CORTEXT: Pelvis & lower limb

Question 1

Hip pathology may cause pain at what sites?

Answer 1

Groin
Knee (obturator supplies both joints)

Question 2

What are the possible causes of secondary Avascular Necrosis?

Answer 2

Alcohol abuse
steroids
hyperlipidaemia
thrombophilia

Question 3

What are the X-ray sings of Avascular Necrosis?

Answer 3

• patchy sclerosis

- lytic zone (granulation tissue) - hanging rope sing

Question 4

Pain and tenderness in the region of the greater trochanter, with pain on resisted abduction is indicative of…

Answer 4

Trochanteric bursitis (gluteal cuff sundrome)

Question 5

Localized pain (usually medial knee) following a twisting motion on a loaded knee, with effusion developing the following day, with a catching sensation or 15o locking of knee describes….

Answer 5

acute meniscal tear

Question 6

What is a common cause of knee locking following trauma (arising from twisting)?

Answer 6

Bucket handle meniscal tear

-torn meniscus flips over and gets stuck in the joint

Question 7

What is the mechanism of injury leading to ACL rupture?

Answer 7

Twisting the body laterally on a planted foot

Question 8

Following ACL rupture, swelling commonly develops within a day from the injury (T/F)

Answer 8

False

-haemarthrosis causes painful swelling with an hour

Question 9

What are the symptoms and examination findings of ACL rupture?

Answer 9

• rotatory instability
• knee giving way on turning
• swelling
• positive anterior drawer test
• positive Lachman test

Question 10

How is the Lachman test performed?

Answer 10

1. flex knee to 30o
2. hold femur with one hand
3. grab tibia with the other - thumb on tibial tuberosity
4. pull tibia forward
   - firm end point indicates an intact ACL
   - soft end point indicates ACL damage

Question 11

How is ACL reconstruction carried out?

Answer 11

Tendon grafts are passed through tibial and femoral tunnels at the usual location of the ACL.

Question 12

MCL injuries are treated with reconstructive surgery (T/F)

Answer 12

False

• usually self resolving
• treat with brace

Question 13

What are the components of the Extensor mechanism of the knee? (5)

Answer 13

1. tibial tuberosity
2. patellar tendon
3. patella
4. quandriceps tendon
5. quadriceps muscles

Question 14

What are the risk factors for extensor mechanism rupture (patellar or quadrceps tendon)?

Answer 14

1. Hx of tendonitis
2. heavy steroid use
3. RA
4. Renal failure
5. Quinolone antibiotics

Question 15

What treatment should be avoided in extensor mechanism insults?

Answer 15

Steroid injections

-exacerbate rupture risk

Question 16

What examination assesses the extensor mechanism integrity?

Answer 16

1. Straight Leg Raise

2. a gap may be palpated below the patella

Question 17

The patella tends to dislocate medially (T/F)

Answer 17

False

Laterally

Question 18

What is Hallux rigidus? What is the gold standard treatment?

Answer 18

Osteoarthritis of the 1st MTP joint

Arthrodesis

Question 19

What is arthrodesis?

Answer 19

Surgical immobilisation of a joint

Question 20

Positive Mulder’s click test (squeezing the metatarsal heads) is indicative of what condition?

Answer 20

Morton’s neuroma

-overgrowth of interdigital nerves due to repeat trauma

Question 21

Which metatarsals are most commonly affected by Metatarsal stress fracture?

Answer 21

2nd and 3rd metatarsals

Question 22

List 3 factors predisposing to Achilles tendonitis.

Answer 22

Quinolone antibiotics (ciprofloxacin)
Rheumatoid arthritis
Steroids

Question 23

Damage to which muscle can result in acquired flat foot (pes planus)?

Answer 23

tibialis posterior

Question 24

What is the cause of Claw and hammer toes?

Answer 24

imbalance between flexor and extensor tendons