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Pass Med finals pack > Orthopaedics 1 > Flashcards

Orthopaedics 1 Flashcards

1
Q

24 y/o male

  • 2 month hx localised spine pain
  • worse on movement
  • IVDU
  • no hx of TB
  • excruciating pain at rest
  • not improving with analgesia
  • 39 degrees temp

possible diagnosis?

A

osteomylelitis

differential diagnoses:

  • Osteosarcoma
  • Traumatic stress fracture
  • Inflammatory arthritis
  • Gout
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2
Q

likely organism causing osteomylelitis

A

staph aureus

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3
Q

most commonly affected region in osteomyelitis

A

cervical spine

TB tends to affect thoracic spine

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4
Q

22 y/o male

  • shot in lumbar region of back
  • increased tone and hyperreflexia in right leg
  • cannot feel left leg

diagnosis?

A

Brown-sequard syndrome
- caused by hemisection of the spinal cord

  • ipsilateral paralysis (pyrimidal tract)
  • loss of proprioception and fine discrimination (dorsal columns)
  • pain and temp sensation lost on contra-lateral side
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5
Q

spinal disorders:

loss of pain, sensation and temperature

A

spinothalamic tract lesion

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6
Q

spinal disorders:

flaccid paralysis of the upper limbs

A

central cord lesion

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7
Q

spinal disorders:

  • normally progressive
  • staph aureus in IVDU
  • normally cervical region affected
  • fungal infections in immunocompromised
  • thoracic region affected in TB
A

Osteomyelitis

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8
Q

spinal disorders:

  • dorsal column signs
  • loss of proprioception
  • loss of fine discrimination
A

infarction spinal cord

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9
Q

spinal disorders:

  • UMN signs
  • malignancy
  • haematoma
  • fracture
A

cord compression

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10
Q

spinal disorders:

  • hemisection of spinal cord
  • ipsilateral paralysis
  • ipsilateral loss of proprioception
  • ipsilateral loss of fine discrimination
  • contralateral loss of pain and temperature
A

brown-sequard syndrome

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11
Q

dermatome:

elbow flexors/ bicep

A

C5

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12
Q

dermatome:

wrist extensor

A

C6

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13
Q

dermatome:

elbow extensor / triceps

A

C7

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14
Q

dermatome :

long finger flexors

A

C8

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15
Q

dermatome:

small finger abductors

A

T1

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16
Q

dermatome:

hip flexors (psoas)

A

L1 and L2

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17
Q

dermatome:

knee extensors (quadriceps)

A

L3

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18
Q

dermatome:

ankle dorsiflexors (tibialis anterior)

A

L4 and L5

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19
Q

dermatome:

toe extensors (hallucis longus)

A

L5

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20
Q

dermatome:

ankle plantar flexors (gastrocnemius)

A

S1

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21
Q

management for subluxation of the radial head

A

passive supination of the elbow joint

whilst flexed to 90 degrees

analgesia

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22
Q

why is subluxation of the radial head (pulled elbow) the most common upper limb injury in children under 6

A
  • in this age group

- distal attachment of the annular ligament covering radial head is weaker in children in this group

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23
Q

A FRAX score of 10% or greater is considered to indicate

A

high risk of suffering fragility fracture in the next 10 years

value is threshold for arranging a DEXA scan

24
Q

where are stress fractures most common

A
  • 2nd metatarsal
  • this is the longest metatarsal bone
  • thin and vulnerable to stress fractures
25
Q

pain over radial styloid on forced abduction/flexion of thumb is

A

finkelstein test positive

patient most likely has de quervains tenosynovitis

26
Q

common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed

A

De Quervain’s tenosynovitis

27
Q

management of De Quervain’s tenosynovitis

A
  • analgesia
  • steroid injection
  • immobilisation wit a thumb splint
  • surgical treatment?
28
Q

the following clinical features show damage to which nerve:

Weakness in knee extension, loss of the patella reflex, numbness of the thigh

A

femoral nerve

29
Q

the following clinical features show damage to which nerve:

Weakness in ankle dorsiflexion, numbness of the calf and foot

A

lumbosacral trunk

30
Q

the following clinical features show damage to which nerve:

Weakness in knee flexion and foot movements, pain and numbness from gluteal region to ankle

A

sciatic nerve

31
Q

the following clinical features show damage to which nerve:

Weakness in hip adduction, numbness over the medial thigh

A

obturator nerve

32
Q

most nerve injuries recover within how many weeks

A

6 - 8 weeks

occasionally nerve damage can be permanent

33
Q

a patient with a sub trochanteric fracture fixed with an intramedullary nail should weight bear how soon post op?

A

immediately as long as tolerated.

reduced risk associated with prolonged immobilisation
- venous thromboembolism

34
Q

Reshma is a 68-year-old with a history of type 2 diabetes who has presented with intermittent tingling of her left 4th and 5th fingers.

A

cubital tunnel syndrome

  • caused by compression of ulnar nerve
  • can present with tingling and numbness of the 4th and 5th finger
35
Q

Carpal tunnel syndrome is caused by…

A
  • median nerve entrapment in the wrist

- affects the 1st, 2nd, 3rd fingers plus lateral side of 4th finger

36
Q

A teenage girl with knee pain on walking down the stairs is characteristic for

A

chondromalacia patellae
- anterior knee pain

managed with physio

37
Q

15 y/o boy

  • 3 week hx knee pain
  • worse with activity
  • settles with rest

OE

  • tenderness over tibial tuberosity
  • associated swelling at this site

Indicative of:

A

Osgood Schlatters disease

OSD is a traction phenomenon resulting from repetitive quadriceps contraction through the patellar tendon at its insertion upon the skeletally immature tibial tubercle

38
Q

what is the most appropriate imaging modality to diagnose meniscal tears?

A

magnetic resonance imaging

39
Q

32 y/o rugby player presents with a painful knee.

  • pain worse on straightening the knee
  • knee might give way
  • displaced meniscal tears may cause knee locking tenderness along the joint line

indicative of:

A

meniscal tear

40
Q

what is the most common cause of osteomyelitis?

A

staphylococcus aureus

41
Q

weakness of hip abduction and foot drop, no specific reflex los

indicative of compression of which nerve root:

A

L5 radiculopathy

42
Q

which nerve root compression would present with sensory loss over the anterior aspect of the knee, weakened quadriceps, and a reduced knee reflex:

A

L4 nerve root compression

43
Q

which nerve root compression would present with sensory loss over the anterior thigh,

weakened quadriceps, and a reduced knee reflex:

A

L3 nerve root compression

44
Q

which nerve root compression would present with back, groin, and anterior thigh pain.

There may be weakness of hip flexion but lower limb reflexes tend to be normal:

A

L2 nerve root compression

45
Q

which nerve root compression typically presents with sensory loss of the posterolateral aspect of the leg

and lateral aspect of the foot.

There may be weakness of foot plantar flexion

and a reduced ankle reflex:

A

S1 nerve root compression

46
Q

82 y/o woman admitted with fall
- diagnosed with displaced intracapsular fracture of the hip

  • she has hypertension, mild cognitive impairment, and osteoarthritis.
  • she appears frail, normally walks with aid of Zimmer frame

what is the correct surgical management?

A

patient not suitable for a total hip replacement due to

  • decreased mobility
  • cognitive impairment
  • general frailty

correct treatment: cement hemiarthroplasty

47
Q

give some examples of red flags for lower back pain:

A
  • age < 20 years
  • history of previous malignancy
  • night pain
  • history of trauma
  • weight loss, fever, systemically unwell
48
Q

patient presents with:

  • pain on walking, relieved by rest
  • absent of weak foot pulses and other signs of limb ishcaemia
  • past history may include smoking and other vascular diseases

indicative of:

A

peripheral arterial disease

49
Q

what is important to do in the presence of a displaced ankle fracture:

A
  • reduce the ankle fracture asap

- due to risk of damage to the skin

50
Q

a fracture resulting in a shortened, externally rotated leg:

A

neck of femur fracture

Garden classification system

51
Q

a shortened, internally rotated leg suggests:

A

posterior dislocation

52
Q

The affected leg is shortened, adducted, and internally rotated…

type of hip dislocation:

A

posterior dislocation

53
Q

The affected leg is usually abducted and externally rotated. No leg shortening.

type of hip dislocation:

A

anterior dislocation

54
Q

squaring of the thumb is characteristic of…

A

osteoarthritis

  • bony outgrowths at the basilar joint of the thumb
55
Q

condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed…

A

De Quervain’s tenosynovitis

typically affects 30 - 50 years old

56
Q

indicative of:

pain on the radial side of the wrist
tenderness over the radial styloid process
abduction of the thumb against resistance is painful
Finkelstein’s test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus

A

De Quervain’s tenosynovitis

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