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Medicine Finals > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What does the femoral nerve supply?

A

Motor = knee extension and thigh flexion

Sensory = anterior and medial aspect of thigh and lower leg

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2
Q

What is the most common indication for elective joint replacement?

A

Osteoarthritis

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3
Q

What are options for joint replacement?

A

Total joint replacement

Hemiarthroplasty

Partial joint resurfacing

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4
Q

What are complications of a hip replacement?

A

VTE

Fracture

Nerve injury

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5
Q

What are reasons for hip replacement revision?

A

Aseptic loosening (most common)

Infection

Dislocation

Pain

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6
Q

Which bones have a vulnerable blood supply?

A

Scaphoid

Femoral head

Humeral head

In the foot = talus, navicular, 5th metatarsal

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7
Q

What is a compound fracture?

A

The skin is broken and the broken bone is exposed to the air

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8
Q

What is a stable fracture?

A

The bone bone remains in alignment at the fracture

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9
Q

What is a pathological fracture?

A

Bone breaks due to an abnormality within the bone

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10
Q

Patient has fallen onto outstretched hand and now has tenderness in the anatomical snuffbox - what is this?

A

Scaphoid fracture

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11
Q

What is the risk of a scaphoid fracture?

A

Avascular necrosis due to the retrograde blood supply

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12
Q

What fracture causes a ‘dinner fork deformity’ of the hand?

A

Colle’s fracture (fracture of the distal radius)

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13
Q

Which classification is used to classify lateral malleolus fractures? How does this affect management?

A

Weber classification

Described in relation to the distal syndesmosis – fibrous join between the tibia and the fibula

Tibiofibular syndesmosis = very important for stability and function of ankle joint.

A = below ankle (will leave syndesmosis intact)

B = at level of ankle (syndesmosis may be intact or partially torn)

C = above ankle (syndesmosis will be disrupted)

If syndesmosis disrupted - surgery more likely to be needed

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14
Q

Which are the main cancers which metastasise to bone

A

PoRTaBLe

Prostate

Renal

Thyroid

Breast

Lung

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15
Q

What are complications of fractures?

A

Damage to local structures

Haemorrhage

Compartment syndrome

Fat embolism

Avascular necrosis

Infection

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16
Q

What is a fat embolism and how does it present?

A

Fat globules get released into the circulation following fracture of a long bone (e.g. femur)

Systemic inflammatory response - respiratory distress, petechial rash, cerebral involvement

Management is supportive

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17
Q

What are signs of a scaphoid fracture?

A

Tenderness over the anatomical snuffbox

Wrist joint effusion

Pain on ulnar deviation

Loss of grip/pinc strength

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18
Q

How can a scaphoid fracture be diagnosed?

A

MRI

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19
Q

How is a scaphoid fracture treated?

A

Initial management is to immobilise with a splint

Then..
Undisplaced = cast for 6-8 weeks

Displaced or in the scaphoid pole = surgical fixation required

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20
Q

After a fall on outstretched hands, the elbow is in a semi-flexed position with swelling - what is it?

A

Supracondylar fracture of the humerus

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21
Q

Sharp pain in elbow on pronation/supination after FOOSH - what is it ?

A

Radial head fracture

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22
Q

How is a rib fracture diagnosed?

A

CT chest

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23
Q

How is a rib fracture managed?

A

Conservatively with analgesia

Surgery if not healed by 12 weeks

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24
Q

What is a buckle fracture?

A

A type of fracture that occurs in children

One side of bone bends without breaking, forming a small buckle

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25
Q

What is a greenstick fracture?

A

Paediatric fracture

When only one side of the cortex is breached

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26
Q

What is a complete fracture?

A

Both sides of the cortex are breached

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27
Q

What are causes of pathological fractures in children?

A

Osteogenesis imperfecta

Osteopetrosis

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28
Q

What are risk factors for hip fractures?

A

Increasing age

Osteoporosis

Female

Prev fracture

parent w fracture

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29
Q

What are the two types of hip fractures? What are these in relation to?

A

In relation to the intertrochanteric line

Extracapsular (below the intertrochanteric line) –> This can be split into intertrochanteric and subtrochanteric

Intracapsular (above the intertrochanteric line)

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30
Q

Which type of hip fracture is more severe?

A

Intracapsular

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31
Q

How can we classify intracapsular hip fractures?

A

Garden classification

Type I = incomplete, non-displaced

Type II = complete, non-displaced

Type III = complete, partially displaced

Type IV = complete, completely displaced

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32
Q

How do you manage an intracapsular hip fracture? Displaced vs. non-displaced

A

Displaced = requires total hip arthroplasty or hemiarthroplasty

Non-displaced = internal fixation

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33
Q

What criteria does a patient need to meet for a total hip arthroplasty?

A

Able to walk independently

No cognitive impairment

Medically fit for procedure + anaesthesia

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34
Q

How is an extra capsular hip fracture managed?

A

Dynamic hip screw

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35
Q

How does a hip fracture present?

A

Pain in groin/hip

Pain may radiate to knee

Unable to weight bear

Shortened, abducted and externally rotated leg

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36
Q

What can you look for on pelvic x-ray to indicate a hip fracture?

A

Disruption of Shenton’s line

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37
Q

What are the two types of hip dislocation and how do they present?

A

Posterior hip dislocation = shortened, adducted, internally rotated

Anterior hip dislocation = abducted, externally rotated

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38
Q

What are complications of a hip dislocation?

A

Sciatic nerve injury

Avascular necrosis

Osteoarthritis

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39
Q

What are risk factors for avascular necrosis?

A

Long term steroid use

Chemotherapy

Alcohol excess

Trauma

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40
Q

What are signs of a vertebral fracture?

A

Loss of height

Kyphosis (curvature of spine)

Localised tenderness to palpation

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41
Q

What is seen on spinal X-ray in a vertebral fracture?

A

Wedging

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42
Q

What is compartment syndrome?

A

Complication that can occur following fractures/trauma

Causes increased pressure within the compartment which compromises tissue perfusion and leads to necrosis

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43
Q

What are the 2 main fractures that cause compartment syndrome?

A

Supracondylar fracture

Tibial shaft injuries

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44
Q

How does compartment syndrome present?

A

Disproportionate pain

Parasthaesia

Pallor

Pulses = present

Pulses may become absent in. later stages

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45
Q

How is compartment syndrome diagnosed?

A

Primarily clinical diagnosis

Needle manometry can show elevated intracompartmental pressure <40 = diagnostic

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46
Q

How is compartment syndrome managed?

A

Initial = elevate, remove any bandages

Emergency fasciomomy

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47
Q

What is the main acute complication of fasciotomy?

A

Myoglobinuria causing AKI

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48
Q

What is the most common mode of infection to bone in osteomyelitis?

A

Haematogenous - through the blood

Can also be via ulcer/fracture/surgery

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49
Q

What is the most common causative organism of osteomyelitis?

A

Staph aureus

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50
Q

What are risk factors for osteomyelitis?

A

Diabetes

Increasing age

Peripheral vascular disease

Immunocompromised

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51
Q

How does osteomyelitis present?

A

Fever

Pain

Signs of local inflammation - erythema, tenderness, swelling

May be some evidence of ulcer/skin break

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52
Q

How is osteomyelitis diagnosed?

A

If there is a wound can do a wound swab

MRI = diagnostic

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53
Q

What is seen on x-ray in osteomyelitis?

A

Periosteal reaction

Local osteopenia

Cortical loss

Bone lysis

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54
Q

How is osteomyelitis managed?

A

IV 6 week course of flucloxacillin

Clindamycin if pen-allergic

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55
Q

Which bone malignancy causes a sunburst appearance on x-ray?

A

Osteosarcoma

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56
Q

Which bone malignancy causes an onion skin appearance on x-ray?

A

Ewing’s sarcoma

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57
Q

Which bone malignancy causes a fluffy popcorn calcification appearance on x-ray?

A

Chondrosarcoma

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58
Q

How is mechanical back pain managed?

A

NSAIDs

Codeine

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59
Q

What is Sciatica and how does it present?

A

Pain caused by compression of sciatic nerve

Pain from button to back of thigh/knee

Shooting/electric pain

Paraesthesia

Numbness

Motor weakness

60
Q

What are causes of sciatica?

A

Herniated disc

Spinal stenosis

Spondylolithesis

61
Q

What should you consider in bilateral sciatica?

A

Cauda equina syndrome

62
Q

How can the pain be managed in sciatica?

A

1st line = NSAIDs/Codeine

2nd line = Amitriptyline/Duloxetine

63
Q

What is cauda equina syndrome?

A

A surgical emergency

Nerve roots of the cauda equina are compressed - emergency decompression required

64
Q

What are causes of cauda equina syndrome?

A

Herniated disc

Tumour/metastases

Spondylolisthesis

Abscess

Trauma

65
Q

What are red flag signs for cauda equina syndrome?

A

Saddle anaesthesia

Urinary/faecal incontinence

Bilateral sciatica

Bilateral motor weakness of the legs

Reduced anal tone on PR

Lower motor neurone signs = reduced tone, reduced reflexes

66
Q

How does metastatic spinal cord compression present?

A

Similar to cauda equina

Worse on coughing/straining

67
Q

What is spinal stenosis? What are the causes?

A

Narrowing of a part of the spinal canal - leads to compression of the spinal cord

Most commonly affects the lumbar spine

Causes = degenerative changes, herniated disc, spinal fractures

68
Q

How does spinal stenosis present?

A

Depends on degree of narrowing

If severe - presents as cauda equina syndrome

Otherwise gradual onset of -

Intermittent neurogenic claudication

Lower back pain

Leg pain

Leg weakness

Problems absent at rest.

An ABPI should be conducted to rule out PAD

Bending forwards improves symptoms

Symptoms may be worse on walking downhill

Sitting is better than standing

69
Q

What improves/worsens symptoms in spinal stenosis?

A

Flexing spine (bending forwards) improves symptoms

Standing straight worsens symptoms

Easier to walk downhill than uphill

70
Q

How is spinal stenosis diagnosed?

A

MRI spine

71
Q

How is spinal stenosis managed?

A

Laminectomy

72
Q

What is meralgia paraesthetica?

A

Localised sensory symptoms on the outer thigh due to compression of the lateral femoral cutaneous nerve

73
Q

How does meralgia paraesthetica present?

A

Abnormal sensation or loss of sensation in the outer upper thigh

May be burning/numbness/coldness

Symptoms worse on standing and better on sitting

74
Q

What is trochanteric bursitis?

A

Inflammation of a bursa over the greater trochanter on the outer hip

Causes pain localised to the outer hip

75
Q

What are causes of trochanteric bursitis?

A

Friction

Trauma

Inflammatory conditions

Infection

76
Q

How does trochanteric bursitis present?

A

Gradual onset of-

Lateral hip pain (aching/burning)

Tenderness over greater trochanter

77
Q

How is trochanteric bursitis diagnosed? How is it managed?

A

Trendelenberg test

Rest, ice, analgesia

Can take 6-9 months to heal

78
Q

How does a torn meniscus present?

A

History of twisting movement of knee e.g. sports

Pain, swelling, stiffness of knee

Reduced ROM

Locking of the knee

Instability or knee ‘giving way’

79
Q

How is a torn meniscus diagnosed?

A

MRI

80
Q

How does an ACL injury present?

A

History of twisting movement of knee

Instability of knee

Tibia can move anteriorly below the knee - anterior drawer test

81
Q

What is Osgood-Schlatter disease?

A

Inflammation at the tibial tuberosity - where the patella ligament inserts

Common in adolescents

Due to multiple minor avulsion fractures that occur where the patella ligament pulls away tiny pieces of bone, leading to a growth of the tibial tuberosity and a visible lump below the knee

82
Q

How does Osgood-Schlatter disease present?

A

A visible/palpable hard lump at the tibial tuberosity

Pain in anterior aspect of knee - exacerbated by physical activity, kneeling, knee extension

83
Q

What is a Baker’s cyst? How does it present?

A

A distention of the gastrocnemius-semimembranous bursa in the popliteal fossa

Palpable lump/Swelling in the popliteal fossa - more apparent on standing with legs fully extended

Pain/discomfort

84
Q

How is a Baker’s cyst diagnosed?

A

ultrasound

85
Q

What are the two types of Achilles tendinopathy?

A

Insertion tendinopathy

Mid-portion tendinopathy

86
Q

What are risk factors for Achilles tendinopathy?

A

Sports

Inflammatory conditions - RA/AS

Increased cholesterol - can cause tendon xanthomata

Quinolone Abx - e.g. Ciprofloxacin

87
Q

How does an Achilles tendon rupture present?

A

Sudden onset pain in achilles/calf

Snapping sound/sensation

Feeling as though something has hit them in back of leg

88
Q

Which medication can cause Achilles tendon pain/rupture?

A

Quinolone antibiotics e.g Ciprofloxacin

89
Q

How does plantar fasciitis present?

A

Gradual onset of pain on plantar aspect of foot

especially on heel

Worse with pressure (walking/standing)

Worse when walking on toes

90
Q

What is Morton’s neuroma? How does it present?

A

A benign neuroma affecting the intermetatarsal plantar nerve - most commonly between the 3rd and 4th toes

Pain in-between 3rd and 4th toes

Burning/shooting

Worse on walking

Sensation of something in shoe

Mulder’s click - painful click when squeezing metatarsals togehter

91
Q

What is the key risk factor for adhesive capsulitis (frozen shoulder)?

A

Diabetes

92
Q

How does adhesive capsulitis (frozen shoulder) present?

A

3 phases

  1. Painful phase - shoulder pain
  2. Stiff phase/adhesive phase - shoulder stiffness develops. most affected = external rotation
  3. Recovery phase - gradual improvement
93
Q

How do rotator cuff tears present?

A

Shoulder pain worse on specific movement - usually on abduction (Supraspinatus)

94
Q

Which rotator cuff muscle is most commonly injured?

A

Supraspinatus

95
Q

What is the most common type of shoulder dislocation?

A

Anterior dislocation

96
Q

What is the main complication of shoulder dislocation?

A

Axillary nerve damage (loss of sensation over lateral deltoid)

97
Q

What is olecranon bursitis?

A

Inflammation and swelling of the bursa over the elbow

Often due to leaning on elbow

98
Q

How does olecranon bursitis present?

A

Swollen, warm, tender elbow

99
Q

How does lateral epicondylitis present?

A

Pain worse on resisted wrist extension or supination of forearm

100
Q

How does medial epicondylitis present?

A

Pain worse on resisted wrist flexion or pronation of the forearm

101
Q

What is DeQuervain’s tenosynovitis? Which tendons does it affect?

A

Swelling and tenderness of the tendon sheaths in the wrist

Primary affects - abductor policus longs and extensor pollicus brevis

102
Q

How does DeQuervain’s tenosynovitis present?

A

Symptoms at radial aspect of wrist - near base of thumb

Pain

Aching

Burning

Weakness

Numbness

Positive Finkelstein’s test - patient makes his with thumb inside fingers. then adduct wrist (towards ulnar). If painful = positive.

103
Q

What is trigger finger?

A

Abnormal flexion of the digits

Stiffness when trying to move the affected finger

Painful

Stuck in flexed position

A nodule may be felt at the base of the affected finger

104
Q

How is trigger finger treated?

A

1st line = steroid injections

If no improvement - surgery

105
Q

What is Dupuytren’s contracture? How does it present?

A

Fascia of the hand becomes thickened and tight which leads to contracture of the fingers

Thick nodular cord from palm to affected finger

No pain

106
Q

How is Dupuytren’s contracture treated?

A

Fasciotomy

107
Q

What are risk factors for carpal tunnel syndrome?

A

Pregnancy

Rheumatoid arthritis

Obesity

Acromegaly

Hypothyroidism

Diabetes

108
Q

What are features of carpal tunnel syndrome?

A

Pain, numbness, parasthesia over the thumb, index finger and middle finger

May be weakness

109
Q

How is carpal tunnel syndrome managed?

A

Wrist splints

Surgical decompression via splitting the flexor retinaculum

110
Q

Which shoulder problem is associated with diabetes?

A

Adhesive capsulitis (frozen shoulder)

111
Q

Systemic inflammatory response (respiratory distress, petechial rash) after a long bone fracture – what to consider?

A

Fat embolus

112
Q

What is the classic presentation of a supracondylar fracture of the humerus?

A

Elbow in semi-flexed position

Swelling

113
Q

What is the classic presentation of a radial head fracture?

A

Sharp pain in elbow on pronation/supination

114
Q

What is the most common cause of needing a hip fracture revision?

A

Aseptic loosening

115
Q

What is a Type I intracapsular fracture?

A

Incomplete, non-displaced

116
Q

What is a Type II intracapsular fracture?

A

Complete, non-displaced

117
Q

What is a Type III intracapsular fracture?

A

Complete, partially displaced

118
Q

What is a Type IV intracapsular fracture?

A

Complete, completely displaced

119
Q

What is osteopetrosis?

A

Genetic condition where there the bones are hard and dense

120
Q

What does disruption of Shenton’s line on XR indicate?

A

Hip fracture

121
Q

What is the pelvic compression test and what is it used for?

A

Used for diagnosing meralgia paraesthetica

Deep palpation just below the ASIS can reproduce symptoms

122
Q

What will reproduce symptoms in meralgia paraesthesia?

A

Hip extension

Deep palpation below the ASIS

123
Q

What is McMurray’s test used for?

A

Diagnosing a meniscal tear

124
Q

How to differentiate between meniscal tear and ACL/PCL injury?

A

Both diagnosed with MRI knee

Meniscal tear = McMurray’s test
ACL injury = Anterior draw test

125
Q

What is the most common causative organism of discitis?

A

Staph aureus

126
Q

What other organ needs to be investigated if a patient is diagnosed with infective discitis?

A

Needs echocardiogram to look for endocarditis

127
Q

How is a subtrochanteric fracture managed? (below the lesser trochanter)

A

Intramedullary nail

128
Q

When does pain in the ankle warrant an x-ray?

A

Bony tenderness at the posterior edge of the medal or lateral malleolus
Inability to bear weight for 4 steps

129
Q

What are signs of osteogenesis imperfecta?

A 
Several fractures during childhood
Long bowing
Short stature
Hearing loss
Blue sclerae
130
Q

What kind of fracture is it when the bone is exposed to air?

A

Compound

131
Q

How can you tell the difference between Dupuytren’s contracture and Trigger finger?

A

Trigger finger = passively correctable, painful

Dupuytren’s contracture = cannot be passively corrected, no pain

132
Q

What XR sign is pathognomonic for a posterior shoulder dislocation?

A

Lightbulb sign

133
Q

What is cubital tunnel syndrome and how does it present?

A

Compression of the ulnar nerve as it passes through the cubital tunnel

Tingling and numbness of the 4th + 5th fingers
Pain worse on leaning on elbow

134
Q

Which movement is most affected in adhesive capsulitis?

A

External rotation

135
Q

Which nerve is compressed in meralgia paraesthetica?

A

Lateral femoral cutaneous nerve

136
Q

What are the actions of the 4 rotator cuff muscles?

A

Supraspinatus - abduction (up to 15 degrees then taken over by deltoid)

Infraspinatus - external rotation

Teres minor - external rotation

Subscapularis - internal rotation

137
Q

Which muscle is responsible for the first 15 degrees of arm abduction? Which muscle is responsible for the rest?

A

First 15 degrees = Supraspinatus

Rest = Deltoid

138
Q

Which imaging to look for rotator cuff pathology?

A

MRI

139
Q

What is subacromial impingement and how does it present?

A

Tendons of rotator cuff muscles become compressed

Painful arc of abduction

140
Q

How does L3 nerve compression present?

A

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

141
Q

How does L4 nerve compression present?

A

Sensory loss in anterior knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

142
Q

How does L5 nerve compression present?

A

Sensory loss - dorsum of foot
Weakness of foot + big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

143
Q

How does S1 nerve compression present?

A

Sensory loss in the posterolateral aspect of the leg and lateral aspect of foot
Weakness of foot plantarflexion
Reduced ankle reflexes
Positive sciatic nerve stretch test

144
Q

What are the Salter-Harris fractures? How are they classified?

A 
Growth plate fractures
I = Physis only
II = Physis + Metaphysis
III = Physis + Epiphysis
IV = Physis, Metaphysis + Epiphysis
V = Crush injury
145
Q

What is a Charcot foot?

A

AKA Neuropathic jont
joint body is damaged/disrupted due to loss of sensation
usually largely swollen, loss of sensation
Destruction of the bones

Most commonly seen in diabetics

Medicine Finals (32 decks)

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