Definitions and random cases

Question 1

adhesive capsulitis

Answer 1

frozen shoulder

connective tissue becomes inflamed, thick and stiff

Question 2

differentials for orthopaedic problems of the hand:

Answer 2

dupuytren’s disease

trigger finger

de Quervian’s tenovaginitis

carpal tunnel

cubital tunnel syndrome

ganglion

OA at the base of the thumb

Question 3

dupruytren’s disease risk factors:

Answer 3

diabetes

alcohol

tobacco .

HIV

epilepsy

(it is also autosomal dominant)

Question 4

what is paget’s disease of the bone?

Answer 4

increased bone turnover!

increased bone resorption and increased bone formation

(leads to disorganised bone- more fractures, less compact, more vascular)

Question 5

RFs for paget’s disease of the bone:

Answer 5

strong genetic component

chronic viral infection

Question 6

symptoms of paget’s disease of the bone:

Answer 6

bone pain

excessive heat

hearing loss

bone deformity or fracture

Question 7

patient has synovitis - what do you think of?

Answer 7

Rheumatoid arthritis

Question 8

what condition gives thin bones with an increased risk of low trauma fracture?

Answer 8

osteoporosis

Question 9

what is FRAX? what is it used for?

Answer 9

Fracture risk assessment tool (by WHO)

used for assessing fracture risk in osteoporosis

Question 10

DXA scan
what is it?
when is it used?

Answer 10

dual energy X-ray absorptiometry

scan that measures the density of your bones

osteoporosis

Question 11

What is gout?

hyperuricaemia

Answer 11

a form of inflammatory arthritis

high levels of uric acid in the blood

acid creates deposits of mineralised/ crystal material

Question 12

how do you treat an acute flare of gout?

Answer 12

NSAIDs

colchicine

steroids (IM, Oral)

Question 13

JIA

Answer 13

group of inflammatory disorders affecting children under 16

most common rheumatic disease in children

Question 14

important disease in disability and blindness in children:

Answer 14

JIA

juvenile idiopathic arthritis

Question 15

what are the 3 main criteria for JIA?

Answer 15

children under 16

lasts for under 6 weeks

has joint swelling (arthritis), decreased range of motion, swelling etc

Question 16

what are the 3 types of JIA?

Answer 16

pauciarticular (4 or less joints)

periarticular (5 or more joints)

systemic onset

Question 17

how do you treat JIA?

Answer 17

1st line: simple pain killers (NSAIDs, steroid injections into the joint)

2nd line: methotrexate, anti TNF, IL-1 inhibitors

Question 18

what is osteogenesis imperfecta?

Answer 18

deficiency in type 1 collagen

genetic disorder of connective tissue characterised by fragile bones (from mild trauma or even just day to day life)

Question 19

what is osteoporosis?

Answer 19

micro architectural deterioration of bone resulting in and increased risk of fracture

Question 20

what tool do you use to assess fracture risk?

Answer 20

FRAX

fracture risk assessment tool (WHO)

Question 21

causes of osteoporosis:

Answer 21

rheumatoid arthritis

ankylosing spondylitis

polymylagia rheumatica

cushings

thyrotoxicosis

steroids

PPI

menopause

Question 22

how do you investigate osteoporosis?

Answer 22

DXA scanning

dual energy x-ray absorptiometry

Question 23

how do you treat osteoporosis?

Answer 23

biphosphonates (main treatment)

HRT

SERM (selective oestrogen receptor modulator)

Question 24

how do you reduce you fracture risk in osteoporosis?

Answer 24

reduce the risk factors

ensure good calcium and vitamin D

medication adherence

Question 25

what is ankylosing spondylitis?

Answer 25

long term inflammation of the joints of the spine

Question 26

hallux valgus

Answer 26

bunions

lateral angulation of the big toe

Question 27

how do you test for achilles tendinopathy?

Answer 27

calf squeeze test (simmonds test)

squeeze calf and if the foot moves then the achilles is NOT fully ruptured

Question 28

what are some uses for methotrexate?

Answer 28

RA

ectopic pregnancy/ abortion

psoriasis

Crohn’s

Chemo

Question 29

most common malignant bone tumour in children

Answer 29

osteosarcoma

Question 30

most common malignant bone tumour in older patient

Answer 30

myeloma

Question 31

Bone tumours give what symptoms?

Answer 31

mass

pain (mostly activity related)

Question 32

what do you look for in a bone tumour?

Answer 32

shape

texture

tenderness

location

consistency

mobility

temperature

Question 33

7 most common cancers that metastasise to the bone

Answer 33

lung

breast

prostate

kidney

thyroid

GI tract

melanoma

Question 34

classic signs of mortons neuroma?

Answer 34

maulders click

loss of sensation between 3rd and 4th webspace

Question 35

Mensical tear causes

Answer 35

twisting of knee

hyper-flexing of the knee joint

Question 36

signs of carpal tunnel syndrome

Answer 36

burning/tingling/itch in thumb and palm

weakness

pain at night

waster thenar eminences and lack of sensation over lateral 3 and a half digits

Question 37

what tests can you do for carpal tunnel syndrome?

Answer 37

tinnels - hit wrist (tap) median nerve - feels tingling

phalens - reverse prayer sign - tingling in lateral hand (thumb, index, middle fingers)

Question 38

how do you treat carpal tunnel?

Answer 38

wrist brace

surgery

Question 39

capsaicin is used to treat what?

Answer 39

osteoarthritis

Question 40

colchicine is used to treat what?

Answer 40

gout

Question 41

SALTR harris fracture scale is what?

Answer 41

fractures in children that involve the growth plate

Question 42

what are the stages of the SALTR harris scale?

Answer 42

s - straight across the growth plate

a - away from the joint (into metaphysis)

L - lower than joint (into epiphysis)

t - through the joint (extends into epiphysis and metaphysis)

R - rammed (crush injury without displacement)