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AMC MCQ > Ortho by Dr Riwa > Flashcards

Ortho by Dr Riwa Flashcards

1
Q

Plexus Brachialis - Major Branches

A
  • Musculocutaneus nerve ( C5, 6, 7) - M. Biceps brachii, brachialis,
  • Axillary nerve (C5,6) M. deltoidius, regimental badge sign
  • Median nerve (C5 -T1) - All flexors of the forearm except 1.5
  • Radial nerve( C5-T1) - All extensors
  • Ulnar nerve ( C8-T1) - 1.5 Flexors, all intrigate muscles of the hand
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2
Q

Median Nerve (C5-T1)- motor/sensory

A
  • Motor
    all flexors of the forarm except F.carpii ulnaris and half of F. digitotum proundus
    Lateral two lumbriccals and thenar muscles except Adductor polices
  • Sensory:
    supplies palmar aspect of the lateral 3.5 fingers
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3
Q

Median course

A
  1. *Anterior compartment of arm *
    Anteromendial,
    **with brachial artery **
  2. **Forearm **
    all flexors exept F carpii ulnaris and F digitorum profundus
  3. Hand* *
    through Carpal Tunnel
    supplies lateral two lumbricals
  4. *Terminal branches *
    * Anterior interosseous nerve
    * palmar cutaneus branch
    * recurrent branch - supplies thenar musles
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4
Q

Median Nerve Injury - Elbow (supracondylar fractur of the humerus)

A

Motor: All motor lost

Sensory: lost

Classical Sign: Hand of benediction( when pat makes a fist) and Thenar wasting

Symptoms worse with rotation (pronation) of forarm

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5
Q

Median Nerve Injury - Wrist
(Laceration, Carpal tunnel syndrom)

A

Motor: Lumbricalis and thenar lost - thenar wasting

Sensory: Similar to injury at elbow except no sensory loss over thenar muscle

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6
Q

Median nerve injury - test anterior interosseous nerve

A
  • Ok-sign
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7
Q

Carpal tunnel syndrom - cause

A
  • idiopatic -mc
  • inflammatory - RA/OA
  • posttraumatic
  • pregnancy
  • endocrine (Myxedema/Acromegaly)
  • Gout
  • repititive wrist movements
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8
Q

Carpal tunnel syndrom -S/S

A
  • Hand and wrist pain
  • Paraesthesia
  • Hyposthesia
  • Patient wakes up at night with burning/aching, has to shake hand to restore sensation- CLASSICAL-IMPORTANT FOR EXAM
  • Late signs- Thenar atrophy and weakness of thumb
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9
Q

Carpal tunnel syndrom - Examination

A
  • Thenar wasting
  • Phalens sign ( flexion of the wrist produces symptomes)
  • Tinel sign ( tapping of the wrist produces tingeling)
  • NCS - BEST TEST
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10
Q

Carpal tunnel syndrom - MX

A

First : splint/wrist bands
If not working: steroid infections
Best: Surgery to relase the flexor retinaculum

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11
Q

Radial nerve ( C5-T1) - Motor supply

A

Most commonly injured nerve
best prognosis post injury.

Motor:
- Axilla : long head of triceps (first elbow extensor)
- Spiral groove : lateral and medial head of triceps, Anconeus
- After piercing the intermuscular septum : Extensor carpi radialis (first wrist extensor)
- divides into-Posterior interosseous nerve (major motor nerve) which extends thumb & fingers and a superficial branch

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12
Q

Radial nerve ( C5-T1) - Sensory supply

A
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13
Q

Radial nerve injury - Axilla

A
  • Saturday night palsy/ crutch palsy
  • all sensory & motor function loss
  • Wrist drop classical seen
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14
Q

Radial nerve injury - Radial groove

A
  • Fracture of the humerus

MOTOR
* Triceps retained
* Extension of fingers and wrist lost ( Wrist drop)

SENSORY
* Arm and forearm retained
* sensation lost on dorsal lateral 3.5 fingers

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15
Q

Radial nerve injury -forearm superficial branch

A
  • Laceration/stabbing
    ​
    MOTOR
  • none
    ​
    SENSORY
  • sensation lost on dorsal lateral 3.5 fingers
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16
Q

Radial nerve injury - forearm deep branch

A
  • Fracture of the radial head or posterior dislocation of the radius
    ​
    MOTOR
  • Majority of muscles in posterior forarm efected
    ** NO wrist drop ** - Extensor carpi radialis not effected Posterior interosseous nerve

SENSORY
* none

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17
Q

Ulnar nerve injury - Compression Pisohammat ligament (eg cyst)

A
  • loss of sensation over fingers and hypothenar muscle wasting.
  • Sensations over hypothenar eminence are spared
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18
Q

Ulnar nerve ( C8-T1)- Sensory Supply

A
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19
Q

PATTERNS OF SENSORY LOSS

A

Mononeuropathies
localised sensory disturbance in the area supplied by the damaged nerve

Peripheral neuropathy
symmetrical sensory deficits in a ‘glove and stocking’ distribution in the peripheral limbs, m/c diabetes mellitus & chronic alcohol excess.

Radiculopathy
due to nerve root damage (e.g. compression by a herniated intervertebral disc), -sensory disturbancesin the associated dermatomes.

Spinal cord damage
sensory loss both at and below the level of involvement in a dermatomal pattern

Thalamic lesions (e.g. stroke)
contralateral sensory loss

Myopathies
symmetrical proximal muscle weakness

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20
Q

Nerve injury - Clavicular

A

Brachial Plexus - Subclavian artery

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21
Q

Nerve injury - anterior GH dislocation

A

N.axillaris

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22
Q

Nerve injury - Surgical neck of humerus

A

N.axillaris

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23
Q

Nerve injury - Midshaft humerus

A

N.radialis

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24
Q

Nerve injury - medial epicondyle

A

N.ulnaris

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25
Q

Nerve injury - greater tuberosity of the humerus

A

N.axillaris

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26
Q

Nerve injury - Supracondylar humerus

A

Median nerve - brachial artery

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27
Q

Nerve injury - Colles

A

N.median

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28
Q

Nerve injury - ERB

A

Brachial plexus – high: C5 – C6

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29
Q

Nerve injury - Klumpke

A

Brachial plexus – low: C8 – T1

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30
Q

Biceps reflex

A

C5/6

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31
Q

Supinator -Brachioradialis reflex

A

C5/6

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32
Q

Triceps reflex

A

C7

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33
Q

Injury Ulnar nerve - at wrist

A

Sensory
* numbness in the little and ring fingers
Motor
* weakness of abduction of his little finger
* weakness of flexion of the terminal
phalanx of his little and ring fingers

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34
Q

Lumbar Plexus

A
  • formed by anterior rami L1-L4 and contributions of T12
  • Important Obturator and Femoral nerve
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35
Q

Obdurator nerve (L2-4)

A
  • innervates muscles of the medial thigh
  • obturator externus, adductor longus,adductor brevis, adductor magnus and gracilis
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36
Q

Femoral nerve (L2-L4)

A
  • innervates muscles of the anterior thigh
  • the illiacus, pectineus, sartorius and quadriceps femoris
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37
Q

Sacral plexus

A
  • anterior rami S1-S4 and L4-5
  • Important Sciatic nerve
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38
Q

Sciatic nerve (L4,5, S1-3)

A

**Tibial portion **
* muscles in the posterior compartment of the
thigh (apart from the short head of the biceps femoris)
* hamstringcomponent of adductor magnus
* muscles in the posterior compartment of the leg and sole of the foot

Common fibular portion
* Short head of biceps femoris, all muscles in the
anterior and lateral compartments of the leg and extensor digitorum brevis
* Motor fn- dorsiflexion and eversion

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39
Q

Myotomes - upper limb

A

C4 = shoulder shrugs
C5 = Shoulder abduction and elbow flexion
C6 = Wrist extension
C7 = Elbow extension and wrist flexion
C8 = Thumb extension and fingers flexion
T1 = Finger abduction

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40
Q

Myotomes - lower limb

A

L2 = Hip flexion
L3 = Knee extension
L4 = ankle dorsiflexion
L5 = Big toe extension
S1 = Ankle plantar flexion
S4 = Bladder and rectum motor supply

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41
Q

Complication of fractures and fracture healing

A
  • Osteomyelitis
  • Haemorrhage – Mostly seen with pelvic fractures
  • Vascular/Nerve injuries- Popliteal artery / common peroneal nerve
  • Avascular Necrosis- NOF fractures/ scaphoid/ talus
  • Malunion / Nonunion
  • Compartment Syndrome
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42
Q

Compartment Syndrome

A
  • Emergency
  • High risk : fractures of elbow/forearm/proximal third of tibia/multiple fractures of hand or foot/ crush injuries / circumferential burns / tight plasters/ infection/ post surgery
  • > 6h - severe irreversible myonecrosis - Volkmans ischemic contracture
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43
Q

Compartment Syndrome - Clinic

A

Pain out of proportion with injury
Paresthesia
Pallor ( may last symptom with Pulselessness)
Paralysis
Pulselessness

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44
Q

Compartment Syndrom - RX

A
  • SIGN- passive stretch test
    if toes/fingers are passively stretched it results in pain in calf or forearm
  • Confirmation- Measuring the inter compartmental pressure
  • clinical diagnosis
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45
Q

Compartment Syndrom - Mx

A
  • Fasciotomy
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46
Q

Clavicle Fracture

A
  • Fall onto affected shoulder
  • Pat is supporting arm which is in full adduction
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47
Q

Clavicle Fracture - Thinks to look for

A
  • Careful NEUROVASCULAR examination
  • skin integrity to r/o open fracture
  • lung fields to r/o apical lung injury
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48
Q

Clavicle Fracture - Classification

A
  • middle third
  • lateral third
  • medial third
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49
Q

Clavicle Fracture - Middle third

A
  • 80%
  • Defined by shortening/comminution/angulation

MX
* Broad arm sling to support limb for 2 weeks or untilcomfortable.Regular analgesia as required

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50
Q

Clavicle Fracture -Lateral third

A
  • 15%
  • Around and lateral to
    coracoclavicular Ligaments

Mx
* If undisplaced,no reduction required
* If displaced,refer
* Broad arm sling to support limb for 2 weeks or until
comfortable
Regular analgesia as required

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51
Q

Clavicle Fracture -medial third

A
  • 5%
  • Bony injury alone associated with sternoclavicular
    dislocation
  • look for vascular,injury/neurological injury

Mx
* If Undisplaced,no reduction required
* If displaced,urgent referral
* Broad arm sling to support limb

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52
Q

Clavicle Fracture -medial third

A

 Brachial plexus injury
 Subclavian vessel injury
 Shortening of the shoulder arc
 Stiffness of the shoulder joint
 Cosmetic side effects

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53
Q

Shoulder disslocation - Types

A
  • Anterior- m/c
  • Posterior- seen in seizures or electric shock
  • Inferior dislocation (luxatio erecta)
  • Superior dislocation
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54
Q

Shoulder dislocation - Anterior Clinic

A
  • most common of trauma indirect & direct

Clinic
* injured shoulder in slight abduction and
external rotation, SUPPORTED by the normal side
* Presents with pain/ discomfort and inability to move the affected shoulder.
* ALWAYS do a careful neurovascular examination (axillary nerve)

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55
Q

Shoulder dislocation - Anterior RX/Mx

A

Rx
* Xray AP
* CT/MRI post reduction

Mx
* reduction in trauma bay under anaestesia

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56
Q

Fracture proximal humerus - Pathopysiology

A
  • common in elderly (osteoporosis) - outstreched arm (low energy)
  • High energy - risk of soft tissue and neurovascular complications
  • Nerve - axillaris injury M/C
  • Aterial - uncommon, higher risk in elderly x
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57
Q

Fracture proximal humerus - Rx/Mx

A

Rx
* X-ray

Mx
* Nonsurgical: in minimal displaced, Sling immobalisation, Pain relief
* Surgical: if multiple part fracture, review by orthop team

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58
Q

Adhesive Capsulitis

A
  • = frozen schoulder - functional loss of passiv and active shoulder motion due to inflammatory process
  • unilateral/bilateral
  • clinical diagnose
  • increased in DM
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59
Q

Adhesive Capsulitis - Presentation

A
  • Pain partricularly at night
  • Stiffness
  • Global reduction in movements

On Examination-
* Global tenderness
* Active movements restricted
* Passive movements-restricted
* Power- normal
* Sensations-normal

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60
Q

Adhesive Capsulitis - Management

A
  • Rest during the acute phase
  • Analgesics + physiotherapy
  • if pain doesn’t subside, Imaging guided injection :
    1 ml corticosteroid with 2-5 ml 1% lidocaine
    (may be done to divide the thickened ligaments +/-
    acromioplasty)

general approach :
* stiffness present along with pain = arthroscopy to divide adhesions
* Pain alone present = NSAIDS / Steroid injection.

61
Q

Impingement/ Rotator cuff tear

A
  • subacromial impingement M/C cause for shoulder pain ( 4% in <40y, >50% in over 60Y)
62
Q

Impingement/ Rotator cuff tear - Stages

A
  • Subacromial impingement = first stage of rotator cuff disease
  • continuum of disease from
     Impingement and bursitis
     Partial to full-thickness tear
     Massive rotator cuff tears
     Rotator cuff tear arthropathy
63
Q

Impingement- Symptoms

A
  • Pain-insidious onset,exacerbated by overhead activities and lifting objects away from body.
  • night pain
64
Q

Impingement - Physical examination

A
  • Strength-usually normal
  • Painful Arc Test-pain with arm abducted in scapular plane from 60° to 120°
  • Active and passive movements usually full
65
Q

Impingement - Rx/Mx

A

Rx
* X-ray - initially
* US - Next
* MRI - Best

Mx
* Anagesics+ Physio- initial
* Trial of steroid injections- next
* Arthroscopic decompression - best

66
Q

Rotator Cuff Tear

A
  • one or more of the rotator cuff tendons is
    torn –> tendon becomes partially or
    completely detached from the head of the
    humerus.
  • Most tears occur in the supraspinatus tendon

Cause :
* injury
* wear (degeneration).

Types
* Partial thickness tear
* Full thickness tear

67
Q

Rotator Cuff Tear - Symptomes

A
  • Pain at rest and at night, particularly if lying on the affected shoulder
  • Pain with movement
  • Weakness when lifting or rotating your arm
68
Q

Rotator Cuff Tear - Examination

A
  • Active movements weak
  • Passive movements normal
  • Impingement+ Power weak
  • often supraspinatus weakness( Jobes test/empty cane)
69
Q

Rotator Cuff Tear - Rx/Mx

A

Rx
* First-xray
* Next-usg
* Best-MRI

Mx
* Analgesics+ rest
* Steroid injection
* Surgery

70
Q

Fracture Midshaft humerus

A
  • common fracture caused by twisting force following a fall

Clinic
* Severe pain/ deformity +/- wrist drop
* Check for : radial nerve

Investigation:
* X-ray

Treatment:
* Undisplaced: reduce and place a U-Slab, always check for radial nerve post reduction
* Displaced: surgery

71
Q

Fracture Supracondylar

A
  • m/c fracture in children around the elbow
  • FOOSH = Fall on outstreched hand
  • Hyper extention
72
Q

Fracture Supracondylar - Clinic

A
  • pain/ deformity
  • always check for the integrity of the triangle
  • Check: median/ulnar/radial nerve and brachial artery
73
Q

Fracture Supracondylar - Types

A
74
Q

Fracture Supracondylar - Rx/Mx

A

Rx
* Xray

Mx
* Rx = hyperflexion of the elbow
* then apply collar and cuff
* Cast only if displacement

75
Q

Biceps tendon rupture

A
  • proximal ruptur more common (90%)

Cause:
* Injury
* overuse due to age or repetitive oberhead movement ( tennis / swimming)

76
Q

Biceps tendon rupture - Clinic

A
  • painful pop
  • pain
  • weakness especially in supination
77
Q

Biceps tendon rupture - Examination

A

Distal rupture:
* varying degree of proximal retraction of the muscle belly-“reverse Popeye sign”
* change in contour of the muscle, proximally
* medial ecchymosis

Proximal
* popeye sign
* change in contour of the muscle, proximally
* medial ecchymosis

78
Q

Biceps tendon rupture - Rx/Mx

A

Rx
* mostly pysical exam
* Xray
* MRI

Mx
* Older, limited use - proximal -conservative( rice and Nsaids)
* young, athletes- proximal - surgical repair

79
Q

Pulled elbow

A
  • children 3-5
  • subluxation/dislocation of the radial head ( not stable in ligaments)
  • axial traction and pronation of hand ( lifted with their wrist)
80
Q

Pulled elbow- clinic

A
  • pain
  • refusal to use affected arm
  • affected arm in flexion and pronation
  • child will refuse supination
81
Q

Pulled elbow - Rx/Mx

A

Rx
* clinical
* may Xray for conformation

Mx
* Reduction = Elbow flexion and supination under analgesia
* Hyperpronation/supination and pronation alternation

82
Q

Flow chart - Child not using upper limb

A
83
Q

Lateral epicondylitis - Tennis Elbow

A
  • wrist extensor ( externsor carpi radialis brevis)
  • 40-60a
  • carpenter, gardener, computer, vioinist, dentist
84
Q

Lateral epicondylitis - Clinic

A
  • pain - outer elbow
  • Rest pain/night pain
  • pain during gripping and hand movements
  • lateral tenderness
  • wrist extension by extend arm reproduces pain
85
Q

Lateral epicondylitis - Mx

A
  • 6-24 month self limiting
  • lifestyle modifications
  • Nsaids/rice
  • brace ( counterforce)
  • Physiotherapy
  • Stereoids with severe pain
86
Q

Medial epicondylitis

A
  • golfers elbow, forehand tennis elbow
  • flexor origin
  • reverse dumbell eexercise
87
Q

Fracture of the forearm

A
  • Monteggia
  • Galeazzi

Both requiere surgery

88
Q

Montaggia Fracture

A

Fracture of the proximal
third of the ulna with fracture of the
radial head and dislocation of the
proximal radio-ulnar joint.

89
Q

Galezzi Fracture

A

Fracture of the distal third of
the radius with dislocation of the DRUJ.

90
Q

Greenstick Fracture - definition

A
  • incomplete fracture, in which on cortex is broken and bending of the opsite side
  • kids

Investigation
* Xray

Treatment:
* Closed reduction
* Suitable for local anaest, manipulation and plaster
* Plaster for 4-6 weeks

91
Q

Fracture types distal radius

A

intrarticular : Bartons fracture
Extra- articular: Colles/ smith fracture

92
Q

Colles fracture

A

*extraarticular
* distal end of the radius (2cm)
* commenly in postmenopausal women
* mechanism = FOOSH +wrist extension

93
Q

Colles fracture - Management

A

Colles Cast
* below the elbow
* Hand is mid pronation and ulnar
deviation.
* wrist joint will be in palmar
flexion = HAND SHAKING CAST

  • high displacement: K-wires/open reduction using plates
  • repeated X-rays are recommended at 1, 2 and 6 weeks to verify proper healing.
94
Q

1.

Colles fracture - Complication

A
  • M/C stiffness of fingers.
  • 2nd m/c dinner fork deformity.
  • Others
  • Damage to the median nerve
  • Rupture of extensor pollicis longus tendon
  • Non-union (extremely rare)
95
Q

Colles vs Smith- Xray

A
96
Q

Colles vs Smith

A
97
Q

Smith - Fracture

A
  • extra articular fracture
  • Distal end of radius – volar / ventral displacement
  • Mechanism of injury = FOOSH + wrist in flexion
  • Deformity = Garden spade deformity
  • Management – POP cast below elbow / Surgery using plate fixation.
98
Q

Bartons fracture

A
  • intra-articular fracture
  • fragment can be dorsally or ventrally displaced
  • Needs surgical management
99
Q

Scaphoid Fracture

A
  • Common after Foosh injury
  • Blood supply from distal to proximal > any # in the waist can lead to AVN
100
Q

Scaphoid Fracture - Clinic

A
  • Pain/Tenderness in anatomical snuffbox
  • Pain/tenderness on axial compression
101
Q

Scaphoid Fracture - Rx/Mx

A

Rx
* X ray followed by Mri

Mx
* Thimb spica cast for 4-6 weeks
* If on initial Xray no # but symptoms apply cast and retest in 1 week

102
Q

De Quervains Tendosynovitis

A

Cause
* Cumulated injuries/ overuse

Effected tendons
* Extensor pollicis brevis and Abductor pollicis longus

RX
* Finkelstein Test - Localize pain at the base of the thumb

MX
* Splinting of the hand at night
* NSAIDs
* Steroid injections

103
Q

Mallet finger

A

Cause:
* injury to the finger extensor
* tear of tendon/ distal avulsion
* Hyperextension/hyperflexion injury
(Ball hits distal phalanx)

Mx
* Mallet finger splint (hyperflexion of the distal interphalangeal joint for 6 weeks)

104
Q

Trigger finger

A

Epidermiology/Pathophysio
* problem of the flexor tendons-locking tendon in flexion with difficulty of extension
* f>m, older, more in DM
* Affected pully: A1
* m/c Flexor digitorum profundus, ring finger

**Cause **
* trauma/DM/ Autoimmune conditions like RH/SLE

**Examination **
* inflammation

Mx
* initial: Rest, splinting, Nsaids, steroid
* Corticosteroids
* surgical release

105
Q

Pelvic Fractures - Unstable

A
106
Q

Pelvic Fracture - Clinical evaluation

A
  • follow Atls protocoll
  • neurovasc status of limb
  • pelvic instability - length discrepancy with internal or external rotation
  • peritoneum for open injuries
  • Rule out vaginal or rectum involvement
107
Q

Pelvic fractures - Complications

A
  • Massive hemorrhage due to rupture of the venous plexus in the posterior pelvis/ large vessel injury
  • Neurological injury- damage to lumbosacral plexus /nerve roots
  • Genitourinary/gastrointestinal injury
  • DVT/PE/Fat embolism
108
Q

Pelvic fractures - Rx/Mx

A

Rx
* Xray

Mx
* Stable: strict bed rest
* unstable: Aplly pelvic binder
* may require ex fix before surgical exploration

109
Q

Coxa vara/ valga

A
110
Q

Shoulder pain differentials

A
111
Q

Common shoulder conditions

A
112
Q

Evaluation of Subacromial Impingement/Cuff Pathology

A
113
Q

Comparison of important causes of hip pain in chidren

A
114
Q

L4 ( Motor/reflex/sensory)

A

Motor : ankkle dorsi flexion deficit ( tibialis ant)

Reflex: patella reflex defizit

Sensory: medial leg, medial big toe

115
Q

L5 ( Motor/reflex/sensory)

A

Motor: big toe, dorsiflexion deficit

Reflex: ankle reflex

Sensory: dorsum foot, anteroir lower leg big toe

116
Q

Osgood schlatter

A
  • children who play active sport

Symptoms
* pain with physical activity

Signs
* palpable lump below the knee
* red inflammed skin over tibial tuberosity
* sometime quadriceps loose strenght and bulk

117
Q

Osgood schlatter - Mx

A
  • rest
  • ice
  • Physio
  • Analgesics
118
Q

Proximal femoral fracture - Epi/Pathothology

A
  • M/c in elderly, rare in young( high energy trauma)
  • displaced : non ambulatory, shortend leg + external rotation
  • Impacted or stress fracture: my weight bearing, more groin pain/pain on axial compression
119
Q

Proximal femoral fracture Rx/Mx

A

Rx
* Xray

Mx
* Surgery: DCS/DHS/Nailing/Hemi/THR

120
Q

Knee injuries

A
121
Q

ACL- Anatomy

A
  • runs from posterior femur to anterior tibia. Has two bundles- AM/PL
  • prevent anterior tibial translation and internal tibial rotation.
122
Q

ACL - Injury

A

Contact : football, basketball, netball

non-contact: post a jump

123
Q

ACL- Injury- Symptoms

A
  • Pain/audible pop
  • swelling
  • Instability - esp when climbing down the stairs/running ets
  • LAchmans test and anterior drawer test positiv
124
Q

ACL Injury - Rx/Mx

A

RX
* MRI

MX
* rest
* ice
* Surgical repair
* Physio

125
Q

Meniscal injury

A
126
Q

Meniscal injury

A
  • walking/squatting
  • trauma( twisting while leg is bent)
  • wear and tear (older people)
127
Q

Meniscal injury - Symptoms

A
  • pain
  • Swelling, typical delayed
  • catch/locking of the knee
  • Instability or the knee “giving way”
  • Restricted range of motion
  • Mc Murry +
128
Q

Meniscal injury - Rx/Mx

A

RX
*MRI

Mx
*depend on location and zone involed
*rest
*ice
*Physio
*Surgery
*

129
Q

Genu varum/valgum

A
130
Q

Ankle injury

A
  • sprain or fracture
131
Q

Ankle injury- Symptoms

A
  • pain
  • swelling
  • sprain: can weight bear
  • fracture: no weight bearing
  • watch out for displaced fractures can lead to neurovascular injuries
132
Q

Ankle injury

A
  • sprain - rice
  • Fracture - cast boot , if displaced surgery
133
Q

Ottowa Rule

A

Bony tenderness:

  • along distal 6 cm of the posterior edge of fibula or tip of lateral malleolus
  • along distal 6 cm of the posterior edge of tibia/tip of medial malleolus
  • at the base of 5th metatarsal
  • at the navicular
  • Inability to bear weight both immediately after injury and for 4 steps during an initial evaluation
134
Q

Achilles tendon injury

A
  • overuse injury
  • strain/partial tear or complete tear

RF
* overuse
* history of previous injury
* obesity
* family history
* Muscle and tendon stiffness

135
Q

Achilles tendon injury- Symptoms

A

Tendinopathy
* pain
* swelling

Tear
* shot feeling
* Thompson test - no plantar flexion of the foot being observed

136
Q

Achilles tendon injury- Mx

A

Initial: RICE
Splinting with ankle in plantar flexion
Definitiv: surgery

137
Q

Spine- Acute lower back pain

A
  • injury
  • overuse
138
Q

Spine- Acute lower back pain- Symptoms

A
  • pain
  • tenderness
  • inability to do daily task
  • Can radiate- down legs or be associated with tingeling or numbness
139
Q

Lower back pain - Red flags

A

Tumour
* History of cancer
* Weight loss
* Night pain
* Age >40 or <15 years

Fracture
* History of trauma
* Risk factors for fragility fracture

Infection
* Fever >38.0°C
* Night sweats/chills
* Immunosuppression
* Intravenous drugs
* Concomitant infection

Cauda equina syndrome
* Urinary retention
* Saddle anaesthesia
* Worsening neurology – flaccid paralysis

140
Q

Lower back pain - Rx/Mx

A
  • Unless red flags, no radiological evaluation
  • if red flag: Xray, MRI

MX
* no red flags: Analgesics/continue normal activity/Physio
* First line analgesics: Paracetamol
* second line : Nsaids
* Third : codein

141
Q

Cervical spondylosis

A
  • natural degenerative process of the cervical motion segment –> cervical radiculopathy, cervical myelopathy, or axial neck pain.

RX
* plain radiographs of the cervical spine

Mx
* observation, medical management, or surgical management
* depending on the severity and chronicity of pain, presence of instability or,presence of neurological deficits

142
Q

Classification of Back pain

A

1- Acute low back pain lasts less than 6 weeks.
2- Sub-acute low back pain lasts between 6 and 12 weeks.
3- Chronic low back pain persists for more than 12 weeks.

A chronic back pain persisting longer than 3 months, requires further investigations to exclude central canal stenosis and nerve root compression.

143
Q

Sacroiliitis - Investigation

A

1-HLA-B27
2-Chlamydia and Gonorrhea serology
3-RA factor, anti-ccp to rule out Rheumatoid arthritis
4-Inflammatory markers such as ESR and C-reactive protein.

144
Q

Vit D Level

A

75-250 nanomole/L

145
Q

Specific test after knee injury

A
  • ACL (anterior cruciate ligaments) rupture-Lachman and pivot shift tests.
  • PCL (posterior cruciate ligament) injury-posterior draw test and posterior sag.
  • Meniscal injury -McMurray test.
  • Collateral ligament injury – varus and valgus stress tests.
  • Patella dislocation – patellar apprehension test.
146
Q

Paget

A
147
Q

Osteoporosis - Riskfactors

A

– Menopause
– Age over 70
– Corticosteroid use longer than three months – Rheumatoid arthritis
– Alcoholism
– Smoking
– Anorexia nervosa.
– Inflammatory Bowel Disease

148
Q

Ottawa knee rules

A

to see if a x ray is reqiered in a child

A knee X-ray is required when a child presents after an injury with:
– Isolated patellar tenderness.
– Tenderness at the head of the fibula.
– Inability to flex at 90 degrees.
– Inability to bear weight immediately after trauma and in an emergency.
- Age over 55

149
Q

Autonomic Dysreflexia

A
  • after spinal cord injury T6 or above
  • parasympatic signal cant travel below injury
  • Hypertension, bradycardia, flushing and sweating above

AMC MCQ (55 decks)

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