Ortho Flashcards
A 34-year-old man reports the sudden onset of back pain after bending over to tie his shoe laces. There is tenderness over the lumbar spine on examination and leaning back worsens the pain. Neurological examination and straight leg raising is normal
A. Peripheral arterial disease B. Prolapsed disc C. Facet joint pain D. Perforated duodenal ulcer E. Leaking abdominal aortic aneurysm F. Pyelonephritis G. Ankylosing spondylitis H. Rheumatoid arthritis I. Crush fracture J. Spinal stenosis
Facet joint pain
A 76-year-old man reports pain is his buttocks when he walks the dog. The pain comes on after around 500 yards and resolves when he stops. He has a past history of chronic obstructive pulmonary disease and ischaemic heart disease. Neurological examination is normal and the foot pulses are difficult to feel in both feet
A. Peripheral arterial disease B. Prolapsed disc C. Facet joint pain D. Perforated duodenal ulcer E. Leaking abdominal aortic aneurysm F. Pyelonephritis G. Ankylosing spondylitis H. Rheumatoid arthritis I. Crush fracture J. Spinal stenosis
Peripheral arterial disease
A 68-year-old man obese man presents with a one day history progressively severe lower back pain. There was no obvious trigger. Abdominal examination is unremarkable. Blood pressure is 90/60 mmHg and his pulse is 120 bpm
A. Peripheral arterial disease B. Prolapsed disc C. Facet joint pain D. Perforated duodenal ulcer E. Leaking abdominal aortic aneurysm F. Pyelonephritis G. Ankylosing spondylitis H. Rheumatoid arthritis I. Crush fracture J. Spinal stenosis
Leaking abdominal aortic aneurysm
A 23-year-old female presents with a painful ankle following an inversion injury whilst playing tennis. Which one of the following findings is least relevant when deciding whether an x-ray is needed?
Swelling immediately after the injury and now
A 38-year-old woman develops lower back pain radiating down her right leg whilst performing DIY. She describes a severe, sharp, stabbing pain which is worse on movement. Clinical examination reveals a positive straight leg raise test on the right side but otherwise the examination is unremarkable. Appropriate analgesia is prescribed. Of the following, what is the most suitable next-step in management?
Arrange physiotherapy
Prolapsed Disc
A 78 year old female is admitted to the surgical receiving unit from the community. She has presented with an oozing surgical wound following total left hip replacement. She is a known poorly controlled insulin dependent diabetic.The scar is non healing and oozing yellow pus. It appears red and inflamed. The registrar requests you place the patient on the emergency theatre list for removal and wash out of the hip prosthesis. You send a full blood count, CRP and swabs to the microbiology lab. The results are phoned through later that day and the microbiologist describes clusters of gram positive cocci visible from microscopy. What is the most likely organism?
Staphylococcus aureus
A 14-year-old presents with left knee pain for the past 4 weeks. There is no history of trauma. The pain is felt in the anterior aspect of the joint and is worse when walking up and down stairs. Examination is unremarkable. What is the most likely diagnosis?
Chondromalacia patellae
A 65-year-old man presents with bilateral leg pain that is brought on by walking. His past medical history includes peptic ulcer disease and osteoarthritis. He can typically walk for around 5 minutes before it develops. The pain subsides when he sits down. He has also noticed that leaning forwards or crouching improves the pain. Musculoskeletal and vascular examination of his lower limbs is unremarkable. What is the most likely diagnosis?
Spinal stenosis
A 35-year-old man attends your surgery two days after being struck on the lateral aspect of his right knee by the bumper of a car travelling at low speed. He is able to walk, all be it with an antalgic gait. However, he is unable to dorsiflex the ankle, evert the foot or extend his toes. There is loss of sensation of the dorsum of the foot. Which structure is he most likely to have damaged?
Common peroneal nerve
A 50-year-old male presented to his GP with pain and paresthesia in his right hand, particularly after he wakes up. On examination, there was a general weakness in the affected hand, with a sensory disturbance in the anterior aspect of his thumb and index finger. He was referred to an orthopaedic consultant who diagnosed the condition as carpal tunnel syndrome. Which of the following structures passes through the carpal tunnel?
Flexor pollicis longus
A 6-year-old girl falls over whilst playing at school and presents to the Emergency Department with an extremely painful right arm. X rays show a closed, posteriorly displaced supracondylar fracture of the distal humerus.
Which of the following would indicate an urgent need for surgery?
Distal neurovascular deficit
A 32-year-old man is involved in a motorcycle accident and sustains a closed unstable spiral tibial fracture. This is managed with an intramedullary nail. On return to the ward he is noted to have increasing pain in the limb and on examination the limb is swollen and tender with pain on passive stretching of the toes. The most likely diagnosis is:
Compartment syndrome
A 43-year-old woman presents with pain in the right elbow. This has been present for the past month and she reports no obvious trigger. On examination she reports pain on wrist extension against resistance whilst the elbow is extended. What is the most likely diagnosis?
Lateral epicondylitis
A 13-year-old girl presents to clinic with right knee pain. She is a keen hockey player but has had no recent injuries. On examination there is a painful swelling over the tibial tubercle. What is the most likely diagnosis?
Osgood-Schlatter disease
A 64-year-old woman who is known to have rheumatoid arthritis presents with pain in her right ring finger when she flexes it. On one occasion she reports it became ‘stuck’. Clinical examination is unremarkable other than a palpable nodule at the base of the finger. What is the most likely diagnosis?
Trigger finger
You are performing a newborn examination. What best describes the clinical findings of a clubfoot?
Inverted + plantar flexed foot which is not passively correctable
A 50-year-old man complains of a 9-month history of stiffness in the right shoulder. The shoulder was originally extremely painful but now only the stiffness remains. On examination you note that the right shoulder is very stiff on both active and passive moments.
What is the most likely cause?
Adhesive capsulitis
A 23-year-old man wakes up on a Sunday morning unable to extend his wrist . He had been drinking heavily the previous night. What is the likely cause of his weakness?
Radial nerve palsy
You see an 81 year old lady with a history of diabetes, osteoarthritis and hypertension. She twisted her leg whilst getting out of a car and developed increasing pain weight bearing which has eased with simple analgesia. She also tells you she has a lump under her knee. On examination she has a 4cm non-tender lump just below the popliteal fossa which becomes tense on extending the leg. She has full power throughout. What is the most likely diagnosis?
Baker’s cyst
A 34-year-old man presents with pain after falling onto his backward stretching right hand. On examination the right shoulder contour is flattened and a small bulge is felt below the right clavicle. You also note that there is a small patch of anaesthesia over the distal achievement of the deltoid muscle.
What injury would explain all the examination findings?
Anterior shoulder dislocation
A 75-year-old female presents with weakness of her left hand. On examination wasting of the hypothenar eminence is seen and there is weakness of finger abduction. Thumb adduction is also weak. Where is the lesion most likely to be?
Ulnar nerve
