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Specialities > Ortho 3 > Flashcards

Ortho 3 Flashcards

1
Q

What is the single most important part of the management of a bone tumour?

A

referral to MDT

  • surgeons
  • pathologist
  • radiologist
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2
Q

When should you do a bone biopsy of a suspected tumour?

A

Only when guided by MDT

- otherwise may make it worse

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3
Q

What generalised investigations would you do into bone tumours? and which is gold standard

A 
Full history & examination 
Blood 
Myeloma screen 
X-ray 
\+/- 
CT scan

*most will require a biopsy for definitive diagnosis but this must be done after MDT - require guidance
x-ray is gold standard
- huge amount of info regarding the lesion can be seen

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4
Q

What are the general broad rules regarding lytic and sclerotic lesions of bone?

A

If there is narrow lytic or sclerotic lesion its likely narrow

If there is a large area its likely aggressive

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5
Q

What is meant by the zone of transition on a bony tumour?

A

an area where new bone is forming around the lesion to try and protect it

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6
Q

Name some specific descriptions used to describe periosteal retraction that occurs with bone tumours:

A

Lamellated/ onion ring:
- new layers of bone forming over a tumour growing just to fast to keep up with it

Speculated/ sun-set burst
- where the tumour protrudes and breaks through the Sharpe’s fibres that then ossify in a perpendicular fashion to the bone

Codman’s
- where the Sharpe’s fibres do not even get a chance to ossify and only do so at the edges

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7
Q

What is a solitary tumour of multiple myeloma called?

A

Plasmacytoma

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8
Q

How would you inform a patient to take their bisphosphonate in the morning?

A

30mins before breakfast and sit up straight for 30mins after

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9
Q

What is the most common benign bony tumour? how many become malignant and when should their removal be thought of?

A

Osteochondroma

1% become malignant. removal if cartilaginous cap exceeds >2cm

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10
Q

If a patient has a pacemaker and has symptoms suggestive of cauda equina, what investigation should they have?

A

CT myelogram

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11
Q

What are the compications of cauda equina syndrome?

A

Bowel dysfunction

Bladder dysfunction

Sexual dysfunction

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12
Q

What are the anatomical differences of a surgical neck of humerus and anatomical neck?

A

Surgical is a weaker place under the head, more prone to fracture

Anatomical neck is the old epiphyseal plate. usually stronger and less likely to fracture.

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13
Q

Define a simple and complex elbow dislocation:

A

Simple

  • only a dislocation.
  • usually posterolateral

Complex

  • associated fracture
  • typically in form of terrible triad (dislocation, radial head fracture, coronoid tip fracture)
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14
Q

What is the position of safety when immobilising the hand?

A

30 degrees wrist extension

90 degrees of MCJ flexion

0 degrees PIP, DIP

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15
Q

What is a Bennet’s fracture?

A

Fracture at the base of the 1st which extends into the CMC joint.
- usually with subluxation due to the pull of the abductor pollicis longus

*note a Roland fracture is the same but Comminuted

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16
Q

Where is a boxer’s fracture?

A

Surgical neck of the 4th or 5th

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17
Q

When x-raying a shaft fracture of a metacarpal what x-rays do you get and why?

A

AP
Lateral
oblique

Oblique allows for visualisation of the 4th and 5th base

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18
Q

Name some deformities which can occur from phalanx fractures:

A

Mallet finger

Boutonniere deformity

Swan neck deformity

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19
Q

What is the name of a fracture that can occur on the distal phalanx causing an open fracture and nail damage, typically due to hyperflexion?

A

Seymore fracture

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20
Q

What determines whether a finger tip following injury can be preserved?

A

The amount of bone loss and nail loss

> 50% of nail loss it may be better to shorten nail

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21
Q

What are the key ideas of treatment following finger tip injuries?

A

Preserve as much length as possible

Try to preserve the FDP

Preserving nail bed

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22
Q

Anatomically where on a finger amputation may it be suitable for replantation?

A

Distal to the FDS and proximal to the FDP

  • if the amputation occurs proximal to the FDS then it is unlikely to suitable for replantation
  • typically only replanted if multiple digits involved
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23
Q

Following tendon and nerve injuries what should be checked?

A

Vascular assessment

  • cap refill
  • pulses
  • if vascular compromise but potential for replant hten it is a medical Emergancy

Neurological assessment

Tendon assessment
- make sure on hand to differentiate between FDS and FDP

24
Q

What is the management for a tendon/ nerve injury?

A

LA and irragation
- do not LA until neurological assessment is completed

Tetanus

Antibiotics
- maybe IV

Dressing

Back slab

Refer to ortho for washout if needed

25
Q

In human bites or fist fights why should you always organise an x-ray, and which joint is particularly susceptible to damage?

A

x-rays to check not only for bone damage but also teeth

MCP joints are at high risk of damage and infection

26
Q

What is the most common muscle to be affected by lateral epicondylitis/ tennis elbow?

A

Extensor Carpi Radials Brevis

27
Q

What nerves innervate the flexor digitirum profundus?

A

Medial half - ulnar nerve

Lateral half - Anterior interosseous nerve of the median nerve

28
Q

What two muscles in the forearm does the ulnar nerve innervate?

A

Flexor carpi ulnaris

Medial half of the flexor digitorum profundus

29
Q

Which muscles does the ulnar nerve innvervate in the hand?

A

Hypothenar muscles

Medial 2 lumbricals

Adductor pollicis

interossei muscles

30
Q

What are the interossei muscles?

A

There are two sets of interossei muscles.

Dorsal - which abduct the digits

Plantar - which adduct the digits
also aids in flexion of the digits

31
Q

What tendon can often be injured alongside a distal radius fracture?

A

Extensor Pollicis longus

32
Q

Following a suspected scaphoid fracture - how should the patient be managed following a negative x-ray?

A

Placed into a cast to hold thumb in neutral position.

- re xray in 2 weeks

33
Q

What are the clinical signs of a scaphoid fracture and What type of x-ray should be requested for suspected scaphoid fractures?

A

Anatomical snuff box tenderness
Pain on telescoping of the the thumb
Pain on ulnar deviation
Wrist joint effusion (>4 years old maybe delayed)

Scaphoid views x-ray:

  • PA
  • Lateral
  • Oblique
  • Ziter view (ulnar deviated whilst oblique)
34
Q

Describe the 3 main types of pelvic fractures:

A 
Type A: 
Stable fracture. usually includes: 
- avulsion 
- pubic fracture 
- iliac wing fracture 
Type B: 
Unstable fracture: open book fracture 
- lateral internal rotation forces 
- stable in vertical motion 
- unstable in rotational forces

Type C:
Very unstable fracture. At least 2 points broken.
- unstable in vertical forces
- unstable in rotational forces

Other classification: Young Burges classification:

Lateral compression:
- internal rotational forces

AP compression:

  • external rotational forces
  • if the posterior sacro-iliac ligaments are damaged the pelvis is extremely unstable

Vertical sheer

  • vertically moved.
  • very unstable
35
Q

What is the most common place for the ulnar nerve to become entrapped?

A

Between the two heads of the flexor carpi ulnaris

36
Q

List signs and symptoms of cubital tunnel syndrome and Name two clinical tests to help diagnose cubital tunnel syndrome:

A
  • pain at elbow
  • paraesthesia in little and ring finger
  • weakness in abduction of little finger
  • interossei wasting
  • claw hand

Tinnels test

Froment’s sign - unable to pincer grip
- weak adductor pollicis so the flexor pollicus longus flexes the IPJ instead

Finger grip strength

37
Q

Give some differentials for elbow pain:

A

Medial/ lateral epicondylitis

Bicep tendon rupture

OA

Cubital tunnel syndrome

Medial collateral ligament injury

Olecranon bursitis

38
Q

What conditions pre-dispose to quadriceps tendon rupture?

A 
Diabetes 
RA 
Hyperparathyroidism 
Gout 
Steroid injection around the area
39
Q

List the three main functions of the meniscus:

A

Shock absorber
Load Sharing
Joint stabiliser

40
Q

What are the treatment options for a meniscus tear?

A 
Small <4mm 
Red Zone 
Degenerative 
- physiotherapy 
- NSAIDs 
- Steroids injections

Surgical:

  • Meniscectomy (usually for white zone)
  • Mencius repair (usually red zone)
  • Mencius transplant
41
Q

What is a game keeper’s thumb and what complications can occur?
what is diagnostic?

A

Where there is damage to the ulnar collateral ligament of the MCJ

Stenner lesion may occur where they avulsed ligament gets trapped in the aponeurosis of the adductor pollicis

> 40 degree abduction when the thumb is fully extended.

42
Q

What is the diagnostic test for iliopsoas abscess?

A

CT scan

43
Q

What is the most important blood vessels to the neck of the femur:

A

Medial Femoral Circumflex Artery

44
Q

If a patient presents due to NOF fracture and has been lying on the ground for a few days, what do you need to consider?

A

Dehydration
Ulcers
Rhabdomyolysis

45
Q

What signs may be seen on an x-ray of a patient with osteoporosis?

A

there needs to be >30% bone mass loss to be seen, thus x-ray is unreliable. some signs though may include:

  • wedge fractures
  • kyphosis
46
Q

What biochemical marker may be found in the urine of a patient with osteoporosis?

A

Telopeptides

- collagen degradation products

47
Q

Outwith a DEXA scan name two other investigations that can be done to quantify bone density:

A

Quantitative CT scan

Quantitative US
- usually of the calcaneum

48
Q

Highlight some side effects of bisphosphonates:

A

Peptic ulcers/ GORD

Osteonecrosis of jaw

Sub-trochanteric hip fractures
- more so in young affective people

49
Q

Out with bisphosphonates, name some other therapies used in treating osteoporosis:

A

Calcium and Vitamin D
- doesn’t increase BMD but reduces reabsorption

Selective oestrogen receptors

Teriparatide -PTH

Oestrogen therapy (HRT)

Calcitonin

Increased physical activity

50
Q

What are the phases of Paget’s disease?

A

“LAB”

  1. Lytic lesions - increased size and number of osteoclasts
  2. Active phase
    - osteoblast activity 40x over, creating disorganised woven bone
    - increased blood flow
  3. Burn out stage
    - little to no cellular activity
51
Q

What are the most common areas affected by Paget’s disease:

A

Pelvis
Lumbar spine
Skull
Femur

52
Q

Describe the phalens test and tinels test:

A

Phalens:
- flexing then extending the wrist will elicit symptoms in the median nerve distribution

Tinel’s test:
- taping over the volar aspect of the carpal tunnel elicits symptoms

53
Q

In nerve conduction studies of carpal tunnel, what is being measured?

A

Velocity of conduction

54
Q

What are the complications of carpel tunnel syndrome surgery?

A

Damage to blood vessels/ tendons of hand

Infection

Complex regional pain syndrome

Failure to resolve symptoms

55
Q

What is the most serious bacteria infection to follow from an open fracture?

A

Clostridium perfringes

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