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MLA Flashcards > MLA Orthopaedics > Flashcards

MLA Orthopaedics Flashcards

1
Q

Decreased sensation on the palmar surface involving the thenar eminence, and the index and middle fingers as well as half of the ring finger - which nerve is affected?

A

Media nerve compression (carpal tunnel syndrome)

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2
Q

What is the most likely complication of a scaphoid fracture?

A

Avascular necrosis

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3
Q

When should an amputation be performed when irreversible necrotic changes affect a limb?

A

Within 6 hours

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4
Q

A 24-year-old man presents to the Emergency department with a left forearm deformity after a fall playing sport. Radiological imaging reveals dislocation of the radial head and a proximal fracture of the ulna.

What is the most likely diagnosis?

A

Monteggia fracture

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5
Q

Which fracture is associated with dorsal angulation, involving the distal radius?

A

Colles fracture

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6
Q

Which fracture is associated with snuff box tenderness?

A

Scaphoid fracture

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7
Q

Which fracture is associated with dislocation of the radial head and proximal fracture of the ulna?

A

Monteggia fracture

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8
Q

Which fracture is associated with dislocation of the ulna head, and radial shaft fracture?

A

Galaeazzi fracture

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9
Q

What is the first line management for an angualted supracondylar fracture?

A

Open reduction and internal fixation

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10
Q

Pain on passive leg movement accompanied by paraesthesia, and tightness, is consistent with what diagnosis?

A

compartment syndrome

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11
Q

What is the 1st line management for compartment syndrome?

A

Fasciotomy

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12
Q

What should be reimplanted first during replantation of an amputated finger?

A

Bone

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13
Q

What is the first line management for gout?

A

Colchicine

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14
Q

What is the first line of management for septic olecranon bursitis?

A

Aspiration and antibiotics

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15
Q

Following joint aspiration, what is the first line investigation for septic arthritis?

A

Blood cultures

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16
Q

What is the first line management for clubfoot?

A

Manipulation with serial casting

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17
Q

What is the gold-standard diagnostic investigation for suspected osteomyelitis?

A

MRI

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18
Q

What is the earliest sign of compartment syndrome?

A

Severe pain

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19
Q

Which drug increases the risk of an Achilles Tendon rupture?

A

Quinolones

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20
Q

What examination triad is associated with an Achilles Tendon Rupture?

A

Simmond’s triad
1. Abnormal angle of declination (greater Dorsiflexion of the injured ankle and foot)

  1. Feel for a gap in the tendon
  2. Calf muscle squeeze - injured foot will remain in the neutral position
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21
Q

What is the preferred investigation for an Achilles Tendon Rupture?

A

Ultrasound

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22
Q

What is the management for an Achilles Tendon rupture?

A

Immobilisation using a functional brace and refer to orthopaedics

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23
Q

The Achilles tendon is comprised of fibres from which two muscles?

A

gastrocnemius and soleus

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24
Q

Where does the Achilles tendon insert into?

A

calcaneus

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25
Q

What is the presentation of Achilles Tendinopathy?

A

Aching pain in the heel and aggravated by activity

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26
Q

Which assessment tool is used to assess for Achilles tendinopathy?

A

Victorian Institute of Sports Assessment–Achilles Questionnaire

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27
Q

What forms the proximal row of carpal bones (‘She Looks Too Pretty’)

A

Scaphoid

Lunate

Triquetrum

Pisiform

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28
Q

What forms the distal row of carpal bones (Try to Catch Her)?

A

Trapezium

Trapezoid

Capitate

Hamate

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29
Q

What is the highly sensitive examination finding for a scaphoid fracture?

A

Anatomical snuff box tenderness

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30
Q

What is the commonest form of injury for a scaphoid fracture?

A

Fall on an outstretched hand

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31
Q

Which artery supplies the scaphoid bone?

A

Retrograde radial supply by the carpal branch of the radial artery

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32
Q

What is the most concerning complication associated with a scaphoid fractuer?

A

Avascular necrosis

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33
Q

Which test is used to identify a scaphoid fracture?

A

Scaphoid compression test:
- Positive test when pain reproduced with axial load applied through thumb metacarpal.

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34
Q

What is the first line imaging for a scaphoid fracture?

A

MRI

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35
Q

What is the first line management for a scaphoid fracture?

A

Cast immobilisation for stable fractures and refer to orthopaedics (cast for 6-8 weeks)

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36
Q

How is an unstable scaphoid fracture managed?

A

Percutaneous screw fixation

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37
Q

how is a Colle’s fracture managed?

A

Closed reduction with regional analgesia (plaster cast with 3-point moulding)

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38
Q

Which type of radial fracture is unstable?

A

Smith’s fracture

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39
Q

What is the mainstay management for a Smith’s fracture?

A

Open reduction and plate fixation within 1 week

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40
Q

Golfer’s elbow is termed what?

A

Medial Epicondylitis

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41
Q

Medial Epicondylitis is worse on what movement?

A

Forearm pronation

42
Q

Management for Medial Epicondylitis ?

A

Rest, ice and activity modification + passive stretching

43
Q

Which tendon is affected in lateral epicondylitis?

A

Common extensor tendon

44
Q

What is lateral epicondylitis eponymously termed as?

A

Tennis elbow

45
Q

Which anatomical structure reduces friction on movement between the skin, tendons and ligaments and bone within the olecranon process?

A

Olecranon bursa

46
Q

What are the most common causes of non-septic olecranon bursitis?

A

Overuse, repeated trauma e.g., sports or systemic conditions e.g., RA, SLE, scleroderma

47
Q

What is the most common causative organism for infective bursitis?

A

Staphylococcus aureus, streptococci

48
Q

What is the clinical presentation of olecranon bursitis?

A
  • Swelling over the olecranon process (elbow) – appearing over hours-to-days
  • Tender/warm
  • Fluctuant
  • Movement at the elbow joint is painless except at full flexion when the swollen bursa is compressed.
49
Q

What is the first line investigation for olecranon bursitis?

A

Aspirate bursal fluid (+ gram staining and crystal examination)

50
Q

What is the management for non-infective olecranon bursitis?

A

Rest, ice and reduced activity + compressive bandaging and NSAIDs

51
Q

What is the management for septic olecranon bursitis?

A
  • Aspiration bursal fluid + empirical antibiotic cover (7 days)
  • Flucloxacillin 500 mg QDS – prescribe 1000 mg for patients >70 kg.
  • Alternative: Clarithromycin or erythromycin.
52
Q

The sciatic nerve provides sensory innervation to what?

A

Lateral side of the leg, foot and 5th toe

53
Q

The femoral nerve (L2-L4), provides sensory innervation to what?

A

Medial and anterior aspects of the thigh

54
Q

What are the two main motor functions of the sciatic nerve?

A

Knee flexion and hip extension

55
Q

What is the main function of the common peroneal nerve?

A

Foot dorsiflexion, eversion and inversion

56
Q

Which nerve is implicated in a Hill–Sachs deformity post-anterior shoulder dislocation?

A

Axillary nerve

57
Q

Which sign is associated with anterior shoulder dislocation?

A

Apprehension sign: Patient is supine with arm 90 degrees abducted and 90 degrees externally rotated | Positive – patient will exhibit apprehension and resistance in response to pain.

58
Q

What is the simple conservative management for managing an anterior shoulder dislocation?

A

Simple traction-counter traction

59
Q

What is the characteristic presentation of a meniscal tear?

A

Locked knee and localised pain to the medial or lateral side

60
Q

What is the most sensitive examination finding for a meniscal tear?

A

Joint line tenderness

61
Q

What are the two meniscal provocation tests?

A

o Thessaly test: Standing at 20 degrees of knee flexion on the affected limb, the patient twists the knee external and internal rotation, with the positive test being discomfort or clicking.
o McMurray’s test: Flex the knee and place a hand on the medial side of the knee, externally rotate the leg and bring the knee into extension.

62
Q

What is the most sensitivity investigation for investigating a meniscal tear?

A

MRI

63
Q

What is the surgical management for a meniscal tear?

A
  • Partial meniscectomy
  • Meniscal repair
  • Meniscal transplant
64
Q

What classification system is used for an Ankle fracture?

A

Weber classification for fibula fractures

65
Q

What structure is used to determine Weber A-C for ankle fractures?

A

syndesmosis

66
Q

Which is the most stable ankle fracture?

A

Weber A - fibular fracture inferior to the tibiofibular syndesmosis

67
Q

What is the location of a Weber-B ankle fracture?

A

Fibular fracture at the level of the tibiofibular syndesmosis – requires assessment of the ankle mortise for congruency

68
Q

Which Weber class ankle fracture is least stable?

A

Weber C (fibular fracture superior to the tibiofibular syndesmosis)

69
Q

What is the most common mechanism of injury for an ankle fracture?

A

Twisting injury

70
Q

What is the first line investigation for an ankle fracture?

A

Ankle X-ray

71
Q

What is the management for a Weber A-B stable fracture?

A

Analgesia, splinting, weight-bearing as tolerated+ VTE prophylaxis (follow up in 6 weeks).

72
Q

What is the management for unstable ankle fractures (Weber C)?

A

Open reduction internal fixation

73
Q

Which co-morbidity is most associated with frozen shoulder?

A

Diabetes

74
Q

What movements are restricted in frozen shoulder?

A
  • Restricted active and passive external rotation and pain at the end of external rotation
75
Q

What is the first line investigation for adhesive capsulitis?

A

Plain radiography – normal

76
Q

What is the management for frozen shoulder?

A
  • Conservative: Physiotherapy and patient education
  • Medical: Paracetamol or NSAIDs; intra-articular corticosteroid injections.
  • Surgical:
  • Manipulation under anaesthesia
  • Capsular release surgery
77
Q

What is the primary blood supply to the femoral head?

A

Medial and lateral circumflex arteries

78
Q

In displaced hip fractures, what is the main complication?

A

Avascular necrosis of the femoral head

79
Q

What is the definition of an intracapsular fracture?

A

from the edge of the femoral head to the insertion of the capsule of the hip joint.

80
Q

What is an extracapsular fracture?

A

Trochanteric or subtrochanteric (the lesser trochanter is the dividing line).

81
Q

What classification system is used for hip fractures?

A

Garden System

82
Q

What is a type 1 Garden fracture?

A

Stable fracture with impaction in valgus

83
Q

A complete undisplaced fracture is what Garden classification?

A

Type III

84
Q

What is a type IV Garden fracture?

A

Complete bony disruption

85
Q

How often should paracetamol be prescribed in hip fractures?

A

Every 6 hours

86
Q

What is the surgical procedure for displaced intracapsular hip fractures?

A

Replacement arthroplasty
(Total hip replacement or hemiarthroplasty)

87
Q

What are the indications for a total hip replacement is a displaced hip fracture?

A

o Able to walk independently and do not have a pre-existing condition or comorbidity that makes the procedure unsuitable for them AND >2 years of ADLs.

88
Q

What is the management for a trochanteric hip fracture?

A
  • Extramedullary implants e.g., sliding hip screw > intramedullary nails (indicated for subtrochanteric fractures).
89
Q

External rotation and shortened leg is indicative of what type of fracture?

A

Neck of femur fracture

90
Q

What is the first-line imaging modality for suspected femoral fractures?

A

AP and lateral X-ray of hip

91
Q

Which classification system is used to assess for hip fractures?

A

Garden classification

92
Q

What is the major risk factor for a neck of femur fracture?

A

Osteoporosis

93
Q

Which is an immediate post-operative complication associated with hip replacement surgery?

A

Pulmonary fat embolism

94
Q

Pain elicited on resisted wrist extension during the Cozen’s test is suggestive of what?

A

Lateral epicondylitis

95
Q

Shoulder injury to which nerve results in winging of the scapular?

A

Long thoracic nerve

96
Q

What femoral complication is associated with long-term use of steroids?

A

Avascular necrosis of the femoral heads

97
Q

What is the first line conservative management for carpal tunnel syndrome?

A

Wrist splint

98
Q

Numbness in the ring and little finger secondary to compressive neuropathy is indicative of what diagnosis?

A

Cubital tunnel syndrome

99
Q

What is the earliest sign associated with a Duputyren’s contracture?

A

Palmar nodule

100
Q

Wrist drop and weakness of finger extensors is suggestive of what type of radiculopathy?

A

Radial nerve

101
Q

Which nerve innervates the posterolateral distal third of the leg?

A

Sural nerve

MLA Flashcards (19 decks)

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