Orthopaedics 🦴

Question 1

What is osteosarcoma

Answer 1

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

Question 2

Sx osteosarcoma

Answer 2

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

Question 3

Mx of osteosarcoma

Answer 3

Surgical resection and chemotherapy

Question 4

Ix for osteosarcoma

Answer 4

X ray
Shows sunburst appearance

Question 5

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

Answer 5

Osteosarcoma

Question 6

What is Paget’s disease of bone

Answer 6

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

Question 7

What bones does Paget’s disease affect mainly

Answer 7

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

Question 8

Sx of Paget’s disease

Answer 8

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

Question 9

Ix for Paget’s disease and their findings

Answer 9

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

Question 10

Mx of Paget’s disease

Answer 10

only if symptomatic :
Bisphosphonates e.g IV pamidronate

Question 11

Risk factors for Paget’s disease

Answer 11

Male sex
Increasing age
Anglo-Saxon descent
Family history

Question 12

What is osteomyelitis

Answer 12

Infection of the bone

Question 13

What causes osteomyelitis

Answer 13

Most common is staph aureus

Question 14

Sx of osteomyelitis

Answer 14

Constant bone pain
Recent trauma
Redness and swelling
Fever

Question 15

Mx of osteomyelitis

Answer 15

Abx
Flucloaxicillin for adults for 6 weeks
Cefazolin for children

Question 16

Diagnostic imaging for osteomyelitis

Answer 16

MRI

Question 17

What are the two ways of osteomyelitis occurring

Answer 17

Haemotagenous spread and non haemotagneous spread

Question 18

Risk factors for haematogenous osteomyelitis

Answer 18

Endocarditis
IV drug use
Hickman line
Immunosuppression

Question 19

Risk factors for non-haematogenous osteomyelitis

Answer 19

Skin ulcers
Trauma
Surgery

Question 20

Presentation of Chondrosarcoma

Answer 20

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

Question 21

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

Answer 21

medial meniscus tear

Question 22

hip fracture, how would it classically present

Answer 22

the leg is shortened and externally rotated
pain

Question 23

mx of intracapsular hip fracture

Answer 23

undisplaced: internal fixation or hemiarthroplasty if unfit

displaced: total hip replacement or hemiarthroplasty

Question 24

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

Answer 24

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

Question 25

management of intertrochanteric femoral fracture

Answer 25

dynamic hip screw

Question 26

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

Answer 26

acromioclavicular degeneration

Question 27

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

Answer 27

subacromial impingement

Question 28

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

Answer 28

adhesive capsulitis - frozen shoulder

Question 29

Pain in the first 60 degrees of abduction Weakness of rotator cuff muscles Muscle wasting Tenderness hx: repetitive overhead movements/over use/ trauma

Answer 29

rotator cuff injury

Question 30

how to tell the difference between rotator cuff tear and impingement

Answer 30

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

Question 31

management of subacromial impingement

Answer 31

Non-surgical: Rest NSAIDs Physiotherapy Surgical: Arthroscopy if severe

Question 32

management of adhesive capsulitis

Answer 32

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

Question 33

management of rotator cuff tear

Answer 33

Non-surgical: Rest NSAIDs Physiotherapy Surgical: Arthroscopic rotator cuff repair – younger/active patient or large tears

Question 34

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

Answer 34

anterior shoulder dislocation

Question 35

hx: Seizures, electrical injuries Arm position: Adducted, internally rotated on x-ray: lightbulb sign

Answer 35

posterior shoulder dislocation

Question 36

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

Answer 36

ACL tear

Question 37

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

Answer 37

smith's fracture

Question 38

FOOSH

Answer 38

colle's fracture

Question 39

loss of internal rotation of the leg in flexion obese, male 10-15 year old

Answer 39

slipped upper femoral epiphysis

Question 40

4-8 years old hip pain that's developed progressively over a few weeks due to avascular necrosis of femoral head

Answer 40

perthes disease

Question 41

2-10 years old commonest cause of hip pain in children acute hip pain associated with viral infection limp/refusal to weight bear

Answer 41

transient synovitis

Question 42

most often <4 years acute hip pain associated with systemic upset - fever swollen red joint

Answer 42

septic arthritis

Question 43

mx SUFE

Answer 43

internal fixation

Question 44

x-ray findings perthes disease

Answer 44

widening of joint space later changes - decreased femoral head size

Question 45

mx perthes disease

Answer 45

conservative mx cast and braces <6 years - observation >6 or severe deformity - surgery

Question 46

mx transient synovitis

Answer 46

self limiting - rest and analgesia

Question 47

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

Answer 47

osteomalacia

Question 48

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

Answer 48

osteoarthritis