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Clinical Medicine > Orthopaedics 🦴 > Flashcards

Orthopaedics 🦴 Flashcards

1
Q

What is osteosarcoma

A

Malignant bone tumour found at metaphysis of distal femur or proximal tibia

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2
Q

Sx osteosarcoma

A

Dull bone pain worse at night
Localised mass
Soft tissue mass and swelling

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3
Q

Mx of osteosarcoma

A

Surgical resection and chemotherapy

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4
Q

Ix for osteosarcoma

A

X ray
Shows sunburst appearance

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5
Q

What is the most common primary malignancy of bone in children and adolescents

A

Osteosarcoma

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6
Q

What is Paget’s disease of bone

A

Increased bone turnover
Initially starts with increased osteoclastic activity then followed by increased osteoblast activity
Leads to bone deformities

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7
Q

What bones does Paget’s disease affect mainly

A

Commonly affects skull, spine, pelvis and long bones of lower extremities

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8
Q

Sx of Paget’s disease

A

Usually asx
But sx can include :
Constant achy bone pain
Warmness of bone
Hearing loss
Heart failure

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9
Q

Ix for Paget’s disease and their findings

A

Blood tests show raised ALP and normal calcium and phosphate
X RAY show osteolysis in early disease

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10
Q

Mx of Paget’s disease

A

only if symptomatic :
Bisphosphonates e.g IV pamidronate

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11
Q

Risk factors for Paget’s disease

A

Male sex
Increasing age
Anglo-Saxon descent
Family history

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12
Q

What is osteomyelitis

A

Infection of the bone

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13
Q

What causes osteomyelitis

A

Most common is staph aureus

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14
Q

Sx of osteomyelitis

A

Constant bone pain
Recent trauma
Redness and swelling
Fever

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15
Q

Mx of osteomyelitis

A

Abx
Flucloaxicillin for adults for 6 weeks
Cefazolin for children

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16
Q

Diagnostic imaging for osteomyelitis

A

MRI

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17
Q

What are the two ways of osteomyelitis occurring

A

Haemotagenous spread and non haemotagneous spread

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18
Q

Risk factors for haematogenous osteomyelitis

A

Endocarditis
IV drug use
Hickman line
Immunosuppression

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19
Q

Risk factors for non-haematogenous osteomyelitis

A

Skin ulcers
Trauma
Surgery

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20
Q

Presentation of Chondrosarcoma

A

Usually presents in 40-60 males
Axial skeleton I.e pelvis, shoulder, rib
X ray shows fluffy popcorn calcification

21
Q

Gradual swelling of the knee is suggestive of effusion
Tenderness over the medial joint line suggests a medial meniscus tear
Commonly “locks” the joint - fixed flexed position

A

medial meniscus tear

22
Q

hip fracture, how would it classically present

A

the leg is shortened and externally rotated
pain

23
Q

mx of intracapsular hip fracture

A

undisplaced: internal fixation or hemiarthroplasty if unfit

displaced: total hip replacement or hemiarthroplasty

24
Q

when is total hip replacement preferred to hemiarthroplasty for intracapsular hip fracture?

A

if patients were able to walk independently out of doors with no more than the use of a stick and

are not cognitively impaired and

are medically fit for anaesthesia and the procedure

25
Q

management of intertrochanteric femoral fracture

A

dynamic hip screw

26
Q

often associated with popping, swelling, clicking or grindings and a positive scarf test

A

acromioclavicular degeneration

27
Q

Painful arc of abduction on examination 60-120 degrees, no weakness of muscles and often complain of pain on overhead activities

common in swimmers

A

subacromial impingement

28
Q

common in diabetics and presents as a painful stiff shoulder with restriction of active and passive range of motion in abduction, internal and mainly external rotation

3 stages - pain, stiffness and pain improvement and then a gradual return to normal

middle-aged pts

A

adhesive capsulitis - frozen shoulder

29
Q

Pain in the first 60 degrees of abduction
Weakness of rotator cuff muscles
Muscle wasting
Tenderness

hx: repetitive overhead movements/over use/ trauma

A

rotator cuff injury

30
Q

how to tell the difference between rotator cuff tear and impingement

A

he presence of muscle weakness when compared directly to the opposite arm

31
Q

management of subacromial impingement

A

Non-surgical:
Rest
NSAIDs
Physiotherapy

Surgical:
Arthroscopy if severe

32
Q

management of adhesive capsulitis

A

Treatment options are quite poor- episodes usually self-limiting and lasts 6 months to 3 years

Non-surgical:
NSAIDs, oral corticosteroids
Physiotherapy
Intra-articular steroid injections

Surgical:
Manipulation under anaesthesia – forcefully stretching the capsule to improve ROM
Arthroscopy –cut the adhesions to help with the stiffness

33
Q

management of rotator cuff tear

A

Non-surgical:
Rest
NSAIDs
Physiotherapy

Surgical:
Arthroscopic rotator cuff repair – younger/active patient or large tears

34
Q

most common shoulder dislocation
hx: Sport, trauma, falls injuries
Arm position: Slightly abducted and externally rotated

A

anterior shoulder dislocation

35
Q

hx: Seizures, electrical injuries
Arm position: Adducted, internally rotated

on x-ray: lightbulb sign

A

posterior shoulder dislocation

36
Q

sudden twisting force on a bent knee
Common sports injury (skiing)
Sudden ‘popping’ sound
Sudden knee swelling
Lachman’s and Anterior draw positive

A

ACL tear

37
Q

Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed

A

smith’s fracture

38
Q

FOOSH

A

colle’s fracture

39
Q

loss of internal rotation of the leg in flexion

obese, male 10-15 year old

A

slipped upper femoral epiphysis

40
Q

4-8 years old

hip pain that’s developed progressively over a few weeks

due to avascular necrosis of femoral head

A

perthes disease

41
Q

2-10 years old

commonest cause of hip pain in children

acute hip pain associated with viral infection

limp/refusal to weight bear

A

transient synovitis

42
Q

most often <4 years

acute hip pain associated with systemic upset - fever

swollen red joint

A

septic arthritis

43
Q

mx SUFE

A

internal fixation

44
Q

x-ray findings perthes disease

A

widening of joint space
later changes - decreased femoral head size

45
Q

mx perthes disease

A

conservative mx

cast and braces

<6 years - observation
>6 or severe deformity - surgery

46
Q

mx transient synovitis

A

self limiting - rest and analgesia

47
Q

Bone Pain
Bone/Muscle Tenderness
Fractures- Femoral Neck
Proximal Myopathy- Waddling Gait
X-ray:
Translucent bands (Looser’s zones or pseudofractures)

A

osteomalacia

48
Q

Pain following use, improves with rest
Unilateral symptoms
No systemic upset

Typical affected joints:
Large weight-bearing joints (hip, knee)
Carpometacarpal joint
DIP, PIP joints

A

osteoarthritis

Clinical Medicine (26 decks)

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