Orthopaedics Flashcards
1
Q
vitamin D normal serum value
A
75-250 nanomole/L
2
Q
Normal BMD T-score
A
> -1
3
Q
osteopenic BMD T-score
A
-1 to -2.5
4
Q
Osteoporotic BMD T-score
A
< -2.5
5
Q
NEXUS Criteria
A
6
Q
Finkelstein’s test
A
De Quervain tenosynovitis
7
Q
Tinel sign
A
Carpal tunnel syndrome
8
Q
Fromenr’s sign
A
Ulnar nerve injury
9
Q
Thompsons test
A
Achilles tendon lesion/rupture
10
Q
Lachmans test
A
ACL
11
Q
Drawers test
A
anterior: ACL
posterior: PCL
12
Q
Bulb sign
A
Posterior dislocation of shoulder
13
Q
most useful test for evaluation of osteoporosis
A
- DEXA
- 25-hydroxy vitamin D
14
Q
corticosteroid use in osteoporosis
A
at least 3 months
15
Q
Back pain without neurological symptoms
A
pulled muscle/muscle spasm
- analgesia + normal activity
16
Q
Back pain classification
A
1- Acute low back pain lasts less than 6 weeks.
2- Sub-acute low back pain lasts between 6 and 12 weeks.
3- Chronic low back pain persists for more than 12 weeks.
17
Q
Back pain diagnosis
A
chronic back pain persisting longer than 3 months, have to exclude:
- central canal stenosis
- nerve root compression
18
Q
Signs of cauda equina compression
A
- loss of bladder
- loss of bowel control
- paraparesis/paraplegia
19
Q
bilateral leg pain + worse on erect posture + responds to exercise
A
Spinal stenosis
20
Q
Back pain around the anus, scrotum or vagina
A
saddle anaesthesia
- investigate by MRI
21
Q
Acute herniation of an intervertebral disk that will require emergency surgery
A
crushed cauda equina
22
Q
shooting radiating pain through the posterior thigh and posterior leg to little toe + anterior + posterior motor symptoms
A
Sciatica
23
Q
pain radiating to the hip + anterior thigh + medial aspect of knee + calf + diminished knee jerk
A
L4 radiculopathy
24
Q
posterolateral buttock + posterior thigh + lateral leg +
A
L5 radiculopathy
25
posterolateral buttock + posterior thigh + lateral leg posterior calf + lateral foot + diminished Ankle jerk
L5-S1 radiculopathy
26
pain radiates through posterior buttock + posterior calf +
lateral foot + diminished Ankle jerk
S1 radiculopathy
27
weakness of eversion and dorsiflexion + sensory loss of dorsum of foot + hc of colon cancer surgery
Common peroneal nerve damage
28
weakness of foot plantar flexion + inversion
Tibial nerve
29
Hip pain management
- walking stick on the contralateral hand
30
hip joint degeneration affected movement
Internal rotation
31
osteoporosis most common site fracture
Vertebrae
32
Osteoporosis risk factors
– Menopause
– Age over 70
– Corticosteroid use longer than three months
– Rheumatoid arthritis
– Alcoholism
– Smoking
– Anorexia nervosa.
– Inflammatory Bowel Disease
33
pain in the distal interphalangeal joints + carpometacarpal joints + hard/bony swelling + evening stiffness
Osteoarthritis (OA)
34
Osteoarthritis treatment
symptomatic pain treatment
35
Osteoarthritis not responding to pain
Severe
- orthopaedic consult for knee replacement
36
Osteoporosis treatment
- Alendronate, risedronate and zoledronic acid: first-line therapy in **postmenopausal osteoporosis **
and prevent vertebral, Non-vertebral and hip fractures.
- bisphosphonates: primary prevention of fractures in px who never had minimal trauma fracture, secondary prevention of **fractures**
- Strontium ranelate: primary prevention of osteoporosis in women
- bisphosphonates and raloxifene: secondary prevention of fractures in women who have had minimal trauma fractures
37
Osteoporosis treatment not going to plan, what to do
Biphosponate not working
- BMD T-score of =<-3
- > 1 symptomatic new
fracture after at least 12-months of
continuous therapy
- > 2 minimal trauma fractures despite being on sufficient doses of bisphosphonates.
switch to **teriparatide** for 18 months
38
Most common pelvic bone tumour in young adult
Metastatic tumor
39
non-healing diabetic foot ulcer concern
osteomyelitis
- Do MRI
40
child + fever + limp + raised ESR
Acute osteomyelitis
41
osteomyelitis in children
- S aureus
- secondary to deep cellulitis
-MRI investigation
42
pain in the proximal interphalangeal joints + carpometacarpal joints + soft/tender swelling + morning stiffness > 30 minutes
Rheumatoid arthritis (RA)
43
Diagnosis of rheumatoid arthritis (RA)
-Persistent joint pain and swelling affecting at least three joint areas
2-Symmetrical involvement of the MCP or MTP joints
3-Morning stiffness lasting more than 30 minutes.
(if there's a rash: Psoriatic arthritis)
44
Rheumatic arthritis treatment
NSAIDs + DMARDS
45
asymmetrical large joint monoarthritis/oligoarthritis + rash + uveitis + enthesitis
Reactive arthritis
46
Distal interphalangeal joints are most commonly seen in
Psoriatic arthritis
47
septic arthritis
48
septic arthritis management
- IV antibiotics (flucloxacillin) for 2 weeks
- Oral antibiotics after 6 weeks
49
positive rhomboid-shaped birefringent crystals
Pseudogout
50
Negative needle shaped birefringent crystals
Gout
51
Gout causes
- Alcohol (increase urate)
52
Gout investigation
Diagnostic: joint aspiration
53
sclerosis of sacroiliac joint
sacroiliitis
54
sacroiliitis ddx
– Psoriasis.
– Reactive arthritis.
– Ankylosing spondyloarthropathy.
– Arthritis related to inflammatory bowel disease
55
sacroiliitis causes
1-HLA-B27
2-Chlamydia and Gonorrhoea serology
3-RA factor, anti-ccp to rule out Rheumatoid arthritis
4-Inflammatory markers such as ESR and C-reactive protein
56
Ankylosing spondylitis features
- Sacroilitis is the earliest manifestation
- In only 5% cases, onset is after the age of 40 years
- Median age of onset is 23 years of age
- More than 40% patients present with unilateral ocular pain, lacrimation and
photophobia
- Limited chest expansion
- Limitation of movement of lumbar spine in both sagital and frontal planes
- inflammatory back pain
57
Ankylosing spondylitis management
1st line: NSAIDs
2nd: TnF alpha inhibitors
- Infliximab
- Adalimumab
- rituximab
58
Bisphosphonates prerequisites
Vitamin D level (symptomatic hypocalcaemia)
renal function test (creatinine > 35mL)
59
Bisphosphonates side-effects
- oesophagitis
- jaw osteonecrosis
60
Scaphoid fracture
- proximal pole fracture 20%
- Distal pole fractures are 10%
- Most common site of fracture is waist of the bone 70%
61
Most common type of scaphoid fracture
proximal pole fracture 20%
62
blood supply to the scaphoid
distal to proximal
63
Scaphoid fracture complication
– Non-union.
– Avascular necrosis.
– Carpal instability.
– Osteoarthritis.
64
Scaphoid fracture investigation
CT scan
Summary:
• Initial Step: X-ray (including specific scaphoid views).
• If X-ray is negative but suspicion remains: Consider MRI or CT.
• Alternative: Immobilization and follow-up X-rays after 10-14 days.
65
Scaphoid fracture prognosis
distal pole fractures is better than proximal pole because of low risk of vascular compromise
- may take up to 1-2 weeks to become visible radiologically
66
age 3-8 + viral illness + acute hip/thigh Pain + limp + hip decreased range decreased range of motion
transient synovitis transient synovitis (TS),
67
transient synovitis transient synovitis (TS) management
ibuprofen
68
medial deviation of the forefoot with a normal neutral position of the hindfoot
Metatarsus adductus (MA)
- corrects spontaneously;
69
rigid positioning + medial/upward deviation of forefoot & hindfoot + hyperplantar flexion of foot
congenital clubfoot
70
congenital clubfoot management
serial manipulation and casting
-surgery if dire
71
knee X-ray is required when a child presents after an injury
– Isolated patellar tenderness.
– Tenderness at the head of the fibula.
– Inability to flex at 90 degrees.
– Inability to bear weight immediately after trauma and in an emergency.
72
subluxed, dislocated femoral heads + knees are at unequal heights when hips and knees are flexed + asymmetric skin folds + limited abduction
Developmental dysplasia of the hip
73
Developmental dysplasia of the hip risk factors
- female
- breech presentation
- positive family history of hip dysplasia
74
Developmental dysplasia of the hip screening
- < 6 months: Hip examination (Ortolani), US
- > 6 months: X-ray
75
athlete + overuse apophysitis of the tibial tubercle + pain upon quadriceps contraction
Osgood-Schlatter disease
76
4-10 years + avascular necrosis of the femoral head
Legg-Calve-Perthes Disease
77
Overweight adolescent + limping + hip stiffness + hip pain radiating to antero-medial thigh and knee
Slipped capital femoral epiphysis
78
Slipped capital femoral epiphysis management
Percutaneous pin fixation
79
injuries warranting knee X-ray in children
– Isolated patellar tenderness.
– Tenderness at the head of the fibula.
– Inability to flex at 90 degrees.
– Inability to bear weight immediately after trauma and in an emergency
80
by trauma, as a result of a fall, or by the direct pressure and friction of repetitive kneeling
Acute prepatellar bursitis (housemaid's knree)
81
Acute prepatellar bursitis management
- NSAIDs
- glucocorticoid injection
82
Absolute contraindication to total knee
replacement
Septic knee
83
‘pop’ at time of knee injury + severe pain + effusion (hemarthrosis) + instability of the knee changing direction
anterior cruciate ligament (ACL) injury
84
‘twinge’ or sudden pain + Medial Joint line tenderness + able to continue activity with some discomfort
Medial meniscus tear
85
Medial meniscus tear investigation
- barefooted with the knee flexed to 20 degrees and rotates the body
and knee three times internally and externally (Thessaly test) most useful
Flexion/rotation test (McMurray test) for screening
86
hx of type 2 DM + severe global passive movement restriction affecting all planes of movement + bilateral pain
Adhesive capsulitis (Frozen shoulder)
87
adhesive capsulitis movement restriction
all planes of movement but especially internal rotation
88
Adhesive capsulitis features
- bilateral 20%
- Diabetic 80%
- painful freezing phase, adhesive phase and a recovery phase 6months-2years
89
Adhesive capsulitis management
– 1st line: NSAIDS.
– 2nd line: - Intra-articular steroids
- Physiotherapy /Occupational Therapy
– Oral steroids (prednisolone) if NSAIDs not working
90
Winging of the scapula nerve impingmeent
Long thoracic nerve
91
shoulder pain + shoulder abduction weakness + external roation weakness
suprascapular nerve entrapment (SNE)
- shoulder abduction (supraspinatus)
- external rotation (infraspinatus)
92
Muishaft humeral fracture will cause what nerve injruy
radial nerve
93
prominent acromion + loss of deltoid contour + slightly abducted and externally rotated
anterior shoulder dislocation
94
anterior shoulder dislocation nerve injury
Axillary nerve
95
Adhesive capsulitis management
prednisolone 30 mg daily for 3 weeks
- wean after 6 weeks
96
most common complication of Colles
fracture
Malunion
97
earliest complication of Colles fracture
Ischemic Volkmann contracture
98
Most common elbow fracture in children
supracondylar fracture
99
most serious complication of supracondylar fractures
Volkmann ischemic contracture
- permanent damage to nerves and muscles of the forearm leading to contractures
100
Radial nerve injury
wrist drop
- decreased or absent thumb extension and abduction
- Decreased sensation over dorsum of the hand (thumb, index, middle and half of the ring fingers)
101
Median nerve injury
- Colles fracture
- acute carpal tunnel syndrome
- impaired thumb abduction
- paraesthesia
102
Colles fracture nerve injury
median nerve
103
Colles fracture cast management
the wrist should be in 10° flexion and 10° ulnar deviation 4-6 weeks
104
lower limbs trauma or surgery + 24 to 72 hours after injury + altered mental state + dyspnoea + petechiae + eye/torso haemorrhage
fat embolism
105
sudden onset of severe calf pain + limping + absent plantar reflex
Achilles tendon rupture
106
Achilles tendon rupture investigation
Thompson Test
- absent plantar reflex
107
Calcaneal fracture can give rise to what injury
spinal injury
- do Spinal x-ray series
A calcaneal fracture, also known as a heel bone fracture, is a break in the calcaneus, which is the largest bone in the foot and forms the heel. Calcaneal fractures are often caused by high-energy trauma, such as falls from height or motor vehicle accidents. These fractures can have significant impact on foot function and mobility, making prompt diagnosis and appropriate management crucial.
108
serious complication after cast application
compartment syndrome
109
compartment syndrome diagnostic symptom
throbbing pain increasing after wiggling fingers/toes
110
compartment syndrome complications
permanent nerve damage or loss of limb due to decreased circulation and oxygen to the tissue
111
bone pain + tibia bowing + enlarged skull with frontal bossing
Paget’s disease
112
Paget’s disease features
-Elevated alkaline phosphatase (early finding)
- bone pain (most common symptom)
113
Paget's most common location
Pelvis 70%
114
Paget's disease management
IV Zoledronic acid
Bisphosphonate, Alendronate
- paracetamol, NSAIDs
- vitamin D and calcium supplementation (prevent hypocalcaemia and secondary hyperparathyroidism)
115
wrist movements is most likely to reproduce the pain in a patient with lateral epicondylitis
Resisted extension
116
lateral epicondylitis management
Band support below the elbow
117
pain worsens on thumb and wrist + grasping + tenderness on proximal to radial styloid
De Quervain tenosynovitis
118
thickened fascia of 4th digit + joint stiffness + a loss of full extension
Dupuytren’s contracture
119
Dupuytren’s contracture cause
- Alcohol
- DM
- epilepsy
- male
120
Dupuytren’s contracture management
depends on severity
low/moderate: Steroid injection
severe: Open fasciectomy
121
pain and numbness in the fingers + HIV + multiple loose bodies in the ulnar bursal fluid
Mycobacterial tenosynovitis due to Mycobacterium avium complex
122
volleyball and baseball injury + flexion deformity + inability to actively extend finger
Mallet finger
123
Mallet finger management
Maintain hyper-extension of the distal interphalangeal joint for 6-8 weeks
124
most common joint affected in diabetic neuropathy
tarsus and tarsometatarsal joints(midfoot)
125
severe burning pain between the third and fourth toe + gets better walking barefoot + gets worse on weight bearing + localised tenderness
Morton Neuroma
126
Heel pain + medial tuberosity tenderness + worse getting out of bed + relieved by walking
Plantar Fasciitis
127
treatment for plantar fasciitis
- stretching exercises for the plantar fascia and calf muscles
- Avoid flat shoes and barefoot walking
- arch supports
and/or heel cups
- Decreasing causative or aggravating exercise
- NSAIDs
- glucocorticoids and a local anesthetic
128
Major Branches of Brachial Plexus
* MUSCULOCUTANEOUS NERVE ( C5,C6,C7) - REMEMBER IT SUPPLIES- BICEPS
BRACHII, BRACHIALIS
* AXILLARY NERVE ( C5,C6)- it wraps around the neck of humerus. REMEMBER DELTOID AND REGIMENTAL BADGE SIGN
* MEDIAN NERVE ( C5-T1)- REMEMBER - ALL FLEXORS OF FOREARM EXCEPT 1.5
* RADIAL NERVE (C5-T1) - REMEMBER ALL THE EXTENSORS
* ULNAR NERVE (C8-T1)- 1.5 FLEXORS + ALL THE INTRICATE MUSCLES OF THE Hand
