Orthopaedics Flashcards
Female had femoral mid shaft fracture while tramping, she had to wait 24 hours to be rescued, presents with low BP, breathlessness, respiratory acidosis, ecchymosis. Investigations showed a dilated right ventricle and pulmonary artery?
a) Fat embolism
b) Pulmonary embolism
c) ARDS
Fat embolism
Man in his 60’s working with machinery presents to the doctor because his handwriting is getting worse and has decreased grip strength. He is also experiencing difficulty using a pincer grip. He has tingling or numbness feeling of the palmar surface of his 4th and 5th digits. All hand and wrist movements are normal and not painful. What is the most likely cause?
a) Nerve entrapment in carpal tunnel
b) Nerve entrapment at the cubital tunnel
c) Brachial plexus lesion
d) C8/T1 disc protrusion
e) Pancoast tumour
Cubital tunnel at elbow = ulnar nerve
Lady with tingly fingers esp at night and when she’s driving. Has to get up in the middle of the night to shake out her fingers - this tends to improve her symptoms. Worse with pressure over the wrist crease. What is the most likely diagnosis?
a) Carpal tunnel syndrome
b) Cubital tunel synrome
Carpal
Young man just had ORIF of tibia. 6 hours post-op complains of pain, worse with passive dorsiflexion of big toe. Next step in management?
a) Calf fasciotomy
b) Increase analgesia
c) Plaster
d) Reassess in 2 hours
e) Raise the calf
Compartment syndrome sx = 6 Ps – pain (severe on passive movement), paraesthesia, pallor, paralysis, pulseless (+ high opioid requirement)
- Tx = remove casts + dressings, elevate to level of heart, fasciotomy
Woman, 56, who fell on arm and got wrist fracture. They are worried about bone strength. What’s the greatest concern?
a) Menopause at 48
b) Drinks 1 glass of wine a night
c) Never pregnant
d) Smokes 10 cigs a day
Smokes 10 cigs a day
48 normal age for menopause
35 year old male secondary school teacher presents with 6 hours of weakness in the right arm. There is a dull ache on the outside of the upper arm. The symptoms were present when he woke this morning, having fallen asleep in a chair watching late night TV. He played professional football for 10 years and had several neck injuries. 2 weeks ago he had a diarrhoeal illness. O/E there was weakness of abduction of the right shoulder. There is reduced pin prick sensation on the outer part of his arm. Of the provided options, which diagnosis is most likely?
a) C5 radiculopathy
b) Musculocutaneous nerve issue c) Radial nerve issue
d) Guillain Barre Syndrome
e) Polymyalgia rheumatica
C5 radiculopathy
Regimental badge area
55 year old post-menopausal lady with family history of osteoporosis. T-score of -2.8. Vertebral compression fractures. Last menstrual period 8 years ago. Never goes outside in the sun because husband had melanoma. Doesn’t eat regular meals. Management?
a) Alendronate
b) Vitamin D and calcium
c) Transdermal estradiol
Severe case - not just risk so biphosphonate
Old lady with tingling, shooting pain in the foot. Tenderness in 3rd and 4th web space. Dx?
a) Morton’s neuroma
b) Osteoarthritis
c) Plantar fasciitis
d) Stress fracture
Morton’s neuroma
Old man with progressive pain in heel. Deep palpation over heel elicits tenderness.
a) Plantar fasciitis
b) Morton’s neuroma
c) Stress fracture
Plantar fasciitis = overstretched (small tears) + inflamed plantar fascia on bottom of foot progressive heel pain (worse in morning, better with walking) + stiffness bony spurs
Pain in the shoulder with both active and passive abduction through 45-135 degrees. No pain straight down or held straight up at 180 degrees. Pain on letting the arm down. Dx?
a) Rotator cuff syndrome
b) Frozen shoulder
c) Deltoid injury
Rotator cuff syndrome
a) IV fluclox
b) IV fluclox and physio
c) Surgical exploration
d) Oral abx
IV fluclox
if signs of improvement within 24 hours, no surgery is required
Guy who got kicked in the leg playing football. Now has pain out of keeping with injury and weakness dorsiflexion of foot and big toe. Tender and swollen lower leg. Pedal pulses palpable. Reduced sensation on the foot. What is the diagnosis?
a) Compartment syndrome
b) Common peroneal nerve palsy
Compartment syndrome
Compartment syndrome = pallor, pulselessness (late sign), pain out of keeping with injury, paraesthesia, paralysis
Car accident. Man has weak pulses and is in extreme pain in legs. Dx?
a) Compartment syndrome
b) Cauda equina syndrome
Compartment syndrome
Woman with painful hand at night, dangles over bed for relief. Which nerve is affected? a) Median
b) Radial c) Ulnar
Median
Median nerve compressed w/ wrist flexion (sleeping position)
Man cuts flexor aspect of wrist and needed surgical repair via sutures. Can’t bend middle finger DIP joint, otherwise normal. What is the structure that is damaged?
a) Flexor digitorum profundus
b) Flexor digitorum superficialis
c) Palmar fascia
d) Median nerve
FD profundus
Lady with hx of malignant melanoma on back, which was excised. Hurt back lifting a box. Now has back pain, shooting pain down right leg, foot drop. Normal reflexes. Dx?
a) L4-5 disc prolapse
b) L5-S1 disc prolapse
c) Spinal stenosis
d) Compression fracture from bony mets
Foot drop
Dorsiflexion of foot is L4/5
L5 = pain back of thigh + lat leg
Wrist drop = radial nerve
Acute knee pain. X-ray of knee and aspirate showed no crystals. Dx?
a) Septic arthritis
b) Reactive arthritis
c) Gout
d) Pseudogout
e) Haemarthrosis
?
