
  1. IV ABx - co-amox
  2. Neurovascular status - immediate surgery if impaired
  3. Plastics and orthopaedic involvement
  4. Debridement
  5. Cover sound in saline gauze
  6. Splint the limb
44
Q

When would ORIF be used?

A

Fractures involving joint articulations

45
Q

When is external fixation used?

A

Burns, loss of skin and/or bone, or in cases of open fractures (causes less damage to surrounding soft tissue)

46
Q

Symptoms and signs of carpal tunnel

A

Symptoms - shooting pain + tingling in thumb, index and middle finger; worse at night; relieved by shaking hand

Signs - wasting of thenar muscles (LLOAF); loss of sensation in radial 3 1/2 digits (excl palm); ±loss of 2 point discrimination; weak thumb abduction; +ve Phalen’s and Tinel’s

47
Q

Differentials for hand pain

A

Bone - #
Joints - OA, RA, crystal arthritis
Soft tissue - De Quervain’s tenosynovitis, flexor tendon injury
Neuro - median n injury (carpal tunnel), ulnar n injury, peripheral neuropathy, referred pain from C-spine
Vascular - Raynaud’s

48
Q

Management of carpal tunnel

A

Conservative - avoid precipitants, PT, braces/splints
Medical - NSAIDs, steroid injections
Surgical - carpal tunnel release

49
Q

Symptoms and signs of adhesive capsulitis

A

Symptoms - pain in shoulder (worse at night), affecting daily tasks (driving, dressing), Hx shoulder injury, no relief from minimal analgesia

Signs - tender on ant + post capsule of shoulder, all movements reduced (active + passive), ext rotation most affective, +ve painful arc

50
Q

Differentials for shoulder pain

A

Intrinsic:

  • muscles/ligaments -> calcific tendonitis, rotator cuff tears
  • joints -> glenohumeral OA, AC disease, inflammatory arthritis, septic arthritis (rare)

Extrinsic:

  • Polymyalgia rheumatica
  • Neurological -> referred pain from cervical radiculopathy
51
Q

Management of adhesive capsulitis

A

Conservative - hot packs, cont careful use of arm, PT
Medical - analgesia (paracetamol, NSAIDs, codeine), steroid injection
Surgical - if conservative methods ineffective

52
Q

Differentials for hip pain in an elderly pt

A

Bone - #NOF, hip dislocation
Joints - OA, septic arthritis, seronegative spondyloarthropathy, referred from lumbar spine
Soft tissues - trochanteric bursitis
Neuro - meralgia paraesthesia, femoral n compression
Vascular - AVN femoral head

53
Q

XR features of OA

A 
LOSS
L oss of joint space
O steophytes
S ubchondral sclerosis
S ubchondral cysts
54
Q

Management of OA

A

Conservative - lifestyle, PT, OT (walking aids)
Medical - NSAIDs, steroid injections
Surgical - THR, hip-resurfacing

55
Q

Examination findings in an L5-S1 prolapse causing an S1 radiculopathy

A

+ve SLR
Motor - weak ankle/hallux plantarflex
Reflex - dec ankle reflex (S1-2)
Sensory - loss over sole, back of calf and outer dorsum of foot; calf pain

56
Q

Examination findings in an L4-5 prolapse causing an L5 radiculopathy

A

+ve SLR

Motor - weak long toe extensor
Sensory - loss over medial dorsum of foot

57
Q

Examination findings in an L3-4 prolapse causing an L4 radiculopathy

A

-ve SLR and +ve femoral stretch
Motor - weak ankle dorsiflexion and knee ext
Reflex - dec patellar reflex
Sensory - loss over medial calf

58
Q

Differentials of back pain

A

1) Mechanical (80%):
- muscle strain/ligament sprain
- disc/facet joint OA
- lumbosacral spondylosis
- spondylolysis/spondylolisthesis
- kyphoscoliosis
- vertebral #

2) Neurogenic (10%):
- disc herniation/prolapse
- lumbal spinal stenosis

3) Non-mechanical (red flags)
- inflammatory arthritis (e.g. ank spond)
- Malignancy (e.g. myeloma, mets)
- Infection
- Paget’s disease

4) Referred (RAP)
5) Function (yellow)

59
Q

Management of back pain

A

Conservative - initial bed rest (<48hr) then early mobilisation (>48hr), PT
Medical - NSAIDs
Surgical - discectomy/laminectomy (only if intractable pain or progressive neuro signs)

60
Q

Symptoms/signs of cauda equina syndrome

A 
Severe back pain
BL sciatica
BL motor deficit (LMN)
BL sensory loss
Saddle anaesthesia
Urinary retention/overflow incontinence
Constipation/overflow faecal incontinence
Dec anal tone on PR
61
Q

Immediate investigations and management of cauda equina

A

Urgent MRI spine within 4hrs
Immediate neurosurgical referral
Urgent surgical decompression within 1d

62
Q

Back pain red flags

A 
Age <20 or >55
Acute onset in elderly
Constant or progressive
Nocturnal 
Fever, night sweats, weight loss
Neurology
Infection and/or immunosuppression
Leg claudication
63
Q

Describe the aspirates in septic arthritic, gout, and pseudogout

A

Septic arthritis - cloudy, high WCC, neurophilic, culture +VE
Gout - cloudy, needle-shaped -ve birefringent, culture sterile
Pseudogout - cloudy, rhomboid shaped weakly +ve, culture sterile

64
Q

Outline the Gustilo classification for open fractures

A 
I - low energy, <1cm
II - >1cm, mod ST injury
III - >10cm OR high energy, >1cm, extensive ST injury
IIIA - adequate ST coverage
IIIB - inadequate ST coverage
IIIC - associated with arterial injury
65
Q

Management of open fractures

A

Pain relief
IV Abx (co-amox)
Consider tetanus status (booster?)
Debridement (immediate if contaminated) - plastics + surgeons
Cover wound
Splinting limb
Definitive fixation/wound cover - ORIF, skin flap

66
Q

Outline the Garden classification for #NOF

A

I - undisplaced, incomplete
II - undisplaced, complete
III - complete fracture, incompletely displaced
IV - complete fracture, completely displaced

67
Q

Management of #NOF

A

Conservative - traction, immobilisation, bed rest, manage fall risk
Medical - pain relief, manage osteoporosis
Surgical - THR if mobile, hemiarthoplasty if immobile, cannulated screws (rare) in younger pts

68
Q

Symptoms and signs of supraspinatus tendonitis

A

Rotator cuff injury
Painful arc of abduction between 60 and 120’
Tenderness over ant acromion

69
Q

What is tibial stress syndrome?

A

aka. shin splints
Overuse injury or repetitive-load injury of the shin.
Medial tibial stress syndrome is the most common (posteromedial tibia), but is can also be anterior.

70
Q

Risk factors for tibial stress syndrome

A 
Runners without enough shock absorption
Training errors
Running >20miles/wk
High training early in season
Hx prev lower extremity injuries
Over-pronation or inc
71
Q

Pathophysiology of tibial stress syndrome

A

Caused by traction periostitis

  • ant lat = traction periostitis of tibialis ant on tibia + IO membrane
  • post med = traction periostitis of tibialis post + soleus
72
Q

Symptoms and signs of tibial stress syndrome

A

Symptoms - diffuse pain along middle-distal tibia that dec with running (early stage). Earlier onset of pain with more frequent training

Signs - tenderness along postmed border of tibia (4cm prox to med mal, ext prox up to 12cm). Flat feet, tight Achilles tendon, and weak core muscles may be present.
Provocative test - pain on resisted plantar flexion

73
Q

Investigations and management of tibial stress syndrome

A

XR - to excl stress #. Often normal in first 2-3wks, but long-term changes incl periosteal exostoses

Conservative - activity modification (dec distance, freq + intensity), shoe modification, PT

Surgical - deep posterior compartment fasciotomy + release of painful portion of periosteum (if conservative mng fails)

74
Q

Differentials for tibial stress syndrome

A

Compartment syndrome
Stress fracture
Tendinopathy
Radiculopathy

75
Q

Pt with progressive hip pain, waking at night and mildly raised Ca and Alk Phos. Likely diagnosis?

A

Metastatic tumour to bone

76
Q

Pt with bone pain, worse on walking. o/e there is deformity. XR looks thickened and sclerotic. Inc Alk Phos, normal Ca. Diagnosis?

A

Pagets

77
Q

Pathophysiology of Pagets disease of bone

A

Focal bone resorption followed by excessive and chaotic bone deposition.
Affects (in order): spine, skull, pelvis, and femur

78
Q

Investigations and results for Pagets

A

Alk phos raised

XR - abnormal thickened, sclerotic bone

79
Q

Management of Pagets disease of bone

A

Bisphosphonates

80
Q

Presentation of a dorsal column lesion. Examples

A

Loss of vibration + proprioception

Tabes dorsalis, SACD

81
Q

Presentation of a spinothalamic tract lesion

A

Loss of pain, sensation and temp

82
Q

Presentation of a central cord lesion

A

Flaccid paralysis of the upper limbs

83
Q

Presentation of a spinal cord infarction

A

Dorsal column signs (loss of proprioception and fine discrimination)

84
Q

Presentation of cord compression

A

UMN signs
Malignancy
Haematoma
Fracture

85
Q

Presentation of Brown-sequard syndrome

A

Hemisection of the spinal cord
Ipsilateral paralysis
Ipsilateral loss of proprioception and fine discrimination
Contralateral loss of pain and temp

86
Q

What is syringomyelia?

A

Cystic cavity forms within the spinal cord
Classically spares the dorsal columns and med lemniscus, affecting only the spinothalamic -> loss of pain and temp.
Often bilateral presentation

87
Q

Presentation of spinal stenosis

A

Gradual onset
Uni or bilateral leg pain (±back pain), numbness, weakness which is worse on walking
Resolves on sitting down, leaning forwards and crouching
Pain often described as ‘aching’, ‘crawling’

88
Q

Symptoms and signs of compartment syndrome

A 
Pain (esp on movement incl passive)
Parasthesiae
Pallor may be present
Arterial pulse may still be felt
Paralysis
89
Q

What is a Bennett’s #? What is the mechanism of injury?

A

Intra-articular # if 1st CMC joint
Impact on flexed MC, caused by fist fights
XR shows triangular fragment at ulnar base of MC

90
Q

What is a Montteggia’s #? What is the mechanism of injury?

A

Dislocation of prox radioulnar joint in association with an ulnar fracture
Fall onto outstretched hand with forced pronation

91
Q

What is a Galeazzi #? What is the mechanism of injury?

A

Radial shaft # with associated dislocation of the distal radioulnar joint
Direct blow

92
Q

What is a Pott’s #? What is the mechanism of injury?

A

Bimalleolar ankle fracture

Forced foot eversion

93
Q

What is a Barton’s #? What is the mechanism of injury?

A

Distal radius fracture (Colles’/Smith’s) with associated radiocarpal dislocation
Fall onto extended and pronated wrist

Finals (25 decks)

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