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
A 7-year-old boy is brought in by his mother. For the past day he has felt generally unwell with a headache and nausea. This morning he complained of pain in his right hip and now just able to walk with a limp. On examination flexion, extension and rotation of the hip is painful and limited. Examination of the ears, throat and chest is normal. His temperature is 38.2ºC.
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
Septic Arthritis
This boy needs to admitted for further evalulation of a suspected septic hip joint. There is no obvious alternative focus to explain his fever.
This degree of pain and fever is not common in transient synovitis.
4-year-old girl with a three month history of a limp. Her parents report that she has ‘not been right’ for a few weeks now. She typically complains of pain in her left hip and right knee in the morning which gets better during the day.
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
Juvenile idiopathic arthritis
A 4-year-old girl presented with sore left little finger after a door closed on it. A resulting radiograph shows a fracture line that passes through the metaphysis, growth plate, and epiphysis. What type of fracture is this?
Salter harris 1 Salter harris 2 Salter harris 3 Salter harris 4 Salter harris 5
Salter harris 4
A 55-year-old woman presents to the Emergency Department with new back pain. She describes the pain radiating down the back of her left leg into her big toe and she has an associated weakness of her left leg which is stopping her from walking. She reports not having been able to pass urine all day despite feeling as though she needs to go.
On examination she has a 4/5 weakness of the right leg throughout and a 3/5 weakness of the left leg throughout. Her reflexes are absent on her left and reduced on her right. She has a loss of pin prick sensation throughout the L5, S1 and S2 dermatomes on the left as well as in her perineum. On digital rectal examination she has a loss of perianal sensation with normal anal tone but a reduced anal squeeze.
Given the suspected diagnosis, which of the following investigations is most appropriate?
MRI of lumbar within 6 hours
MRI of lumbar within 72 hours
CT of lumbar within 6 hours
CT of lumbar within 72 hours
MRI of lumbar within 6 hours
Features in keeping with cauda equina require an urgent MRI
A 23-year-old female presents with a painless swelling on the back of her wrist
Of the following options, what is the most appropriate management?
arrange USS
inject sclerosing agent
reassurance
check FBC
reassurance
A 75-year-old man presents with lower back pain that comes on when he walks. After taking a full history and completing a neurological and vascular examination which is normal a diagnosis of spinal stenosis is suspected. After prescribing analgesia, what is the most appropriate next step?
lumbar spine Xray Arrange phsyiotherapy refer for duplex scam Refer for MRI perform myeloma screen
Refer for MRI
This presentation requires a MRI to confirm the diagnosis of spinal stenosis and exclude other causes such as metastatic disease.
A 72-year-old diabetic gentleman attends with a painful stiff right shoulder with restriction in all movements. He reports being right handed and is no longer able to play bowls due to pain. You suspect adhesive capsulitis.
Which of the following factors are associated with adhesive capsulitis?
playing bowls
age 60-80
male
Hx of DM
Hx of DM
Diabetes mellitus is a risk factor for developing adhesive capsulitis
Which one of the following is a risk factor for congenital hip dislocation?
polyhydraminos male macrosomia breech presentation maternal hypothyroidism
breech presentation (fetus is lieing in stomach with buttocks closest to cervix and cross legged
A 40-year-old woman presents with new onset dull lower back pain since moving home. She is normally fit and well. She has a normal examination with no neurology or concerning features.
What would be the first-line treatment for her pain?
paracetamol amitriptyline diazepam naproxen physiotherapy
naproxen
NSAIDS are first line for lower back pain
A 55-year-old man presents as he has noticed thickening of the ‘tendons’ on both hands:
Which one of the following is least associated with this condition?
\+ve FHx phenytoin Tx manual labour alcholic liver disease CKD
CKD
An 83-year-old lady with a background of dementia is found on the floor in her nursing home. She is brought to the Emergency Department and complains of left sided hip pain and is unable to weight bear. Plain films of the hip and pelvis are unremarkable. Despite adequate analgesia she still complains bitterly of hip pain and remains non-weight-bearing. What is the next most appropriate action?
MRI hip
CT hip
Bone scan
Repeat plain films
MRI hip
A 45-year-old woman complains of painful tingling in her fingers. The pain is relieved by hanging the arm over the side of the bed. She has a positive Tinel’s sign. Which of the following is most likely to contribute to her diagnosis?
MTX use Crohns disease Hyperthyroidism TB RA
RA
This woman has a diagnosis of carpal tunnel syndrome. Rheumatological disorders are a common cause.
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?
swan neck deformity
dupuytren’s contracture
trigger finger
mallet finger
trigger finger
A 35-year-old female presents with pain on the radial side of the wrist and tenderness over the radial styloid process. On examination, abduction of the thumb against resistance is painful, and when the thumb is flexed across the palm of the hand, pain is reproduced by movement of the wrist into flexion and ulnar deviation. What is the most likely diagnosis?
carpal tunnel syndrome de quervain's tenosynovitis polymyalgia rheumatica RA flexor tenosynovitis
de quervain’s tenosynovitis
Pain over radial styloid process on forced abduction or flexion of the thumb (+ve Finkelstein test) - De Quervain’s tenosynovitis
A 56-year-old motorcyclist is involved in a road traffic accident and sustains a displaced femoral shaft fracture. Not other injuries are identified on the primary or secondary surveys. The fracture is treated with closed, antegrade intramedullary nailing. The following day the patient becomes increasingly agitated and confused. On examination he is pyrexial, hypoxic SaO2 90% on 6 litres O2, tachycardic and normotensive. Systemic examination demonstrates a non blanching petechial rash present over the torso. What is the most likely explanation for this?
PE fat embolism meningococcal sepsis alcohol withdrawal chronic sub dural haematoma
fat embolism
This man has a recent injury and physical signs that would be concordant with fat embolism syndrome
Triad of symptoms:
Respiratory
Neurological
Petechial rash (tends to occur after the first 2 symptoms)
A 22-year-old male patient presents with thoracic back pain that came on acutely 3 days ago. He finds the pain is worse on movement and turning over in bed. He has been taking regular co-codamol with no effect. He has a past medical history of Crohn’s disease but is on no regular medication. On examination, he has restricted range of motion and can not touch his toes due to pain.
What factor within the history would be considered a red flag and warrant further investigation?
past medical Hx ofcrohns age 22 thoracic back pain acute onset pain worse on movement
thoracic back pain
Thoracic pain is a red flag in patients presenting with back pain
A 14-year-old boy is brought to surgery by his mother. For the past two weeks he has been complaining of pain in his distal right thigh, which is made worse when he runs. On examination he is noted to be obese and have a full range of movement in the right knee. He is able to flex his right hip fully but internal rotation is painful. What is the most likely diagnosis?
Perthes disease
medial collateral ligament strain
SUFE
SUFE
Slipped upper femoral epiphysis - typically an overweight adolescent boy with knee / hip problems
A 25-year-old male attended the emergency department after dislocating his shoulder while playing rugby. His shoulder was reduced in the emergency department and then put into a sling. Following this, the emergency department doctor tested for sensation in the ‘ regimental badge area’, which was normal. Which nerve is commonly injured during a dislocation of the shoulder joint, and the one in which the emergency department doctor was testing?
radial nerve
ulnar nerve
axillary nerve
median nerve
axillary nerve
A 22-year-old male presents to the emergency room with pain in the left knee following a twisting injury during a rugby match. He states that it has gradually swollen over the past 24 hours, and he is unable to fully extend it. On examination you note tenderness over the medial joint line, a joint effusion, and the joint is held in a flexed position. There is no laxity on valgus stress test.
medial meniscus tear lateral meniscus tear ACL tear PCL tear medial collateral ligament tear
medial meniscus tear
valgus = knock kneed varus = bow legged
no laxity on valgus stress test - shows medial mensicus isnt working properly
A 57 year - old lady presents with a three month history of pins and needles in the fingers of the right hand, particularly at night. On examination, there is some loss of the sensation over the palmar aspect of the lateral three fingers and wasting of the thenar eminence.
A. de Quervain's tenosynovitis B. Dupuytren's contracture C. Bouchard's nodes D. Ganglion E. Carpal tunnel syndrome
Carpal tunnel syndrome
Carpal tunnel syndrome 91%
Carpal tunnel syndrome commonly produces pain at night as the wrists are flexed during sleep. Compromise of the median nerve may produce wasting of the thenar eminence muscles.
A 66-year-old lady presents with pain in her right hip. It has been increasing over the previous three weeks and waking her from sleep. On examination she is tender on internal rotation. Blood tests reveal a mildly elevated serum calcium and alkaline phosphatase levels.
A. Osteogenesis imperfecta B. Osteoporosis C. Rickets D. Pagets disease E. Chondrosarcoma F. Metastatic breast cancer
Metastatic breast cancer
Increasing pain at rest, together with increased serum calcium and alkaline phosphatase are most likely to represent metastatic tumour to bone. Chondrosarcomas do occur in the pelvis but are not associated with increased serum calcium and typically have a longer history.
A 73-year-old man presents with pain in the right leg. It is most uncomfortable on walking. On examination he has a deformity of his right femur, which on x-ray is thickened and sclerotic. His serum alkaline phosphatase is elevated, but calcium is within normal limits.
A. Osteogenesis imperfecta B. Osteoporosis C. Rickets D. Pagets disease E. Chondrosarcoma F. Metastatic breast cancer
Pagets disease
A 73-year-old lady presents with pain in her left hip. She was walking around the house when she tripped over a rug and fell over. Apart from temporal arteritis which is well controlled with prednisolone she is otherwise well. On examination he leg is shorted and externally rotated.Her serum alkaline phosphatase and calcium are normal.
A. Osteogenesis imperfecta B. Osteoporosis C. Rickets D. Pagets disease E. Chondrosarcoma F. Metastatic breast cancer
Osteoporosis
