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Orthopaedics Flashcards

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1
Q

What does tenderness in the anatomical snuffbox suggest?

A

scaphoid fracture

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2
Q

What mechanism of injury typically leads to a scaphoid fracture?

A

falling on an outstretched hand

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3
Q

How do you test for carpel tunnel syndrome?

A
  1. Tinnel’s test
    - tapping over area for 60 seconds
  2. Phalen’s test
    - reverse prayer sign for 60 seconds
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4
Q

What conditions is carpel tunnel commonly seen in?

A
  • acromegaly
  • RA
  • diabetes
  • pregnancy
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5
Q

What is the management of achilles tendon rupture?

A
  1. surgical repair

2. above the knee back slab with foot in equinus position

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6
Q

What is Simmond’s test? And if positive what does this indicate?

A
  • no plantarflexion on squezzing the affected calf

- sign of achilles tendon rupture

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7
Q

In a patient with a tibial plateau fracture which nerve is most likely to be damaged?

A

common peroneal nerve –> foot drop

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8
Q

List some common causes of posterior shoulder dislocation.

A
  • epileptic fit
  • electric shock
  • fall from motorbike

–> usually due to forced internal rotation of the abducted arm or direct blow from front of shoulder

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9
Q

Which is detectable on an AP CXR - anterior OR posterior shoulder dislocation?

A

anterior should dislocation only

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10
Q

What is the common mechanism leading to anterior shoulder dislocation?

A

falls backwards on an outstretched hand or by forced abduction and external rotation of the shoulder

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11
Q

List some medical conditions affecting orthopaedic function.

A

RPT - MSK - DHS

R - rheumatic fever (or childhood arthritis)
P - psoriasis
T - TB affects joints
M - MuSculosKeletal disorders - SLE, OA, malignancy
D - diabetes
H - hypo/hyper-thyroidism
S - STIs

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12
Q

What is the UK MRC scale?

A
  • it objectifies strength :
    grade 5 - normal power
    grade 4 - active movement against resistance but not achieving full power
    grade 3 - active movement against gravity but not resistance
    grade 2 - active movement with gravity eliminated
    grade 1 - flicker of contraction
    grade 0 - no muscle contraction
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13
Q

What is the Ottawa ankle rules and what is it used for?

A
  • this is used to exclude ankle and mid-foot fractures without the need to x-ray the ankle
  • ankle xrays required if there is pain in the malleolar zone, tenderness at posterior edge of lateral malleolus or an inability to weight bear initially and in ED
  • mid-foot xray required if there is pain in the mid-foot zone or tenderness at base of fifth metatarsal and/or navicular
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14
Q

What sort of joint is the knee joint?

A

hinge joint between femur and tibia

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15
Q

What is the largest sesamoid bone?

A

patella (lies within quadriceps tendon)

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16
Q

How does time for swelling develop indicate knee injury?

A
  1. immediate - think fracture e.g. tibial plateau
  2. hours - think ACL tear
  3. over night - meniscal tear
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17
Q

What injury do you expect when the knee locks?

A
  • meniscal tear
  • the tear flips in and out of the joint
  • displaced segment lodges between femoral and tibial condyles
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18
Q

What differentials do you think if a knee ‘gives way’?

A

non-specific for:

  • muscle weakness
  • meniscal tear
  • ligament instability
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19
Q

What is the function of the patella tendon?

A

active extension of the knee

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20
Q

What does tenderness over the lateral join of the knee indicate?

A

iliotibial band tendinitis

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21
Q

Which 4 ligaments stabilise the knee?

A
  1. anterior cruciate ligament (ACL)
  2. posterior cruciate ligament (PCL_
  3. medial collateral ligament
  4. lateral collateral ligament

NB medial collateral ligament is much broader than the lateral collateral ligament and is securely attached to the joint capsule therefore more frequently torn than lateral

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22
Q

What are the secondary stabilisers of the knee?

A
  1. iliotibial band
  2. biceps femoris
  3. the menisci (medial and lateral)
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23
Q

Describe the anatomical location of the ACL and PCL.

A

extrasynovial but intracapsular

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24
Q

What is arthroscopy?

A

Arthroscopy is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed

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25
List the differential diagnoses of knee pain.
1. patellofemoral pain syndrome (PFPS) 2. Bipartite patella 3. Patella tendinopathy (jumper's knee) 4. Hoffa's fat pad syndrome 5. Chodromalacia patellae 6. Osgood-Schlatter disease 7. Bursitis
26
What is a positive Clarke's test?
pain on patellofemoral compression with tensed quadriceps muscles
27
What is Hoffa's fat pad syndrome?
- very painful impingement of the infrapatella fat pad - thought to be caused by maltracking of the patella - typically caused by over-extension of the knee
28
What is chondromalacia patellae?
softening of the articular cartilage of the patella
29
What is Osgood-Schlatter disease?
pain +/- swelling over the tibial tuberosity
30
What are bursae?
- small fibrous sacs of fluid with synovial lining | - typically found around joints and between tendons and ligaments where they pass over bone
31
Which is the most commonly affected bursa which causes knee bursitis?
- prepatellar bursa - causes anterior knee pain (esp. on kneeling) - caused by overuse/ following trauma
32
What are the causes of prepatellar bursitis?
- overuse - trauma - infection - crystalarthropathies - RA
33
How is prepatellar bursitis managed?
aspiration +/- corticosteroid injection pain relief from topical NSAIDs if resistant can surgically remove
34
What is the difference between a semimembranous bursa and a baker's cyst?
semimembranous bursa (lies in the popliteal fossa) is a popliteal cyst whereas a baker's cyst is a herniation from the joint synovium
35
List the differential diagnoses of a swollen knee.
1. OA 2. knee replacement 3. meniscal cyst 4. ligament tears 5. meniscus lesions 6. patellar dislocation 7. baker's cyst 8. septic arthritis
36
What is the average join survival of a knee replacement?
about 15 years
37
What is a meniscal cyst?
- cyst development typically sometime after a traumatic event - lateral 5-10x more common than medial
38
What is the most common swelling of the popliteal fossa?
baker's cyst
39
What is the common pattern of patella dislocation?
- typically lateral following twisting of the lower leg + contraction of the quadriceps - can get recurrent patella subluxation after dislocation due to tightened lateral retinaculum
40
Which is more commonly damaged the anterior/posterior cruciate ligaments?
anterior because the posterior is twice as strong.
41
Give an example scenario which would lead to rupture of the posterior cruciate ligament.
RTA - knee hits dashboard
42
Give an example scenario which would lead to rupture of the anterior cruciate ligament.
typically follows a twisting injury to the knee with the foot fixed to the ground
43
What is the most common reason for knee arthroscopy?
meniscal (semilunar cartilage) tears
44
What is the blood supply to the knee?
genicular branches of popliteal and femoral arteries
45
What is the nerve supply to the knee?>
nerves crossing knee are femoral, tibial and common fibular nerves
46
What cartilage are the menisci made up of?
fibrocartilage
47
What are common causative organisms of osteomyelitis?
- staph aureus - pseudomonas - E.coli - streptococci
48
What investigation findings would you expect with osteomyelitis?
- raised ESR and CRP - raised WCC - blood cultures positive
49
What is the gold standard investigation for pathogen identification if diagnosis remains uncertain in ??osteomyelitis?
bone biopsy and culture
50
What are the complications of acute osteomyelitis?
- chronic osteomyelitis - septic arthritis - fracture - deformity
51
What is the treatment of osteomyelitis?
6 weeks of ABx: - vancomycin 1g BD AND - cefotaxime 1g BD
52
What is Pott's disease?
TB in vertebral body
53
List the risk factors for osteomyelitis.
- diabetes - vascular disease - impaired immunity - sickle cell disease - surgical prostheses - open fractures - impaired immunity
54
What sort of joint is the hip?
- ball and socket synovial joint | - formed by articulation of the pelvic acetabulum and head of the femur
55
What are the 3 axes of movement for the hip?
1. flexion and extension 2. abduction and adduction 3. medial and lateral rotation
56
How do you measure leg length?
from anterior superior iliac spine to medial malleolus
57
What is Thomas test and if positive what does it detect?
- detects fixed flexion deformity - patient lies supine on couch - flex the good leg until obliteration of lumbar lordosis (cannot pass hand through small of back) - the thigh on the affected side will lift off the couch
58
What is trendelenburg test?
- assesses abduction of hip and ability to support the pelvis when standing on one leg - hip should rise when leg lifted - +ve test is when the weakness of the abductors of the weight bearing leg causes the pelvis to fall on the side of the lifted hip (sound side sags!)
59
What are the ligaments of the hip?
1. intracapsular - ligament of femoral head 2. extracapsular - iliofemoral - pubofemoral - ischiofemoral
60
What are the causes of a positive Trendelenburg test?
1. abductor muscle paralysis - weakened muscle in OA - nerve damage (gluteus medius and minimus are supplied by the superior gluteal nerve) 2. upward displacement of the greater tronchanter 3. absence of a stable fulcrum
61
What gaits can develop from hip pathology?
1. Trendelenburg's gait (waddling gait) 2. short-leg gait (equinus deformity) 3. antalgic gait (quick and short steps with shortening of stance phase on painful leg)
62
What are the 4 prognostic clinical signs of septic arthritis in a child?
1. temp >38.5 2. WCC >12 3. CRP >20 4. non-weight bearing NB/ if 3 or more present there is a 93% chance it is septic arthritis
63
What are your main differential diagnoses for a 4y/o presenting with pyrexia and limp due to hip pain?
- septic arthritis | - transient synovitis
64
What are the differentials for painful hips in children?
- septic arthritis (must rule out) - tubercular arthritis (2-5yrs) - Perthe's disease (4-7yrs) - SUFE (10-16yrs) - inflammatory arthritis - osteomyelitis - transient synovitis
65
How is transient synovitis diagnosed?
diagnosis of exclusion
66
What is transient synovitis?
- main cause of hip pain in children aged 4-10 - acute onset - self-limiting - cause: viral illness preceded by viral URTI/ autoimmune - O/E pain with extremities of movement but bloods and radiology are normal - treat with rest and NSAIDs
67
What is Perthe's disease?
- avascular necrosis of the femoral head with unknown cause | - PC: pain in hip/knee --> limp
68
What will you find on examination of the hip on Perthe's disease?
all movements of hip are limited especially internal rotation and abduction
69
What is a slipped upper femoral epiphysis?
- displacement through the growth plate with the epiphysis always slipping down and back - PC: limp + pain in groin, anterior thigh or knee usually following minor injury / atraumatic - treat with early internal fixation (surgically)
70
How should a ?SUFE be investigated?
- anteroposterior and frog-leg lateral xrays of both hips
71
How is developmental dysplasia of the hip usually managed?
- Pavlik harness - holds the femoral head in the acetabular fossa - promoting normal development of the hip joint

Orthopaedics (1 decks)

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