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Y4 > Ortho / Rheum > Flashcards

Ortho / Rheum Flashcards

1
Q

Which STI is most likely to lead to reactive arthritis?

  • chlamydia
  • gonorrhoea
A

Chlamydia

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2
Q

Which STI is most likely to lead to septic arthritis?

  • chlamydia
  • gonorrhoea
A

Gonorrhoea

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3
Q

Can’t see, pee or climb a tree makes you think of what condition

A

Reactive arthritis

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4
Q

inability to dorsiflex the foot after a blow to the knee

Which nerve is likely to be injured?

A

Common peroneal nerve

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5
Q

Foot drop.

Which nerve is likely to be injured?

A

Common peroneal nerve

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6
Q

Which nerve supplies the serratus anterior?

A

Long thoracic nerve

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7
Q

Which cranial nerves are present in the cerebellopontine angle?

A

V, VII, VIII

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8
Q

60 year old woman walks with a drop foot and a high stepping gait shortly after a hip replacement. Which nerve is responsible for this?

  • femoral
  • sciatic
A

Sciatic nerve

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9
Q

A broad based unstable gait with veering to the right side.

A

Cerebellar disease

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10
Q

34 year old woman falls to the ground after hearing some bad news suggests a vasovagal syncope. True or false>

A

True

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11
Q

First line DMARD in RA?

A

Methotrexate

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12
Q

How is disease activity in RA measured?

A

DAS 28 score

- score > 5.1 then eligible for biologic therapy

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13
Q

DMARDs are useful in ankylosing spondylitis. True or false?

A

False

- not useful in spinal disease

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14
Q

RA is usually symmetrical. True or false?

A

True

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15
Q

Psoriatic arthritis is usually symmetrical / asymmetrical ?

A

Asymmetrical

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16
Q

Reactive arthritis mainly affects large / small joints?

A

Large joints

  • commonly the knee
  • presents few weeks after illness
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17
Q

In SLE there is low complement / raised complement?

A

Low complement

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18
Q

How does systemic sclerosis come around?

A

Excess collagen deposition in the skin

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19
Q

Which medication is used to manage raynauds phenomenon?

A

CCB

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20
Q

Anti phospholipid syndrome

- prolonged PT / APTT

A

APTT

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21
Q

Lupus anticoagulant +ve

Anticardiolipin +ve makes you think

A

Anti phospholipid syndrome

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22
Q

Patients who are found to have positive antibodies for anti-phospholipid syndrome but who have never had had an episode of thrombosis do not require anti-coagulation. True or false?

A

True

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23
Q

Gout - synovial fluid sample shows

A

Needle shaped monosodium urate crystals

Negative bifringence

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24
Q

Polymyalgia rheumatica - use high dose / low dose steroids?

A

Low dose steroids (15mg)

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25
Q

Constant headache, visual disturbances, jaw claudication and scalp tenderness suggests

A

GCA

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26
Q

Typical biopsy findings include mononuclear infiltration or granulomatous inflammation, usually with multinucleated giant cells.
This suggests which condition

A

GCA

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27
Q

Which dose of steroids should you use for GCA?

A

40-60mg

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28
Q

What does this suggest?
symmetrical, proximal muscle weakness in the upper and lower extremities. This is often insidious in onset and is commonly noticed as difficulty with particular activities e.g. climbing stairs
Anti-Jo-1 +ve

A

Polymyositis

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29
Q

What does this suggest?
symmetrical, proximal muscle weakness in the upper and lower extremities. This is often insidious in onset and is commonly noticed as difficulty with particular activities e.g. climbing stairs
+ heliotrope rash
+ gottrons papules on fingers

A

Dermatomyositis

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30
Q

Name 2 large cell vasculitis

A

GCA

Takayasu arteritis

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31
Q

Takayasu arteritis commonly affects young / old woman?

A

Young (2nd / 3rd decade of life)

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32
Q

Mainstay of treatment for takayasu arteritis

A

40-60mg prednisolone

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33
Q 
nose bleeds, deafness,  recurrent sinusitis and nasal crusting (over time there can be collapse of the nose). Respiratory symptoms such as haemoptysis and cavitating lesions on x-ray are frequently seen.
What does this suggest? 
- EGPA 
- GPA 
- MPA
A

GPA

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34
Q 
late onset asthma, rhinitis and a raised peripheral blood eosinophil count. Neurological symptoms such as mono neuritis multiplex are common.
What does this suggest? 
- EGPA
- GPA 
- MPA
A

EGPA

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35
Q

Child
URTI few weeks ago
Now has vasculitis type non blanching rash. purpuric rash over the buttocks and lower limbs, abdominal pain and vomiting and joint pain.
What is likely diagnosis?

A

HSP

- IgA mediated

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36
Q

What is the management of HSP

A

Usually self limiting

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37
Q

Which of these autoantibodies is most specific for SLE?

a. Anti-Scl-70
b. Anti-nuclear antibody
c. Anti-Ro antibody
d. Anti-DNA binding antibody
e. Anti-smooth muscle antibody

A

d. Anti-DSDNA

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38
Q

Which of these tests is the initial investigation of choice for detecting renal involvement in vasculitis?

a. Urea
b. Glomerular filtration rate (GFR)
c. Urinalysis
d. Creatinine
e. Renal ultrasound scan

A

c. urinalysis

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39
Q

If allopurinol cant be tolerated, which drug is used instead?

A

Febuxostat

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40
Q

Pain, weakness, wasting - is this a joint problem or is this a muscle problem?

A

Muscle problem

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41
Q

what duration is prolonged early morning stiffness?

A

over 1 hour

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42
Q

Inflammatory conditions have had a shorter/longer duration of onset?

A

Shorter

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43
Q

DIP joint involvement - think which type of arthritis?

A

OA

won’t be RA

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44
Q

Base of thumb involved - which type of arthritis?

A

Osteoarthritis

‘squaring of the thumb’

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45
Q

Why are the DIP joints not involved in rheumatoid arthritis?

A

Only a little amount of synovial fluid in DIP joints

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46
Q

Over 50, acute onset pain in shoulder girdle and hip girdle.

A

Polymyalgia rheumatica

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47
Q

Whats the most common organism to cause reactive arthritis?

A

Campylobacter

also chlamydia if STI

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48
Q

Which medications can precipitate gout?

A

Thiazide like diuretics

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49
Q

Which medications can precipitate gout?

A

Thiazide like diuretics

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50
Q

Have you ever been to the eye clinic as an emergency. Why is this important in rheumatology?

A

Uveitis - think about seronegative arthropathies

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51
Q

Butterfly malar rash is made worse by

A

Sun
- it is photosensitive

takes a while to go away

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52
Q

Raynauds that develops later on in life. What disease does this suggest?

A

Systemic sclerosis

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53
Q

Bilateral carpal tunnel syndrome. What should you be wary of?

A

Rheumatioid arthritis

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54
Q

50 year old woman develops raynauds and dysphagia?

A

Systemic sclerosis

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55
Q

low trauma fractures and family history of osteoporosis. What is the best investigation?

A

bone density scan

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56
Q

Bilateral hilar lymphadenopathy
erythema nodosum
fever
This is the triad of

A

Sarcoidosis

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57
Q

Approach to acute monoarthritis. What investigations must you do?

A

Joint aspirate
Blood tests: FBC, CRP, blood cultures, serum uric acid
X-rays

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58
Q

Patient with gout like symtoms but normal serum uric acid levels. What should you do>

A

Treat for gout and re-check serum uric acid levels in a few weeks

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59
Q

Where are heberdens nodes?

What condition is this seen in?

A

DIP joints

OA

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60
Q

Onycholisis and nail pitting and dactylitis is common in which condition?

A

Psoriatic arthritis

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61
Q 
Age between 20 and 40.
Lasting longer than 12 weeks.
Worse in the morning ,improving with exercise.
Buttock pain
Relief with NSAIDs
Night time awakening.
These patients get investigated for?
A

Ankylosing spondylitis

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62
Q

Should you always x-ray both hands and feet in ?RA even if the patient doesn’t have any problems with the feet? or just do hands?

A

Do both Hands and feet x-ray

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63
Q

First line DMARD in Rheumatoid arthritis

A

methotrexate

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64
Q

How long do DMARDs take to work roughly?

What are used in the interm?

A

3 months

Steroids are used in the interim as DMARDs take months to work

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65
Q

What can methotrexate do in the lungs?

A

Pulmonary pneumonitis

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66
Q

How is methotrexate given in the treatment of rheumatoid arthritis?

A

It is given as a weekly dose followed by folic acid at least 24 hours later.

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67
Q

Hydroxychloroquine is never used on its own. True or false?

A

True

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68
Q

What is the first line treatment in gout?

A

NSAIDs

- can use colchicine if NSAIDs don’t work but this carries risk of diarrhoea

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69
Q

What is the management of compartment syndrome?

A

Emergency fasciotomy

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70
Q

Management of hypertrophic non union fracture

A

Plate and screws to stabilise

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71
Q

What are the 3 x-ray views for assessing c-spine fracture

A

AP
Lateral
Peg open mouth

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72
Q

When thinking of pelvic fractures, what analogy do you think of?

A

Polomint

- if break in one place there is most likely going to be another break elsewhere

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73
Q

‘open book pelvic fracture’. how does this occur and what is the management

A

Occurs due to anterior-posterior compression injury whereby the pubic symphisus is disrupted

Tx:
Initial reduction -> pelvic binder -> external fixation

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74
Q

shortening of the affected limb, leg flops into external rotation, can’t straight leg raise
this makes you think

A

NOF fracture

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75
Q

What is the main complication of NOF fracture to be aware of?

A

avascular necrosis

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76
Q

Which carries more risk for AVN:

  • intracapsular NOF fracture
  • extracapsular NOF fracture
A

Intracapsular NOF fracture

- in the capsule so risk of disrupting blood supply to femoral head

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77
Q

Management of intracapsular NOF fracture

A

Hip replacement

  • total
  • partial
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78
Q

Management of extracapsular (intertrochanteric) NOF fracture

A

Internal fixation

  • hip screw
  • IM nail
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79
Q

Management of extracapsular (subtrochanteric) NOF fracture

A

Thomas splint + analgesia -> IM nail

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80
Q

Which nerve is most likely to be damaged in humeral shaft fracture?

A

Radial nerve

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81
Q

Wrist drop
Loss of sensation in first dorsal web space
This suggests injury to which nerve?

A

Radial nerve

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82
Q

Define colles fracture

A

Extra-articular fracture of the distal radius

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83
Q

Which nerve is at risk of damage in a colles fracture

A

median nerve

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84
Q

Smiths fracture has volar/dorsal displacement

A

Volar displacement

- occurs after falling onto flexed wrist

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85
Q

Pain in the anatomical snuff box following FOOSH may indiacte?

A

Scaphoid fracture

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86
Q

What is the major complication to be aware of for scaphoid fracture?

A

Avascular necrosis

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87
Q

Management of stable ankle fracture

A

Moonboot / cast for 6 weeks

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88
Q

Management of unstable ankle fracture

A

Open reduction + internal fixation

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89
Q

Monteggia fracture is fracture of the radius / ulna?

A

Fracture of ULNA with dislocation of the radial head

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90
Q

Galeazzi fracture-dislocations is fracture of the radius / ulna?

A

Fracture of the RADIUS with dislocation of the ulna

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91
Q

Supracondylar fractures of the elbow risks damage to which nerve?

A

Median nerve damage

92
Q

In general, how are femoral shaft fractures managed in children over 6?

A

IM nail

93
Q

Displaced subcapital / transcervical (intracapsular) NOF fracture in frail elderly patient. What is the management

A

Unipolar hemiarthroplasty

  • keep the acetabulum
  • replace the femoral head
94
Q

Displaced subcapital / transcervical (intracapsular) NOF fracture in younger fitter patient. What is the management

A

Total hip replacement

95
Q

In child: Force to one side of bone may cause break in only one cortex and the other cortex bends. What is this?

A

Greenstick fracture

96
Q

What is the salter harris classification used for?

A

Classifying fractures in children

97
Q

Which fat pad sign is always abnormal

  • anterior
  • posterior
A

Posterior

98
Q

Which fracture type is most suspicious of NAI ?

A

Spiral

99
Q

Suspect NAI from x-ray images. Which investigation is done next?

A

Skeletal survey

100
Q

In what way can pelvic fractures result in massive blood loss ?

A

arterial bleeding (internal iliac artery & branches), venous bleeding (pelvic venous plexus)

101
Q

If you describe the angulation of a lower limb fracture as “varus” this means the distal fragment points towards / away from the midline?

A

Distal fragment points towards the midline

102
Q

Early local complications of fractures

A

Compartment syndrome
Vascular injury
Nerve compression

103
Q

What is the treatment of acute reactive arthritis?

A

Ibuprofen

104
Q

Malignancy and raised CK makes you think

A

Polymyositis

105
Q

WHat is the medical name for a pulled elbow?

A

Nursemaids elbow

106
Q

Osteoporosis is typically associated with normal blood test values. True or false?

A

True

107
Q

NICE recommend performing x-rays of the hands and feet of all patients with suspected rheumatoid arthritis. True or false?

A

True

108
Q

oral ulcers, genital ulcers and anterior uveitis triad makes you think

A

Bechets syndrome

109
Q 
presents in childhood
fractures following minor trauma
blue sclera
deafness secondary to otosclerosis
dental imperfections
A

osteogenesis imperfecta

110
Q

Child
Long bone (diaphysis) lesion
onion skin’ appearance on X-ray
What does this make you think>

A

Ewing’s sarcoma

111
Q

what is the most appropriate initial investigation to confirm a diagnosis of ankylosing spondylitis?

A

x-ray of pelvis

112
Q

What is the 1st line management for ankylosing spondylitis?

A

Exercise + NSAIDs

113
Q

Which condition has Raised CK?

  • polymyalgia rheumatica
  • polymyositis
A

Polymyositis

114
Q

The cardinal clinical signs of ________ are (1) increased pain on passive stretching of the involved muscle, and (2) severe pain outwith the anticipated severity in the clinical context

A

compartment syndrome

115
Q

Anterior dislocation of the shoulder is associated with which nerve palsy

A

Axillary nerve palsy

116
Q

Posterior dislocation of the hip is associated with which nerve injury?

A

Sciatic nerve injury

117
Q

What is the most common causative organism of septic arthritis in adults?

A

Staph aureus

118
Q

Any joint suspected of septic arthritis should be aspirated under aseptic technique before antibiotics are given. True or false?

A

True

119
Q

What is the most common type of shoulder dislocation?

a. Anterior
b. Posterior
c. Lateral
d. Inferior

A

A. Anterior

120
Q

Anterior dislocation of the shoulder could damage which nerve?

A

Axillary nerve

121
Q

How are extra-capsular hip fractures often treated?

a. Hemiarthroplasty or Total Hip Replacement
b. Dynamic hip screw
c. Open reduction, internal fixation

A

Dynamic hip screw

122
Q

patients who cannot straight leg raise after a fall. What do you suspect?

A

Quadriceps tendon rupture

123
Q

the majority of minimally displaced proximal humerus fractures are managed in what way?

A

Collar and cuff

124
Q

Name 3 drugs which can precipitate gout?

A

Thiazide diuretics / loop diuretics

Chemotherapy drugs

125
Q

What is the mainstay of treatment of gout?

A

NSAIDs and COX-2 inhibitors

126
Q

What is the mechanism of action of allopurinol,febuxostat?

A

Xanthine oxidase inhibitors

127
Q

Which patients with gout should be offered preventative medication: More than X attacks per year

A

2

128
Q

Why should uric acid lowering therapy should not be started while the patient has an acute episode of gout?

A

any sudden changes in uric acid levels can

precipitate further attacks of gout or prevent the acute episode from settling down

129
Q

Women rarely get gout before the menopause. Why is this?

A

Oestrogen promotes excretion of uric acid

130
Q

You suspect SLE in a patient and auto-antibody tests are carried out which confirm the diagnosis. Which other investigations are now required?

A

Urinalysis - SLE is associated with glomerulonephritis

CXR - to exclude interstitial lung disease

131
Q

Active SLE disease is associated with poor maternal and fetal outcomes. True or false?

A

True
- patients should be asked not to get pregnant
until their disease has been quiescent for at least 6 months

132
Q

Central cord syndrome - more likely to have paralysis of the UPPER/LOWER limbs. Why?

A

Upper limbs

Corticospinal tract for upper limbs lies more centrally within the spinal cord

133
Q 
loss of motor function (corticospinal tracts) as well as loss of coarse touch, pain and temperature sensation (lateral spinothalamic tract) whilst proprioception, vibration sense and light touch are preserved (dorsal columns).
A - anterior cord syndrome 
B - posterior cord syndrome 
C - central cord syndrome 
D - brown sequard syndrome
A

A - anterior cord syndrome

134
Q 
Ipsilateral paralysis and loss of dorsal column sensation occurs with contralateral loss of pain, temperature and coarse touch sensation.
A - anterior cord syndrome 
B - posterior cord syndrome 
C - central cord syndrome 
D - brown sequard syndrome
A

D - brown sequard syndrome

135
Q

Which is more common

anterior or posterior shoulder dislocation?

A

Anterior shoulder dislocation

136
Q

The risk of recurrent shoulder dislocation is predicted by the age of the patient at the time of initial dislocation. The younger/older you are, the more likely you are to have recurrent dislocations?

A

The younger you are

137
Q

How are recurrent shoulder dislocations managed surgically?

A

Bankart repair

138
Q

Anterior shoulder dislocations usually occur if the arm is internally/externally rotated?

A

Externally rotated

139
Q

Light bulb sign on x-ray think

A

Posterior shoulder dislocation

140
Q

Typical management of a diaphyseal fracture of both bones of the forearm in adults

A

ORIF with plate and screws

141
Q

In a colles fracture there is often an associated injury of ?

A

The ulnar syloid

142
Q

What is A specific late local complication of Colles fractures

A

rupture of the extensor pollicus longus tendon

143
Q

Smiths fractures are usually stable / unstable?

What is the management?

A

Usually unstable

Management: ORIF using plate and screws

144
Q

If a scaphoid fracture is suspected clinically but the x‐ray fails to demonstrate a fracture, what do you do?

A

Splint the wrist - and further clinical assessment +/‐ further x‐ray is arranged around two weeks after the injury

145
Q

Typical management of a scaphoid fracutre?

A

Plaster cast for 6-12 weeks

146
Q

pain, a drooped DIPJ of the affected finger and inability to extend at the DIPJ - what does this describe?
How do you treat it?

A

Mallet finger

Treat: splint for at least 4 weeks

147
Q

Long term bisphospinate use for osteoporosis can cause which strange complication?

A

Stress fracture ( commonly seen in femoral shaft)

148
Q

Osteosarcoma is most common in adults/children. It usually affects which region of long bones?

A

Children

Metaphyseal region

149
Q

Pain is elicited during wrist flexion and pronation

  • tennis elbow
  • golfers elbow
A

Golfers elbow

150
Q

Tennis elbow

  • medial epicondylitis
  • lateral epicondylitis
A

Tennis elbow - lateral epicondylitis

- pain elicited during wrist extension and supination

151
Q

Which is more likely to present with pain and weakness?

  • polymyalgia rheumatica
  • polymyositis
A

Polymyositis

152
Q

Name 4 side effects of using steroids

A

Cataracts
Thin skin
Osteoporosis
weight gain

153
Q

What should you co-prescribe along with steroids in a post-menopausal woman with Polymyalgia rheumatica (+GCA)

A

Refer for Dexa scan

Start bisphosphinates

154
Q

Mainstay of treatment for ankylosing spondylitis

A

NSAIDs and physiotherapy exercises

155
Q

If in spite of trying 2 NSAIDS for ank spon for a period of 4 WEEKS EACH but not working, what do you do?

A

Introduce biologic agents

- anti-TNF agents

156
Q

Treatment of distal femur fracture

A

these fractures are usually fixed with a plate and screws as the fracture position is difficult to maintain in a cast

157
Q

Patellar dislocations are usually medial/lateral?

A

Lateral

158
Q

Common complication of intra-articular fractures

A

Post-traumatic osteoarthritis

159
Q

Which nerve causes foot drop

A

Injury to the common peroneal nerve

160
Q

Ankle injuries are most often inversion. True or false?

A

True

161
Q

In the foot, what is a common site for a stress fracture?

A

2nd metatarsal

162
Q

Be suspicious of which condition if you have a patient
with prolonged ENT symptoms not responding to
conventional treatment. Sinusitis, nasal crusting and
blockage, epistaxis, collapse of nasal cartilage due to
necrosis causing a saddle nose deformity can all
occur.

A

GPA

163
Q

The presence of red cell casts in the urine indicates

A

Glomerulonephritis

164
Q

What is the screening test for small vessel vasculitis?

A

ANCA

165
Q

cANCA or pANCA in GPA?

A

cANCA

166
Q

cANCA or pANCA in IBD?

A

pANCA

167
Q

What is the treatment of vasculitis?

A

Immunosuppression with steroids and steroid sparing agents (methotrexate)

168
Q

Pneumocystis jirovecii prophylaxis with

Which antibiotic? in patients getting cyclophosphamide

A

Co-trimoxazole

169
Q

Name 5 early local complications of joint replacement

A 
Infection 
Dislocation / instability 
Nerve injury 
Bleeding 
DVT
170
Q

Which nerve entrapment causes cubital tunnel syndrome?

A

Ulnar nerve at elbow

171
Q

What is a sequestrum?

A

Dead fragment of bone

172
Q

An acute osteomyelitis in the absence of recent surgery usually occurs in children/adults ?

A

Children

173
Q

What is the most common causative organism for osteomyelitis?

A

Staph aureus

174
Q

For mechanical back pain, bed rest is advised. True or false?

A

False

175
Q

L3/4 prolapse > causes L? root entrapment > pain down to

A 
L4 root entrapment 
medial ankle (L4), loss of quadriceps power, reduced knee jerk
176
Q 
pain down dorsum of foot, reduced power Extensor Hallucis Longus and tibialis anterior - this suggests 
- L4
- L5
- S1 
entrapment?
A

L5 entrapment

177
Q 
pain to sole of foot, reduced power planarflexion, reduced ankle jerks - this suggests 
- L4 
- L5
- S1 
entrapment?
A

S1 entrapment

178
Q

What nerve roots does sciatica typically affect?

A

L4, L5, S1

179
Q

Urgent imaging investigation for ?cauda equinae syndrome?

A

MRI scan

180
Q

Cervical myelopathy has UMN signs. True or false?

A

True

181
Q

atlanto‐axial subluxation can occur in which rheumatology condition?

A

Rheumatoid arthritis

182
Q

Which 3 muscles attach to the greater tuberosity of the shoulder joint

A

supraspinatous
infraspinatous
teres minor

183
Q

Which rotator cuff muscle is responsible for external roatation

A

Infraspinatous + teres minor

184
Q

Which rotator cuff muscle is responsible for initiation of abduction ?

A

Supraspinatous

185
Q

Which rotator cuff muscel is responsible for internal rotation?

A

Subscapularis

186
Q

In impingement syndrome, which muscle is most likely to be affected?

A

Supraspinatous

187
Q

First line management of impingement syndrome

A

NSAIDs
Analgesia
Physiotherapy
Subacromial Intraarticular steroid injection (up to 3)

188
Q

What is the principal clinical sign of frozen shoulder?

A

loss of external rotation

189
Q

Which surgery is done if there are recurrent shoulder dislocations / instability ?

A

Bankart repair

190
Q

Which nerve passes through the carpal tunnel ?

A

Median nerve

191
Q

On examination there may be demonstrable loss of sensation and/or muscle wasting of the thenar eminence - this makes you think

A

Carpal tunnel syndrome (median nerve compression)

192
Q

Movement of the finger produces a clicking sensation, as this nodule catches on and then passes underneath the pulley. This sensation may be painful and the finger may lock in a flexed position as the nodule passes under the pulley but can’t go back though on extension. The patient may have to forcibly manipulate the finger to regain extension, usually with pain. Any finger can be affected but the middle and ring are those most commonly affected.

  • trigger finger
  • dupetrynes contracture
A

Trigger finger

193
Q

WHat is the most likely management of trigger finger

A

Intra-articular steroid injections

194
Q

The 1st carpo‐metacarpal joint (trapziometacarpal joint) at the base of the thumb metacarpal is commonly affected by OA/RA

A

OA

195
Q

What is the most common soft tissue swelling of the hand?

A

Ganglion cyst

196
Q

pain and tenderness in the region of the greater trochanter with pain on resisted abduction.
this makes you think

A

Trochanteric bursitis

197
Q

The MCL in the knee resists valgus/varus force?

A

Valgus

198
Q

twisting force on a loaded knee (eg turning at football, squatting). The patient localizes pain to the medial (majority) or lateral joint line and an effusion develops by the following day - this suggests which type of injury

A

Meniscal tear

199
Q

turning the upper body laterally on a planted foot (leading to internal rotation force on the tibia), often at football, rugby, skiing or another high impact sport. A “pop” is usually felt or heard and the patient usually develops a haemarthrosis (an effusion due to bleeding in the joint) - what injury does this suggest

A

ACL rupture

200
Q

burning pain and tingling radiating into the affected toes. Women are four times more commonly affected and the wearing of high heels has been implicated as a cause. The third interspace nerve is most commonly involved followed by the second. Clinical examination may reveal loss of sensation in the affected web space. - what is the likely pathology?

A

Morton’s neuroma

201
Q

hyperextension at the MTPJ with hyperflexion at the PIPJ and DIP

  • claw toe
  • hammer toe
A

Claw toe

202
Q

What degree of fixed flexion deformity in dupetryns is required at the MCPJs for a patient to fail the Hueston Table Top Test?

a. >50 degrees
b. >10 degrees
c. >70 degrees
d. >30 degree

A

D - over 30 degrees

203
Q

The thickest hyaline cartilage in the body is found on the articular surface of which bone?

a. Talar dome
b. Patella
c. Femoral head
d. Radial head
e. Tibial plateau

A

Patella

204
Q

Adhesive capsulitis is a disorder characterized by progressive pain and stiffness of the shoulder in patients between 40 and 60, resolving after around 18‐24 months. Patients will initially complain of pain, which will subside (after around 2‐9 months) as stiffness increases (for around 4‐12 months) and then the stiffness gradually “thaws” out over time, usually with good recovery of shoulder motion.

The principle clinical sign on examination is restriction of shoulder movement in which direction?

a. Flexion
b. Abduction
c. Internal rotation
d. External rotation

A

External rotation

205
Q

A varus malalignment of the knee will predispose the patient to early osteoarthritis of which compartment of the knee?
medial
lateral

A

Medial

206
Q

Hip and knee joint arthroplasty is a common elective orthopaedic operation. From the list below, choose the chief indication for performing this operation. Please select only one answer:
To increase strength at the joint
To improve function
To improve range of movement at the joint (reduce stiffness)
Pain

A

Pain

207
Q

multiple fragility fractures of childhood, short stature with multiple deformities, blue sclerae and loss of hearing. What is the likely diagnosis?

A

Osteogenesis imperfecta

208
Q

What is the medical name for short stature?

A

Skeletal dysplasia

209
Q

Which disorder does this suggest

  • marfans
  • ehlers danlos
  • down syndrome
A

Marfans syndrome

210
Q

How do you confirm the diagnosis of duchenes muscular dystrophy?

A

raised serum creatinine phosphokinase and abnormalities on muscle biopsy

211
Q

More at risk of getting compartment syndome with

  • high energy open fracture
  • closed fracture
A

High energy open fracture (surprisingly)

212
Q

If someone has potential compartment syndrome, what would the symptoms be and how would you assess?

A

Pain pain pain pain pain
pain around the fracture site
tense when you palpate
assess pain on passive stretch of the affected compartment
- flex big toe for posterior compartment
- extend big toe for anterior compartment

213
Q

What is the key management of compartment syndrome

A

fasciotomy

214
Q

Sensation: First dorsal web space in back of hand . Which nerve is responsible

A

Radial nerve

215
Q

Motor: which nerve is responsible for abduction and adduction of the fingers?

A

Ulnar nerve

216
Q

Motor: which nerve is responsible for making a fist?

A

Median nerve

217
Q

Sensation: first dorsal web space in foot. Which nerve is responsible?

A

Deep peroneal nerve

218
Q

Treatment of choice for extracapsular hip fracture

A

Dynamic hip screw

219
Q

Child with bone pain worse at night, fever, swelling. What is this typical of?

A

Osteosarcoma

220
Q

Which typical type of bone is osteosarcoma most common in

A

Long bone

221
Q 
What is cervical spondylosis? 
Slipping of cervical vertebrae 
Crushing of cervical vertebrae 
Degenerative osteoarthritis of the neck 
Degenerative rheumatoid arthritis of the neck 
The same as ankylosing spondylitis
A

Degenerative osteoarthritis of the neck

222
Q 
A 65-year-old woman patient presents with gross irreversible retinopathy. Which of the following DMARDs is most likely to be responsible?
Methotrexate
Gold
Anti-TNF therapy
Prednisolone
Hydroxychloroquine
A

Hydroxychloroquine

223
Q

Which nerve supplies the posterior compartment of the leg?

A

Tibial nerve

224
Q

Which nerve supplies the posterior compartment of the thigh?

A

sciatic nerve

225
Q 
80-year-old man presents with pathological fracture. On X-ray there is thickened, brittle and mis-shaped bones, including pelvis and femur. There is excessive osteoclast reabsorption and increased osteoblast activity. Bone scans show increased uptake in the area. Blood tests show normal calcium, normal phosphate, normal PTH and increased ALP. Diagnosis?
A – Osteoporosis 
B - Paget’s Disease
C - Osteoarthritis 
D - Bony Mets 
E – Osteomalacia
A

Padgets

- everything normal but Raised ALP

226
Q 
A 19 year old male is playing football when another player’s boot collides with the outside of his leg. There is pain and about 4 hours later there is stiffness, bruising and swelling. The pain is felt on the medial aspect of the knee. On examination, there is abnormal passive abduction of the knee. What is the most likely diagnosis? 
A – MCL
B – LCL 
C – ACL
D – PCL
E – meniscus
A

MCL

227
Q 
Patient has a positive Steinman’s test – pain is worse on internal rotation, better on external rotation
A – ACL tear
B – PCL tear
C - Lateral meniscal tear
D – Medial meniscal tear 
E – Lateral collateral tear
A

Lateral meniscal tear
Pain is worse on internal rotation that means the outside (lateral) ligament is more stretched to allow the leg to move inwards

Y4 (23 decks)

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