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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
What is the presentation of Achilles Tendinopathy?
Aching pain in the heel and aggravated by activity
26
Which assessment tool is used to assess for Achilles tendinopathy?
Victorian Institute of Sports Assessment–Achilles Questionnaire
27
What forms the proximal row of carpal bones ('She Looks Too Pretty')
Scaphoid Lunate Triquetrum Pisiform
28
What forms the distal row of carpal bones (Try to Catch Her)?
Trapezium Trapezoid Capitate Hamate
29
What is the highly sensitive examination finding for a scaphoid fracture?
Anatomical snuff box tenderness
30
What is the commonest form of injury for a scaphoid fracture?
Fall on an outstretched hand
31
Which artery supplies the scaphoid bone?
Retrograde radial supply by the carpal branch of the radial artery
32
What is the most concerning complication associated with a scaphoid fractuer?
Avascular necrosis
33
Which test is used to identify a scaphoid fracture?
Scaphoid compression test: - Positive test when pain reproduced with axial load applied through thumb metacarpal.
34
What is the first line imaging for a scaphoid fracture?
MRI
35
What is the first line management for a scaphoid fracture?
Cast immobilisation for stable fractures and refer to orthopaedics (cast for 6-8 weeks)
36
How is an unstable scaphoid fracture managed?
Percutaneous screw fixation
37
how is a Colle's fracture managed?
Closed reduction with regional analgesia (plaster cast with 3-point moulding)
38
Which type of radial fracture is unstable?
Smith's fracture
39
What is the mainstay management for a Smith's fracture?
Open reduction and plate fixation within 1 week
40
Golfer's elbow is termed what?
Medial Epicondylitis
41
Medial Epicondylitis is worse on what movement?
Forearm pronation
42
Management for Medial Epicondylitis ?
Rest, ice and activity modification + passive stretching
43
Which tendon is affected in lateral epicondylitis?
Common extensor tendon
44
What is lateral epicondylitis eponymously termed as?
Tennis elbow
45
Which anatomical structure reduces friction on movement between the skin, tendons and ligaments and bone within the olecranon process?
Olecranon bursa
46
What are the most common causes of non-septic olecranon bursitis?
Overuse, repeated trauma e.g., sports or systemic conditions e.g., RA, SLE, scleroderma
47
What is the most common causative organism for infective bursitis?
Staphylococcus aureus, streptococci
48
What is the clinical presentation of olecranon bursitis?
* 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
What is the first line investigation for olecranon bursitis?
Aspirate bursal fluid (+ gram staining and crystal examination)
50
What is the management for non-infective olecranon bursitis?
Rest, ice and reduced activity + compressive bandaging and NSAIDs
51
What is the management for septic olecranon bursitis?
* Aspiration bursal fluid + empirical antibiotic cover (7 days) - Flucloxacillin 500 mg QDS – prescribe 1000 mg for patients >70 kg. - Alternative: Clarithromycin or erythromycin.
52
The sciatic nerve provides sensory innervation to what?
Lateral side of the leg, foot and 5th toe
53
The femoral nerve (L2-L4), provides sensory innervation to what?
Medial and anterior aspects of the thigh
54
What are the two main motor functions of the sciatic nerve?
Knee flexion and hip extension
55
What is the main function of the common peroneal nerve?
Foot dorsiflexion, eversion and inversion
56
Which nerve is implicated in a Hill–Sachs deformity post-anterior shoulder dislocation?
Axillary nerve
57
Which sign is associated with anterior shoulder dislocation?
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
What is the simple conservative management for managing an anterior shoulder dislocation?
Simple traction-counter traction
59
What is the characteristic presentation of a meniscal tear?
Locked knee and localised pain to the medial or lateral side
60
What is the most sensitive examination finding for a meniscal tear?
Joint line tenderness
61
What are the two meniscal provocation tests?
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
What is the most sensitivity investigation for investigating a meniscal tear?
MRI
63
What is the surgical management for a meniscal tear?
- Partial meniscectomy - Meniscal repair - Meniscal transplant
64
What classification system is used for an Ankle fracture?
Weber classification for fibula fractures
65
What structure is used to determine Weber A-C for ankle fractures?
syndesmosis
66
Which is the most stable ankle fracture?
Weber A - fibular fracture inferior to the tibiofibular syndesmosis
67
What is the location of a Weber-B ankle fracture?
Fibular fracture at the level of the tibiofibular syndesmosis – requires assessment of the ankle mortise for congruency
68
Which Weber class ankle fracture is least stable?
Weber C (fibular fracture superior to the tibiofibular syndesmosis)
69
What is the most common mechanism of injury for an ankle fracture?
Twisting injury
70
What is the first line investigation for an ankle fracture?
Ankle X-ray
71
What is the management for a Weber A-B stable fracture?
Analgesia, splinting, weight-bearing as tolerated+ VTE prophylaxis (follow up in 6 weeks).
72
What is the management for unstable ankle fractures (Weber C)?
Open reduction internal fixation
73
Which co-morbidity is most associated with frozen shoulder?
Diabetes
74
What movements are restricted in frozen shoulder?
* Restricted active and passive external rotation and pain at the end of external rotation
75
What is the first line investigation for adhesive capsulitis?
Plain radiography – normal
76
What is the management for frozen shoulder?
* Conservative: Physiotherapy and patient education * Medical: Paracetamol or NSAIDs; intra-articular corticosteroid injections. * Surgical: - Manipulation under anaesthesia - Capsular release surgery
77
What is the primary blood supply to the femoral head?
Medial and lateral circumflex arteries
78
In displaced hip fractures, what is the main complication?
Avascular necrosis of the femoral head
79
What is the definition of an intracapsular fracture?
from the edge of the femoral head to the insertion of the capsule of the hip joint.
80
What is an extracapsular fracture?
Trochanteric or subtrochanteric (the lesser trochanter is the dividing line).
81
What classification system is used for hip fractures?
Garden System
82
What is a type 1 Garden fracture?
Stable fracture with impaction in valgus
83
A complete undisplaced fracture is what Garden classification?
Type III
84
What is a type IV Garden fracture?
Complete bony disruption
85
How often should paracetamol be prescribed in hip fractures?
Every 6 hours
86
What is the surgical procedure for displaced intracapsular hip fractures?
Replacement arthroplasty (Total hip replacement or hemiarthroplasty)
87
What are the indications for a total hip replacement is a displaced hip fracture?
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
What is the management for a trochanteric hip fracture?
- Extramedullary implants e.g., sliding hip screw > intramedullary nails (indicated for subtrochanteric fractures).
89
External rotation and shortened leg is indicative of what type of fracture?
Neck of femur fracture
90
What is the first-line imaging modality for suspected femoral fractures?
AP and lateral X-ray of hip
91
Which classification system is used to assess for hip fractures?
Garden classification
92
What is the major risk factor for a neck of femur fracture?
Osteoporosis
93
Which is an immediate post-operative complication associated with hip replacement surgery?
Pulmonary fat embolism
94
Pain elicited on resisted wrist extension during the Cozen's test is suggestive of what?
Lateral epicondylitis
95
Shoulder injury to which nerve results in winging of the scapular?
Long thoracic nerve
96
What femoral complication is associated with long-term use of steroids?
Avascular necrosis of the femoral heads
97
What is the first line conservative management for carpal tunnel syndrome?
Wrist splint
98
Numbness in the ring and little finger secondary to compressive neuropathy is indicative of what diagnosis?
Cubital tunnel syndrome
99
What is the earliest sign associated with a Duputyren's contracture?
Palmar nodule
100
Wrist drop and weakness of finger extensors is suggestive of what type of radiculopathy?
Radial nerve
101
Which nerve innervates the posterolateral distal third of the leg?
Sural nerve

MLA Flashcards (19 decks)

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