Orthopaedic Questions Flashcards
A 23-year-old rugby player falls directly onto his shoulder. There is pain and swelling of the shoulder joint. The clavicle is prominent and there appears to be a step deformity.
A. Glenohumeral dislocation B. Acromioclavicular dislocation C. Sternoclavicular dislocation D. Biceps tendon tear E. Supraspinatus tear F. Fracture of the surgical neck of the humerus G. Infra spinatus tear
Acromioclavicular dislocation
Acromioclavicular joint (ACJ) dislocation normally occurs secondary to direct injury.
Loss of shoulder contour and prominent clavicle are key features.
A 22-year-old man falls over and presents to casualty. A shoulder x-ray is performed, the radiologist comments that a Hill-Sachs lesion is present.
A. Glenohumeral dislocation B. Acromioclavicular dislocation C. Sternoclavicular dislocation D. Biceps tendon tear E. Supraspinatus tear F. Fracture of the surgical neck of the humerus G. Infra spinatus tear
Glenohumeral dislocation
A Hill-Sachs lesion is when the cartilage surface of the humerus is in contact with the rim of the glenoid. About 50% of anterior glenohumeral dislocations are associated with this lesion.
An 82-year-old female presents to A&E after tripping on a step. She complains of shoulder pain. On examination there is pain to 90 degrees on abduction.
A. Glenohumeral dislocation B. Acromioclavicular dislocation C. Sternoclavicular dislocation D. Biceps tendon tear E. Supraspinatus tear F. Fracture of the surgical neck of the humerus G. Infra spinatus tear
Supraspinatus tear
A supraspinatus tear is the most common of rotator cuff tears.
It occurs as a result of degeneration and is rare in younger adults.
A 30-year-old man attends complaining of pain on the inner side of his right elbow and forearm since he built a bookcase at home 3 days ago. He is normally fit and well and on no regular medication. On examination you elicit some tenderness of the medial elbow joint and the patient reports discomfort felt in the elbow on resisted pronation of the wrist. What is the likely diagnosis?
golfer’s elbow
tennis elbow
de quervain’s tenosynovitis
olecranon bursitis
golfer’s elbow
Golfer’s elbow or medial epicondylitis produces tenderness over the medial epicondyle and medial wrist pain on resisted wrist pronation.
A young Bangladeshi man presents to the emergency department with back pain and a fever. An MRI is performed and a diagnosis of discitis is made. A CT guided biopsy is performed and cultures were taken. They come back showing Staphylococcus aureus as the causative organisms and antibiotic therapy was started based off of sensitivity testing. 2 weeks later he returns to the emergency department as he has spiked another fever and the back pain is worsening.
Which of the following may be the cause of this patients worsening features?
acute pyelonephritis
epidural abscess
epidural haematoma
vertebral metastasise
epidural abscess
Epidural abscess is a complicaiton of discitis
A 60-year-old male is admitted to A&E with a fall. He lives with his wife and still works as a restaurant manager. He has a past history of benign prostatic hypertrophy and is currently taking tamsulosin. He is otherwise fit and healthy. On examination there is right hip tenderness on movement in all directions. A hip x-ray confirms an intertrochanteric fracture.
A. Conservative management B. Percutaneous pinning C. Fracture reduction and internal fixation D. Hemiarthroplasty E. Total hip replacement F. Dynamic hip screw G. Intramedullary femoral nail
Dynamic hip screw
An 86-year-old retired pharmacist is admitted to A&E following a fall. She complains of right hip pain. She is known to have hypertension and is currently on bendrofluazide. She lives alone and mobilises with a Zimmer frame. Her right leg is shortened and externally rotated. A hip x-ray confirms a displaced intracapsular fracture
A. Conservative management B. Percutaneous pinning C. Fracture reduction and internal fixation D. Hemiarthroplasty E. Total hip replacement F. Dynamic hip screw G. Intramedullary femoral nail
Hemiarthroplasty
A 74-year-old male is admitted to A&E with a fall. He is known to have rheumatoid arthritis and is on methotrexate and paracetamol. He lives alone in a bungalow and enjoys playing golf. He is independent with his ADLs. He complains of left groin pain, therefore has a hip x-ray which confirms a displaced intracapsular fracture.
A. Conservative management B. Percutaneous pinning C. Fracture reduction and internal fixation D. Hemiarthroplasty E. Total hip replacement F. Dynamic hip screw G. Intramedullary femoral nail
Total hip replacement
A 15-year-old boy presents to the out-patient clinic with tiredness, recurrent throat and chest infections, and gradual loss of vision. Multiple x-rays show brittle bones with no differentiation between the cortex and the medulla.
Osteopetrosis
A 12-year-old boy who is small for his age presents to the clinic with poor muscular development and hyper-mobile fingers. His x-rays show multiple fractures of the long bones and irregular patches of ossification.
Osteogenesis imperfecta
A 1-year-old is brought to the Emergency Department with a history of failure to thrive. On examination, the child is small for age and has a large head. X-ray shows a cupped appearance of the epiphysis of the wrist.
: Rickets
A 75-year old male presents to the emergency room after being involved in a head-on car crash. He complains of severe pain in his left knee. On examination of the lower limbs, you note that the tibia displaces posteriorly on application of a force.
What is the most likely diagnosis?
patellar tear capsular tear meniscal tear ACL rupture PCL rupture
PCL rupture
The clinical case describes a positive posterior drawer test which is indicative of PCL damage
A 25-year-old man reports that he experienced a sharp pain in the back of his calf while he was playing football and had to go offside following this as he was struggling to walk. He is seen by his team doctor who examines him and remarks that he has a positive Simmond’s sign.
Which one of the following injuries is he likely to have sustained?
navicular bone fracture
achilles tendon rupture
posterior ankle impingement
stress metatarsal fracture
achilles tendon rupture
Achilles tendon rupture should be suspected if the person describes the following whilst playing a sport or running; an audible ‘pop’ in the ankle,
A 82-year-old woman is admitted from her nursing home following a fall. She is diagnosed with a displaced intracapsular fracture of the hip. She has hypertension, mild cognitive impairment, and osteoarthritis. She appears frail and normally walks with the aid of a zimmer frame. What is the correct surgical management?
total hip replacement
cement hemiarthroplasty
sliding hip screw
IM nail
cement hemiarthroplasty
6-year-old boy with a limp. His parents report that this has been getting steadily worse over the past few weeks. He complains of pain in the right groin/hip region. An x-ray shows widening of the right hip joint space with flattening of the femoral head.
A. Septic arthritis B. Perthes disease C. Transient synovitis D. Osteochondritis dissecans E. Juvenile idiopathic arthritis F. Development dysplasia of the hip G. Slipped upper femoral epiphysis
Perthes Disease
Pointers to Perthes:
gender: 5 times more common in boys
age: typical presents in children aged 4-8 years
x-ray findings
