Orthopaedics

Question 1

How does fat embolism present?

Answer 1

Fever
Petechial rash
Respiratory distress
Cerebral involvement

After fracture of long bone

Question 2

What are signs of a scaphoid fracture?

Answer 2

Tenderness over the anatomical snuffbox
Pain on ulnar deviation
Pain on telescoping of the thumb
Wrist joint effusion
Loss of grip/pinch strength

Question 3

What is a subtrochanteric hip fracture and how is it managed?

Answer 3

Fracture below the lesser trochanter

managed with intramedullary screw

Question 4

What is seen on XR in osteomyelitis?

Answer 4

Periosteal reaction
Local osteopenia
Cortical loss
Bone lysis

Question 5

How is sciatica managed?

Answer 5

1) NSAIDs/codeine

2) Amitriptyline/Duloxetine

Question 6

What are causes of spinal stenosis?

Answer 6

Herniated disc
Degenerative changes
Spinal fracture

Question 7

Which nerve is compressed in meralgia paraesthetica?

Answer 7

Lateral femoral cutaneous nerve

Question 8

What is Osgood-Schlatter disease?

Answer 8

Growth of the tibial tuberosity due to multiple minor avulsion fractures

Leads to tender lump on tibial tuberosity

Question 9

What are RF for achilles tendinopathy?

Answer 9

Quinolone abx
Sports
Increased cholesterol (due to tendon xanthomata)

Question 10

What is Morton’s neuroma and how does it present?

Answer 10

Benign neuroma in between toes
Most commonly in between 3rd and 4th toes
Burning/shooting worse when walking
Mulder’s click – painful click when MTP squeeze

Question 11

How does lateral epicondylitis present?

Answer 11

Pain on resisted Supination + extension

Question 12

How does medial epicondylitis present?

Answer 12

Pain on resisted pronation + flexion

Question 13

How can you tell the diff between trigger finger and Dupuytren’s?

Answer 13

Trigger finger = painful, can be passively moved

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

Question 14

What are RF for carpal tunnel syndrome?

Answer 14

Pregnancy
Obesity
Diabetes
Acromegaly
Hypothyroidism

Question 15

What are features of carpal tunnel syndrome?

Answer 15

Sensory: Pain and pins and needles in the thumb/index/middle finger
Motor: weakness of thumb abduction. Wasting of thenar eminence.

Question 16

How do you manage a patella fracture?

Answer 16

If undisplaced can be managed conservatively

If displaced needs surgery

Question 17

Which movement is reduced in SUFE?

Answer 17

Internal rotation

Question 18

What is the management of hip dislocation?

Answer 18

x

Question 19

What is the management of shoulder dislocation?

Answer 19

Reduction - may not need analgesia/sedation

Question 20

What is sublaxation of the radial head?

Answer 20

Most common upper limb injury in children under the age of 6

Analgesia + passively supination of the elbow joint whilst elbow flexed to 9 degrees

Question 21

What is the initial management of an ankle fracture?

Answer 21

Prompt closed reduction to remove pressure

Question 22

What are causes of cauda equina syndrome?

Answer 22

Herniated disc
Tumour/metastases 
Spondylolisthesis 
Abscess 
Trauma

Question 23

What are causes of trochanteric bursitis?

Answer 23

Friction
Trauma
Inflammatory conditions
Infection

Question 24

What XR sign is pathognomonic for a posterior shoulder dislocation?

Answer 24

Lightbulb sign

Question 25

Posterior vs. anterior hip dislocation

Answer 25

anterior dislocation- abducted + externally rotated. no leg shortening!

posterior dislocation - adducted + internally rotated. leg shortening!

Posterior = most common!

Question 26

What is cubital tunnel syndrome and how does it present?

Answer 26

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

Question 27

What is a Charcot foot?

Answer 27

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

Question 28

What are signs of osteogenesis imperfecta?

Answer 28

Several fractures during childhood
Long bowing

Short stature
Hearing loss
Blue sclerae

Question 29

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

Answer 29

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

Question 30

Management of a scaphoid fracture

Answer 30

Initial management =
Immobilisation with either a Futuro splint or a below elbow backstab
Then refer to orthopaedics


Orthopaedic management =
Undisplaced = cast for 6-8 weeks
Displaced = surgical fixation

Question 31

What is Finkelstein’s test?

Answer 31

Test for DeQuervain’s tenosynovitis

Examiner pulls the thumb of the patient in ulnar deviation + longitudinal traction

In tenosynovitis - pain over the radial syloid process and along the extensor pollicis breves and abductor pollicis longs

Question 32

What two tendons are affected in DeQuervain’s tenosynovitis?

Answer 32

Extensor pollicis brevis

Abductor pollicis longus

Question 33

What imaging can be used to confirm a Morton’s neuroma?

Answer 33

Ultrasound

Question 34

What Is the ulnar paradox?

Answer 34

proximal lesions of the ulnar nerve produce a less prominent deformity than distal lesions

Ulnar nerve damaged at wrist —> claw appearance
Ulnar nerve damaged at elbow —> less marked clawing. Gets worse before getting better.

Question 35

What is the most common type of shoulder dislocation?

Answer 35

Anterior dislocation - glenohumeral

Question 36

Which artery supplies the scaphoid bone?

Answer 36

Dorsal carpal branch of the radial artery