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AKT > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

L3 nerve root compression

A

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex

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2
Q

L4 nerve root compression

A

Sensory loss knee
Weak quadriceps
Reduced knee reflex

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3
Q

L5 nerve root compression

A

Sensory loss dorsum of foot

Weakness in foot and big toe dorsiflexion

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4
Q

S1 nerve compression

A

Sensory loss lateral leg and lateral foot
Weakness in plantar flexion of foot
Reduced ankle reflex

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5
Q

Types of hip replacement

A

Cemented hip replacement most common

Uncemented hip replacements in active patients

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6
Q

Advice for patients with hip replacements to avoid dislocation

A

Avoid flexing hip >90 degrees
Avoid low chairs
Do not cross legs
Sleep on back for first 6 weeks

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7
Q

Complications of joint replacement

A

Infection
Thromboembolism
Dislocation

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8
Q

How long do patients receive LMWH for after hip replacement?

A

4 weeks

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9
Q

Scoring systems to assess risk of fracture

A

FRAX

QFracture

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10
Q

What does the FRAX scoring system estimate?

A

10 year risk of fragility fracture

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11
Q

Who is FRAX valid for?

A

Patients age 40-90 years

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12
Q

Factors included in FRAX

A 
age
sex
weight
height
previous fracture
parental fracture
smoking
steroids
RA
secondary osteoporisis
alcohol
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13
Q

What does QFracture estimate?

A

10 year risk of fragiity fracture

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14
Q

Who is QFracture valid for?

A

Age 30-99 years

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15
Q

Who should get a DEXA?

A

If FRAX is ‘intermediate”

If starting treatment with rapid effect on bone density

If <40 years and major risk factors

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16
Q

Who should be assessed for risk of fragility fracture?

A

Women over 65
Men over 75

Younger patients with risk factors

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17
Q

First line treatment for lower back pain

A

NSAIDs

+PPI if over 45

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18
Q

Who should get an MRI for their back pain?

A

Only if result will change management or red flags for malignancy, fracture, infection, ank spond or cauda equina

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19
Q

Features of acetabular labral tear

A

Hip/groin pain
Snapping sensation around hip
Occasional locking sensation

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20
Q

Associations with trigger finger

A

RA

Diabetes

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21
Q

Management of trigger finger

A

Steroid injection
Finger split
Surgery if no response to steroids

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22
Q

Investigations of Baker’s cysts

A

In children - ultrasound

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23
Q

What are myxoid cysts?

A

Benign ganglion cysts usually found on distal, dorsal aspect of the finger

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24
Q

What is associated with myxoid cysts?

A

Osteoarthritis

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25
Q

Causes of Dupuytren’s contracture

A 
Manual labour
Phenytoin
Alcoholic liver disease
Diabetes
Trauma to hand
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26
Q

Ottawa rules for ankle injury

A

Pain in the malleolar zone AND

  • bony tenderness at lateral malleolar
  • bony tenderness at medial malleolar
  • unable to walk 4 steps after injury and in the ED
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27
Q

What is a charcot joint?

A

Joint which has become badly disrupted and damaged secondary to a loss of sensation

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28
Q

Main cause of charcot joint

A

uncontrolled diabetes

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29
Q

Features of charcot joint

A

Joint pain

Joint is swollen, red and warm

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30
Q

Online risk stratification tool for lower back pain

A

StarT BACK

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31
Q

Test used for meniscal tear

A

Thessaly’s test

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32
Q

What is Thessaly’s test used for?

A

Meniscal tear

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33
Q

Features of meniscal tear

A

Pain worse on straining the knee
Knee may ‘give way’
Displaced meniscal tears may cause knee locking
Tenderness along joint line

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34
Q

Features of greater trochanteric pain syndrome

A

Pain over lateral side of hip/thigh

Tenderness on palpation of greater trochanter

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35
Q

Which nerve is compressed in carpal tunnel syndrome?

A

Median nerve

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36
Q

Causes of carpal tunnel syndrome

A 
Idiopathic
Pregnancy
Oedema e.g. heart failure
Lunate fracture
Rheumatoid arthritis
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37
Q

History in carpal tunnel syndrome

A

Pain/paraesthesia in thumb, index, middle finger

Shakes hand at night to relieve pain

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38
Q

Examination findings in carpal tunnel syndrome

A

Weakness of thumb abduction
Wasting of thenar eminance
Tinel’s sign
Phalen’s sign

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39
Q

Describe Tinel’s sign

A

Tapping over wrist causes paraesthesia

Test for carpal tunnel syndrome

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40
Q

Describe Phalen’s sign

A

Flexion of wrist causes symptoms

Test for carpal tunnel syndrome

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41
Q

Management of carpal tunnel syndrome

A

Corticosteroid injection
Wrist splint at night
Surgery - flexor retinaculum division

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42
Q

Findings in talipes equinovarus

A

Inverted and plantar flexed foot

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43
Q

What percentage of talipes equinovarus are bilateral?

A

50%

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44
Q

Associations with talipes equinovarus

A 
Spina bifida
Cerebral palsy
Edward's syndrome
Oligohydramnios
Arthrogryposis
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45
Q

Management of talipes equinovarus

A

Ponseti method

Manipulation and progressive casting from birth
Corrected by 6-10 weeks
May need achilles tenotomy
Braces at night till age 4
15% relapse rate
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46
Q

Which nerve is compressed in cubital tunnel syndrome?

A

Ulnar nerve

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47
Q

Features of cubital tunnel syndrome

A

Paraesthesia of 4th and 5th finger
Weakness and muscle wasting
Pain worse on leaning on affected elbow

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48
Q

Risk factors for osteoporotic fractures

A 
Advancing age
Previous fragility fracture
Steroid use
Falls
Family history of hip fracture
Low BMI
Smoking
Alcohol history
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49
Q

Signs of osteoporotic vertebral fractures

A

Loss of height
Kyphosis
Localised tenderness

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50
Q

Investigations for osteoporotic vertebral fractures

A

Xray spine 1st line
CT spine
MRI to check for other causes e.g. tumour
DEXA scan

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51
Q

What percentage of frozen shoulder is bilateral?

A

20%

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52
Q

How long does frozen shoulder last?

A

6 months to 2 years

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53
Q

Features of frozen shoulder

A

Active and passive movement restricted

External rotation most affected

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54
Q

Features of intersection syndrome

A

Pain in distal forearm, 5-10cm proximal of wrist

Swelling and erythema

55
Q

Who is affected by intersection syndrome?

A

Skiers
Tennis players
Weight lifters
Canoeists

56
Q

What is intersection syndrome?

A

A tenosynivitis
Symptoms in forearm above wrist
Seen in sporty folk

57
Q

Features of de Quervain’s tenosynovitis

A

Pain over radial side of wrist
Tenderness over radial styloid process
Abduction of thumb against resistance is painful
Finkelstein’s test

58
Q

What is the test for de Quervain’s tenosynovitis

A

Finkelstein’s test

59
Q

What does Finkelstein’s test test for?

A

De Quervain’s tenosynovitis

60
Q

Malignant fibrous histiocytoma

A

May arise from soft tissue and bone

Most common sarcoma in adults

61
Q

What is the most common cause of anterior heel pain?

A

Achilles tendon disorders

62
Q

Risk factors for achilles tendon disorders

A

Quinolones (e.g. ciprofloxacin)

Hypercholesterolaemia causing tendon xanthomata

63
Q

Features of achilles tendinopathy

A

Gradual onset posterior heel pain
Worse after activity
Morning pain and stiffness

64
Q

Management of achilles tendinopathy

A

Simple analgesia
Reduce activities that trigger pain
Calf muscle eccentric exercises

65
Q

History given in achilles tendon rupture

A

Sudden onset pain whilst playing sport
Audible pop
Can’t walk or continue exercise

66
Q

Examination findings in achilles tendon rupture

A

Palpable gap

Simmonds triad

67
Q

Investigations for achilles tendon rupture

A

Ultrasound

68
Q

In a patient with possible hip OA, which red flags should make you reconsider?

A

Rest pain
Night pain
Morning stiffness >2 hours

69
Q

Risk factors for hip OA

A

Increasing age
Female
Obesity
Developmental dysplasia of the hip

70
Q

Reasons for total hip replacement revision

A

Aseptic loosening (most common)
Pain
Dislocation
Fracture

71
Q

What is lumbar spinal stenosis?

A

Central canal narrowed by tumour, disc prolapse or other degenerative changes

72
Q

Features of lumbar spinal stenosis

A 
Back pain
Neuropathic pain, sciatica
Sitting relieves pain, sitting forward relieves pain
Walking uphill easier than downhill
Paraesthesia in leg
Foot drop
Sexual dysfunction
73
Q

Investigations for lumbar spinal stenosis

A

MRI

74
Q

Management of lumbar spinal stenosis

A

Laminectomy

75
Q

Features of lateral epicondylitis

A

Pain and tenderness at lateral epicondyle
Pain worse on resisted wrist extension with elbow extended
Pain worse on supination of forearm with elbow extended

76
Q

What is lateral epicondylitis also called?

A

Tennis elbow

77
Q

Formal name for tennis elbow

A

Lateral epicondylitis

78
Q

Features of medial epicondylitis

A

Pain and tenderness at medial epicondyle
Pain worse by wrist flexion and pronation
Paraesthesia of 4/5th finger due to ulnar nerve compression

79
Q

What is medial epicondylitis also called?

A

Golfers elbow

80
Q

Formal name for golfers elbow

A

Medial epicondylitis

81
Q

Features of olecranon bursitis

A

Swelling over posterior aspect of elbow

Pain, warmth, erythema

82
Q

Who usually gets olecranon bursitis?

A

Middle aged men

83
Q

Radial tunnel syndrome features

A

Pain 4-5cm distal to lateral epicondyle

Worse on extending forearm and pronating forearm

84
Q

Lower back pain - red flags

A 
Age <20 or >50
history of malignancy
night pain
history of trauma
systemically unwell (fever, weight loss)
85
Q

When to refer a patient with sciatica?

A

consider MRI if persistent symptoms at 4-6 weeks

86
Q

Management of lower back pain

A

Stay active

NSAIDS (+PPI if over 45)

87
Q

Morton’s neuroma - features

A

Forefoot pain - shooting/burning, worse on walking
Mulder’s click
Loss of sensation distally in toes

88
Q

What is Morton’s neuroma?

A

Benign neuroma affecting the intermetatarsal plantar nerve

89
Q

Most common location of Morton’s neuroma

A

3rd inter-metatarsophalangeal space

90
Q

Morton’s neuroma - diagnosis

A

Clinical

Ultrasound may be helpful

91
Q

Morton’s neuroma - management in primary care

A

Avoid high heels
Metatarsal pad
Refer if symptoms >3 months despite these

92
Q

Morton’s neuroma - management in secondary care

A

Metarsal dome orthotic
Corticosteroid injection
Neurectomy

93
Q

Injury of which nerve causes foot drop?

A

Common peroneal nerve

94
Q

Which area gets sensation from lateral cutaneous nerve of the thigh?

A

Lateral and posterior thigh

95
Q

Origin of axillary nerve

A

C5, C6

96
Q

Origin of median nerve

A

C6, C8, T1

97
Q

Sensory supply of median nerve

A

Palmar aspect of lateral 3 1/2 fingers

98
Q

Wrist lesion of median nerve presentation

A

Paralysis of thenar muscles and opponens pllicis

Carpal tunnel

99
Q

Elbow lesion of median nerve presentation

A

Loss of pronation of forearm

Weak wrist flexion

100
Q

Origin of ulnar nerve

A

C8, T1

101
Q

Motor supply of ulnar nerve

A

Intrinsic hand muscles

102
Q

Sensory supply of ulnar nerve

A

Medial 1 1/2 fingers

103
Q

What nerve is injured in claw hand?

A

Ulnar nerve

104
Q

How is the ulnar nerve commonly injured?

A

Medial epicondyl fracture

105
Q

Origin of long thoracic nerve

A

C5-C7

106
Q

Which muscle is innovated by the long thoracic nerve?

A

Serratus anterior

107
Q

Causes of long thoracic nerve injury

A

Sports injury e.g. chest wall collision

Complication of mastectomy

108
Q

What does damage to the long thoracic nerve result in?

A

Winged scapula

109
Q

Origin of radial nerve

A

C5-C8

110
Q

Motor function of radial nerve

A

Extension

111
Q

Sensory supply of radial nerve

A

Dorsal aspect between 1st and 2nd metacarpals

112
Q

Causes of injury to radial nerve

A

Humeral midshaft fracture

113
Q

What does radial nerve injury result in?

A

Wrist drop

114
Q

Origin of musculocutaneous nerve

A

C5-C7

115
Q

Motor function of musculocutaneous nerve

A

Elbow flexion and supination

116
Q

Sensory supply of musculocutaneous nerve

A

Lateral part of forearm

117
Q

What is osteochondritis dissecans?

A

A small part of bone separates due to lack of blood supply

Causes fragmentation of articular surface and intraarticular loose bodies

118
Q

Types of osteochondritis dissecans

A

Adult

Juvenile - when growth plate still open

119
Q

Features of osteochondritis dissecans

A 
Subacute onset
Knee pain and swelling after exercise
Knee catching and giving way
"Clunk" when flexing/extending
Joint effusion
120
Q

Investigations of osteochondritis dissecans

A

Xray = subchondral crescent sign, loose bodies

MRI

121
Q

Management of osteochondritis dissecans

A

Conservative = analgesia, immobilise, PT

Surgery

122
Q

Osteoarthritis of the hand - xray findings

A

Osteophytes

Joint space narrowing

123
Q

Osteoarthritis of the hand - features

A 
Bilateral
Carpometacarpal joints, DIP joints, PIP joint
Heberden's nodes
Bouchard's nodes
Squaring of the thumb
Episodic pain provoked by movement
Stiffness after rest lasts minutes
124
Q

What does Heberden’s nodes mean?

A

OA

125
Q

What does Buchard’s nodes mean?

A

OA

126
Q

Where are Heberden’s nodes found?

A

DIP

in OA

127
Q

Where are Buchard’s nodes found?

A

PIP

in OA

128
Q

What is meralgia paraesthetica?

A

Paraesthesia in distribution of lateral femoral cutaneous nerve

129
Q

Meralgia paraesthetica - causes

A

Entrapment of nerve under inguinal ligament

Iatrogenic - after surgery
Idiopathic
Trauma
Neuroma

130
Q

Meralgia paraesthetica - risk factors

A 
Obesity
Pregnancy
Tense ascites
Trauma
Diabetes
Sports = gymnastics, football, body building
131
Q

Meralgia paraesthetica - features

A

Symptoms in upper lateral aspect of thigh
Burning, tinging, shooting pain, numbness
Deep muscle ache
Worse on standing better sitting
Reproduce symptoms by deep palpation below ASIS

132
Q

Meralgia paraesthetica - investigations

A

Clinical diagnosis with pelvic compression test
Ultrasound
Injecting nerve with LA abolishes pain

133
Q

Meralgia paraesthetica - management

A 
Lose weight
NSAIDS
TENS
Pregabalin
Severe - decompressive surgery

AKT (20 decks)

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