Ortho

Question 1

RF for Achilles tendon disorders

Answer 1

Cipro
Hypercholesterolaemia (predispose to tendon xathomata)

Question 2

Gradual onset posterior heel pain, worse following activity, morning stiffness

Answer 2

Achilles tendinitis

Question 3

Pt playing sport, sudden ‘pop’, sudden onset significant ankle/calf pain`

Answer 3

Achilles tendon rupture
Simmonds test - squeeze calf and see if foot moves
Imaging - Uss

Question 4

Asso/ft/Tx for adhesive capsulitis

Answer 4

Asso with DM

Ft - external rottaion> internal, passive + active, lasts 6mo-2yrs

Tx - NSAIDs, physio, Steroids (PO/inj)

Question 5

Ottowa rules for ankle injury/X-ray

Answer 5

Xray req if pain in the malleolar zone:
- Bony tenderness at the lateral or medial malleolar zone
- Inability to walk four weight-bearing steps immediately after injury and in the ED

Question 6

Low ankle sprain grading

Answer 6

> 90% = due to injury to ant talofibula joint (most commonly inversion)

1 (mild) - stretch/mico tear, minimal buising/swelling, no pain on weight bearing
2 (moderate) - partial etar, moderate bruising/swelling, minimal pain on weight bearing
3 (severe) - complete tear, severe bruising/swelling, severe pain on weight bearing

Question 7

Boxer fracture

Answer 7

minimally displaced fracture of the fifth metacarpal

Question 8

pain in thumb, index. middle finger
weakness oif thumb abduction
wasting of thenar eminence
Shaking hand improves sympto

Answer 8

Carpel tunnel (compression of median n.)

Tinel’s sign: tapping causes paraesthesia
Phalen’s sign: flexion of wrist causes symptoms

Tx - 6w corticosteroid inj/ wrist splinting, surgical decompression

Question 9

pain/tingling in 4th and 5th finger, worse when leaning on affected elbow

Answer 9

Cubital tunnel (Ulnar n.)

Question 10

inf. causes and Ix for discitis

Answer 10

Common cause = Staph a.
Ix - MRI, should also have transthoracic echo
Tx 6-8w abx

Question 11

Causes of Dupytrens contracture (5)

Answer 11

Labour, phenytoin, Alcpo liver D, DM, trauma

Question 12

Pain and tenderness in elbow, worse on wrist extension with elbow extended or supination of forearm with elbow extended

Answer 12

Lateral epicondylitis (tennis elbow)

Question 13

Pain and tenderness in elbow, worse on wrist flexion/pronation, numbness/tingling in 4th/5th fingers

Answer 13

Medial epicondylitis (golfers)

Question 14

Pain and tenderness 4-5cm, distal to elbow, worse on wrist extension with elbow extended or pronation of forearm with elbow extended

Answer 14

Radial tunnel syndrome

Question 15

Tx for undisplaced intracapsular frac

Answer 15

Internal fixation
Hemi if unfit

Question 16

Tx for displaced intracapsular frac

Answer 16

THR or hemi

Question 17

Tx for stable intertrochanteric extracapsular fracture

Answer 17

DHS

Question 18

Tx for subtrochantetric fracture

Answer 18

IM device

Question 19

Lateral knee pain in a runner

Answer 19

iliotibial band syndrome

Question 20

Pain in knee, worse on straightening knee
Knee locks or gives way
Tenderness over joint line

Answer 20

Meniscal tear
Commonly from twisting injury

Question 21

Teenager, pain in knee, worse when going down stairs, tenderness + wasting of quads

Answer 21

Chondromalacia Patellae

Question 22

Knee pain after twisting injury in older adult,
Rapid onset knee effusion
+ve draw test

Answer 22

ACL tear

Question 23

Gradual onset back pai, uni/bilat leg pain (acheing) - worse on walking, relieved by sitting down or leaning forward

Answer 23

Spinal stenosis - refer for MRI to confirm

Question 24

Back pain, Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

Answer 24

L3 compression

Question 25

Back pain Sensory loss anterior aspect of knee and medial malleolus Weak knee extension and hip adduction Reduced knee reflex Positive femoral stretch test

Answer 25

L4 compression

Question 26

Back pain, Sensory loss dorsum of foot Weakness in foot and big toe dorsiflexion Reflexes intact Positive sciatic nerve stretch test

Answer 26

L5 compression

Question 27

Back pain Sensory loss posterolateral aspect of leg and lateral aspect of foot Weakness in plantar flexion of foot Reduced ankle reflex Positive sciatic nerve stretch test

Answer 27

S1 nerve compression

Question 28

Motor/Sensory of femoral nerve Mech of inj?

Answer 28

Motor - knee extension, thigh flexion Sensory - Anterior and medial aspect of the thigh and lower leg Inj - stabbing, hip/pelvic fracture

Question 29

Motor/sensory Obturator nerve mech of inj

Answer 29

Motor - Thigh adduction Sensory - Medial thigh Inj - ant hip dislo

Question 30

Motor/sensory Lateral cutaneous nerve of the thigh mech of inj

Answer 30

Motor - nil Sensory - Lateral and posterior surfaces of the thigh Compression -> meralgia paraesthetica

Question 31

Motor/sensory Tibial n

Answer 31

Motor - foot plantarflexion/inversion Sensory - sole of foot

Question 32

Motor / sensory common peroneal n

Answer 32

Motor - foot dorsiflexion/eversion (inj -> foot drop) Sensory - dorsum of foot and lower lateral part of leg

Question 33

Motor / sensory for superior gluteal n

Answer 33

Motor - hip abduction Sensory - nil inj - in posterior hip dislo, IM injection, hip surg, pelvic fracture Inj -> +ve trundellenberg sign

Question 34

Motor / sensory inferior gluteal n

Answer 34

Motor - hip extensions and lat rotation Inj -> cant climb stairs or jump, difficulty rising from sittting Sensory - nil

Question 35

Burning, tingling, numbness on lateral thigh, aggravated by standing and relieved by sitting

Answer 35

Meralgia Paraesthetica (entrapment of lat femoral cutaneous nerve) RFs - obesity, pregnancy, More at 30-40y

Question 36

Red flags for back pain

Answer 36

age < 20 years or > 50 years history of previous malignancy night pain history of trauma systemically unwell

Question 37

Common cause and Tx for osteomyelitis

Answer 37

Staph A Tx = Fluclox for 6w (clinda if penn allergic)

Question 38

Painfull arc of shoulder abduction, worse between 60 and 12 deg

Answer 38

Subacromial impingement

Question 39

Painful arc of shoudler abduction, worse in first 60 daf

Answer 39

rotator cuff tear

Question 40

Tx for scaphoid fractures

Answer 40

undisplaced frac of scaphoid waist - cast for 6-8w Displaced frac of scaphoid waste / proximal scaphoid pole frac - surgical fixation

Question 41

Motor + sensory of musculocutaneous nerve

Answer 41

C5-7 Motor - elbow flexion and supination Sensory - lat part of forearm

Question 42

Motor + Sensory of axillary n

Answer 42

C5-6 Motor - shoulder abduction Sensory - inf region of delt Inj - humeral neck frac -> flattened delt

Question 43

Motor + sensory of Radial n

Answer 43

C5-8 Motor - Extension Sensory - Small area between the dorsal aspect of the 1st and 2nd metacarpals inj - humeral midshaft frac -> wrist drop

Question 44

Motor + sensory Median n

Answer 44

C6,8, T1 Motor - LOAF Sensory - Palmar aspect of lat 3 fingers Inj: - at wrist -> paralysis of thenar muscles, opponens pollicis, carpel tunnel syndro - at elbow -> loss of pronation of forearm and weak wrist flexion

Question 45

Motor + sensory Ulnar n

Answer 45

C 8, T1 Motor - intrinsic muscle of hand (except LOAF), wrist flexion Sensory - medial 1 1/2 fingers inj - medial epicondyle frac - > claw hand

Question 46

Motor + sensory long thoracic n

Answer 46

C5-cC7 Motor = Serratus anterior - inj -> winged scapula

Question 47

Colles frac

Answer 47

Fall onto extended outstretched hands dinner fork type deformity of wrist (Dorsal displacement and angulation)

Question 48

Smiths fracture

Answer 48

Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed Garden spade deformity ( volar angulation of wrist)