Ortho

Question 1

Cause of true leg length shortening

Answer 1

Fractured NOF 
Hip dislocation 
Growth disturbance of tibia/fibula e.g osteomyelitis or fracture 
Surgery e.g. Total hip replacement 
SUFE 
Perthes

Question 2

Cause of apparent shortening of leg

Answer 2

Scoliosis of the spine

Question 3

Feature of OA in hip

Answer 3

Pain
Stiffnes
Trendelenburg gait or positive trendenlburg test
Decreased range of motion - especially internal rotation
Fixed flexion deformity

Question 4

Definition of osteoarthritis

Answer 4

Degenerative joint disorder in which there is progressive loss of hyaline cartilage and new bone formation at the joint surface and its margin

Question 5

Risk of posterior approach - hip athroplasty

Answer 5

Higher dislocation rates than anterolateral

Injury to sciatic nerve - foot drop

Question 6

Complication of anterolateral approach - hip athroplasty

Answer 6

Injury to superior gluteal nerve - trendenlburg gait

Question 7

Complications of hip athroplasty

Answer 7

Immediate: nerve injury, fracture, cement reaction 
Early: DVT, deep infection, dislocation 
Late: 
- loosening - septic or aseptic 
- leg length discrepancy 
- metalosis 
- need for revision

Question 8

Knee locking differential

Answer 8

Meniscal tear
Crucible ligament injury
Osteochondritis dissecans: adolescents
Loose body

Question 9

Surgical management of ACL repair

Answer 9

Autograft repair - classically using semitendonous and gracillis

Question 10

Aietology of hallux valgus

Answer 10

Familial tendency
Increased enclosed and pointed shoes
Associated with rheumatoid athritis

Question 11

Surgical management of hallux valgus

Answer 11

Bunionectomy
1st metatarsal reallimgement surgery
Excision athroplasty

Question 12

Definition of Charcot joints

Answer 12

Progressive destructive joint athropathy secondary to disturbance of the sensory innervation to the joint. It results in a painless deformed joint resulting from repatitive minor trauma

Question 13

Cause of Charcot joints

Answer 13

Peripheral: DM, peripheral never Injury, leprosy
Central: syringomyelia, tabes dorsalis

Question 14

Definition of a bakers cyst

Answer 14

Posterior herniation of knee joint capsule

Question 15

Cause of winging of the scapula

Answer 15

Long thoracic nerve damage
Upper brachial plexus injury
Muscular dystrophy

Question 16

Froment test

Answer 16

Flexion of thumb at IPJ - weak adductor policis

Indicates ulnar nerve lesion

Question 17

Contents of the carpal tunnel

Answer 17

4 tendon of FDS
4 tendon of FDP
1 tendon of flexor palmaris longus
Median nerve

Question 18

Muscle in hands innervates by median nerve

Answer 18

Lateral two lumbricals
Oppens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

Question 19

Cause of carpal tunnel syndrome

Answer 19

Idiopathic - commonest 
Water: pregnancy, hypothyroidism 
Radial fracture 
Inflammation: RA, gout
Soft tissue swelling: lipomas, acromegaly,Amyloidosis 
Toxic: diabetes melitus, EtOH

Question 20

Cause of a positive trendelenburg test

Answer 20

Abductor wasting secondary to chronic pain
Superior gluteal nerve injury
Structural - developmental dysplasia of the hip

Question 21

Cause of an ulnar palsy

Answer 21

Anatomical compression 
- cubital tunnel syndrome at elbow 
- guyons canal syndrome at wrist 
Trauma 
- supracondylar fracture of the humerus 
- elbow dislocation

Question 22

Ulnar pardox

Answer 22

Proximal lesion lead to paralysis of ulnar half of FDP which leads to less wasting

Question 23

Feature of ulnar nerve palsy

Answer 23

Partial claw hand - little and ring fingers
Weak abduction and adduction of fingers
Weak flexion of DIPJ in little and ring finger
Wasting: hypothenar emminance, dorsal interossei

Question 24

Indication for surgical management of lumbar disc herniation

Answer 24

Progressive neurological defecit
Severe incapacitating pain
Failing of non surgical management

Question 25

Risk factors for OA

Answer 25

Age Obesity Joint abnormality Physical/manual occupation

Question 26

Definition of athrodesis

Answer 26

Artificial induction of joint ossification between two bones by surgery

Question 27

Risk factor for septic athritis

Answer 27

Joint diesease Chronic renal failure Immunosprresion e.g DM prosthetic joints

Question 28

Comlications of septic athritis

Answer 28

Sepsis Osteomyelitis Athritis Ankylosis - fusion

Question 29

Risk factors for osteoporosis

Answer 29

``` SHATTERED Steroids Hyperthyroid, Hyperparathyroidism, HIV Alcohol and cigarettes Thin - BMI ```

Question 30

Indication for a DEXA scan

Answer 30

Low trauma fracture Women > 65 with one or more risk factor Before giving long term steroids Parathyroid disorders, myeloma, HIV

Question 31

Intepretation of T scores produced from a DEXA scan

Answer 31

T>1 = normal T: 1-2.5 = osteopenia T:

Question 32

Osteoporotic fractures

Answer 32

Vertebral collapse neck of femur Neck of humerus Colles

Question 33

Definition of a sublaxation

Answer 33

Normal anatomy of the joint is disrupted but there remain some contact between the articualar surfaces of the joint

Question 34

Definition of dislocation

Answer 34

Complete disruption of the joint with no contact between joint surfaces

Question 35

Clincal sign of a fracture

Answer 35

``` Pain Swelling Crepitus Deformity Adjacent structural injury: nerves ligaments, vessel, tendon ```

Question 36

Complication of fractures

Answer 36

``` Immediate - neurovascular complications - visceral damage Early - compartment syndrome - infection - fat embolism Late - problems with union - Avascular necrosis - growth disturbances - post traumatic OA - complex regional pain syndrome - myosotis ossificans - reflex sympathetic dystrophy ```

Question 37

Complication of a Colles fracture

Answer 37

``` Median nerve injury Frozen shoulder/adhesive capuslitis Tendon rupture - EPL Carpal tunnel syndrome Mal/non-Union Complex regional pain syndrome ```

Question 38

What is a dinner fork deformity

Answer 38

Dorsally displaced and angulated with shortening of the radius

Question 39

Smiths fracture

Answer 39

Fracture of the distal radius with volar displacement and angulation of the distal fragment

Question 40

Barron's fracture

Answer 40

Oblique intra-articular fracture involving the dorsal aspect of the distal radius and dislocation of the radio-ulnar joint

Question 41

Monteggia fracture

Answer 41

Fracture of the proximal 1/3 of the ulna shaft with anterior dislocation of the radial head of the capiteleum

Question 42

Galleazi fracture

Answer 42

Fracture of radial shaft between mid and distal 1/3

Question 43

Bankart lesions

Answer 43

Damage to anteroinferior glenoid labrum following shoulder dislocation

Question 44

Hill-Sachs lesion

Answer 44

Cortical depression in the posterolateral part of the humeral head following impaction against the glenoid rim during anterior dislocation

Question 45

Complication of shoulder dislocations

Answer 45

``` Recurrent dislocation Axillary nerve damage Brachial plexus injury Axillary artery damage Associated fracture ```

Question 46

Muscles of the rotator cuff and test

Answer 46

1. Supraspinatus - jobes test 2. Infraspinatus - external rotation 3. Subscapularis - gerber lift of test 4. Teres minor - external rotation

Question 47

Impingement syndrome

Answer 47

Entrapment of supraspinatus tendon and subacromial bursa between acromion and greater tuberosity of the humerus

Question 48

Unhappy triad of O'donoghue

Answer 48

ACL MCL Medial meniscus

Question 49

Spinal fractures

Answer 49

1. Anterior wedge # - loss of vetebral body 2. Burst # - axial compression of spine (unstable) 3. Chance # - transverse # across L2/3 4. L2# - unstable 5. Jefferson #

Question 50

Definition of Dupuytrens contracture

Answer 50

Progressive, painless, fibrotic thickening of palmar fascia