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msk formative Flashcards

1
Q

What is a pseudo tumour

A

An inflammatory granuloma produced in response to metal wear particles in the context of a joint replacement which may be locally invasive but cannot metastasise

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2
Q

What is a neurotmesis

A

Complete transaction of a nerve requiring surgical repair for any change of recovery of function

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3
Q

What is axonotmesis

A

Nerve injury sustained due to compression or stretch or from a higher degree of forces, with death of the long nerve cell axons distal to the point of injury die

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4
Q

What is neurapraxia

A

A temporary conduction defect from compression or stretch and will resolve over time with full recovery

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5
Q

What is Wallerian degeneration

A

Long nerve cell axons dying

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6
Q

T/F prognosis is worse as Salter-Harris classification increases

A

T

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7
Q

Vessel at risk in shoulder dislocation

A

Auxiliary artery

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8
Q

Vessel at risk in knee dislocation

A

Popliteal artery

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9
Q

How is chronic osteomyelitis managed ?

A

Antibiotics and surgery

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10
Q

An example of a fracture that has a high rate of non-union due to poor retrograde blood supply

A

Waist of scaphoid fractures

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11
Q

What is CRPS (chronic regional pain syndrome)

A

Needs urgent referral to orthopaedics

It is a heightened chronic pain response after an injury

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12
Q

What is the radiocapitallar joint responsible for ?

A

Supination / pronation along with the proximal and distal radioulnar joints

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13
Q

What muscle powers elbow extension

A

Deltoid via olecranon process

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14
Q

Which muscles are responsible fro elbow flexion

A

Brachialis and biceps

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15
Q

The humero-ulnar joint is is responsible for what action

A

Flexion and extension

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16
Q

What are the 4 muscles that make up the rotator cuff

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

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17
Q

What structure is impinged in hip impingement t

A

Acetabular labrum

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18
Q

What structure is impinged in shoulder impingement

A

Rotator cuff tendon

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19
Q

T/F risk of recurrent shoulder dislocation following a traumatic shoulder dislocations increases with age after first time dislocation

A

F - it decreases

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20
Q

Adhesive capsulitis affects which movement

A

External rotation

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21
Q

What makes up a + Froment’s test

A

1st dorsal interosseous and adductor pollicis weakness = + Froments

(Innervated by ulnar nerve)

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22
Q

What are the conditions that increase likelihood of developing Carpal tunnel

A

RA
Pregnancy
Diabetes
CKD
Hypothyroidism
Colles fracture

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23
Q

Which sex more likely Carpal tunnel

A

8:1 W

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24
Q

What degree of fixed flexion deformity is required at MCPJs for a patient to fail the Hurston Table Top test

A

> 30 degrees

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25
Q

Is the periosteum in kids much thicker than adults ?

A

YES - proportionally so

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26
Q

What percentage of women develop brachial plexus injury in childbirth

A

0.2%

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27
Q

What is mallet finger

A

An avulsion of the extensor tendon from its insertion into the terminal phalanx and is caused by forced flexion of the extended DIPJ - often from a ball at sport

Present with a drooped DIPJ of the affected finger and inability to extend

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28
Q

Are thoracic-lumbar wedge type fracture stable ?

A

Yes - they do not need surgical intervention

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29
Q

*lightbulb sign on x-ray

A

Posterior shoulder dislocation

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30
Q

What is needed to clear C-spine in A&E

A

-no pain on gentle active neck movement
-no significant distracting injury
-GCS 15 with no alcohol
-no neurological symptoms in lower or upper limbs
-no midline tenderness

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31
Q

How are intra-capsular fractures often treated

A

With hemiarthroplasty or THR

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32
Q
A
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33
Q

Splintage required for femoral shaft fractures

A

Thomas splint

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34
Q

Example of a tendon which is commonly surgically managed conservatively

A

Long head of biceps

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35
Q

Which tendon ruptures need surgical repair

A

Quadriceps tendon
Patellar tendon

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36
Q

What is a transverse fracture

A

Pure bending force is applied to bone

The cortex on one side fails in compression and the cortex on the other side fails in tension

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37
Q

What is an oblique fracture

A

Bone is exposed to shearing force ie falling

There is risk of shortening and angulation with these fractures - they are inherently unstable

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38
Q

What is a spiral fractire

A

Torsional forces acting on the bone

These ones are the MOST UNSTABLE but can also angulate

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39
Q

What is Wolf’s law

A

Refers to fracture having the potential to remodel over time

They change shape with areas of stress

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40
Q

When does primary bone healing occur

A

Minimal fracture (<1mm) and the bone bridges the gap with the new bone from osteoblasts

Ie hairline fractures and when fractures are fixed with compression screws and plates

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41
Q

What is secondary bone healing

A

Majority of fractures - the gap at the fracture site needs to be filled temporarily

Involves an inflammatory response with recruitment of pluropotential stem cells

42
Q

Imaging modality of choice for suspected DDH

A

Ultrasound

43
Q

What is femoral neck anteversion

A

Mild intoeing and apparent knock knees

However the degree of apparent intoeing is not of a magnitude which would warrant surgical intervention

44
Q

What is internal tibial torsion

A

Mild intoeing
Alignment of the knees seems normal but the tibial tubercle appears internally rotated

45
Q

What is forefoot adduction

A

Can cause apparent intoeing , the rotational and coronal alignment of the hips, knees and ankles appear normal

Surgery indicated after year 7-8 of life - before this should resolve itself

46
Q

What is talipes equinovarus

A

Ankle equinas (plantarflexion) supination of the forefoot and varus alignment of the forefoot

47
Q

Who gets acute osteomyelitis more

A

Kids more than adults

48
Q

Which nerve is particularly at risk of injury in humeral shaft fractures

A

Radial nerve

49
Q

Are flat feet present at birth

A

At birth , all feet are flat and the arch develops as we begin to walk and the muscles of gait develop

In some people the flat foot will persist into adulthood without any functional problem

50
Q

Nail changes of psoriatic arthritis

A

Onycholysis
Pitting

51
Q

A malignant tumour of endothelial cells in the marrow

Most cases occur between 10-20 years, may be associated with fever , raised inflammatory markers and a warm swelling and may be misdiagnosed as osteomyelitis

A

Ewings sarcoma

52
Q

Most common primary bone tumour

A

Osteosarcoma

53
Q

A malignant primary bone tumour that occurs in abnormal bone

Most commonly in adolescents and young adults

A

Fibrosarcome

54
Q

*chalky material discharging from joint

A

Erosive arthritis

(Crystalarthropathy)

55
Q

Which artery is most at risk in a paediatric supracondylar fractire

A

Brachial artery

56
Q

The thickest hyaline cartilage in the body is found on the articular surface of which bone ?

A

Patellar

57
Q

Where is the patellar tendon

A

Attaches patella to tibial tuberosity

58
Q

Do ACL ruptures need surgery all the time

A

No not all will need surgery

59
Q

Define ‘knee locking’

A

Describes the lack of full extension possible in the situation where a meniscus has sustained a bucket handle tear and torn the inner portion of the meniscus has displace into the notch and front of the knee

A spongy block of usually 10-15 degrees to active and passive knee extension due to a displaced bucket handle meniscal tear

60
Q

What will a valgus malalignment of knee in the lateral compartment predispose the patient to

A

Early osteoarthritis

61
Q

What is the Ortolani test

A

Palpable clunk as the examiner abducts the flexed hip

62
Q

What is Barlow test

A

In joint abnormal femoral head to posteriorly dislocated from the acetabulum with a palpable clunk as the examiner pushes the flexed hip posteriorly

63
Q

What is mallet finger

A

Avulsion of the extensor tendon form the distal phalanx resulting in inability to actively extend the DIPJ

64
Q

Name

A

A = greater trochanter
B = lesser trochanter
C = pubic symphysis
D = superior pubic rami
E = lesser tuberosity

65
Q

*hyperextension at PIPJ with flexion at DIPJ
Describes what deformity

A

Swan neck deformity

66
Q

What is the Danis - Weber classification

A

A simple method for classifying fractures of lateral ankle fractures - based on radiographic material

Split into type A, B and C

67
Q

What does a type A Danis Weber describe

A

Fracture of lateral malleolus

Treatment = usually stable and can be managed with plaster cast or orthosis

68
Q

Type B Danis - Weber classification

A

Fracture at level of the tibial plafond

Treatment = implies a degree of damage to the syndesmosis itself - not visible on x-ray

Usually unstable - may need surgery

69
Q

Type C - Danis - Weber

A

Describes fracture proximal to level of tibial plafold with syndesmotic injury

Treatment = ORIF (unstable)

70
Q

What are the Ottawa ankle rules

A

Determine need for radiograph in acute ankle injuries - avoids unnecessary imaging

71
Q

When would an ankle x-ray be required ? (Ottawa)

A

If there is any pain in the malleolar zone and:

(Any one of the following)

  • bone tenderness along the distal 6cm of the posterior edge of tibia or tip of medial malleolus
  • bone tenderness along the distal 6cm of the posterior edge of the fibula or tip of the lateral malleolus
  • an inability to bear weight both immediately and in the emergency department for four steps
72
Q

When would a foot x-ray be required? (Ottawa)

A

There is any pain in the midfoot zone and :

(Any one of the following)

  • bone tenderness at the base of the 5th metatarsal
  • inability to bear weigh both immediately and in the E.D
73
Q

Dislocation to shoulder at humerus can cause damage to which nerve

A

Axillary

74
Q

Fracture at mid-shaft of humerus can cause damage to which nerve

A

Radial

Get a loss of function down the posterior forearm and loss of sensation down arm

75
Q

Distal humerus fracture in young people can cause damage to which vessel

A

Brachial artery

76
Q

Axillary nerve damage can cause shoulder weakness - why ?

A

Innervates the deltoid

77
Q

A medial condyle fracture can damage which nerve

A

Ulnar nerve

78
Q

Galezzi fracture

A

Distal humerus

GRUESOME (g - galezzi r - radial fracture - u - ulnar dislocation)

79
Q

Monteggia fracture

A

Proximal humerus

MURDER (m-monteggia , u - ulnar fractures, r-radial dislocation)

80
Q

*garden spade deformity

A

Smithsa

81
Q

*dinner fork deformity

A

Colles

82
Q

What is the blood supply to the scaphoid

A

Dorsal carpal branch of radial

83
Q

Which scaphoid fractures are managed conservatively

A

Distal scaphoid and the body

*proximal fracture needs surgery as artery is at risk

84
Q

*telescoping thumb

A

Bennett’s

85
Q

What type of fracture would end up in a high energy trauma

A

Comminuted - so much energy bone ‘explodes’ from within

86
Q

Which Garden classification types need internal fixation

A

I and II

87
Q

Treatment for fractures above the inter-trochanteric line

A

Replacement

88
Q

Tx of fractures below the inter-trochanteric line

A

Dynamic hip screw

89
Q

Treatment of subtrochanteric fractures

A

IM nails

90
Q

Damage to neck of femur could lead to what nerve damage ?

A

Superior gluteal nerve - relevant as this nerve —> innervates gluteus medius —> abducts and keeps hip level

91
Q

Mxm of ACL vs PCL

A

ACL = usually surgery
PCL = will heal by itself (conservative)

92
Q

*bucket handle meniscal tear treatment

A

Surgery with arthroscopy

93
Q

What quad muscle flexes the hip ?

A

Rector femoris

94
Q

Main causative organisms for discitis

A

Staph aureus
Gonorrhea

95
Q

*onion-skinning

A

Ewing’s sarcoma

96
Q

What are the 3 main malignant bone tumours

A

Ewings sarcoma
Osteosarcoma
Chondromsarcoma

97
Q

*sunburst appearance on x-ray / Sharpey’s fibres

A

Osteosarcoma

98
Q

*isolated raised ALP (phosphate and calcium are normal) ?

A

Paget’s

99
Q

Why can you get a vitamin D deficiency

A
  1. Poor diet
  2. Lack of sun
  3. Kidney not working
100
Q

What makes something pANCA or cANCA ?

A

Ratio of serum proteinase 3 and myeloperoxidase

Ie. More MPO = pANCA , more PR3 = cANCA

101
Q

GPA vs MPA ?

A

GPA = cANCA
MPA = pANCA

102
Q

*DVT/ clots + nephrotic picture or CKD ?

A

Deficiency of anti-thrombin III

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