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A final year of medicine > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

ACL rupture features?

A

Prevents forward subluxation of femur, so rupture gives instability associated with joint effusion

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2
Q

Osteochondritis dissecans?

A

Get necrosis of subchondral bone, detachment of fragment to give a loose body, intermittent locking and swelling. Most commonly affects the lateral surface of the medial femoral condyle

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3
Q

Who gets chondromalacia patellae?

A

Girls who exercise regularly; get anterior knee pain in teenagers (invariably chondromalacia)

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4
Q

How does medial meniscus tear present?

A

Get locking (inability to fully extend), pain along medial joint line, swelling

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5
Q

How does Osgood-Schlatter’s disease present?

A

Tends to occur in active boys, get anterior knee pain and tender swelling of the tibial tuberosity. Traction osteochondritis.

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6
Q

X-ray findings of multiple myeloma?

A

‘Punched-out’ lesions caused by malignant plasma cells.

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7
Q

What is conus medullaris syndrome?

A

Get compression on the spinal cord in adults. Spinal cord ends at L1/L2. Get UMN signs (weakness is symmetrical, get hyper-reflexia rather than areflexia in CES). Causes are similar to CES

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8
Q

How does teriparatide (PTH derivative) help in osteoporosis?

A

Has anabolic effect on bone

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9
Q

Adhesive capsulitis signs?

A

Unable to internally and externally rotate or abduct. Patients often diabetic. Can remain stiff for 18-24 months. Treatment = analgesia, NSAIDs, corticosteroid injections, physio and exercise (after pain relief commenced)

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10
Q

What is golfer’s elbow?

A

Medial epicondylitis

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11
Q

Subacromial impingement symptoms?

A

Degree of movement, painful abduction (complete)

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12
Q

Which nerve runs around the surgical neck of the humerus?

A

The anterior branch of the axillary nerve

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13
Q

What does the axillary nerve innervate?

A

Teres minor, deltoid, glenohumeral joint and the skin over the inferior part of the deltoid

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14
Q

MRI finding of bone marrow oedema suggests what?

A

Osteomyelitis; requires surgical debridement and intravenous antibiotics

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15
Q

Side effect of bisphosphonates?

A

Oesophagitis, gastritis, ONJ, fevers, myalgias, arthralgias. The latter three are common in IV bisphosphonates and are transient

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16
Q

What is ITB syndrome?

A

Excessive friction between ITB and lateral femoral condyle, causing compression. May get cysts, bursitis. Common in athletes with repetitive knee flexion/extension. Get tenderness over lateal femoral condyle, crepitus, reduced hip and knee motion. Treatment is non-operative primarily.

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17
Q

Osteoporosis and vertebral fractures?

A

Fractures at T4 or above are suggestive of cancer rather than osteoporosis

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18
Q

Best management of complete ACL tear in young, fit person?

A

Operative repair with ACL reconstruction

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19
Q

Four features of Colles’?

A

Dorsal displacement of distal fragment, radial displacement of the hand, radial shortening due to impaction, avulsion of the ulnar styloid

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20
Q

Management of mechanical back pain?

A

Mobilisation, analgesia, then can try physiotherapy

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21
Q

Features of autonomic dysreflexia?

A

Tachycardia, hypertension, sweating and flushing. Caused by excessive sympathetic activity in the absence of parasympathetic supply in high spinal lesion. Stimuli such as UTI, full bladder, bladder/rectal instrumentation can induce it.

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22
Q

Features of scaphoid fracture?

A

Pain on abduction of thumb, tenderness in anatomical snuffbox and thenar eminence.

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23
Q

Borders of anatomical snuffbox?

A

Tendons of EPL posteriorly, anteriorly by EPB and APL

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24
Q

Supracondylar fracture of humerus?

A

Triceps pulls forearm posteriorly, impinging brachial artery. Orthopaedic emergency. Common in children. Must monitor radial pulse during and after reduction to avoid ischaemic injury.

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25
Q

Features of De Quervain’s?

A

Stenosing tenosynovitis. Occurs as a result of repetitive movements e.g. factory work, often worse at night, swelling is of sheath around APL and EPB at radial styloid

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26
Q

Sciatica triad?

A

Pain, tingling, numbness

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27
Q

Causes of sciatic?

A

Herniated disc (secondary to heavy lifting or strenuous exercise), spondylolisthesis, spinal stenosis

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28
Q

Diagnosis sciatica?

A

Positive SLR (pain at 30-70% angle)

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29
Q

Management of sciatica?

A

Analgesia, physiotherapy; if persists after 6-8 weeks then referral to specialist warranted

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30
Q

Housemaid’s knee?

A

Prepatellar bursitis (infrapatellar is clergyman’s knee)

31
Q

Volkmann’s contracture?

A

Permanent, claw-like deformity of the fingers and hand as a result of muscle fibrosis and shortening due to ischaemia

32
Q

What is osteoporosis defined as?

A

T score of -2.5 or lower.

33
Q

Nerve prone to injury in anterior dislocation of the shoulder?

A

Axillary nerve

34
Q

Typical history for osteosarcoma?

A

Bone pain worse at night, fever and swelling

35
Q

Radiograph of osteosarcoma?

A

Get characteristic blastic and destructive lesion (sunburst), periosteal elevation, soft tissue swelling

36
Q

Clinical picture of lumbar disc prolapse?

A

Initial back pain, later radiating to leg, if nerve roots compressed get parasthesia, muscle cramps and tenderness, progressing to sensory loss and motor weakness. If urinary or anal sphincter tone compromised (i.e. CES) then need emergency decompression)

37
Q

Classical signs of compartment syndrome?

A

Increasing pain, parasthesiae and other signs of ischaemia (6 Ps). Pain on passive movement is early sign.

38
Q

Diagnosing compartment syndrome?

A

Usually clinic, but can measure compartment pressures if in doubt (any >30mmHg indicates fasciotomy needed).

39
Q

Osteopenia (decreased bone mass) with normal ratio of mineral to matrix?

A

Osteoporosis (in osteomalacia get low ratio of mineral to matrix)

40
Q

Subluxation of the radial head?

A

Children 2-5. Longitudinal traction applied to extended arm. Radiographs normally negative. Treatment is closed reduction. Often presents with elbow in slight flexion and forearm pronation

41
Q

Management of Pott’s disease?

A

Spinal immobilisation and antibiotics

42
Q

Management of subtrochanteric femoral fractures?

A

Intramedullary nail preferred to DHS

43
Q

What condition is de Quervain’s associated with?

A

Rheumatoid arthritis

44
Q

First line therapy for Paget’s?

A

Bisphosphonates

45
Q

Bloods in Paget’s?

A

Normal calcium and phosphate, markedly raised ALP

46
Q

Three causes for symptoms after joint replacement?

A

Loosening or dislocation of the prosthesis, osteomyelitis of the surgical site

47
Q

Clinical significance of suprapatellar bursa communicating with the knee joint?

A

Effusion of knee can extend 3-4cm above patella in to suprapatellar pouch

48
Q

What type of injury is likely to affect menisci?

A

Twisting strains applied to weight-bearing knee

49
Q

Associations with Dupuytren’s contracture?

A

Alcohol, familial, diabetes, epilepsy, hand trauma, manual labouring

50
Q

Cruciate ligaments relation to capsule and synovial cavity?

A

They are intracapsular but extra-synovial

51
Q

How do ACL and PCL injuries occur?

A

ACL tear is common sports injury; when femur moves forward on tibia. Tears of PCL are rare because is much stronger, but occurs secondary to hyperextension of the knee joint

52
Q

When is the PCL used?

A

Walking downstairs, or downhill, as prevents posterior displacement of the tibia on the femur

53
Q

Malignant risk in Paget’s?

A

Risk of osteosarcoma

54
Q

What injury is associated with Hills-Sachs lesion?

A

Associated with anterior shoulder dislocation; get cortical depression in posterolateral head of the humerus (caused by forceful impaction of the humeral head)

55
Q

What % of ACL injuries are associated with meniscal injuries?

A

50%

56
Q

What is cervical spondylosis?

A

Degenerative disease producing osteophytes that project into intervertebral foramen; sudden neck movements/strain can cause symptoms as narrowed foramen puts pressure on issuing nerve root

57
Q

Fracture of the fifth metacarpal?

A

“Boxer’s fracture”

58
Q

Hallmarks of deep infection post-operatively?

A

High inflammatory markers, oozing from wound, pyrexial

59
Q

Signs of posterior dislocation of the hip?

A

Leg will be internally rotates, adducted and flexed at the hip

60
Q

Causes for slow progress post-operatively?

A
  1. Premorbid health
  2. Pathological fall (MI, CVA, arrhythmia)
  3. Operative complications, significant blood loss, prolonged anaesthesia
  4. Post-op complications (sepsis, confusion, anaemia, depression)
61
Q

Best imaging to visualise meniscal tear?

A

MRI

62
Q

Which nerve is most likely to be damaged by supracondylar humeral fractures?

A

Median nerve

63
Q

Painful arc with drop arm test?

A

Suggests rotator cuff tear (complete). Painful arc alone could be subacromial bursitis but would not give positive drop test. If it was just tendinitis, would also not get drop arm test.

64
Q

Investigating ?septic arthritis?

A

Radiographs (may be normal, may show joint space widening or effusion), US may show effusion and guide aspiration. Also do FBC, ESR, CRP, and joint fluid aspiration (gram stain, culture and sensitivity, glucose levels and crystal analysis)

65
Q

Management of suspected scaphoid fracture although not shown on radiographs?

A

Treat as clinical scaphoid fracture i.e. apply scaphoid plaster, review after a week in the fracture clinic with repeat x-rays

66
Q

Findings that indicate scaphoid injury?

A

Tender in ASB, pain on telescoping the thumb, over scaphoid tubercle on palmar side of wrist, and on ulnar deviation of the wrist

67
Q

Typical feature of steroid-induced osteoporosis?

A

Exuberant callus formation

68
Q

What are the features of hammer toe?

A

Deformity characterised by flexion at PIP and extension deformity at DIP

69
Q

Features of lumbar spinal stenosis?

A

Narrowing of lumbar spinal canal, pressure on sciatic nerve roots. Get positional back pain (when back straight), nerve root compression symptoms and lower extremity pain when walking, running, climbing stairs, standing. Pain relieved by flexing back or by sitting. Pain better when walking uphill (back flexed), unlike vascular claudication

70
Q

Proximal and distal row of carpals?

A

Proximal = scaphoid, lunate, triquetrum, pisiform
Distal = trapezium, trapezoid, capitate, hamate
“some lovers try positions that they cannot handle”

71
Q

Gout vs pseudogout on aspiration?

A

Gout is negatively birefringent, pseudogout is positively

72
Q

Key thing to test when re-locating anterior dislocation of shoulder

A

May get vascular injury (axillary artery) or nerve injury (axillary nerve); latter is more likely so check before and after

73
Q

What other injuries are associated with dislocation/trauma to shoulder in patients older than 40?

A

Acute avulsion injuries and rotator cuff tears of the supraspinatus, infraspinatus, teres minor, so look for features of these after primary injury resolves

A final year of medicine (20 decks)

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