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Y2 MSK > Hip and Lower Leg - Conditions > Flashcards

Hip and Lower Leg - Conditions Flashcards

1
Q

what is avn

A

bone infarct

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2
Q

which parts of the body are higher risk of avn and why

A

femoral head, scaphoid, talus, lunate, since tenuous BS

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3
Q

risk factors for avn

A

alcohol, CCS, hyperlipidaemia, sickle cell

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4
Q

investigations for avn of the hip

A

early: mri
late: xr showing hanging rope sign

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5
Q

management of ealry and late presentations of avn of the femoral head

A

early; decompression, late; THR

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6
Q

another name for irritable hip

A

transient synovitis

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7
Q

age and gender most commonly affected by irritable hip

A

boy 2-5yr

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8
Q

presentation of irritable hip

A

can’t bear weight after URTI +- pyrexic

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9
Q

investigations for irritable hip

A

normal bloods, US effusion

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10
Q

irritable hip management

A

self-limiting

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11
Q

risk factors for sufe

A

10-16yr black obese male

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12
Q

what does sufe stand for

A

slipped upper femoral epiphysis

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13
Q

presentation of sufe

A

acute/chronic knee+-distal thigh pain, loss of internal rotation

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14
Q

what is sufe

A

femoral epiphysis slips inferior to femoral neck

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15
Q

what is seen on xr in sufe

A

Trethowan’s sign

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16
Q

SUFE Mx

A

surgical stabilization of physis

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17
Q

complication of sufe

A

avn

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18
Q

what is perthes disease

A

unilateral transient AVN of femoral head

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19
Q

risk factors for perthes disease

A

4-8yr short hyperactive boy

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20
Q

what is seen on examination in perthes disease

A

Trendeleberg gait

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21
Q

complication of perthes disease

A

oa

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22
Q

risk factors for ddh

A

breech, FH, 1st born, girl

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23
Q

what does ddh stand for

A

developmental dsyplasia / dislocation of the hip

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24
Q

investigations for ddh

A

US, XR; uncalcified epiphysis

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25
Q

management of ddh presenting early

A

palvik harness

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26
Q

management of ddh presenting <2yr

A

reduce + cast

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27
Q

presentation of ddh >2yr

A

trendelenberg, short leg, no pain, >OA

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28
Q

what is the 1st sign of hip pathology

A

loss of internal rotation

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29
Q

what is trochanteric bursitis

A

abductor gluteus medius tendonitis

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30
Q

trochanteric bursitis presentation

A

pain/tender at greater trochanter & on abduction

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31
Q

presentation of ddh in newborn

A

asymmetric skin crease, feel for click

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32
Q

what is seen on examination in hip fractures

A

shortened externally rotated leg. can’t SLR

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33
Q

classification of hip fractures

A

intracapsular, extracapsular

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34
Q

complications of intracapsular hip fractures

A

avn, non-union

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35
Q

investigations for hip fractures

A

x-ray showing break in shenton’s line

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36
Q

management of intracapsular hip fracture in inactive old people

A

THR or hemiarthroplasty

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37
Q

management of intracapsular hip fracture in young people or active old people

A

internal fixation

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38
Q

management of extracapsular hip fractures

A

ORIF dynamic hip screw

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39
Q

infection rate in hip surgeries

A

5%

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40
Q

what are the risks in femoral shaft fractures and what is done to prevent them

A

blood loss, fat embolus, ARDS. thomas splint

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41
Q

management of unstable femoral shaft fracture

A

IM nail

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42
Q

complications of tibial plateau fracture

A

compartment synd, neurovascular injury

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43
Q

risk factor for tibial plateau fracture

A

op

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44
Q

management of tibial plateau fracture

A

orif or ex-fix

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45
Q

describe tibial plateau fracture on x-ray

A

intra-articular, 80% lateral condyle

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46
Q

complication of tibial shaft fracture

A

compartment s.

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47
Q

what is a maisonneuve fracture

A

proximal tibial fracture + interosseous membrane rupture

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48
Q

what is the slowest healing bone

A

tibia

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49
Q

what is a pilon fracture

A

intraarticular distal tibia# +-fibula / ankle#

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50
Q

pilon fracture mx

A

debride + ex-fix, soft tissue settles ORIF

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51
Q

which meniscus is more commonly torn and why

A

medial since its less mobile

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52
Q

menisci function

A

absorb shock, distribute load from convex femoral condyles to flat tibial articular surfaces

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53
Q

function of mcl

A

resists valgus

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54
Q

function of lcl

A

resists varus & external tibial rotation

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55
Q

function of acl

A

resists anterior tibial subluxation & internal tibial rotation in extension

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56
Q

function of pcl

A

resists posterior subluxation of the tibia & knee hyperextension

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57
Q

components of the posterolateral corner

A

PCL, LC, popliteus & smaller ligaments

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58
Q

function of posterolaternal corner

A

resist tibial external rotation on flexion

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59
Q

what types of cartilage are in the knee

A

hyaline and fibrocartilage

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60
Q

consequence of failed extensor mechanism

A

can’t extend knee or SLR

61
Q

knee deformity caused by rickets

A

genu varum or genu valgum

62
Q

knee deformity caused by skeletal dysplasia

A

genu varum

63
Q

complication of genu varum

A

medial oa

64
Q

complication of genu valgum

A

lateral oa

65
Q

when to refer genu valgum

A

asymmetric, pain, >16°/>8cm age 11

66
Q

management of genu varum in an adult

A

osteotomy

67
Q

what is severe genu varum

A

> 16°

68
Q

what is abnormal genu varum

A

> 6°

69
Q

what is normal knee alignment

A

6° valgum

70
Q

what is housemaid’s knee

A

prepatellar bursitis

71
Q

what is jumper’s knee

A

Patellar tendonitis

72
Q

jumper’s knee mx

A

self limiting

73
Q

condition associated with baker’s cysts

A

oa

74
Q

pathology of baker’s cysts

A

popliteal synovial fluid outpouching

75
Q

baker’s cyst mx

A

self-limiting

76
Q

what is osgood schlatter

A

lump at tibial tuberosity

77
Q

presentation of osgood-schlatter’s disease

A

unilateral pain/tenderness worse after exercise in teenager

78
Q

what scan to refer for if suspected meniscus problem

A

mri

79
Q

presentation of patello-femoral dysfunction

A

tender knee, worse downhill, teenage girl, clicks

80
Q

imaging to view quadriceps and patellar tendon

A

us

81
Q

imaging to view cruciate ligaments

A

mri

82
Q

causes of knee haemarthrosis

A

ACL ruptur, tibial plateau #, patellar dislocation

83
Q

how quickly do knee haemarthrosis and effusions present

A

haemarthrosis 1 hour

effusion 1 day

84
Q

difference in pain between haemarthrosis and effusion

A

haemarthrosis all over knee, effusion localised to joint line

85
Q

causes of knee effusions

A

meniscal/chondral injury

86
Q

risk factors for patella dislocation

A

adolescent valgus female

87
Q

which way does the knee dislocate

A

laterally

88
Q

management of patellar dislocation

A

3wk splint

89
Q

management of recurred patellar dislocaion

A

osteotomy or soft tissue reconstruction

90
Q

complication of knee dislocation

A

50% popliteal artery injury, also common fibular nerve injury

91
Q

which age are affected by patellar and quadriceps tendon rupture

A

patellar <40 yr

quad >40 yr

92
Q

knee injury caused by valgus

A

mcl

93
Q

mcl injury mx

A

heals itself

94
Q

lcl injury mx

A

repair/reconstruct

95
Q

complications of lcl injury

A

peroneal nerve palsy

96
Q

presentation of acl rupture

A

pop, haemarthrosis, +ve Lachman test, 50% + mensicular tear

97
Q

management of acl rupture

A

1/3 reconstruction; patellar tendon / semitendinosus / hamstring / allograft / Achilles / synthetic

98
Q

injury mechanism of acl rupture

A

internal rotation

99
Q

mechanism of pcl rupture

A

hyperextension/direct blow

100
Q

examination test postive in pcl rupture

A

posterior drawar test

101
Q

examination test positive in meniscal tear

A

steinman

102
Q

management of a meniscal tear in a young patient

A

arthroscopic repair

103
Q

management of a meniscal tear repair catching/locking in a young patient

A

arthroscopic menisectomy

104
Q

what surgery can be done for patients over 40 and when is it indicated for meniscal tears

A

if unstable or pain for >3mth do arthroscopic menisectomy

105
Q

cause of an acute locked knee

A

bucket handle meniscus tear

106
Q

how to diagnose bucket handle meniscus tear

A

mri

107
Q

what is a complication of bucket handle meniscus tears

A

ffd fixed flexion deformity

108
Q

management of a meniscal tear in patients over 40yrs

A

ccs injection

109
Q

classification of pes planus

A

flexible or fixed

110
Q

age and gender affected by tibialised posterior dysfunction

A

40-50 female

111
Q

presentation of tibialis posterior dysfunction

A

adult acquired flat foot, progressive midfoot/ankle pain,

112
Q

management of tibialis posterior dysfunction

A

no CCS, synovectomy

113
Q

intoeing pathology

A

femoral neck anteversion, internal tibial torsion, metatarsus adductus

114
Q

club foot aka

A

Talipes equinovarus

115
Q

club foot mx

A

Ponseti splint +- tenotomy

116
Q

condition associated with club foot

A

ddh

117
Q

bunion aka

A

Hallux valgus

118
Q

risk factors for hallux valgus

A

> age, female, high heel, RA

119
Q

toe affected by hallux valguss

A

big toe or pinky

120
Q

management of hallux valgus

A

conservative -> osteotomy

121
Q

what is hallux rigidus

A

1st MTPJ OA

122
Q

management of hallux rigidus

A

change shoe, wait 2 yr -> cheilectomy/arthrodesis

123
Q

high arched feet aka

A

pes cavus

124
Q

what is hallux valgus

A

1st metatarsal medial deviation lateral toe deviation

125
Q

age and gender affected by morton’s neuroma

A

female 45-55

126
Q

pathology of morton’s neuroma

A

digital nerve fibrosis -> neuroma

127
Q

presentation of morton’s neuroma

A

forefoot burn/tingles, Mulder’s click test

128
Q

diagnosis of morton’s neuoma

A

us

129
Q

management of morton’s neuroma

A

insole, nerve injection, surgical excision

130
Q

plantar fasciitis prsentation

A

pain on exercise, swell/tender

131
Q

plantar fasciitis mx

A

NSAID, splint, rest, CCS injection, 50% success surgery

132
Q

achilles tendinopathy pathology

A

repetitive microtrauama collagen repair failure

133
Q

achilles tendinopathy presentation

A

morning stiff, pain better w/ walking

134
Q

achilles tendinopathy dx

A

clinical diagnosis or US

135
Q

achilles tendinopathy mx

A

splint, activity, analgesia, NSAID, PT

136
Q

tendo-achilles rupture presentation and which examination test is positive

A

can’t bear weight, weak plantarflexion, Simmond’s test

137
Q

tendo-achilles rupture mx

A

no CCS, cast or surgery

138
Q

does an ankle fracture or sprain take longer to heal

A

sprain

139
Q

when to xr a suspected ankle sprain

A

bony tenderness or can’t bear weight

140
Q

what is an unstable ankle fracture

A

bimalleolar, >1cm talar shift XR

141
Q

management of stable ankle fracture

A

6wk boot

142
Q

management unstable ankle fracture

A

orif

143
Q

what is a lisfranc injury

A

2nd TMTJ avulsion # / subluxation

144
Q

lisfranc injury mx

A

orif

145
Q

lisfranc injury dx

A

AP & oblique XR + CT

146
Q

what is claw toe

A

MTPJ hyperextension, PIPJ/DIPJ hyperflexion

147
Q

what is mallet toe

A

MTPJ hyperextension, PIPJ hyperflexion, DIPJ hyperextension

148
Q

what foot fracture isn’t seen on xr (seen on mri)

A

talar dome fracture

Y2 MSK (20 decks)

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