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Finals > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What is a hemiarthroplasty?

A

Replacing only half the joint e.g. head of femur in the hip joint only as opposed to a total hip replacement

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2
Q

What is given to patient before/during a joint replacement surgery?

A

Prophylactic antibiotics
Tranexamic acid
VTE prophylaxis

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3
Q

What types of fracture typically only occur in children?

A

Greenstick, buckle, salter-harris

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4
Q

What is a comminuted fracture?

A

Multiple fragments of bone

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5
Q

A fall on an outstretched hand is likely to result in what two kinds of fracture?

A

Colle’s fracture and scaphoid fracture

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6
Q

What is a Colle’s fracture?

A

Transverse fracture of the distal radius near the wrist causing the distal portion to displace posteriorly

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7
Q

What is a key sign of a scaphoid fracture?

A

Tenderness in the anatomical snuffbox

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8
Q

Why do displaced scaphoid fractures require surgical fixation?

A

They have a retrograde blood supply which can result in avascular necrosis

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9
Q

What are the Ottawa criteria for ankle x-rays following ankle injury?

A

Pain is present in the malleolar zone and one of the following:
1. Inability to walk four steps
2. Bony tenderness at the medial malleolar zone
3. Bony tenderness at the lateral malleolar zone

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10
Q

Can you break you pelvis in only one place?

A

No due to it being a ring you have to break it in two locations

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11
Q

What are the most common sites for pathological fractures?

A

Femur and vertebral bodies

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12
Q

How can you achieve mechanical alignment of a fracture?

A

Closed reduction via manipulation of the limb OR open reduction via surgery

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13
Q

How can you provide relative stability to a joint in order to allow it to heal?

A

External casts, K wires, intramedullary wires, screws, plates

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14
Q

What is a fat embolism?

A

Occur 24-72 hours following a fracture in a long bone, fat globules are released and becomes lodged in blood vessels

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15
Q

Where are intracapsular fractures located?

A

Break in the femoral neck, affect the area proximal to the intertrochanteric line

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16
Q

How is a non-displaced intracapsular fracture treated?

A

Internal fixation

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17
Q

How is a displaced intracapsular fracture treated?

A

If older/frail = hemiarthroplasty

Otherwise = total hip replacement

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18
Q

How are intertrochanteric fractures managed?

A

Dynamic hip screw

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19
Q

How are subtrochanteric fractures treated?

A

Intramedullary nail

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20
Q

What is the presentation of hip fracture?

A

Pain in groin/hip, fall, not able to weight bear, shortened, abducted and externally rotated leg

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21
Q

What is the imaging of choice for a hip fracture?

A

AP and lateral view XR

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22
Q

How long following surgery should patients be encouraged to weight bear?

A

Immediately

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23
Q

What is compartment syndrome?

A

Where the pressure within the fascial compartment is abnormally elevated cutting off the blood flow to the contents of that compartment

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24
Q

What causes acute compartment syndrome?

A

Acute injury where bleeding or tissue swelling leads to the increased pressure

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25
Q

What are the symptoms of compartment syndrome?

A

Disproportionate pain to the underlying injury, worse pain on passive stretching, pale, paraesthesia, paralysis

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26
Q

What is the management of compartment syndrome?

A

Emergency fasciotomy

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27
Q

What is the most common cause of osetomyelitis?

A

Staph aureus

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28
Q

What are the modes of infection in osteomyelitis and which is most common?

A

Haematogenous (most common)
Direct (fracture or during surgery)

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29
Q

What is the presentation of osteomyelitis?

A

Fever, pain, erythema, swelling, non-specific

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30
Q

What is the best imaging modality for diagnosing osteomyelitis?

A

MRI scans

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31
Q

How is osteomyelitis managed?

A

Surgical debridement, 6 weeks of IV flucloxacillin (+ rifampicin or fuscidic acid)

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32
Q

What are the red flags for back pain?

A

Non-mechanical back pain, history of previous malignancy/HIV, night pain, systemically unwell, thoracic back pain, widespread neurological symptoms

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33
Q

What are the red flag causes of back pain?

A

Cauda equina, spinal fracture, spinal stenosis, ankylosing spondylitis, spinal infection, malignancy

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34
Q

Where does the sciatic nerve supply sensory and motor innervation to?

A

Sensation to lateral lower leg and foot
Motor function to posterior thigh, lower leg and foot

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35
Q

What are the symptoms of sciatica?

A

Unilateral pain from buttock radiating down the back of the thigh to knee/foot - electric/shooting pain

Paraesthesia, numbness, motor weakness, absent or reduced reflexes

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36
Q

What is the initial management for sciatica and what is the chronic management?

A

NSAIDs
Amitriptyline or duloxetine for persisting pain

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37
Q

What do the nerves of the cauda equina supply?

A

Sensation - lower limbs, perineum, bladder and rectum
Motor - lower limbs, anal and urethral sphincters
Parasympathetic innervation of bladder and rectum

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38
Q

What are the causes of cauda equina?

A

Herniated disc - most common
Tumours
Spondylolisthesis
Abscess
Trauma

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39
Q

What are the red flag symptoms in cauda equina?

A

Saddle anaesthesia, loss of sensation in bladder and rectum, urinary retention or incontinence, faecal incontinence, bilateral sciatica, bilateral motor weakness in legs, reduced anal tone on PR exam

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40
Q

What is the management of cauda equina?

A

Emergency MRI and lumbar decompression surgery

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41
Q

What is the management of metastatic spinal cord compression?

A

High dose dexamethasone

May require surgery or radiotherapy/chemotherapy

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42
Q

What is spinal stenosis?

A

Narrowing of part of the spinal cord resulting in compression of the spinal cord or nerve roots (most commonly lumbar spine)

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43
Q

What are the causes of spinal stenosis?

A

Congenital, degenerative, herniated disc, thickening of the ligamenta flava, spinal fractures, spondylolisthesis, tumours

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44
Q

What is the presentation of spinal stenosis?

A

Intermittent neurogenic claudication - lower back/buttock/leg pain, leg weakness, numbness

Symptoms are worse on standing/walking and are relieved by leaning forward (e.g. cycling)

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45
Q

What is the management of spinal stenosis?

A

Exercise, weight loss, physio, analgesia

Laminectomy can be performed

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46
Q

What are the features of L3 nerve root compression?

A

Sensory loss over anterior thigh, weak hip flexion and knee extension, reduced knee reflex

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47
Q

What are the features of L4 nerve root compression?

A

Sensory loss over anterior aspect of knee and medial malleolus, weak knee extension and hip adduction, reduced knee reflex

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48
Q

What are the features of L5 nerve root compression?

A

Sensory loss over dorsum of foot, foot drop, intact reflexes

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49
Q

What are the features of S1 nerve root compression?

A

Sensory loss over posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex

50
Q

What is in initial investigation of choice in bony lumps and soft tissue swellings?

A

Bony lumps = x-ray
Soft tissue swellings = USS

51
Q

What is meralgia paraesthetica?

A

Mononeuropathy - sensory symptoms of the outer thigh due to compression of the lateral femoral cutaneous nerve

52
Q

What are the presenting symptoms of meralgia paraesthetica?

A

Abnormal or loss of sensation in the outer thigh, aggravated by walking or standing for a long duration and improve when sitting down, symptoms worse with extension of the hip

53
Q

What are the management options for meralgia paraesthetica?

A

Physio, analgesia, surgical decompression

54
Q

What is discitis and what is the most common causative agent?

A

Infection of the intervertebral disc space

Staph aureus is most common cause

55
Q

What is the management of discitis?

A

MRI spine
6-8 weeks of IV antibiotics (e.g. IV flucloxacillin)

56
Q

What is trochanteric bursitis?

A

Also known as greater trochanteric pain syndrome
Bursa because inflamed due to repetitive movements, trauma or inflammatory conditions such as RA

57
Q

What are the symptoms of trochanteric bursitis?

A

Gradual onset lateral hip pain, worse with activity, may disrupt sleep, pain on resisted movement but ROM should be normal

58
Q

What is the management of trochanteric bursitis?

A

Rest, ice, analgesia, physio and steroid injections

59
Q

What kind of knee injury results in a meniscal tear?

A

Twisting movement in the knee - common in sporting injuries

In older age the meniscus becomes more prone to injury and tears can occur with very minor twisting movements

60
Q

What is the presentation of meniscal tear?

A

Popping sensation, pain, swelling, stiffness, restricted ROM, locking of the knee, knee giving way

61
Q

What is the 1st line and gold standard imaging investigation in meniscal tears and ACL injuries?

A

1st line = MRI
Gold = arthroscopy

62
Q

What is the management of meniscal tears?

A

NSAIDs, physio, arthroscopy with repair or resection of the meniscus

63
Q

What are the Ottawa knee rules for determining whether a patient requires a knee XR after acute injury?

A

Age 55 or above
Patella tenderness (not anywhere else)
Fibular head tenderness
Cannot flex the knee to 90 degrees
Cannot weight bear

64
Q

What is the presentation of an ACL injury?

A

Damaged during twisting injury
Pain, swelling, popping of the knee, instability of the knee

65
Q

What is the management of ACL injury?

A

NSAIDs
RICE
Arthroscopic surgery to reconstruct knee
Crutches and knee braces required to protect knee while mobilising

66
Q

What are the causes of a baker’s cyst?

A

Most common = degenerative changes in the knee
Meniscal tears, knee injuries, inflammatory arthritis, osteoarthritis

67
Q

What is the presentation of a baker’s cyst?

A

Pain, fullness, pressure, lump/swelling, restricted ROM

Lump is most obvious when patient stands with their knees fully extended

68
Q

What is the presentation of a ruptured baker’s cyst?

A

Pain, swelling and erythema of the knee and calf muscle

(need to exclude DVT as differential)

69
Q

What imaging investigations can be done in Baker’s cyst?

A

USS (diagnose but also rules out DVT)

MRI can evaluate cyst further if required

70
Q

What is the management of baker’s cyst?

A

Analgesia, physio, USS guided aspiration, steroid injections

71
Q

What are the causes of achilles tendinopathy?

A

Sports that stress the achilles, inflammatory conditions, diabetes, raised cholesterol, fluoroquinolone antibiotics

72
Q

What is the presentation of achilles tendinopathy?

A

Gradual onset of pain or aching in the achilles tendon or heel with activity, stiffness, tenderness, swelling

73
Q

What is the management of achilles tendinopathy?

A

Exclude rupture, RICE, physio, orthotics (insoles), surgery to remove nodules and adhesions

Do not do steroid injections as increases risk of rupture

74
Q

What are the risk factors for achilles tendon rupture?

A

Sports that stress the achilles, increasing age, existing achilles tendinopathy, family history, fluoroquinolone antibiotics, systemic steroids

75
Q

What is the presentation of of achilles tendon ruputre?

A

Sudden onset of pain in achilles or calf, snapping sound, something has hit them in the back of the leg, rest in a more upright position

76
Q

What is the Simmond’s calf squeeze test?

A

Positive result in achilles tendon rupture

Squeezing the calf muscles will not cause plantar flexion of the ankle

77
Q

What investigation is used in achilles tendon rupture?

A

USS

78
Q

What are the management options of achilles tendon rupture?

A

Non-surgical - specialist boot to immobilise the ankle

Surgical - surgery followed by boot to immobilise ankle

79
Q

What is the presentation of plantar fasciitis?

A

Gradual onset of pain on the plantar aspect of the heel, worse with pressure and standing for prolonged periods

80
Q

How is plantar fasciitis managed?

A

RICE, NSAIDs, physio

81
Q

What is fat pad atrophy and what are the symptoms?

A

Fat pad over heel atrophies due to age or inflammation (measured with USS), pain and tenderness over plantar aspect of heel

82
Q

What is the management of fat pad atrophy?

A

Comfortable shoes, custom insoles, weight loss

83
Q

What is Morton’s neuroma and what are the symptoms?

A

Dysfunction of the nerve between the toes towards the top of the foot, pain at the foot of the foot, sensation of lump in shoe, burning/numbness/paraesthesia

84
Q

What is the management of Morton’s neuroma?

A

USS/MRI to confirm
Analgesia, insoles, weight loss, steroid injections

85
Q

What is a bunion and what are the symptoms?

A

Bony lump created by deformity at base of big toe, first MTP becomes angled medially and toe is angled laterally

Pain in the area when walking and wearing tight shoes

86
Q

What are the management options for bunions?

A

Conservative = wide shoes, analgesia

Surgical correction

87
Q

What is the presentation of frozen shoulder/adhesive capsulitis?

A

Painful phase, followed by stiff phase (external rotation most affected), gradual improvement and return to normal

88
Q

What are the differential diagnoses for shoulder pain not preceded by trauma?

A

Supraspinatus tendinopathy (tested with empty can test), acromioclavicular joint arthritis (tested with scarf test), frozen shoulder, glenohumeral joint arthritis

89
Q

What are the differential diagnoses for shoulder pain preceded by trauma?

A

Shoulder dislocation, fractures, rotator cuff tear

90
Q

What is the management of frozen shoulder?

A

Continue to use arm but do not make pain worse, NSAIDs, physio, steroid injection

91
Q

What are the causes of rotator cuff tears?

A

Acute injuries such as falling on outstretched hand, degenerative, overhead activities such as playing tennis

92
Q

What 4 muscles make up the rotator cuff?

A

Supraspinatus, infraspinatus, teres minor, subscapularis

93
Q

What imaging is done in suspected rotator cuff tears?

A

USS/MRI

94
Q

What is the management of rotator cuff tears?

A

Rest, analgesia, physio
Can have surgery if young or full thickness tear

95
Q

Which is more common anterior or posterior should disclocations?

A

Anterior - posterior are caused by electric shocks and seizures

96
Q

Which nerve is commonly damaged in shoulder discloations and what symptoms occur as a result?

A

Axillary nerve - loss of sensation over lateral deltoid, motor weakness in deltoid

97
Q

What is the apprehension test?

A

Test for shoulder instability due to previous anterior shoulder dislocation - won’t allow you to do movement due to fear of shoulder popping back out

98
Q

What imaging is done for shoulder dislocations?

A

X-rays are used in acute scenarios
Arthroscopy

99
Q

What is the management of shoulder dislocations?

A

Relocated as soon as possible as the muscle spasms over time making it more difficult followed by immobilisation

100
Q

What is olecranon bursitis and what are the symptoms?

A

Inflammation and swelling of bursa over elbow due to repetitive movements or leaning on elbow, infection

Symptoms = swollen, warm, tender and fluid filled elbow

101
Q

What is the management of olecranon bursitis?

A

Aspirate the fluid for MC+S (rule out infection as a cause)

RICE, analgesia, protect elbow from pressure, aspirate the fluid to relieve pressure, steroid injections if problematic

102
Q

What is lateral epicondylitis?

A

Tennis elbow, pain and tenderness at the lateral epicondyle (outer elbow) - type of RSI

103
Q

What is medial epicondylitis?

A

Golfer’s elbow, pain and tenderness on inner elbow - type of RSI

104
Q

How do you manage epicondylitis?

A

Self-limiting, NSAIDs, physio, steroid injections, rest

105
Q

What is De Quervain’s tenosynovitis?

A

RSI –> swelling and inflammation of tendon sheaths of abductor pollicis longus and extensor pollicis brevis

106
Q

What are the symptoms of De Quervains’s tenosynovitis?

A

Symptoms at the radial aspect of the wrist near the thumb - aching, burning, weakness, numbness, tenderness

107
Q

What is the test for De Quervains’s tenosynovitis?

A

Finkelstein’s test - make fist with thumb inside fist and deviate wrist towards ulnar

Positive test = pain on this movement

108
Q

What is the management of De Quervains’s tenosynovitis?

A

Rest, splints, analgesia, physio, steroid injections

109
Q

What is the presentation of trigger finger?

A

Painful finger around MCP joint, does not move smoothly, makes popping noise, gets stuck in flexed position

110
Q

What is the management for trigger finger?

A

Rest, analgesia, splinting, steroid injection, surgery

111
Q

What are the risk factors for carpal tunnel?

A

Repetitive strain, obesity, perimenopause, RA, diabetes, acromegaly, pregnancy, hypothyroidism

112
Q

What is the presentation of carpal tunnel?

A

Sensory symptoms in palmar aspects of thumb, index, middle and lateral half of ring finger, shaking hands may relieve symptoms, difficulty with fine movements of thumb

113
Q

What special tests can be done to help aid diagnosis of carpal tunnel?

A

Phalen’s test - reverse prayer sign
Tinel’s test - tapping of the wrist

114
Q

What is the management of carpal tunnel?

A

Rest, wrist splints at night for 4 weeks, steroid injections, surgery

115
Q

What investigations are done for ganglionic cysts?

A

USS can confirm and exclude other causes - usually a clinical diagnosis

116
Q

How can ganglionic cysts be managed?

A

Conservatively
Needle aspiration, surgical excision

117
Q

How can you differentiate between meniscal tear and ACL/PCL injury?

A

Meniscal tear will gradually swell and have pain on the joint line
ACL/PCL will swell immediately will have pain above/below the joint line where the ligament inserts

118
Q

When should you refer to orthopaedic surgeons in trauma cases?

A

If there is any neurovascular deficit

119
Q

How do c-spine fractures present?

A

Severe pain in neck/chest/back, may have neuro findings in hands/arms

120
Q

What is the best imaging modality for C-spine fractures?

A

CT scan neck

121
Q

What initial imaging investigation should be done in someone with persistent/red flag back pain?

A

Plain x-ray (followed by MRI)

122
Q

Compression of the T1 nerve leads to …

A

Intrinsic hand muscle wasting and loss of sensation over the ulnar aspect of the forearm

Finals (21 decks)

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