MSK

Question 1

Define Major Trauma

Answer 1

any injury that has the potential to cause prolonged disability or death. injury severity score >15.

Question 2

Define Polytrauma

Answer 2

A syndrome of multiple injuries exceeding a defined severity with sequential systemic reactions that may lead to dysfunction or failure of remote organs and vital systems which have themselves been directly injured.

Question 3

Initial management of major trauma.

Answer 3

Primary Survey - ABCDE approach.

Question 4

What are the main sources of internal bleeding?

Answer 4

Head
Chest
Abdomen
Retroperitoneum
Pelvis
Long Bones 
(+ on the floor)

Question 5

GCS scoring system.

Answer 5

Eyes: 1-4.
Verbal: 1-5.
Motor: 1-6.
Minor brain injury - 13-15.
Moderate - 9-12.
Severe - 3-8.

Question 6

Define shock.

Answer 6

A life-threatening condition of circulatory failure resulting in cellular injury and inadequate tissue function.

Question 7

Define compartment syndrome.

Answer 7

Where an osseo-fascial compartment pressure rises to a level that decreases perfusion.

Question 8

Management of compartment syndrome.

Answer 8

Fasciotomy.

Question 9

Define dislocation.

Answer 9

Displacement of bones at a joint from their normal position, resulting in complete loss of congruity.

Question 10

Define subluxation.

Answer 10

Partial displacement, some congruity maintained.

Question 11

Management of dislocation.

Answer 11

Urgent reduction of joint using appropriate analgesia/sedation/anaesthesia.
Document neurovascular status before and after.

Question 12

Define open fracture.

Answer 12

When the skin overlying a fracture is broken, allowing communication between the fracture and the external environment.

Question 13

Define compound (from within) fracture.

Answer 13

the broken end of the bone breaks through/pierces the skin.

Question 14

Define compound (from without) fracture.

Answer 14

External violence causes laceration or tissue damage, higher likelihood of contamination.

Question 15

Classification of open fractures.

Answer 15

Gustillo-Anderson Classification.
Type 1 <1cm
Type 2 1-10cm
Type 3 >10cm or high energy
A – adequate tissue for coverage.
B – extensive periosteal stripping and requires flap.
C – vascular injury requiring vascular repair.

Question 16

Complications of open fractures.

Answer 16

• Soft tissue infection.
• Osteomyelitis.
• Tetanus.
• Crush syndrome.
• Skin loss.
• Non-union.
• Amputation.

Question 17

Initial Management of open fractures.

Answer 17

• Control bleeding.
• Cover with sterile dressing.
• Splint.
• IV antibiotics.
• Tetanus prophylaxis.
• Assume any open wound over or near a joint extends to the joint until proven otherwise.

Question 18

Definitive management of open fractures.

Answer 18

Stabilise bone to protect soft tissues.

May require multiple surgical procedures if severe soft tissue management.

Question 19

Management of septic arthritis.

Answer 19

Aspiration of joint
IV antibiotics.
Washout of joint.

Question 20

Clinical Features of septic arthritis.

Answer 20

• Rapid onset.
• Joint pain, swelling, warmth and erythema.
• Fever.
• Decreased range of motion.
• Pain with active and passive ROM.

Question 21

Complications of septic arthritis.

Answer 21

• Rapid destruction of joint with delayed treatment (>24 hours).
• Degenerative joint disease.
• Soft tissue injury.
• Osteomyelitis.
• Joint fibrosis.
• Sepsis.
• Death.

Question 22

Clinical features of compartment syndrome.

Answer 22

Pain.
paraesthesia. 
pallor.
pulselessness.
paralysis.
pressure.

Question 23

Define necrotising fasciitis.

Answer 23

A life-threatening bacterial infection of the subcutaneous fascia.

Question 24

Management of necrotising fasciitis.

Answer 24

Urgent surgical debridement.

High dose broad spectrum abx.

Question 25

Define cauda equina syndrome.

Answer 25

A syndrome where a space occupying lesion within the lumbosacral canal puts pressure on the nerves of the cauda equina.

Question 26

Clinical features of cauda equina syndrome.

Answer 26

Bowel/bladder dysfunction.
Saddle anaesthesia.
Lower sensorimotor changes.

Question 27

Investigations into cauda equina syndrome.

Answer 27

Pre and post voiding bladder scan.
MRI scan.
PR exam recording sensation and anal tone.

Question 28

Treatment of cauda equina syndrome.

Answer 28

Urgent spinal decompression within 24 hours.

If due to malignant, may treat with radiotherapy.

Question 29

Complications of missed cauda equina syndrome.

Answer 29

Urinary dysfunction requiring catheterisation.
Sexual dysfunction.
Chronic pain.
Persistent leg weakness/altered sensation.

Question 30

Define intra-articular fracture.

Answer 30

Any fracture which involves a joint.

Question 31

3 principles of fracture management.

Answer 31

Reduce - realign the fragments.
Retain - immobilise the fragments.
Rehabilitate - restore function to the limb.

Question 32

Complications of fractures.

Answer 32

Compartment syndrome.
Infection.
Malunion.
Non-union - atrophic or hypermetrophic.

Question 33

Management of mechanical back pain.

Answer 33

Patient education.
Good early symptomatic control with simple analgesia.
Early return to normal activities and work.
Self referral to physio

Question 34

Diagnosis of nerve root impingement.

Answer 34

MRI indications:

• initially radicular pain >6 weeks with no improvement with conservative treatment.
• neurological deficit.
• bilateral lower limb deficit/peroneal symptoms - urgent referral for assessment of CES

Question 35

Management of nerve root impingement.

Answer 35

Majority non-surgical:
- physio.
- analgesia.
- muscle relaxants.
- alternative therapies (acupuncture). 
Surgery if no improvement.

Question 36

Indications for surgery in nerve root impingement.

Answer 36

Absolute:
- cauda equina syndrome.
- progressive neurological deficit.
Relative:
-intractable radicular pain.
- neurological deficit with no improvement.
- recurrent sciatica with no improvement.

Question 37

Red flags of serious spinal pathology.

Answer 37

Age <18 or >50 at onset of non-mechanical pain.
Bilateral radicular leg pain.
Limb weakness.
Alternation of bladder and/or bowel function.
Perianal numbness.
PMH cancer.
Constitutional symptoms/weight loss.
Trauma.
Thoracic pain.
PMH immunocompromise/prolonged steroid use.

Question 38

Common organisms of discitis and vertebral osteomyelitis.

Answer 38

Staph and strep most common.
Strep and haemophilus in children.
Consider TB.

Question 39

Clinical features of discitis/vertebral osteomyelitis.

Answer 39

Fever.
Generally unwell.
Unrelenting back pain.
Late cases may present with spinal deformity - kyphosis, scoliosis.

Question 40

Management of discitis/vertebral osteomyelitis.

Answer 40

Biopsy with CT guidance.
IV abx (minimum 6 weeks). 
surgery may be required:
- stabilisation.
- drainage of large abscess.

Question 41

Investigation of spinal tumours.

Answer 41

MRI whole spine.
Bone scans.
Serum calcium - hypercalcaemia.

Question 42

Clinical exam findings of spinal injury.

Answer 42

Bony midline tenderness.
Clinical deformity or palpable step.
Boggy swelling or bruising.
Neurological compromise.

Question 43

Features of spinal shock.

Answer 43

Bradycardia.

Hypotension.

Question 44

Complications of shoulder dislocation

Answer 44

Neuro/plexus injuries.
Bankhart/Hill-Sachs lesions.
Recurrent rates higher in younger patients.
Cuff tears in older patients.

Question 45

Classification of acromioclavicular dislocation.

Answer 45

Rockwood types 1-6.
Grade 1-3: conservative (physio)
Grades 4-6: reconstruction or ORIF with hook plate.

Question 46

Classification of proximal humerus fracture.

Answer 46

Neer system.

4 parts based upon displacement and angulation.

Question 47

Classification of radial head fracture.

Answer 47

Mason types 1-4.
1 - conservative management.
2 - conservative unless unable to rotate.
3 and 4 - ORIF, excision or replacement.

Question 48

Monteggia fracture.

Answer 48

Proximal 1/3 ulnar fracture with radial head dislocation/instability.
Types 1-4.

Question 49

Galeazzi fracture.

Answer 49

Distal 1/3 radius shaft fracture and associated DRUJ injury.

Question 50

Colle’s fracture.

Answer 50

• Transverse fracture of the radius.
• 2.5 cm (0.98 inches) proximal to the radio-carpal joint.
• dorsal displacement and dorsal angulation, together with radial tilt.