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Med School Finals > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Rotator cuff muscles (SITS) and function?

A

Supraspinatus
→ abduction
Infraspinatus
→ external rotation
Teres minor
→ adduction and external rotation
Subscapularis
→ adduction and internal rotation

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2
Q

Features of a rotator cuff injury?

A

Painful arc (60°-120°)
Muscle weakness
Tender anterior acromion

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3
Q

Axillary nerve roots, motor function and common mechanism of injury?

A

C5, C6
Shoulder abduction
Humeral neck fracture or anterior dislocation

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4
Q

Radial nerve roots, motor function and common mechanism of injury?

A

C5-T1
Arm extension
Humeral midshaft fracture

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5
Q

Median nerve roots, motor function and common mechanism of injury?

A

C6-T1
LOAF muscles
Wrist lesion e.g. fracture, carpal tunnel

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6
Q

LOAF muscles?

A

Lateral two lumbricals
Opponens pollis
Abductor pollis brevis
Flexor pollis brevis

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7
Q

Ulnar nerve roots, motor function and common mechanism of injury?

A

C8-T1
Intrinsic hand muscles except LOAF, wrist flexion
Medial epicondyle fracture

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8
Q

Long thoracic nerve roots, motor function and common mechanism of injury?

A

C5-C7
Serratus anterior
Chest trauma, mastectomy complication

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9
Q

Nerve affected in wrist drop vs claw hand vs winged scapula?

A

Wrist drop = radial
Claw hand = ulnar
Winged scapula = long thoracic

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10
Q

Colles’ fracture features and mechanism?

A

A “dinner fork” deformity
Transverse fracture of the radius
Dorsal (posterior) displacement
Mechanism = FOOSH

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11
Q

Smith’s (reverse Colles’) fracture features and mechanism?

A

A “garden spade” deformity
Transverse fracture of the radius
Volar (anterior) displacement
Mechanism = FOOSH

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12
Q

Bennet’s fracture feature and management?

A

Intra-articular fracture of the thumb base
Management = casting (stable), ORIF (unstable)

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13
Q

Galeazzi fracture features and mechanism?

A

GRUsome MURder
Distal radial fracture
Dislocated ulnar head
Mechanism = FOOSH

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14
Q

Monteggia’s fracture features and mechanism?

A

GRUsome MURder
Proximal ulnar fracture
Dislocated radial head
Mechanism = FOOSH

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15
Q

Feature and management of scaphoid fracture?

A

Pain in the anatomical snuffbox
Management = splint + fracture clinic review

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16
Q

List some paediatric fractures?

A

Buckle fracture
Greenstick fracture
Salter-Harris (growth plate) fracture

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17
Q

General fracture management?

A

Reduce, immobilise, rehabilitation:
Reduce = manual, closed, ORIF
→ only required if displaced or angulated
Immobilise = casting, splinting, K-wires, screws
Rehabilitation = movement as early as possible

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18
Q

Features and management of compartment syndrome?

A

Disproportionately severe pain
Pallor, pulseless, paralysis
PMH limb trauma
Management = fasciotomy + analgesia

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19
Q

Features and management of Dupuytren’s contracture?

A

Fixed flexion of the fingers
Ring and pinky most affected
Management = physiotherapy, fasciectomy

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20
Q

Features and management of carpal tunnel syndrome?

A

Tingling/numb thumb, index and middle digit
Thenar eminence wasting
Tinel’s and Phalen’s test +ve
Management = conservative and steroid injection (mild-moderate), surgical decompression (severe)

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21
Q

How is surgical decompression of the median nerve achieved?

A

Division of the flexor retinaculum

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22
Q

Features and management of cubital tunnel syndrome?

A

Tingling/numb ring and pinky digit
Worse leaning on affected elbow
Management = conservative and steroid injection (mild-moderate), surgical decompression (severe)

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23
Q

Features and management of De Quervain’s tenosynovitis?

A

Pain at the thumb base
Tender radial styloid process
Finkelstein’s and Eichhoff’s test +ve
Management = conservative and steroid injection (mild-moderate), surgery (severe)

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24
Q

Features and management of trigger finger?

A

Stiffness and snapping when extending digit
Nodule at the base of affected finger
Management = conservative and steroid injection (mild-moderate), surgery (severe)

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25
Q

Features and management of a ganglion?

A

Firm, well-defined mass that transilluminates
Management = usually self-resolving, surgery if persistent or neurovascular complications

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26
Q

Features and management of lateral epicondylitis (tennis elbow)?

A

Tenderness over lateral epicondyle
Worse on resisted wrist extension and forearm supination
Management = conservative, steroid injection, physiotherapy

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27
Q

Features and management of medial epicondylitis (golfer’s elbow)?

A

Tenderness over medial epicondyle
Worse on wrist flexion and forearm pronation
Management = conservative, steroid injection, physiotherapy

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28
Q

Groups with higher risk of adhesive capsulitis?

A

Diabetics
Middle-aged women

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29
Q

Features and management of adhesive capsulitis?

A

Painful → stiff shoulder
Worse on external rotation
Reduced active and passive movement
Management = conservative, steroid injection, physiotherapy

30
Q

Most common type of shoulder dislocation?

A

Anterior (> 95%)

31
Q

Management of shoulder dislocation?

A

Reduction +/- analgesia or sedation
Sling immobilisation

32
Q

Loss of sensation over the “regimental badge” area following an anterior shoulder dislocation?

A

Axillary nerve damage

33
Q

Red flags for lower back pain?

A

Age < 20 or > 50
PMH malignancy
Thoracic pain
Night pain
PMH spine trauma
Systemically unwell e.g. fever

34
Q

Investigation and management of lower back pain?

A

Investigation = clinical diagnosis or MRI
Management = NSAID (1st line)

35
Q

Features and management of lumbar spinal stenosis?

A

Back and leg pain/weakness
Relieved by sitting down or leaning forward
Management = laminectomy

36
Q

Spondylolysis vs spondylolithesis?

A

Spondylolysis = fracture of the pars interarticularis
Spondylolithesis = anterior slipping of a verterbra

37
Q

Typical level of disc prolapse in cauda equina syndrome?

A

L4/L5 or L5/S1

38
Q

Features, investigation and management of cauda equina syndrome?

A

Back pain
Bilateral sciatica
Decreased anal tone
Urinary dysfunction (late sign)
Investigation = whole spine MRI
Management = surgical decompression

39
Q

Management of a prolapsed disc?

A

1st line = analgesia e.g. NSAIDs
2nd line = neurosurgery referral if persistent after 4-6 weeks

40
Q

Investigation for osteoporotic vertebral fracture?

A

1st line = X-ray

41
Q

Most common cause of osteomyelitis in normal adults vs sickle cell patients?

A

Normal = staphylococcus aureus
Sickle cell = salmonella

42
Q

Features, investigations and management of osteomyelitis?

A

Generally unwell e.g. fever
Pain and erythema at affected site
Persistently draining wound
Investigations = MRI, bone biopsy
Management = IV antibiotics + surgical debridement

43
Q

Most common type of hip dislocation?

A

Posterior (~90%)

44
Q

Features and management of posterior vs anterior hip dislocation?

A

Posterior = leg shortened and internally rotated
Anterior = leg not shortened and externally rotated
Management = surgical reduction within 4 hours

45
Q

Features of a hip fracture?

A

Leg shortened and externally rotated

46
Q

Anatomy of intracapsular vs extracapsular hip fractures?

A

Intracapsular = femoral neck or femoral head
Extracapsular = trochanteric or subtrochanteric

47
Q

Management of intracapsular hip fracture?

A

Undisplaced = internal fixation
Displaced = THR (young) or hemiarthroplasty (old)

48
Q

Most common cause of a THR revision?

A

Aseptic loosening of the implant

49
Q

Management of extracapsular hip fracture?

A

Trochanteric = dynamic hip screw
Subtrochanteric = intramedullary device

50
Q

Sensation of hip snapping +/- locking when walking?

A

Acetabular labral tear

51
Q

Pain over the lateral hip and Trendelenberg +ve?

A

Trochanteric bursitis

52
Q

Burning sensation over lateral thigh?

A

Meralgia paraesthetica (lateral cutaneous nerve damage)

53
Q

Anterior knee pain in adolescents?

A

Osgood-schlatter’s disease

54
Q

Lateral knee pain in a runner?

A

Iliotibial (IT) band syndrome

55
Q

Mechanism of ACL vs PCL vs MCL rupture?

A

ACL = twisting force on bent knee or rapid deceleration
PCL = knee hyperextension
MCL = lateral impact

56
Q

Features of an ACL rupture?

A

Sudden painful “pop”
Rapid swelling
Joint line tenderness
Anterior drawer and Lachman +ve

57
Q

Unhappy triad?

A

ACL rupture
MCL rupture
Meniscal tear

58
Q

Features of a meniscal tear?

A

Rotational force injury
Delayed knee swelling
Joint locking and “giving way”
Tenderness along joint line
Recurrent effusion and pain

59
Q

Investigation and management of ligament or meniscal damage?

A

Knee MRI, arthroscopy
Management = RICE, physiotherapy, surgery

60
Q

Management of patellar fracture?

A

Undisplaced + intact extensor mechanism = knee brace for 6 weeks
Displaced +/- damaged extensor mechanism = surgery + knee brace for 6 weeks

61
Q

Features of L3 vs L4 lesion?

A

L3 = sensory loss anterior thigh, weak hip adduction, weak knee extension, reduced knee reflex
L4 = sensory loss anterior knee, weak hip adduction, weak knee extension, reduced knee reflex

62
Q

Features of L5 vs S1 lesion?

A

L5 = sensory loss on dorsum of foot, weak foot dorsiflexion, weak big toe dorsiflexion, ankle reflex intact
S1 = sensory loss posterior leg, weak plantar flexion, reduced ankle reflex

63
Q

Examination technique for suspected Achilles rupture?

A

Simmond’s triad:
→ angle of declination
→ palpation for gap
→ calf squeeze

64
Q

Imaging used to diagnose Achilles rupture?

A

USS

65
Q

Ottawa rules for ankle injury?

A

Only x-ray if pain in the malleolar zone and:
→ tenderness at lateral malleolus or
→ tenderness at medial malleolus or
→ inability to walk 4 steps

66
Q

Most common type of ankle sprain?

A

Anterior talofibular liagment (ATFL)

67
Q

Foot drop sign?

A

Common peroneal nerve damage

68
Q

Bone tumour with “soap bubble” x-ray appearance?

A

Giant cell tumour

69
Q

Bone tumour with Codman triangle or “sunburst pattern” x-ray appearance?

A

Osteosarcoma

70
Q

Bone tumour with “onion skin” x-ray appearance?

A

Ewing’s sarcoma

Med School Finals (18 decks)

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