Orthopaedics

Question 1

How do you manage an open fracture?

Answer 1

Take photo
Saline soaked gauze
IV Co-amox
Tetanus booster
Analgesia
IVI/tranfusion
XR
CTA/Doppler if arterial injury suspected
Pre-op bloods
Specialist- reduce and splint , debride, Gustilo and Anderson classification

Question 2

Bloods to prep for theatre

Answer 2

U&E
Group & save
FBC
Clotting
ECG/CXR
Cannula
Fluids O/N
Consented by reg
Neurovascular status

Question 3

Shoulder fracture- which nerve affected and how do you test for it?

Answer 3

Axillary

Sensation on top of arm

Question 4

How do you test ulnar nerve?

Answer 4

Hand sensation

Finger spread for motor

Question 5

How do you damage the ulnar?

Answer 5

Elbow injury

Question 6

What is colles?

Answer 6

Wrist fracture with dorsal angulation

Question 7

How do you test motor radial?

Answer 7

Thumbs up

Question 8

How do you test motor of median nerve

Answer 8

form a fist

and cross fingers over (interosseus)

Question 9

What are criteria for a THR?

Answer 9

displaced, intracapsular NOF fracture and old, but

-able to mobilise with 1 stick or less outside, not cognitively impaired and medically well

Question 10

What are criteria for hemiarthorplasty?

Answer 10

intracapsular and old

Question 11

How to manage an intertrochanteric NOF?

Answer 11

Dynamic hip screw

MOST COMMON

Question 12

How to manage a extracapsular NOF?

Answer 12

IM nail

Question 13

Where do you press for ottawa ankle rules?

Answer 13

Midfoot zone, lateral and medial malleolus and 5th metatacal head

Question 14

What criteria are used in deciding on cast and ops for ankles?

Answer 14

Webber criteria

Based on ligament placement- if below then stable so no cast (A), if aboce then C, least stable so pin

Question 15

What investigations do you need to do in myeloma?

Answer 15

IgG
RBC with film
U&E with calcium
Urinary bence jones
Xray any painful bones
Refer to radiology for myeloma screen

Question 16

What fractures does osteomalacia present with?

Answer 16

Pseudo
Luscent lines on xray
Painful but not fracture as not displaced

Question 17

What is osteomalacia?

Answer 17

impaired bone mineralisation resulting in softening which deforms.

Question 18

How is osteomalacia manages?

Answer 18

Ca++ and vit D and monitor response with serium Ca++ and alkaline phos
OR PUT THEM OUTSIDE!

Question 19

What is Pagets?

Answer 19

Disregulation of osteoclasts and blasts forming large, new, weak bone quickly.
Focal disease of remodelling- mosaic of woven and lamellar bone

Question 20

How does Pagets present?

Answer 20

Bone pain in elderly
FH history
Isolated raised ALK PHOS, all other LFTs, GGT, calcium etc normal

Question 21

How is Pagets assessed?

Answer 21

Isotope bone scan to identify all affected
Radiographs for diagnosis
Serum alk phos for monitoring

Question 22

How is pagets Managed?

Answer 22

Bisphosphonates (zolendronate (IV)/ alendronate/ risedronate)
Give Ca and vit D too

Question 23

What are Pagets complications?

Answer 23

Deafness
Cord compression
nerve compression
Long bone weakness

Question 24

What cells are present in Pagets?

Answer 24

Giant multinucleate osteoclasts

Question 25

How do you diffentiate between mets and pagets lesions?

Answer 25

Mets- small areas on axial skeleton and tend to be symetrical PAgets- unilateral lesions on mono/poly joints

Question 26

What are 3 signs of on xray?

Answer 26

white sclerotic patches increased bone size loss of trabecular acrhitecture

Question 27

What are red flags for back pain?

Answer 27

``` Under 16 or over 65 new onset Neurology Night pain pain at rest/unrelenting Immunocompromised Long term steroid use Malignancy history Weight loss concurrent illness ```

Question 28

What are symptoms of cauda equina?

Answer 28

``` Asymmetrical Flaccid Decreased reflexes Bladder and bowel present late LMN (PR needed) ```

Question 29

What are symptoms of spinal cord compression?

Answer 29

Symmetrical UMN Perianal numbness Urinary retention, foecal incontinence

Question 30

What is the criteria to decide between NOF treatments called?

Answer 30

Garden criteria

Question 31

What nerve is affected in humerus breaks?

Answer 31

Radial

Question 32

What nerve is affected in wrist fractures?

Answer 32

Median

Question 33

What nerve is affected in proximal fibular fractures?

Answer 33

Common peroneal