ortho on passmed year 5

Question 1

long term steriod use risk for what

Answer 1

avascular necrosis of fem head

Question 2

sx of avn fem head

Answer 2

vdevelopment of anterior hip pain and stiffness
relevant rf such as steriods, chemo, obesity, trauma and alcohol

Question 3

ix of choice for avn

Answer 3

MRI

Question 4

findings on hip XR of avn

Answer 4

This X-ray shows avascular necrosis of the femoral head (AVNFH), visible as flattening and a decrease in volume of the right femoral head. Additionally, a small but pathognomonic ‘crescent’ sign is visible in the lateral articular surface of the femoral head - this describes a curvilinear lucent line below the articular surface, caused by a subchondral fracture typical of AVNFH.

Question 5

what is the crescent sign

Answer 5

The crescent sign refers to a linear cleft due to a subchondral fracture in the setting of osteonecrosis.

Question 6

obvious ankle injury with neuro compromise what do you do

Answer 6

X-rays should not be taken of obvious ankle injuries if neurovascular compromise is present - immediate reduction / stabilisation instead

Question 7

A DEXA scan should be offered without calculating the fragilty risk score in the following situations:

Answer 7

> 50 years of age with a history of fragility fracture
< 40 years of age who have a major risk factor for fragility fracture - these patients should be referred to a specialist depending on the T-score
before starting treatments that may have a rapid adverse effect on bone density (for example, sex hormone deprivation for treatment for breast or prostate cancer)

Question 8

Greater trochanteric pain syndrome is also referred to as trochanteric bursitis

due to what seen in who

Answer 8

It is due to repeated movement of the fibroelastic iliotibial band and is most common in women aged 50-70 years.

Question 9

what node is this

A 42-year-old lady who has systemic lupus erythematosus presents to the clinic with a 5 day history of a painful purple lesion on her index finger. On examination she has a tender red lesion on the index finger.

Answer 9

osler

Question 10

A 62-year-old lady presents with an non tender lump overlying the distal interphalangeal joint of the index finger. On examination she has a hard, non tender lump overlying the joint and deviation of the tip of the finger.

what node is this

Answer 10

herbedens

Question 11

most common type of fracture in the foot which is a stress fracture

Answer 11

2nd metatarsal

Question 12

what is lumbar spinal stenosis and sx

Answer 12

Lumbar spinal stenosis is a condition in which the central canal is narrowed by tumour, disk prolapse or other similar degenerative changes.

Patients may present with a combination of back pain, neuropathic pain and symptoms mimicking claudication.

Question 13

how do you differentiate lumbar spinal stenosis from true claudication

Answer 13

One of the main features that may help to differentiate it from true claudication in the history is the positional element to the pain. Sitting is better than standing and patients may find it easier to walk uphill rather than downhill.

Question 14

simmonds triad for achilles tendon rupture

Answer 14

Calf squeeze test, observation of the angle of declination, palpation of the tendon

Question 15

what is an ORIF

Answer 15

Open reduction internal fixation (ORIF) is a surgical procedure commonly done to repair bone fractures, especially those in which the broken bone fragments are not properly aligned or displaced. This procedure involves making an incision (an ‘open’ approach) to access the fracture site, realigning the fractured bones, and using internal fixation devices such as screws, plates, rods, or pins to stabilise and hold the bone fragments in their correct positions

Question 16

what is charcots joint

Answer 16

Also termed neuropathic arthropathy, is characterised by the destruction of joints secondary to nerve damage. It frequently occurs in individuals with peripheral neuropathy. Alcoholic neuropathy may result in a loss of sensation and proprioception, rendering the joint vulnerable to unrecognised injuries and subsequent deformities.

Question 17

Weber A fractures -

Answer 17

patients with minimally displaced, stable fractures may weight bear as tolerated in a CAM boot

Question 18

Children and young people with unexplained bone swelling or pain: even if dont remember injury from gymnastics or something like that

Answer 18

consider very urgent direct access X-ray to assess for bone sarcoma

Question 19

causes of carpal tunnel syndrome

Answer 19

pregnancy
oedema e.g. heart failure
lunate fracture
rheumatoid arthritis

Question 20

Positive examination findings are that direct pressure on the coracoid elicits pain and there is impairment of active and passive external rotation.

Answer 20

adhesive capsulitis

Question 21

psoas abcess source of infection

Answer 21

pyelonephritis or inflammatory bowel disease

Question 22

psoas irritation indicated by what movements

Answer 22

Psoas irritation is evidenced when the position of comfort is the patient lying on their back with slightly flexed knees. Inability to weight bear or pain when moving the hip is usually evident.

Question 23

what is the most common reason total hip replacements need to be revised

Answer 23

Aseptic loosening is the most common reason total hip replacements need to be revised

Question 24

long term steriod use rf for

Answer 24

avascular necrosis of hip

Question 25

hip replacement complications

Answer 25

perioperative
venous thromboembolism
intraoperative fracture
nerve injury
surgical site infection
leg length discrepancy
posterior dislocation
may occur during extremes of hip flexion
typically presents acutely with a ‘clunk’, pain and inability to weight bear
on examination there is internal rotation and shortening of the affected leg
- aseptic loosening (most common reason for revision )
prosthetic joint infection

Question 26

Axillary nerve palsy can also occur due to shoulder dislocation.

Answer 26

anterior

Question 27

what does imaging of lateral epicondylitis look like

Answer 27

imaging typically shows calcification or microtears at the origin of the extensor tendons.

Question 28

mixed features of SLE, systemic sclerosis and myositis.

Answer 28

sharp syndrome

Question 29

Fever
Joint pain - especially the knees, wrists and ankles
Maculopapular salmon rash
Other - lymphadenopathy, sore throat, hepatosplenomegaly, myalgia, pericarditis.

ferritin and ESR raised

Answer 29

adult onset still disease

Question 30

unexplained lump increasing in size of forearm for exmaple what is the diff between adults and children in examination time

Answer 30

adults - urgent USS 2ww
children USS in 48hr

Question 31

when do you do an LP in CT head

Answer 31

NICE : If CT head done within 6 hours of symptom onset shows no evidence of SAH, do not routinely offer an LP and consider alternative causes
If CT head is done > 6 hours and is negative, consider LP
LP should be performed at least 12 hours after injury to identify xanthochromia

Question 32

acute gout treated with what

Answer 32

NSAIDs such as naproxen are generally used first-line, if there are no contraindications.
colchine

Question 33

coeliac disease can lead to osteomalacia - describe how OM can lead to results of high alp low ca and low phosphate

Answer 33

In osteomalacia, calcium absorption decreases, leading to low serum calcium. In response, parathyroid hormone (PTH) is released to raise serum calcium. PTH increases bone resorption and the conversion of vitamin D to its active form, while also increasing phosphate excretion by the kidneys. ALP, a marker of osteoblast activity, is elevated due to increased bone turnover. Therefore, the expected results are high ALP, low calcium, and low phosphate.

Question 34

hydroxychloroquine main side effect

Answer 34

retinopathy

Question 35

pseduogout is associated with what other conditons and electorlyte abnormalities

Answer 35

haemochromatosis
hyperparathyroidism
low magnesium, low phosphate
acromegaly, Wilson’s disease

Question 36

specific test for SLE

Answer 36

Anti-dsDNA - specific as has the s in it

Question 37

dermatomyositis what autoantiboides

Answer 37

ANA
jo-1