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MRCP Part 1 > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What is the difference between osteoporosis and osteomalacia in terms of…

Pathology

Blood results

Bone density

A

Osteoporosis // osteomalacia

Fragile bones due to reduced density // Soft bones due to abnormal mineralisation

Normal bone profile and vitamin D // Abnormal bone profile and low vitamin D

Reduced bone density // Normal bone density

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2
Q

How do you decide who gets a DEXA scan in osteoporosis?

A

Offer FRAX/Q-fracture to those…

All over 75

Those >50 who…

  • Personal falls or fragility fracture history
  • Malabsorption (inc HPT) or steroids
  • Skinny, drinkers (>4U)
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3
Q

What is diagnostic of osteoporosis?

A

DEXA T-score of -2.5 or below

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4
Q

What is the medical management of osteoporosis

A

Ensure adequate Ca2+ and vitamin D then…

1st: Alendronate OR Risendronate/etidronate if alendronate not suitable

If not tolerated: strontium ranelate/raloxifene pending T score

+ Denosumab if further needed

+ HRT if post-menopausal with vasomotor symptoms

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5
Q

What is the action of…

bisphosphonates

Strontium ranelate

raloxifene

Desonumab

A

Block osteoclastic breakdown

Increase osteoblastic activity + inhibit osteoclastic breakdown

Modulates oestrogen receptors to reduce vertebral fracture risk

RANKL inhibitor that prevents osteoclastic maturation

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6
Q

What lifestyle acivities reduce osteoporosis risk?

A

Stop smoking and diabetes

Weight bearing excercise

Hip protectors in nursing homes

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7
Q

What are the side effects of bisphosphonates

A

Osteonecrosis of the jaw and ear canal

Reflux –> Prescribe a PPI

Atypical femoral fractures

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8
Q

Leg twisted outwards and shortened indicates what?

How do you investigate this?

A

Hip fracture

AP and lateral hip XR +/- MRI to confirm

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9
Q

Whaat is seen in this X-ray?

A

Normal hip XR

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10
Q

What is the significance of intracapsular vs extracapsular fractures?

A

Intracapsular more likely to lose blood supply resulting in AVN

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11
Q

What does this XR show?

A

Intraacapsular (subcapital)

Shenton’s line disrupted

Femoral neck shortening

Increased view of lesser trochanter

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12
Q

What does this XR show?

A

Intertrochanteric fracture

Fracture runs between greater and lesser trochanter

Femoral neck intact

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13
Q

What does this XR show

A

Subtrochanteric fracture

Fracture distal to trochanters

Femoral neck remains intact

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14
Q

What garden staging of hip fracture is AVN likely to occur in?

A

3-4: Indicates displacement

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15
Q

What surgery do you perform a hip fracture is

Intracapsular

Extracapsular

A

Intra: THR if fit, hemi if not

Intertrochanteric: Dynamic screw

Subtrochanteric (<5cm distal to lesser): IM nail

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16
Q

How does hip dislocation characteristically differ from fracture in presentation?

A

Dislocation: Internal rotation if posterior, external with no shortening if anterior

Fracture is external rotation WITH shortening

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17
Q

How do you manage hip dislocation?

A

ABCDE with 4hr reduction with GA

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18
Q

What nerve injuries occur in hip dislocation?

A

Sciatic: Foot drop, loss of external rotation + abduction of hip

Femoral: Poor hip flexion, sensation loss over medial leg

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19
Q

How do you differ between acute and chronic osteomyelitis?

A

Acute: Fever, pain swelling and redness of surgical joint site

Chronic: History of pain, persistently draining wound, diabetics

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20
Q

How do you investigate and treat osteomyelitis?

A

Image with MRI, biopsy is definitive

Treat with fluclox (clindamycin)

Acute: 4-6 weeks

Chronic: 3-6 months

–> IVOST once stable or 2 weeks post surgery

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21
Q

Severly painful, paraesthetic leg following trauma suggests what?

How do you treat this?

A

Compartment syndrome

Raise, fasciotomy and fluids

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22
Q

What are the red flags for back pain?

A

Age < 20 years or > 50 years

History of previous malignancy

Night pain

History of trauma

Systemically unwell e.g. weight loss, fever

23
Q

What are the key things to examine in the back?

A

LNDN

Localised spinal tenderness (esp thoracic)

Neurological deficits bilaterally

Distended bladder

No or reduced anal tone

24
Q

How can you tell between a prolapsed disc at L3 and L4?

A

Both have + ve femoral stretch test and reduced knee reflex

L3: sensation over thigh

L4: Sensation over knee

25
Q

How do L4 and L5 compressions compare?

A

L4: Sensory over knee, knee reflex, femoral stretch

L5: Dorsal foot, foot and 1st toe dorsiflexion, sciatic stretch

26
Q

How do L5 and S1 compression compare?

A

L5: Sensory dorsal foot, weakness in foot and big toe, ANKLE REFLEX INTACT

S1: Posterolateral leg and lateral foot, weak plantar flexion, Ankle reflex lost

27
Q

How do you manage a prolapsed disc?

A

Analgesia, physio, exercise

4-6 weeks persistence: MRI

28
Q

How does mechanical back pain present and what is the pain ladder for it/

A

Pain brought on by actvity

  1. NSAIDs
  2. Codeine

+ Benzos for spasm for 5 days

29
Q

What drugs are avoided in mechanical back pain?

A

Opioids, antidepressants or atypicals

30
Q

How do you differentiate between cauda equina and metastatic spinal cord compression?

A

MSCC worse on valsalva movements

31
Q

For cauda equina what is the…

most common mechanism

Imaging

Treatment

A

L3-4 OR L5-S1 herniation

Admite then emergency MRI

Surgical compression

32
Q

Tender swollen knee following twisting movement, extension causes locked knee indicates what?

A

Meniscal tear

33
Q

How do investigate and treat a meniscal tear?

A

Can do an Apley grind test

MRI if cant weight bear or flex to 90 degrees

RICE, arthroscopic repair if severe

34
Q

How do anterior and posterior cruciate ligaments differ in terms of mechanism?

A

Anterior: Popping noise following twisting injury, can have rapid swelling

Posterior: Anterior force to tibia (eg dashboard injury)

35
Q

How do you differentiate between tendinopathy and rupture of the achilles tendon?

How does management differ?

A

Simmond’s calf squeeze, US

RIPE and orthotics for tendon, NO STEROIDS

Plantarflexion boot, surgical reattachment

36
Q

What are the rules for XR in ankle injuries

A
  • Tenderness along the lateral malleolar zone
  • Tenderness along the medial malleolar zone
  • Can’t walk 4 weight bearing steps
37
Q

What is this X ray of?

A

Normal shoulder XR

Glenoid and humeral head aligned

38
Q

What does this XR show?

A

Anterior dislocation

Humeral head overlaps glenoid more

has moved below coracoid

39
Q

What does this XR show?

A

Posterior dislocation

Humeral head does not touch glenoid

Internal rotation means you can see more rounded part of head causing the lightbulb sign

40
Q

How do you manage shoulder dislocation?

A

Recent: Reduction

Less recent: Analgesia and sedation

Sling immobilisation 1-3 weeks

41
Q

What nerve injury is most associated with shoulder dislocation?

A

Axillary nerve (C5,6)

Deltoid weakness and ‘badge patch’ sensation loss

42
Q

Compare medial and lateral epicondylitis and radial tunnel syndrome in terms of:

Mechanism/worsening pain

A

Medial (Golfer’s) // Lateral (Tennis) // Radial tunnel

Wrist flexion and pronation // wrist extension or supination with extended elbow // pain distal to lateral elbow, worse on PRONATION

43
Q

Compare cubital and carpal tunnel syndrome in terms of affected area?

A

Cubital: 4th and 5th finger, following elbow trauma

Carpal: pain in lateral hand, THENAR wasting; autoimmune, pregnant or lunate fracture

44
Q

How do you treat carpal tunnel?

A

6 weeks rest and splints

Day case surgery and steroids if resistant

45
Q

How do you disntinguish Colle’s and Smith’s fracture

A

Colle’s // Smith

Distal Displaced Dorsally // Volar displacement

Dinner fork deformity // garden spade deformity

46
Q

What does this XR show?

A

Colle’s fracture

Tranverse fracture radius

+/- ulnar styloid fracture

47
Q

What does this XR show?

A

Smith fracture

48
Q

How to tell difference between monteggia and galeazzi fracture?

A

Monteggia: Ulnar fracture, prox radioulnar joint dislocation

Galeazzi: Radial fracture, distal radioulnar joint fracture

49
Q

How does facet joint pain differ from prolapse?

A

No straight leg test in facet joint, worse on back extension

50
Q

Hypoxaemia, neuro changes and petechial rash post op suggests?

A

Fat embolism syndrome

51
Q

How can you differ between PAD and spinal stenosis?

A

PAD will have CVD history

SS will improve on sitting and bending back

52
Q

For avascular necrosis, what are the

Risk factors

Investigations

Management

A

RFs: Steroids, chemo, alcohol excess, trauma

Investigations: XR shows normal or crescent sign; MRI most sensitive.

Joint replacement may be necessary

53
Q
A

MRCP Part 1 (32 decks)

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