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eMRCS questions > Ortho > Flashcards

Ortho Flashcards

1
Q

Mx of snuffbox pain but no obvs fracture

A

Futura splint and review in fracture clinic

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2
Q

Features of neck of femur fracture

A

Non union
External rotation
Shortening

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3
Q

Osteomalacia biochem profil

A

Low Ca
Low P
High ALP

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4
Q

Bennets fracture

A

Intra-articular fracture of the first carpometacarpal joint
Impact on flexed metacarpal, caused by fist fights
X-ray: triangular fragment at ulnar base of metacarpal

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5
Q

Potts fracture

A

Bimalleolar ankle fracture

Forced foot eversion

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6
Q

Barton fracture

A

This is an intra-articular fracture of the distal radius with associated dislocation of the radio-carpal joint.

A Barton fracture can be described as volar (more common) or dorsal (less common

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7
Q

Extracapsular mx of NOF

A

Intertrochanteric- DHS

Subtrochanteric- IMN

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8
Q

Intracapsular mx of NOF

A

Young- IF
Non displaced- IF

Mobile older- Full arthro
Not mobile/cog impaired- Hemiarthro

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9
Q

When does out of hours surgery occur for open fractures

A

there is marine/ sewage contamination, vascular compromise or it is a polytrauma.

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10
Q

Gustillo-Anderson classification

A

Used to classify open wound fractures

1 Low energy, clean wound <1cm

2 Greater than 1cm wound with moderate soft tissue damage

3 High energy wound > 10cm with extensive soft tissue damage

3 A (sub group of 3) Adequate soft tissue coverage

3 B (sub group of 3) Inadequate soft tissue coverage- require plastics

3 C (sub group of 3) Associated arterial injury- require vascular

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11
Q

Mx of open fractures

A

Remove obvious contaminants from very contaminated wounds in the ED

Open fractures constitute an emergency and should be debrided and lavaged within 6 hours of injury

Early wound photography should be performed

Consider transfer of complex cases to centres that provide orthoplastic care

All wounds should be managed within 24 hours and high velocity ones within 12 hours, those with vascular compromise should be managed immediately

CT angiography is useful in delineating the extent of concommitant vascular injury

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12
Q

Depostition in pseudo gout

A

Calcium pyrophosphate
weakly-positively birefringent rhomboid shaped crystals

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13
Q

RF for pseudogout

A

hyperparathyroidism
hypothyroidism
haemochromatosis
acromegaly
low magnesium, low phosphate
Wilson’s disease

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14
Q

Features of pseudogout

A

knee, wrist and shoulders most commonly affected
joint aspiration: weakly-positively birefringent rhomboid shaped crystals
x-ray: chondrocalcinosis

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15
Q

Mx of Grade 3c open fracture

A

Vascular shunting
Temporary skeletal fixation
Vascular reconstruction
Wishing 3-4 hours

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16
Q

Anatomical neck of humerus fracture mx

A

Hemiarthroplasty

Anatomical neck fractures which are displaced by >1cm carry a risk of avascular necrosis to the humeral head.

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17
Q

Mx of ankle fractures

A

Weber A- mobilised fully weight bearing in an ankle boot.

B- treating undisplaced ankle fractures in a below knee plaster, non-weight bearing for six weeks is still widely practised, and a safe approach.
If trimalleolar- fixation

C-require operative fixation.

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18
Q

Rotator cuff tear presentation

A

Weakness in active movement

Passive movement fine

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19
Q

Associated injuries with glenohumeral dislocation

A

Bankart lesion - avulsion of the anterior glenoid labrum with an anterior shoulder dislocation (reverse Bankart if poster labrum in posterior dislocation).

Hill Sachs defect - chondral impaction on posteriosuperior humeral head from contact with gleonoid rim. Can be large enough to lock shoulder, requiring open reduction.

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20
Q

Osgood schlauer syndrome

A

Multiple micro fractures at the point of insertion of the tendon into the tibial tuberosity. Most cases settle with physiotherapy and rest.

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21
Q

Avascular necrosis causes

A

P ancreatitis
L upus
A lcohol
S teroids
T rauma
I diopathic, infection
C aisson disease, collagen vascular disease
R adiation, rheumatoid arthritis
A myloid
G aucher disease
S ickle cell disease

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22
Q

Spiral fracture of the mid shaft of the tibia. Attempts to achieve satisfactory position in plaster have failed. Overlying tissues are healthy
Mx?

A

IM nail

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23
Q

Mx of Colles fracture

A

High velocity- surgical reduction

Osteoporotic- reduction and fixation

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24
Q

Osteoporosis tx

A

Calcium, Vit D,
Bisphosphonates

Treatment is indicated following osteoporotic fragility fractures in postmenopausal women who are confirmed to have osteoporosis
Or if DEXA not required

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25
Q

Immediate mx of displaced ankle fracture

A

Reduction and back slab

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26
Q

Which salter Harris look similar on x ray

A

1 and 5

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27
Q

Brown squared syndrome

A

It results in ipsilateral paralysis (pyramidal tract) , and also loss of proprioception and fine discrimination (dorsal columns). Pain and temperature sensation are lost on the contra-lateral side.

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28
Q

Parsonage Turner syndrome

A

Neuropathy post viral infection usually affecting the shoulder

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29
Q

3a vs 3b open fracture management

A

3a-may not requries plastics
3b- plastic involvement

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30
Q

Perthes disease features

A

Idiopathic avascular necrosis of the femoral epiphysis of the femoral head

Male
>2w

Limp; Hip pain
* Decreased Abduction& internal Rotation

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31
Q

AS features

A

Sacro-ilitis is a usually visible in plain films
Up to 20% of those who are HLA B27 positive will develop the condition
Affected articulations develop bony or fibrous changes
Typical spinal features include loss of the lumbar lordosis and progressive kyphosis of the cervico-thoracic spine

Related to UC

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32
Q

Adhesive capabilities sx

A

Frozen shoulder passes through an initial painful stage followed by a period of joint stiffness.

With physiotherapy the problem will usually resolve although it may take up to 2 years to do so.

Associated with prolonged immobilization, previous surgery, thyroid disorders (AI) and diabetes

The loss of ROM usually follows a specific pattern starting with external rotation, followed by abduction, internal rotation, and forward flexion

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33
Q

Avascular necrosis presentation and imaging

A

Pain and stiffness proceed radiological changes
Often despite apparent fracture union.

Plain film- earliest evidence on plain films is the affected area appearing as being more radio-opaque due to hyperaemia and resorption of the neighboring area
Late evidence- radiolucency and subchondral changes

MRI scanning will show changes earlier than plain films.

Non weight bearing may help to facilitate vascular regeneration.
Joint replacement may be necessary- drilling may be an appropriate alternative

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34
Q

Compartment syndrome RF and sx

A

Delayed fracture management
Two main fractures carrying this complication include supracondylar fractures and tibial shaft injuries

Pain, especially on movement (even passive)
Parasthesia early
Absent pulse late

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35
Q

Pes anserinus bursitis sx

A

Athletes
Medial proximal tibia pain
Eacerbated by particular activities such as ascending and descending stairs
McMurray test is negative

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36
Q

Impacted fractures of the surgical neck of humerus mx

A

Collar and cuff for 3 weeks
Then physio

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37
Q

Pt unable to weight bare and pain on internal rotation of hip- x ray normal what next

A

MRI or CT

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38
Q

Chondromalacia patella

A

Teenage girls, following an injury to knee e.g. Dislocation patella

Pain walking down stairs
Pseudolocking
Tenderness, quadriceps wasting

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39
Q

Sx of radial head fracture

A

It is usually caused by a fall on the outstretched hand.

On examination, there is marked local tenderness over the head of the radius, impaired movements at the elbow, and a sharp pain at the lateral side of the elbow at the extremes of rotation (pronation and supination).

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40
Q

Spondylolisthesis symptoms and management

A

May occur as a result of stress fracture or spondylolysis

Traumatic cases may show the classic ‘Scotty Dog’ appearance on plain films

Treatment depends upon the extent of deformity and associated neurological symptoms, minor cases may be actively monitored.

Individuals with radicular symptoms or signs will usually require spinal decompression and stabilisation

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41
Q

Maisonneuve fracture

A

Combination of a fracture of the proximal fibula together with an unstable ankle injury (widening of the ankle mortise on x-ray

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42
Q

Types of spina bifida

A

spina bifida occulta- 10% of the population may have spina bifida occulta- bone doesn’t develop there properly

meningocele- swelling of CSF in a sac that forms where the vertebrae do not form properly

myelomeningocele - ost severe type with associated neurological defects that may persist in spite of anatomical closure of the defect

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43
Q

Holstein Lewis Fracture and what nerve is at risk

A

Fracture of the distal third of the humerus resulting in entrapment of the radial nerve.

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44
Q

fell on chin, reduced mouth opening, jaw not aligned, pre auricular tenderness which part fractured

A

Coronoid

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45
Q

Mx of Gustillo type 3A

A

Debrided and lavage within 6hrs and external fixation
Best to avoid metal workout in open fractures
IV Abx

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46
Q

Mx of gustily types 3B and 3C

A

Debrife lavage, external fixation, IV abx

Free tissue flaps

3C- vacaular repair

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47
Q

Drugs affecting bone healing

A

NSAIDs

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48
Q

Periosteum and bone healing

A

Aids if in tact
Contains osteoblasts

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49
Q

Most common fractures causing compartment syndrome

A

Tibial or supracondylar

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50
Q

What should you measure with fasciotomy

A

CK in blood and myoglobin levels- in urine
Assess risks of renal failure

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51
Q

Organism for osteomyelitis

A

Staph

Salmonella- sickle cell

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52
Q

Developmental dysplasia of hip sx

A

Acetabulum not well developed with head and dislocated easy
Breech delivery
Antalgic gait
Destruction of femoral head and narrow acetabulum

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53
Q

Test for DDH and management

A

Barlow - hip started reduced- test will dislocate- posterior and adduct force

Ortholani- started dislocated- will reduce - anterior and abduct force

USS

Harness
If years later- osteotomy and realignment

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54
Q

Pain in hip for 8w, X ray normal what next

A

MRI

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55
Q

Movements limited by perches

A

Abduction and internal rotation

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56
Q

Gage sign

A

V-shaped lucent defect at the lateral portion of the epiphysis and/or adjacent metaphysis. It is pathognomonic for Perthes disease

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57
Q

X ray of perches disease

A

Flat femoral head
o Sub-chondral crecent shaped radiolucent line
o Calcification lateral to epiphysis
Increased joint space
Gage sign

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58
Q

Staging of Perthes disease

A

Stage 1- clinical and histology only

2- sclerosis with preservation of articular surface

3- loss of integrity of femoral head

4- loss of acetabulum integrity

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59
Q

Mx of Perthes

A
  • To keep the femoral head within the acetabulum: cast, braces
  • If < 6 years: observation and symptomatic Rx
  • 6-8 yrs: Brace or surgical management with moderate results
  • > 8yrs: Surgical containment: (femoral / pelvic )osteotomy
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60
Q

Osgood schlatter Features

A

Micro fracture in tibial tuberosity
Athletics boys
Settles with rest and physio

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61
Q

Greenstick vs buckle fracture

A

Greenstick - unlateral cortisol breech only

Buckle- Incomplete cortical disruption resulting in periosteal haematoma onl

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62
Q

Ricketts features

A

Start at 1 yrs
Small for age, FTT

Bowing of tibia
Large head
Dental hypoplasia
Pectus carinatum

Widening and cupping of epiphysis

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63
Q

Osteomalacia features

A

Bone pain
Fractures
Muscle tenderness
Proximal myopathy

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64
Q

NAI features

A

Delayed presentation
Spiral fractures
Multiple fractures
retinal haemorrhage
torn frenulum
Rib fractures
Metaphyseal fracture- bucket handle
Non parietal skull fracture

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65
Q

Kocher criteria fo septic arthritis

A

WIFE
W >12
Inability to weight bear
Fever
ESR >40

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66
Q

Osteogenesis imperfecta features

A

Type 1 collagen defect
Hypermobile
Blue sclera
Multiple fractures
Extra bone in skull- workman bone

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67
Q

Types of spina bifida

A

Occulta -10% population- brith mark, patch of hair

Meningocele - meninges form sac

Myelomeningocele - spinal cord- neuro defects

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68
Q

PCL rupture features

A

Hyperextension injury
Tibia posterior
Posterior draw test +

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69
Q

Meniscal injury features

A

Delayed onset knee swelling
Rotational injury
Locked knee
Recurrent effusions and pain

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70
Q

Terrible triad

A

Rupture of MCL, ACL and medial meniscus

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71
Q

MCL and LCL injury forces

A

Valgus- MCL
Pain on valgus force

Varus- LCL
Pain on varus force

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72
Q

Patella dislocation features, x ray

A

Direct trauma
Knee in valgus, external rotation and quad contraction

Skyline x ray- sublux- partial

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73
Q

Extracapsular hip fracture mx

A

Intertrochanteric- DHS

Subtrochanteric- IM device

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74
Q

Intracapsular hip fracture mx

A

Undispaced- IF

Displaced- <70- ORIF
>70 - total hip (mobile and not cognitively impaired)

Unmobile- hemi

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75
Q

Gardner classification

A

Hip
1- undiscpalced, incomplete
2- complete but undisplaced
3- partially displaced (one end in contact)
4- completely displaced

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76
Q

Pauwel Hip fracture classification

A

degree of inclination of the fracture line measured from the horizontal on an AP radiograph

1- <30
2-30-50
3- >50
Angel

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77
Q

Weber fracture mx

A

A- mobilised fully weight bearing in an ankle boot.

B- if trimalleolar (affecting post malleolus) require fixation
Uni- ankle boot

C- fixation

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78
Q

Maisonneuvre facture

A

Spiral fracture of proximal third of fibula
Tear of syndemosis
Widening on x ray

requires fixing

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79
Q

Stress fracture

A

2nd metatarsal frequent
Repetitive injury

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80
Q

Freiberg disease

A

Osteonecrosis of the metatarsal heads, prominently the second metatarsal

Patients present with pain and swelling localized to the involved metatarsal head region of the forefoot. They describe the sensation of walking on something hard, such as a stone. Symptom onset is typically gradual, with no specific acute even

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81
Q

Spondylolithesis features

A

Young female athletes
On vertebrae displaced over another
Occurs as a results of a stress fracture of spondylosis

Radical symptoms- neuro- spinal decompression

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82
Q

Ankylosing spondylitis test and allele

A

Schober
2 points 15cm apart- if doesn’t increase by 5cm

HLA B27- associated with UC

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83
Q

Anterior cord injury mechanism and symptoms

A

Flexion injury

Loss of motor and pain/temp below

84
Q

Central cord

A

Hyperextension

Sensory and motor deficit

Upper>lower-since cervical motor are located more medially than others

85
Q

Crystals in gout and pseudo gout

A

Calcium- pseduogout
Rhomboid- positive birefringent- blue when parallel

Monosodium urate- gout
Needele- negative- yellow when parallel

86
Q

RF for psuedogout

A

Hyperparathyroid
Hyperthyroid
Haemachromatosis
Acromegaly
Wilsons
Low Mg or Phosp

87
Q

X ray of pseudo gout

A

Chondrocalcinosis

88
Q

Gout vs pseudogout

A

Gout
>40
Small joints
Severe pain
Urate acid- yellow when parallel to polirizer

Pseudo
large joint
Elderly
Calcium
Chondrocalicnosis

89
Q

Osteoporosis tx

A

Treatment is indicated following osteoporotic fragility fractures in postmenopausal women who are confirmed to have osteoporosis (a T-score of - 2.5 SD or below).

In women aged 75 years or older, a DEXA scan may not be required if the responsible clinician considers it to be clinically inappropriate or unfeasible

Vitamin D and calcium supplementation should be offered to all women unless the clinician is confident they have adequate calcium intake and are vitamin D replete

Alendronate is first-line
Around 25% of patients cannot tolerate alendronate, usually due to upper gastrointestinal problems. These patients should be offered risedronate or etidronate

SERM and stratum increase thromboembolic events

90
Q

Osteopetrosis features

A

AR adults

Anaemia, thrombocytopaenia, leucocytopaenia -infections

Decreased marrow space

X ray- lack of differentiation between medulla and cortex
Marble bone

91
Q

Osteocondroma features

A

Metaphysis

Cartilage

Mushroom appearance on X ray

Usually asymtpomatic

92
Q

Tibial plateu fracture types

A

Type 1- split

2- split decompression- untreated valves may form

3- central depression

4- split, medial plateau

5- bicondylar

6- dissociation of metaphysic and diaphysis

93
Q

Disclocation of hip presentation

A

Posterior- adducted, IR

Anterior- abducted, ER

94
Q

Tx of Pagets

A

Indications for treatment include bone pain, skull or long bone deformity, fracture, periarticular Paget’s
bisphosphonate (either oral risedronate or IV zoledronate)

95
Q

Common cancers that cause bone mets

A

Breast
Lung
Prostate
Thyroid
Renal

96
Q

Bone mets biochem

A

All raised
PTH normal or low

97
Q

Syringomyelia features

A

Cystic cavity in spinal cord
Arnold chiari malformation

Acquired- prev meningitis or surgery

Spinothalamic- loss of pain and temp in UL

98
Q

Subacromial impingement presentation

A

Insidious onset
Exacerbated by overhead activities

Night pain- poor indicator

Painful arc- 60-120

99
Q

Tests for subacromial impingement

A

Neer impingement sign - flexion >90 causes pain

Neer impingement test- subacromial injection relieves pain with forward flexion

Hawkin - internal rotation and passive forward flexion causes pain

Jobe- resisted pronation and forward flexion to 90 causes pain

Arc

100
Q

X ray of subacromial impingement

A

Proximal migration of humerus- tear arthropathy

Calcification

101
Q

Tx of subacromial impingement

A

Physio, NSAIDs
Injections

Ops- after failure of 4-6m
SA decompression or acromioplasty

102
Q

Classification of rotator cuff tears

A

Anatomical
SIT- associated with subacromial impingement - often degenerative tear

Subscapularis- subcoracoid impingement

Tear size
Small 0-1
Medium- 1-3
Large- 3-5
Massive- >5cm- involves 2 or more tendons

103
Q

Examination findings of rotator cuff

A

Supraspinatus- drop arm, pain with Jobe

Infra- ER weakness at 0 abduction p external rotational lag

Teres- ER weakness at 90 abduction - Hornblower

Subscapularis- IR weakness at 0 abduction- Geber lift off, internal lag

104
Q

Ix for rotator cuff tear

A

X ray
MRI- diagnostic

105
Q

Rotator cuff tear treatment

A

Non op- physio NSAIDs, injection
Avoid overhead activities

Op- decompression, debridement
Repair- arthroscopic

106
Q

Frozen shoulder hx

A

Start of with pain
Then freezing
Then resolve

ER first effected

107
Q

Radial nerve damage location presentation

A

Axilla- loss of elbow extension and reflex and wrist extensnon

Spiral- preservation of elbow extension and reflex

108
Q

Humeral fractures- type and damage to which structures

A

Surgical neck- axillary and circumflex arteries

Spiral groove- radial and profunda brachii

Posterior medial epicondyle- ulnar

109
Q

Proximal humerus fracture mx

A

Collar and cuff or broad arm sling for 4-5w

Mobilise at 3w

110
Q

Mx of diphyseal humeral fracture

A

Undiscpalced or minmal- collar and cuff

Displaced <30 or shortening <2cm- collar and cuff

Displaced >30 or shortening >2cm or neurovascular or compound- reg - potential surgical

111
Q

Tennis vs golfer elbow

A

Tennis- lateral epicondyle

Golf- medial epicondyle

112
Q

Frommet test

A

Weakness of adductor pollicis

Use flexor policies

Sign od ulnar weakness

113
Q

Cause of cubital tunnel syndrome

A

Post supracondylar fracture
Valgus or varus
Tumour

114
Q

Colles fracture features

A
  1. Transverse fracture of the radius
  2. 1 inch (2.5 cm) proximal to the radio-carpal joint 3. Dorsal displacement and angulation
115
Q

Mx of Colles fracture

A

Reduction under block or GA
Plaster

may need surgery down the line

116
Q

Barton fracture

A

Distal radius fracture
That is intra-articular

Radiocarpal disclocation
* Fall onto extended and pronated wrist

117
Q

What is a proximal scaphoid fracutre at risk of

A

Atrophic Non union
AVN

118
Q

RF for non union

A

Age
Smoking
DM
NSAIDs, steroids

Open fracture
Extensive soft tissue injury
Infection
Neurovascular injury
Pathalogical fracture

119
Q

Radial nerve damage at level of humerus vs wrist

A

Humerus- Wrist drop
Inability to sense over snuff box

Wrist- finger extension

120
Q

Ulnar nerve palsy at wrist presentation

A

Adductor polices
Abduction and adduction of fingers
Positive Formment sign
Hypothenar wasting

121
Q

Carpal tunnel borders

A

Scaphoid tubercle and trapezium radially

Hook of hamate and pisiform ulnarly

Transverse carpal ligament roof

Proximal carpal row dorsally

122
Q

Carpal tunnel mx

A

Non op
Steroids -80% improvement

Op- decompression

123
Q

De Quervain tenosynoviitis

A

Sheath inflammation of 1st extensor compartment
EPB, APL

Age 30-50

Pain and tenderness

Finkelstein test
Fist over thumb- deviate in ulnar direction

124
Q

Tx of de Quevain tenosynovitis

A

Non surgical
Steroids

Surgical release of first dorsal wrist compartment

125
Q

Trigger finger features and mx

A

Fibrotic thickening of tendon sheath- stenosis
Flexor tendon gets caught- A1 pulley

Use other hand to open
Feel pop

Flexor tenosynovectomy

126
Q

Dupuyntens contracture

A

Progressive nodules in palm that forms cord- my-fibroblast- contract
Changes of collagen from 1 to 3

Fixed flexion
Ring finger

127
Q

Mx of dupuytrens contracture

A

Fasciectomy

128
Q

Extensor tendon injury level

A

1- distal to or at DIP
2- middle phalanx or proximal phalnx of thumb
3- PIPIJ
4- proximal or thumb
5- MCPJ
6- metacarpal - neuromuscular injury
7- wrist joint
8- forearm

129
Q

Boutonnière deformity extensor zone damage

A

Zone 3

130
Q

How extensor injury present

A

Zone 1- inability to extend at DIP - mallet finger
Forced flexion of

Zone 3- Elson
Central slip intact- DIP supple
Distrupted- rigid

Zone 5- extensor lag and flexion loss

131
Q

Extensor tendon anatomy

A

Central slip attaches to medial phalanges proximally

Lateral bands attach to distal phalanges

SO if damage to central slip- Boutonniere- since lateral remain in tact

132
Q

Mx of extensors tendon injuries

A

Splinting
Full time- 6w
DIP- zone 1
PIP- 3
MCP- 5

Surgical- fight bite (knuckle hits tooth) - washout
>50% tendon- repair

133
Q

Mallet finger features

A

Direct blow
Rupture of distal extensor tendon slip
Causing flexion of DIP

134
Q

Findings in hands with OA

A

Bouchards- PIJ
Herberdens nodes- DIJ- skew finger sideways

135
Q

If patient has anatomical snuffbox tenderness no findings on x ray, then comes back 2 weeks later asymptomatic what do you do

A

Discharge with reassurance

136
Q

Features of ganglion

A

Associated with tendon sheath
Fluid filled
Not usually excised unless troublesome

137
Q

Mx of proximal pole scaphoid fracture

A

Surgical fixation

138
Q

Patient has a 75% lytic lesion in femur mx

A

IM nail

139
Q

Femur lytic lesion, hyper vascular, malignancy location

A

Renal- tend to be hyper vascular

140
Q

Mirel Scoring system for bone mets and tx

A

1- upper extremity, blastic, less than 1/3 width, mild pain

2- lower, mixed, 1/3-2.3, mod pain

3- peritronchanteric, lytic, >2/3, aggravate by function

> 9/=- impending fracture- prophylactic fixation
8- borderline consider
7 or less- non operative

141
Q

Most common cause of osteolytic bone in children

A

Neuroblastoma

142
Q

First sign of Perthes on X ray

A

Scleoris of femoral head

143
Q

Indication for tx of Perthes

A

Indication for treatment (aide memoire):Half a dozen, half a head
Those aged greater than 6 years with >50% involvement of the femoral head should almost always be treated.

144
Q

Management of open patella fracture

A

Abx
Debridement
Fracture control with encircle wires and rpaimary closure

145
Q

Klumpkes vs ulnar

A

Klumpkes affects arm sensation too
Causes clawing in the whole hand

146
Q

Compartment syndrome urine

A

Red cells +

As myoglobin

147
Q

What is at greater risk the longer a hip is dislocated

A

Avascular necrosis

148
Q

Lytic lesion in iliac crest with cytokeratin positive cells

A

Bone mets

149
Q

Lytic vs plastic lesion mets

A

Lytics- thyroid, intestinal, renal, lung

Breast- mixed

Blastic- prostate, lymphoma

150
Q

Fellow bone in tact next to fracture causes

A

Delayed healing as causes distraction

151
Q

Osteoid osteoma features

A

Benign tumours
Radiolucent zone surrounded by sclerotic zone

152
Q

Main muscle supporting medial plantar arch

A

TP

153
Q

Muscular and ligament support of medial arch

A

Muscular support: Tibialis anterior and posterior, fibularis longus, flexor digitorum longus, flexor hallucis, and the intrinsic foot muscles

Ligamentous support: Plantar ligaments (in particular the long plantar, short plantar and plantar calcaneonavicular ligaments), medial ligament of the ankle joint.

154
Q

Muscular and ligament support of lateral arch

A

Muscular support: Fibularis longus, flexor digitorum longus, and the intrinsic foot muscles.

Ligamentous support: Plantar ligaments (in particular the long plantar, short plantar and plantar calcaneonavicular ligaments).

155
Q

Giant cell tumour features

A

Epiphyses
Bening
Lytic lesion
20s-30s

156
Q

Nerves in cauda equina

A

L2-S5
All lower motor nerves
Hyporeflexia

157
Q

Ewing sarcoma histology

A

Small blue cells

158
Q

Most common complication of hip replacement

A

Asymptomatic DVT

159
Q

Mx of septic shock and rapid progressing cellulitis

A

Wide excision fo skin and necrotic fasciae

160
Q

Cause of avulsion fracture

A

Muscle contractions

161
Q

Atrophic non union OP fracture management

A

Plating and bone graft

162
Q

Most common benign bone tumour <21 yrs

A

Osteochondroma

163
Q

Ortho condition that trisomy 18 is associated with

A

Congenital talipes equinovarus

164
Q

Pes cavus features

A

High medial longitudinal arch
High stress on hind foot
Clawing of toes as using extensors

165
Q

What nerve is damaged in tarsal tunnel

A

Tibial

166
Q

Mx of pelvic fractures

A

Pelvic binder

167
Q

Where bleeding occurs with AP pelvic fracture

A

Superior gluteal

168
Q

First X ray feature to appear for OP

A

Narrowing of joint space

169
Q

Greatest flexor of elbow

A

Brachialis

170
Q

Loss of bicep- biggest movement loss

A

Supination

171
Q

Minimum time for callus to appear on x ray

A

2-3 weeks

172
Q

Tibial spine fracture test

A

Anterior draw test +
As ACL inserts on spine

173
Q

Koher disease

A

Avascular necrosis of navicular

174
Q

Ix highest diagnostic value of osteomyelitis

A

MRI

175
Q

Imaging for ankle

A

AP
Lateral
Mortise -20degree IR

176
Q

What indicates syndesmotic injury on Ix

A

Decreased tibiofibular overlap
medial joint clear space
lateral talar shift

177
Q

There is suspicion of syndesmosis involvement in the absence of radiographic evidence

A

Stress radiograph

178
Q

How complex ankle fracture and posterior malleolar fracture are best imaged

A

CT

179
Q

Time taken for ankle fractures to heal

A

6W
Return to activities at 3m

180
Q

Scheuermann’s disease presentation and management

A

Epiphysitis of the vertebral joints is the main pathological process

Predominantly affects adolescents

Symptoms include back pain and stiffness
X-ray changes include epiphyseal plate disturbance and anterior wedging

Clinical features include progressive kyphosis (at least 3 vertebrae must be involved)

Minor cases may be managed with physiotherapy and analgesia, more severe cases may require bracing or surgical stabilisation

181
Q

structural and non structural scoliosis

A

Non-structural scoliosis refers to lateral curvatures of the spine caused by reversible changes to posture and function

Structural scoliosis affects > 1 vertebral body and is divisible into idiopathic, congential and neuromuscular in origin. It is not correctable by alterations in posture

182
Q

Mx of severe or progressive scoliosis

A

managed surgically with bilateral rod stabilisation of the spine

183
Q

Spondylosis cause

A

Congenital or acquired deficiency of the pars interarticularis of the neural arch of a particular vertebral body, usually affects L4/ L5

184
Q

Radial fractures needing surgical fixation

A

Dorsal tilt of more than 20 degrees,
comminuted fracture,
injury to the ulnar styloid,
intra articular disruption

185
Q

How distal radial fractures are reduced

A

under either a haematoma or Biers block and immobilisation in a cast

186
Q

Ix for hip fracture

A

AP and cross table lateral

If the fracture extends below the level of the lesser trochanter, or there is any possibility of pathological fracture, full length femur views are essential to plan surgery.

187
Q

When should NOF surgery occur

A

Within 36 hrs >48 hrs increases morbidity and mortality

188
Q

How reverse oblique NOF is treated

A

IM nail

(Pertronchanteric fracture- reverse of intertrochanteric)

189
Q

Which structures do MCL and LCL attach to

A

MCL- medial epicondyle to adductor magnus tendon and medial meniscus

LCL- lateral epicondyle- splits biceps femoris to fibula
Popliteal inbertween it and capsule

190
Q

RF for discloation of patella

A

Genu valgum, tibial torsion and high riding patella are risk factors

191
Q

X ray of osteomalacia vs rickets

A

x-ray: children - cupped, ragged metaphyseal surfaces; adults - translucent bands (Looser’s zones or pseudofractures)

192
Q

Description of anatomical and surgical neck of humerus

A

Anatomical- between head and tuberosities

Surgical- between tuberosities and metaphysis

193
Q

Attachment of Rotator cuffs

A

Supra, infra, TM- greater

Subscapularis - Lesser

194
Q

Mx of humeral fractures

A

ORIF- complex fractures

IM nail- Suitable for extra-articular configuration, predominantly surgical neck +/- GT fractures.

Hemi- Used for un-reconstructable fractures in the older patient who has good glenoid quality.

Total - Unconstructable fractures where high functioning shoulder is required (hemiarthroplasty will cause glenoid erosion)

Reverse- Total shoulder arthroplasty that provides better functional outcome than conventional total shoulder replacement.

195
Q

Mx of scapula fracture

A

The vast majority of scapula fractures are amenable to conservative management, consisting of sling immobilisation for two weeks followed by early rehabilitation.

Floating shoulder (clavicle and scapula) will usually require fixation, and consideration of surgery should also be given to intra-articular and displaced/angulated glenoid fracture

196
Q

Mx of shoulder dislocation

A

Anterior
Hippocratic.
Milch.
Stimson.

Posterior
Gentle lateral traction to adducted arm.

50% missed in A&E

197
Q

Tx of glenohumeral arthritis

A

Hemiarthroplasty can sometimes be considered if glenoid is in excellent condition or if patient has large comorbidity.

Total shoulder replacement is shown to produce superior outcome when compared to hemiarthroplasty in terms of pain relief, function and implant survival.

Anatomical TSR requires an in tact rotator cuff, so often reverse is preferable when the cuff if questionable in integrity.

198
Q

Central cord lesion

A

Flaccid paralysis
Upper >lower limb

199
Q

Dermatomes

A

C2 to C4 The C2 dermatome covers the occiput and the top part of the neck. C3 covers the lower part of the neck to the clavicle. C4 covers the area just below the clavicle.

C5 to T1 Situated in the arms.

C5 covers the lateral arm at and above the elbow.

C6 covers the forearm and the radial (thumb) side of the hand.

C7 is the middle finger,
C8 is the medial aspect of the hand,
and T1 covers the medial side of the forearm.

T2 to T12 The thoracic covers the axillary and chest region. T3 to T12 covers the chest and back to the hip girdle. The nipples are situated in the middle of T4.

T10 is situated at the umbilicus. T12 ends just above the hip girdle.

L1 to L5 The cutaneous dermatome representing the hip girdle and groin area is innervated by L1 spinal cord.

L2 and 3 cover the front part of the thighs.

L4 and L5 cover medial and lateral aspects of the lower leg.
S1 to S5 S1 covers the heel and the middle back of the leg.

S2 covers the back of the thighs.
S3 cover the medial side of the buttocks and S4-5 covers the perineal region.

S5 is of course the lowest dermatome and represents the skin immediately at and adjacent to the anus.

200
Q

Upper limb myotomes

A

Flexor- C5

Wrist extensors- C6

Elbow extensors- C7

Long finger flexor- C8

Finger abductors- T1

201
Q

Lower limb myotomes

A

Hip flex- L1+2

Knee extensors- L3

Ankle dorsiflexors- L4,5

Toe extensors- L5

Ankle plantar- S1

202
Q

Ix for scaphoid fracture

A

Ulnar deviation AP needed for visualization of scaphoid

203
Q

Position of foot in talipes

A

Inversion, adduction relative to hindfoot and plantarflexion

204
Q

Flexor tendon zones

A

Zone 1- end to middle of middle
2- middle to distal palmar crease
3- distal palmar crease to carpal tunnel
4- carpal tunnel
5- beyond

205
Q

Sign in compartment with poorest prognosis

A

Anaesthesia

206
Q
A

eMRCS questions (45 decks)

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