Knee + other problems lol

Question 1

A teenage girl complains of anterior knee pain when walking downstairs or getting up after sitting for long periods. What’s the most likely diagnosis?

Answer 1

Chondromalacia patellae

Question 2

What is the typical management of chondromalacia patellae?

Answer 2

Usually responds to physiotherapy

Question 2

What causes Osgood-Schlatter disease?

Answer 2

Overuse in active adolescents, leading to traction apophysitis at the tibial tubercle

= Too much exercise pulls on the top of the shinbone, causing pain — common in sporty kids.

Question 3

A sporty teenager presents with pain, swelling, and tenderness over the tibial tubercle. What condition should you suspect?

Answer 3

Osgood-Schlatter disease

Question 4

A teenager presents with intermittent knee swelling, pain after exercise, and occasional locking. What is the likely diagnosis?

Answer 4

Osteochondritis dissecans

Question 5

A young person reports the knee “giving way” with medial pain. On assessment, there is lateral subluxation of the patella. What’s the likely cause?

Answer 5

Patellar subluxation

Question 6

A teenage boy complains of chronic anterior knee pain that worsens with running. Examination reveals tenderness just below the patella. Diagnosis?

Answer 6

Patellar tendonitis (common in athletic teenage boys)

Question 7

What is osteochondritis dissecans?

Answer 7

It is a condition where an area of the knee joint surface loses blood supply, leading to fragmentation of cartilage and possibly bone

Question 8

What are the common symptoms of osteochondritis dissecans?

Answer 8

1. Knee pain
2. Recurrent knee effusions
3. Swelling after exercise
4. Some patients may be asymptomatic

Question 9

Which age group is most commonly affected by osteochondritis dissecans?

Answer 9

Adolescents

Question 10

What imaging modalities are used to investigate suspected osteochondritis dissecans?

Answer 10

X-ray and MRI

Question 11

What are the potential MRI findings in osteochondritis dissecans that influence treatment?

Answer 11

MRI can show if the fragment is stable or detaching—if detaching, it may be pinned in place

Question 12

What are the management options for osteochondritis dissecans?

Answer 12

1. Often resolves spontaneously
2. Surgical fixation if the fragment is unstable or detached
3. Always requires specialist referral!!!

Question 13

‘Pain after exercise
Intermittent swelling and locking’ This suggest what?

Answer 13

osteochondritis dissecans

Question 14

What is traction apophysitis?

Answer 14

It is a condition where excessive tendon pull damages an unfused apophysis (growth plate) where the tendon inserts

Question 15

What is the most common type of traction apophysitis?

Answer 15

Osgood-Schlatter’s disease – inflammation at the tibial tubercle, where the patellar tendon inserts

Question 16

Which group is most commonly affected by Osgood-Schlatter’s disease?

Answer 16

Adolescent active boys

Question 17

What are the clinical features of Osgood-Schlatter’s disease?

Answer 17

1. Anterior knee pain and swelling
2. A prominent bony lump over the tibial tuberosity

Question 18

What are other common sites of traction apophysitis besides the tibial tubercle?

Answer 18

1. Inferior pole of the patella
2. Calcaneus (Achilles tendon insertion)

Question 19

What is the typical age range for physiological flat feet (pes planus)?

Answer 19

All ages, especially common in young children

Question 20

What is in-toeing and when is it most commonly noticed?

Answer 20

In-toeing is a condition where the feet turn inward. It’s typically noticed during the first year of life

Question 20

Is orthotic treatment recommended for flexible flat feet in children?

Answer 20

No, orthotics are not recommended for typical flexible flat feet. Parental reassurance is appropriate.

Question 21

What are the three main causes of in-toeing?

Answer 21

1. Metatarsus adductus
   = forefoot curved inward
2. Internal tibial torsion
   = twist in the tibia
3. Femoral anteversion
   = twist in the femur

Question 22

What is metatarsus adductus, and how is it assessed?

Answer 22

A medial deviation of the forefoot with an abnormal heel bisector line. 90% of cases resolve spontaneously

Question 23

What does the “W” sign suggest in a child who sits down?

Answer 23

Femoral anteversion – a common cause of in-toeing

Question 24

What is out-toeing and when does it commonly appear?

Answer 24

A condition where the feet point outward, often noticed in infancy, usually resolving by age 2

Question 25

What causes out-toeing in infants?

Answer 25

Typically external tibial torsion

Question 26

What is genu varum and at what age is it considered normal?

Answer 26

Bow legs – normal in 1st–2nd year of life, typically resolves by age 4–5

Question 27

What is genu valgum and at what age is it considered normal?

Answer 27

Knock knees – normal in 3rd–4th year of life, typically resolves spontaneously

Question 28

A 4-year-old girl attends with her mother, who is concerned about the appearance of her daughter's legs. She describes that when her daughter stands, her knees touch while her ankles and feet remain apart. There is no pain, and the child's development is progressing normally. She takes daily multivitamins, which include the recommended doses of vitamin D. On physical examination, the child appears well with a normal gait and no evidence of joint inflammation. Examination reveals slightly flat feet and a symmetrically increased inter-malleolar distance. What is the most appropriate management?

Answer 28

Reassure that knock knees usually resolves by age 7-8 and refer to a community paediatric podiatrist

Question 29

A 13-month-old boy is taken to see his general practitioner by his mother. She reports that he recently started walking, but she has noticed that his legs appear strangely shaped, curving outward at the knees. He is otherwise well in himself and has no medical history of note. Both the pregnancy and delivery were straightforward. On examination, the boy appears well in himself. The legs curve noticeably outward at the knees. The ankles touch and the toes point slightly outward. What is the most appropriate next step?

Answer 29

Bow legs in a child < 3 is a normal variant and usually resolves by the age of 4 years

Question 30

What are the common causes of brachial plexus injury during delivery?

Answer 30

1. Large babies (macrosomia) are often due to diabetes 2. Twin deliveries 3. Shoulder dystocia = difficulty delivering the shoulder after the head, with compression on the pubic symphysis

Question 31

What are the classic clinical features of Erb's palsy?

Answer 31

(1) Shoulder internal rotation and wrist flexion (classic "waiter’s tip" posture) (2) Loss of motor function in the affected muscles

Question 31

What is Erb's palsy and what causes it?

Answer 31

The most common type of obstetric brachial plexus palsy, caused by injury to the C5 + C6 nerve roots = leading to loss of motor innervation in muscles like the 1. deltoid 2. supraspinatus 3. infraspinatus 4. biceps 5. brachialis

Question 32

What is Klumpke's palsy, and what causes it?

Answer 32

Klumpke's palsy is caused by injury to the C8 + T1 nerve roots, often from forceful adduction It results in paralysis of the intrinsic hand muscles and potentially Horner's syndrome

Question 33

: What are the clinical features of Klumpke's palsy?

Answer 33

(1) Paralysis of the intrinsic hand muscles, with flexion of the fingers = due to paralysis of the interossei and lumbricals (2) Possible Horner's syndrome = due to the disruption of the first sympathetic ganglion from T1

Question 34

What is the prognosis for Klumpke's palsy?

Answer 34

The prognosis is poorer than for Erb’s palsy, with less than 50% recovery and no specific treatment

Question 35

What is the prognosis for total brachial plexus injury after birth?

Answer 35

Total brachial plexus injury carries the poorest prognosis among obstetric brachial plexus palsies

Question 36

What is the management for Erb’s palsy?

Answer 36

1. Physiotherapy is required to prevent contractures 2. Prognosis depends on the return of biceps function by 6 months, with a good outcome in 80-90% of cases 3. If no recovery, surgical release of contractures and tendon transfers may be needed.

Question 37

Describe Erb-Duchenne paralysis in short

Answer 37

1. damage to C5,6 roots 2. winged scapula 3. may be caused by a breech presentation

Question 38

Describe Klumpke's paralysis in short

Answer 38

1. Damage to T1 2. Loss of intrinsic hand muscles 3. Due to traction

Question 39

A 24-year-old man presents to his GP with weakness of the left hand. He recalls a few weeks ago, he tried to climb a tree when he was drunk but fell, hitting a few branches on the way down. He describes difficulty moving his left hand since then. On examination, all the fingers of the left hand are flexed into a claw position. There is a loss of sensation along the ulnar aspect of the whole hand and arm. What is the most likely cause of his symptoms?

Answer 39

Klumpke's paralysis: T1 nerve root damage

Question 40

A 6-year-old boy is at the park with his parents and is enjoying himself on the swings. He does not wish to leave so his parents pull him by his hand and this causes him to fall and be pulled along the floor a short distance. Later on he complains of pain in his shoulder and struggles to hold cutlery to eat dinner. He cannot adduct his thumb or abduct his fingers and the medial aspect of his elbow feels numb. Which of the following nerve roots is most likely to be affected?

Answer 40

T1

Question 41

'Shoulder internal rotation and wrist flexion' suggests what?

Answer 41

erbs palsy