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MRCS - Part A > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What is the sural nerve?

A

A cutaneous nerve, providing only sensation to the posterolateral aspect of the distal third of the leg and the lateral aspect of the foot, heel, and ankle.
Originates from S1-S2
It is in close proximity to the short saphenous vein

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2
Q

What nerve supplies the gluteus maximus?

A

Inferior Gluteal Nerve

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3
Q

What nerve roots does the Superior Gluteal Nerve arise from?

A

L4-S1

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4
Q

What muscles does the Superior Gluteal Nerve supply?

A

Gluteus minimus and maximus

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5
Q

What nerve supplies the quadriceps muscles?

A

Femoral nerve

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6
Q

What are the boundaries of the anatomical snuff box?

A

Medial - Extensor pollicus longus
Lateral - Extensor pollicus brevis and abductor pollicus longus

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7
Q

What muscles does the musculocutaneous nerve innervate?

A

Coracobrachialis
Biceps Brachii
Brachialis

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8
Q

What are the nerve roots for the musculocutanous nerve?

A

C5-C7

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9
Q

Which branch of the brachial plexus innervates the deltoid and teres minor?

A

Axillary Nerve

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10
Q

What muscle separates the subclavian artery and subclavian vein?

A

Scalene anterior

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11
Q

What are the 3 thenar muscles?

A

Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

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12
Q

What are the 3 hypothenar muscles?

A

Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi brevis

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13
Q

What nerve innervates the hypothenar muscles?

A

Ulnar nerve

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14
Q

What are the other muscles of the hand that are not in the thenar or hypothenar eminences?

A

Lumbricals
Interossei
Palmaris brevis
Adductor pollicis

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15
Q

Which muscles of the hand are supplied by the median nerve?

A

Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

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16
Q

What nerve innervates the deep muscles of the anterior compartment of the forearm?

A

Anterior interosseous branch of the median nerve

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17
Q

What muscles make up the superficial layer of muscles in the anterior compartment of the forearm (Medial to Lateral)?

A

Flexor carpi ulnaris
Palmaris longus
Flexor carpi radialis
Pronator teres

(FPFP)

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18
Q

What are the origins and insertions of the flexor carpi ulnaris?

A

Origins - medial epicondyle of the humerus and olecranon of the ulnar
Insertions - pisiform, hook of hamate, base of 5th metacarpal

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19
Q

Which is the only muscle in the anterior compartment which is not innervated by the median nerve?

A

Flexor carpi ulnaris - ulnar nerve

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20
Q

Which is the only muscle to flex the distal interphalangeal joints of the fingers?

A

Flexor digitorum profundus

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21
Q

Which nerve roots does the ankle reflex test?

A

S1-S2

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22
Q

What muscles lie in the deep posterior compartment of the lower leg?

A

Tibialis posterior
Flexor hallicus longus
Flexor digitorum longus
Popliteus

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23
Q

What nerve are the muscles in the deep posterior compartment of lower leg supplied by?

A

Tibial nerve

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24
Q

Which structure usually herniates in a vertebral disc prolapse?

A

nucleus pulposus

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25
Q

What is a Colle’s fracture?

A

Distal radial metaphyseal transverse fracture with dorsal angulation.
Dinner fork deformity
Fall onto outstretched hand
Cast immobilisation with wrist flexion and ulnar deviation

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26
Q

What is a Smith’s fracture?

A

Distal radial metaphyseal transverse fracture with volar angulation.
Garden spade deformity
Fall onto proned hand or blow to back of wrist
Cast immobilisation with forearm supinated and wrist extended

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27
Q

What is a Barton’s fracture?

A

Distal radial fracture similar to colle’s or smith’s but with intra-articular involvement. Can be volar (more common) or dorsal dislocation
Radio-ulnar dislocation common.

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28
Q

What do you call base of thumb fracture due to forced abduction of metacarpal?

A

Bennett’s fracture
Intra-articular

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29
Q

What are the differential diagnoses of a Bennett’s fracture?

A

Rolando - comminuted
Pseudo-Bennett - extra-articular

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30
Q

Name of ulnar shaft fracture with dislocation of proximal radial head?

A

Monteggia’s fracture

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31
Q

What classification system is used for Monteggia fractures?

A

Bado classification

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32
Q

What is the name of a radial shaft fracture with dislocation of radio-ulnar joint?

A

Galeazzi fracture

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33
Q

What are the 2 types of galeazzi fractures?

A

Type 1 - dorsal displacement
Type 2 - volar displacement

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34
Q

What is a Hutchinson fracture?

A

Also known as chauffeur fracture
Intra-articular fracture of styloid process of distal radius
Due to forced dorsiflexion or direct blow
Unstable - requires percutaneous lag screw fixation

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35
Q

What is a Holstein-Lewis fracture?

A

Simple spiral fracture of distal humerus with radial dispalcement of the distal humeral fragment
Due to fall in elderly or RTC
Requires reduction and functional humeral brace

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36
Q

What nerve is likely to be damaged in a Holstein-Lewis fracture?

A

Radial nerve

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37
Q

What is an Essex-Lopresti fracture?

A

Fracture of radial head, dislocation of distal radio-ulnar joint and rupture of the antebrachial interosseus membrane.
Due to fall from height or high energy trauma.
Requires ORIF +/- prosthetic radial head

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38
Q

What defect in the humeral head occurs as a result of anterior glenohumeral dislocation?
What is the lesion of the infraglenoid labrum?

A

Hill-Sach’s defect - depression fracture of posterolateral humeral head
Bankart lesion

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39
Q

What classification is used to classify ankle fractures?

A

Weber classification

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40
Q

What nerve innervates the deltoid muscle?

A

Axillary

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41
Q

What muscles make up the anterior compartment of the upper arm and what nerve supplies them?

A

Coracobranchialis
Brachialis
Biceps Brachii

Musculocutaneous Nerve (C5-C7)

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42
Q

What muscles make up the posterior compartment of the upper arm and what nerve supplies them?

A

Triceps brachii only

Radial nerve

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43
Q

What nerve root is tested with the biceps reflex?

A

C6

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44
Q

What are the attachments of the biceps brachii?

A

Long head - supraglenoid tubercle of the scapula
Short head - coracoid process of the scapula

Insertion - Radial tuberosity and fascia of forearm via the bicepital aponeurosis

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45
Q

What are the attachments of the triceps brachii?

A

Long head - infraglenoid tubercle of the scapula
Lateral head - humerus, superior to the radial groove
Medial head - humerus, inferior to the radial groove

Insertion - Olecranon of the ulnar

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46
Q

What staging system is used for perthes disease?

A

Catterall staging

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47
Q

What is perthes disease?

A

idiopathic avascular necrosis of femoral head

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48
Q

What blood vessels supply the femoral head and neck?

A

Medial and lateral femoral circumflex arteries

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49
Q

What blood vessel supplies the humeral head?

A

Anterior humeral cirumflex artery

Disrupted in 80% of proximal humeral head fractures with risk of avascular necrosis and therefore fractures of the anatomical neck of humerus require hemiarthroplasty

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50
Q

What are some causes of avascular necrosis?

A

P - pancreatitis
L - lupus
A - alcohol
S - steroids
T - trauma
I - idiopathic, infection
C - caisson disease, collagen vascular disease

R - radiation, rheumatoid arthritis
A - amyloid
G - gaucher disease
S - sickle cell disease

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51
Q

Name the superficial muscles in the posterior compartment of the forearm

A

Brachioradialis
Extensor Carpi Radialis Brevis and Longus
Extensor Digitorum Communis
Extensor Digiti Minimi
Extensor Carpi Ulnaris
Anconeus

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52
Q

Name the deep muscles of the posterior compartment of the forearm

A

Supinator
Extensor Pollicis Brevis
Extensor Pollicis Longus
Abductor Pollicis Longus
Extensor Indicis

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53
Q

What would aspirated joint fluid show for pseudogout?

A

calcium pyrophosphate crystals

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54
Q

What would a raised transferrin saturation level indicate in the context of pseudogout?

A

Haemochromatosis

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55
Q

Tenderness over anatomical snuffbox and tenderness of longitudinal compression of thumb indicate what?

A

Scaphoid fracture

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56
Q

How do you manage spiral fracture of tibia?

A

Intramedullary nail

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57
Q

What classification system is used for open fractures?

A

Gustilo and Anderson Classification

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58
Q

What are the features of a radial head fracture?

A

Fall onto outstretched hand, tenderness on pronation and supination, tenderness over proximal forearm

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59
Q

What part of the humerus does the radial head articulate with?

A

Capitulum

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60
Q

What part of the hip does psoas major insert into?

A

Lesser trochanter of femur

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61
Q

What is Froment’s test?

A

Holding a piece of paper between thumb and finger without flexing IP joint.
Assesses adductor pollicis and therefore for ulnar nerve palsy

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62
Q

Which artery provides blood supply to scaphoid?

A

dorsal carpal branch vessels via retrograde flow

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63
Q

What muscles make up the anterior compartment of the lower leg? What nerve are the innervated by?

A

Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus

+/- Peroneus tertius

Deep peroneal nerve

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64
Q

What are the 3 ligaments stabilising the hip joint?

A

Iliofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament

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65
Q

Weakness of which muscle causes the patella to track laterally?

A

Vastus medialis

66
Q

What ligament is most likely injured with an ankle inversion injury?

A

Anterior talofibular ligament

67
Q

Which muscles make up the anterior compartment of the thigh?

A

Rectus femoris
Vastus lateralis
Vastus intermedius
Vastus medialis
Sartorius
Pectineus
+/- iliopsoas

68
Q

What is the innervation of the anterior component of the thigh?

A

Femoral nerve L2-L4

69
Q

What vessels provide blood supply to anterior compartment of the thigh?

A

Femoral artery
Medial circumflex femoral artery
Lateral circumflex femoral artery
Profunda femoris artery

70
Q

Which nerve innervates the posterior compartment if the thigh?

A

Tibial part of the sciatic nerve

71
Q

Where do the heads of the biceps femoris originate and insert?

A

Long head - ischial tuberosity
Short head - linea aspera of femus

Insert together onto lateral head of fibula

72
Q

Which muscle of the posterior compartment of the thigh is most lateral?

A

Biceps femoris

73
Q

Which muscle lies deeper; semitendinosis or semimembranosus?

A

Semimembranosus

74
Q

Where do the semitendinosus and semimembranosus originate and insert?

A

Semitendinosus
- originates from ischial tuberosity
- inserts to medial surface aspect of tibia

Semimembranosus
- originates from ischial tuberosity
- inserts to medial tibial condyle

75
Q

Which muscles insert onto the pes anserinus?

A

Semitendinosus
Gracilis
Sartorius

76
Q

Which nerves innervate to adductor magnus?

A

Adductor part - Obturator nerve (L2-L4)
Hamstring part - tibial part of the sciatic nerve (L4-S3)

77
Q

Where does the adductor longus originate and insert?

A

Originates from pubis and attaches to linea aspera of femur

78
Q

Where does the adductor brevis originate and insert?

A

Originates from body of pubis and inferior pubic rami and inserts to linea aspera

79
Q

Other than adductor magnus, longus and brevis, what muscles make up the adductor muscles?

A

Gracilis
Obturator externus

80
Q

What is the origin and insertion of obturator externus?

A

Origin is membrane of the obturator foramen.
Passes posteriorly to neck of femur and inserts onto posterior aspect of the greater trochanter.

81
Q

What 6 muscles insert onto the greater trochanter?

A

Gluteus medius
Gluteus minimus
Obturator externus
Obturator internus
Piriformis
Gemelli

82
Q

What muscles cross both the hip and the knee?

A

Rectus Femoris
Gracilis
Sartorius

83
Q

Where does the gracilis muscle originate and insert?

A

Inferior pubic rami to medial surface of tibial shaft

84
Q

Which is the most superficial and deep out of adductor maganus, longus and brevis?

A

Deepest - adductor magnus
Superficial - adductor longus

85
Q

Which nerve innervates the medial compartment of the thigh?

A

Obturator nerve (L2-L4)

86
Q

What is the blood supply to the adductor muscles?

A

Obturator artery

87
Q

What are the origins of the muscles within the anterior compartment of the thigh?

A

Psoas muscle - lumbar spine
Iliacus - ilium of plevis
Rectus Femoris - Anterior inferior iliac spine
Vastus lateralis - Greater trochanter
Vastus intermedius - Anterior and lateral femoral shaft
Vastus medialis - intertrochanteric line and medial lip of the linea aspera

88
Q

What is the blood supply and innervation of the 4 compartments of the lower leg?

A

Anterior - tibial artery and deep peroneal nerve (L4-S1)
Lateral - fibula artery and superficial peroneal nerve
Deep posterior - posterior tibial artery and tibial nerve (L4-S3)
Superficial posterior - posterior tibial artery and tibial nerve (L4-S3)

89
Q

Muscles in superficial posterior compartment of the lower leg and their function

A

Gastrocnemius
Soleus
Plantaris

Plantarflexion

90
Q

Muscles in deep posterior compartment of the lower leg and their function

A

Popliteus- unlock knee
Flexor digitorum longus - flex digits
Flexor hallicus longus - flex great toe
Posterior tibialis - plantarflexion and inverson

90
Q

Injury to what nerve causes foot drop and how is it most commonly injured?

A

Common fibular nerve
Fracture to proximal fibula

91
Q

Muscles in lateral compartment of the lower leg and their function

A

Fibularis longus
Fibularis brevis

Eversion

92
Q

Muscles in anterior compartment of the lower leg and their function

A

Tibialis anterior
Extensor digitorum logus
Extensor hallicus longus

Dorsiflexion

93
Q

What are the nerve roots of the sciatic nerve?

A

L4-S3

94
Q

What nerve innervates the biceps femoris?

A

Long head innervated by the tibial part of the sciatic nerve, whereas the short head is innervated by the common fibular part of the sciatic nerve.

95
Q

What structure separates the ulnar artery and the median nerve in the proximal forearm?

A

Pronator teres

96
Q

What are the contents of the popliteal fossa?

A

Popliteal artery and vein
Small saphenous vein
Common peroneal nerve
Tibial nerve
Posterior cutaneous nerve of the thigh
Genicular branch of the obturator nerve
Lymph nodes

97
Q

Which nerve lies lateral to the brachial artery in the upper arm?

A

Median

98
Q

What tough ligamentous structure lies anterior to the spinous processes?

A

Ligamentum Flavum

99
Q

What are the branches of the lumbar plexus and what vertebrae do they arise?

A

Iliohypogastric T12-L1
Ilioinguinal L1
Genitofemoral L1-L2
Lateral cutaneous L2-L3
Femoral L2-L4
Obturator L2-L4

100
Q

What muscles does the anterior interosseous nerve supply? and what does damage to this nerve look like?

A

Muscles of the deep anterior compartment:
Flexor pollicus longus
Lateral aspect of the flexor digitorum profundus
Pronator quadratus

Loss of pincer grip between thumb ad index finger and inability to pronate

101
Q

Which nerve supplies sensory innervation to skin of anterolateral thigh?

A

Lateral cutaneous nerve of the thigh

102
Q

What structures run posterior to the medial malleolus?

A

T ibialis posterior tendon
flexor Digitorum longus
A rtery (posterior tibial artery)
N erve (tibial nerve)
H allucis longus (flexor)

Tom Dick And Nervous Harry

103
Q

How do sarcomas metastasise and where to?

A

Haematogenous route
Lung

104
Q

What is osteopetrosis?

A

Marble bone disease
Defective osteoclast function resulting in failure of normal bone resorption
due to deficiency in carbonic anhydrase isoenzyme II
Stem cell transplant and interferon-gamma have been used for treatment
Radiology reveals a lack of differentiation between the cortex and the medulla.

105
Q

Which childhood hip disorder is associated with short stature and hyperactivity?

A

Perthes

106
Q

What bone tumour shows multiple lytic and lucent areas (Soap bubble) appearances on xray?

A

Osteoclastoma (giant cell tumor of bone)

107
Q

What is klein’s line?

A

Radiographic finding used to detect SUFE
A line is drawn along the superior border of the femoral neck. In a normal hip, the line intersects the lateral part of the superior femoral epiphysis.

108
Q

What are the risk factors for DDH?

A

Breech
Family history
Female
Firstborn
Oligohydramnios
Swaddling

109
Q

What does perthe’s disease show on xray?

A

Widening of femoral neck
Flattening of femoral head
Patchy density

110
Q

Cause of hip pain in children aged 4-10 following viral URTI

A

Transient synovitis of the hip

111
Q

What type of benign bone tumour shows thickened reactive bone area 1cm radiolucent core?

A

Osteoid osteoma
Affects males > females, ages 10-25 yrs
Usually occurs in femur or tibia
Presents with dull ache which responds to NSAIDs

112
Q

What benign bone tumour presents with painless bony lump?

A

Osteochondroma
Affects ages 10-30
Abnormal growth on surface of the bone near growth plate
Rarely needs treatment - excised if compresses a nerve or vessel

113
Q

How do chondromas present?

A

Found incidentally, usually in hands or feet
Made from cartilage

114
Q

What type of bone tumour has soap bubble appearance on x-ray?

A

Giant cell tumour of bone (osteoclastoma)

115
Q

What solid organ tumours most commonly metastasise to bone?

A

Breast
Thyroid
Lung
Prostate
Kidney

116
Q

How does Ewing’s sarcoma appear histologically?

A

Small blue cells

117
Q

Where do osteosarcomas most commonly metastasise to?

A

Lung

118
Q

What is a chordoma?

A

Neoplasm originating from noctocord - therefore found in axial skeleton only
Accounts for 50% of sacral tumours
Presents in ages 50-70

119
Q

Causes of carpal tunnel

A

Myxoedema
Edema premenstrually
Diabetes
Idiopathic
Acromegaly
Neoplasm
Trauma
Rheumatoid arthritis
Amyloidosis
Pregnancy

120
Q

What lab test is used to test for HIV?

A

P24 antigen test

121
Q

What are lining cells?

A

Dormant osteoblasts

122
Q

What are the most common causes of hypercalcaemia in hospital and in the community?

A

Hospital - metastatic malignancy
Community - Primary hyperparathyroidism

123
Q

What is the radiological finding of a greenstick fracture?

A

Unilateral cortical breach only
+ periosteal haematoma

124
Q

Symptoms of fat embolism?

A

Triad of symptoms:
Respiratory - reduced sats, breathless
Neurological - agitated, confused
Petechial rash (tends to occur after the first 2 symptoms)

125
Q

What treatments does metastatic bone pain respond to?

A

Paracetamol and NSAIDs are first line
Bisphosphonates
Radiotherapy if drugs are not working

126
Q

In the supracondylar area, where does the radial nerve lie in relation to the humerus?

A

Anterolateral

127
Q

Where does the common peroneal nerve divide into the deep and superficial peroneal nerves?

A

Just lateral to the neck of the fibula

Remember that when there is a proximal fibular fracture there is risk of common peroneal nerve damage and results in footdrop

128
Q

What artery does the gluteal arteries arise from?

A

internal iliac artery

129
Q

What are sharpey’s fibres?

A

Collagenous fibres that attach the periosteum to bone

130
Q

At what level is a cervical rib most likely to arise from?

A

C7

131
Q

What nerve innervates the trapezius?

A

Spinal accessory nerve

132
Q

Which nerve provides cutaneous innervation of the 1st webspace of the foot?

A

Deep peroneal nerve (L4-5)

133
Q

What are the nerve roots of the sciatic nerve?

A

L4-S3

134
Q

What structures pass through both the greater and lesser sciatic foramen?

A

Pudendal nerve
Internal pudendal artery
Nerve to obturator internus

135
Q

What is De Quervain’s Tenosynovitis?

A

Inflammation of the tendons in compartment 1:
Abductor pollicis longus
Extensor pollicis brevis

Pain and swelling at base of the thumb with associated difficulty with grasping and pinching

136
Q

What nerve is most likely to be damaged if the sternocleidomastoid is mobilised during surgery?

A

Accessory

137
Q

Where is the radial nerve relative to the humerus at the supracondylar level?

A

Anterolateral

138
Q

Where does the common peroneal nerve bifircate?

A

Lateral to the neck of fibular

139
Q

Which ligament keeps the head of the radius connected to the radial notch of the ulna?

A

Annular (Orbicular) ligament

140
Q

What are the contents of the adductor canal?

A

Saphenous nerve
Superficial femoral artery
Superficial femoral vein

141
Q

Where does the sciatic nerve bifurcate?

A

Apex of the popliteal fossa

142
Q

What nerve supplies sensory innervation to the skin on the back of the knee?

A

posterior cutaneous nerve of the thigh
(S1-S2)
Branch of the sacral plexus

143
Q

What is Lachman’s test?

A

used to determine ACL injury
similar to anterior draw test but the knee is only flexed to 15-20 degrees

144
Q

Which nerve supplies sensory innervation to the medial aspect of the lower leg and foot?

A

Saphenous nerve
Branch of femoral nerve
L3-L4

145
Q

What is pes planus?

A

Flat foot
Due to dysfunction of posterior tibialis muscle

146
Q

What nerve innervates the teres minor? And what are the attachments of this muscle?

A

Axillary

Inferior facet of the greater tubercle of the humerus and lateral border of scapula

147
Q

Which nerves accompany the cephalic and basilic veins in the forearm?

A

Basilic - Medial cutaneous nerve of the forearm
Cephalic - Lateral cutaneous nerve

148
Q

What is the axillary sheath?

A

An extension of the prevertebral fascia.
Contains the axillary artery and the 3 cords of the brachial plexus
Divided in to 3 parts according to pectoralis minor

149
Q

Where do the two heads of the flexor carpi ulnaris arise from?

A

Humeral head from the medial epicondyle of the humerus
Ulnar head from the olecranon and posterior border of the ulnar

150
Q

What does the dorsal scapular nerve innervate?

A

C5
Rhomboid minor and major and levator scapular
Causes retraction and elevation of the scapula

151
Q

What is the canal of guyon?

A

Where the ulnar nerve enters the hand
Superficial to the flexor retinaculum, lateral to the pisiform bone

Ulnar nerve lies medial to the artery within the guyon canal.

152
Q

What nerve innervates teres major?
What other muscle does this nerve innervate?

A

Lower subscapular nerve

Subscapularis

153
Q

What are the contents of the cubital fossa (lateral to medial)?

A

Radial nerve
Biceps tendon
Brachial artery
Median Nerve

154
Q

What is the annular ligament?

A

Encircles the head of the radius
Allows for pronation and supination

155
Q

Where do all the muscles in the superficial compartment of the anterior forearm originate?

A

Medial epicondyle of humerus

156
Q

Which nerve supplies the brachioradialis muscle?

A

Radial nerve

157
Q

Where do the two heads of the extensor carpi radialis brevis an longus arise from?

A

Long - Lateral supracondylar ridge of the humerus
Short - Lateral epicondyle of the humerus

158
Q

Which branch of the median nerve is responsible for innervation of the thenar muscles?

A

Recurrent branch

159
Q

What are the contents of the anatomical snuffbox?

A

Cephalic vein
Radial artery
Radial nerve - superficial branch

160
Q

What is a bankart lesion?

A

Injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder dislocation.

MRCS - Part A (16 decks)

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