Orthopaedics Flashcards
1
Q
What is an osteosarcoma?
A
Malignant bone tumour found at metaphysis of distal femur or proximal tibia
2
Q
What are the symptoms of Osteosarcoma?
A
Dull bone pain that is worse at night, localised mass, soft tissue mass and swelling
3
Q
What investigations are required for osteosarcoma?
A
X-ray shows sunburst appearance, tissue biopsy to confirm
4
Q
What is the management for osteosarcoma?
A
surgical resection and chemotherapy
5
Q
What are the symptoms of pagets disease of the bone?
A
Constant achy bone pain
Warmness of bone
Hearing loss
Heart failure
6
Q
What are the symptoms for osteomyelitis?
A
Recent trauma Bone pain – constant Lump at site Fever Redness
7
Q
What are the symptoms for bony metastasis?
A
Hx of renal, thyroid, lung, prostate, breast cancer
Bone pain worse at night
Anaemia
8
Q
What bacterial infection is usually causative of osteomyelitis?
A
Staph. aureus
9
Q
What type of history would make you suspicious of bony metastasis?
A
Hx of renal, thyroid, lung, prostate, breast cancer
10
Q
What are the symptoms for chondrosarcoma?
A
painful enlarging mass
11
Q
What is chondrosarcoma?
A
a type of bone cancer that develops in cartilage cells
12
Q
What would you expect to find on investigation with pagets disease of the bone?
A
Raised ALP, normal calcium + phosphate
13
Q
What investigations would you do for suspected osteomyelitis?
A
MRI is definitive
14
Q
What investigations would you do for suspected bony metastasis?
A
X-ray
Bloods - Raised calcium
15
Q
What investigations would you do for suspected chondrosarcoma?
A
X-ray – lytic lesions with calficiation, cortical remodelling and endosteal scalloping
16
Q
What is the management for pagets disease of the bone?
A
Bisphosphonates e.g. IV pamidronate
17
Q
What is the management for osteomyelitis?
A
Abx:
Children – cefazolin
Adults - flucloxacillin
18
Q
What is the management for bony metastasis?
A
Palliative and chemotherapy
19
Q
What is the management for chondrosarcoma?
A
Low grade – intralesion curettage
Medium and high grade – wide en bloc local excision
20
Q
What are the symptoms for a slipped upper femoral epiphysis (SUFE)?
A
limited abduction, internal rotation and flexion, externally rotated leg
21
Q
How is a slipped upper femoral epiphysis (SUFE) treated?
A
Internal rotation
22
Q
What are the symptoms of Perthe’s disease?
A
Boys age 4-7
Hip pain gradual
All hip movements limited
23
Q
What are the symptoms of transient synovitis of the hip?
A
4-10 y/o
Post upper respiratory tract infection
Acute onset hip pain
Relieved with rest
24
Q
What are the symptoms of septic arthritis?
A
Hot, red joint
Pain
Restricted movement
Cause: staph. aureus
25
What are the symptoms of reactive arthritis?
```
Usually affects knee, heel, toes
Rash around genitals
Lower back pain
Diarrhoea
Anterior uveitis
Post infection e.g. campylobacter
```
26
How is septic arthritis diagnosed?
Kocher’s criteria
Aspirate
Blood cultures
27
What is Kocher's criteria?
Assesses risk for septic arthritis
Non weight baring on affected side
Temp >38.5
ESR >40mm/hr
WBC>12,000 cells/mm3
Yes (+1) No (0)
28
How is perthes disease managed?
Bed rest, NSAIDs, X-ray surveillance, surgery
29
How is transient synovitis of the hip managed?
Paracetamol, NSAIDs, activity restriction
30
How is septic arthritis managed?
Flucloxacillin and vanc – staph
Ceftriaxone - strep
31
How is reactive arthritis managed?
Rest
NSAIDs and steroids
Methotrexate
32
What are the symptoms of Osgood-Schlatter's disease?
warmth, tender, swelling over tibial tuberosity
33
How is Osgood-Schlatter's disease managed?
conservative (rest, ice, NSAIDs, activity modification) and physiotherapy
34
How does ligament damage generally present?
Swelling, pain, inability to weight bare
35
How would you test a patient's ACL?
anterior draw test
36
How would you test a patient's PCL?
posterior draw test
37
How would you test a patient's MCL?
valgus stress test
38
How would you test a patient's LCL?
varus stress test
39
How is ligament damage generally managed?
PRICER (protect, rest, ice, compression, elevation, rehab)
Crutches
Surgery
40
How would a patient with a meniscal tear present?
Pain over medial or lateral part of the knee
Pop sound
Inability to weight bare
Pain worse on flexion of knee
41
How would a patient with chondromalacia patellae present?
Anterior knee pain in teenage girls that exercise regularly
Grinding when knee is flexed
Worse on walking down stairs
42
How would a patient with Prepatellar Bursitis present?
Pain or swelling over patella
Warmth
Common in roofers, carpet layers, plumbers and gardeners
43
How is a query meniscal tear investigated?
McMurray test
| MRI is gold standard
44
How would you manage a meniscal tear?
Supportive or surgery
45
How would you manage a patient with Chondromalacia Patellae?
Conservative
| Physio
46
What type of injury is common in dashboard car injury?
Posterior hip discloction
47
What type of injury is suggested if the leg is shortened and internally rotated at the knee?
Posterior hip dislocation
48
What is the appropriate management for a posterior hip dislocation?
Closed reduction within 6 hours
49
What type of injury is suggested if the leg is shortened and externally rotated?
Neck of femur fracture
50
What symptoms are associated with a neck of femur fracture?
Hip pain – worse on palpating greater trochanter
Shortened and externally rotated leg
Sudden inability to bare weight
Patients that have osteoporosis or high risk for falls
51
What injury is suggested if the leg is lengthened and externally rotated at the hip?
Anterior hip dislocation
52
What symptoms are associated with an anterior hip dislocation?
Hip pain which radiates to the knee
Lengthened, externally rotated hip
Femoral nerve injury
53
How is an anterior hip dislocation managed?
Closed reduction within 6 hours
54
How is a displaced subcapital intracapsular neck of femur fracture managed?
Hip hemiarthroplasty
Total Hip Replacement (only in elderly patients who are otherwise well)
55
How is a non-displaced subcapital intracapsular neck of femur fracture managed?
Cannulated hip screws (3 screws in triangle fashion)
56
How is an intertrochanteric extracapsular neck of femur fracture managed?
Dynamic Hip Screw
57
How is a subtrochanteric extracapsular neck of femur fracture managed?
Intermedullary nail
58
How would a patient with a rotator cuff tear present?
Loss of active movement
Passive movement intact
Pain on rest and movement
Weakness on abduction
59
How would a patient with an anterior or posterior glenerohumeral dislocation present?
```
Painful shoulder
Reduced mobility
Asymmetry
Loss of shoulder contours
Anterior bulge from head of humerus
```
60
The following is characteristic of which disease?
Common in middle-age and diabetics
Characterised by painful, stiff movement
Limited movement in all directions, with loss of external rotation and abduction in about 50% of patients
Adhesive capsulitis
| frozen shoulder
61
The following is characteristic of which disease?
Rotator cuff injury
Painful arc of abduction between 60 and 120 degrees
Tenderness over anterior acromion
Supraspinatus tendonitis
62
What nerve is commonly injured in an anterior shoulder dislocation?
Axillary nerve (police mans patch)
63
What type of glenohumeral dislocation is described by the following:
External rotation and abduction
35-40% recurrent (it is the commonest disorder)
Associated with greater tuberosity fracture, Bankart lesion, Hill-Sachs defect
Anterior shoulder dislocation
64
What type of glenohumeral dislocation is described by the following:
Rim's sign, light bulb sign.
Associated with Trough sign
Posterior shoulder dislocation
65
Impingement of which nerve at the elbow causes cubital tunnel syndrome?
Ulnar nerve
66
What are the symptoms of cubital tunnel syndrome?
Progressive tingling and numbness of the 4th and 5th fingers
Symptoms worsen when leant on elbow
67
What is the likely diagnosis for an elderly woman presenting with bone pain and isolated raise in ALP. Lumbar spine XR findings are of mixed lytic/sclerotic lesions.
Pagets disease of the bone
68
In children, where is the most common site for osteomyelitis to occur in a long bone?
the metaphysis
69
A 22-year-old rugby player falls onto an outstretched hand and sustains a fracture of the distal radius. The x-ray shows a dorsally angulated comminuted fracture.
How should this patient be managed?
Admit for open reduction and fixation
70
A 10-year-old boy undergoes a delayed open reduction and fixation of a significantly displaced supracondylar fracture. On the ward he complains of significant forearm pain and paraesthesia of the hand. Radial pulse is normal.
How should this patient be managed?
Fasciotomy
71
A 28-year-old man falls onto an outstretched hand. On examination there is tenderness of the anatomical snuffbox. However, forearm and hand x-rays are normal.
How should this patient be managed?
Discharge home with futura splint and fracture clinic appointment
72
What most commonly causes smith's fractures?
a fall onto a flexed hand or a direct blow to the back of the wrist
73
What most commonly causes a colles fracture?
fall onto outstretched hand (FOOSH)
74
What are the features of a colles fracture?
Fracture of the metaphyseal region of the radius
Impaction and dorsal angulation
50% associated with ulnar styloid fracture
75
What are the features of a smiths fracture?
Fracture of the distal radius with volar angulation
76
How should wrist fractures with volar angulation be managed?
Open reduction, plate fixation
77
How should wrist fractures with dorsal angulation be managed?
Under 65:
K wire preferable, if not ORIF
Over 65:
Surgical management not preferable unless significant deformity or neurological compromise
78
What are some of the early complications of wrist fractures?
Median nerve neuropathy
Ulnar nerve neuropathy
Extensor pollicis longus or flexor pollicis longus rupture
Compartment syndrome
79
What are some of the medium to late complications of wrist fractures?
```
Osteoarthritis
Non-union / mal-union
Complex regional pain syndrome
Metalwork infection
Metalwork irritation
```
80
A 62-year-old man complains of pain in his right hip which is worse when he walks. Heberden's nodes are noted on examination of the distal interphalangeal joints.
What is the most likely diagnosis?
Osteoarthritis
81
A 34-year-old man with a history of ulcerative colitis complains of pain and stiffness in his left hip which is worse in the mornings
What is the most likely diagnosis?
Rheumatoid arthritis
82
A 29-year-old man who is a keen jogger complains of pain on the lateral aspect of his left hip. On examination there is a full range of movement but tenderness is noted on the anterolateral aspect of the joint
What is the most likely diagnosis?
Trochanteric bursitis
83
A 40-year-old man with a history of alcohol excess and long-term prednisolone use for brittle asthma presents with a two month history of left hip pain. On examination there is limited movement of the hip in all directions. An x-ray shows a subchondral fracture, segmental flattening of the femoral head and osteopaenia.
What is the most likely diagnosis?
Avascular necrosis
84
A 52-year-old man complains of numbness and pain over the lateral skin of the left thigh
What is the most likely diagnosis?
Meralgia paraesthetica
85
A 43-year-old woman complains of right hip pain. During the examination the patient lies on her left side and the right hip is extended with a straight leg. Flexing the knee then recreates the pain
What is the most likely diagnosis?
Referred lumbar spine pain
86
A 30-year-old man presents with severe pain in the left hip it has been present on and off for many years. He was born at 39 weeks gestation by emergency caesarean section after a long obstructed breech delivery. He was slow to walk and as a child was noted to have an antalgic gait. He was a frequent attender at the primary care centre and the pains dismissed as growing pains. X-rays show almost complete destruction of the femoral head and a narrow acetabulum.
What is the most likely diagnosis?
Developmental hip dysplasia
