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Surgery Extra Questions > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What is the management of suspected Cauda Equina?

A

Urgent MRI Spine

The most common cause is herniation of an intervertebral disc compressing the cauda equina. Other causes include primary or metastatic spinal tumours, infections (such as an epidural abscess) or haematomas

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2
Q

What is De Quervain’s tenosynovitis ?

A

Idiopathic pain syndrome of the lateral aspect of the wrist, involving the tendons of extensor pollicis brevis and abductor pollicis longus at the radial wrist

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3
Q

What is Finkelstein’s test?

A

Getting patient to make a fist but thumb inside fingies and move wrist towards ulna.

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4
Q

What is Spinal Stenosis?

A

The central canal is narrowed by tumour, disk prolapse or other similar degenerative changes.

Patients may present with a combination of back pain, neuropathic pain and symptoms mimicking claudication

Can distinguish from ischaemic pain by positional changes e.g bending forward relives, going downhill hurts more

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5
Q

What are some Red Flags for Lower Back Pain?

A

History of trauma

Fever
Recent infection

Night pain
Age < 20 years or > 50 years
History of previous malignancy
Systemically unwell e.g. weight loss, fever
Thoracic pain

Saddle Anaesthesia
Urinary Incontinence
Bowel Incompetence

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6
Q

What are some differentials for LBP?

A

Ankylosing Spondylitis
Spinal Stenosis
Prolapsed Disc
Peripheral Arterial Disease
Mechanical back pain
Discitis
Cauda Equina
Spinal tumour/ metasases
Osteoarthritis

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7
Q

What are the Ottawa Ankle Rules?

A

Bony tenderness over the malleoli zones
OR an inability to walk four weight-bearing steps

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8
Q

What is Meralgia Paresthetica?

A

A condition characterised by numbness, tingling and burning pain in the outer part of your thigh. It’s caused by compression of the lateral cutaneous nerve of the thigh

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9
Q

What is the treatment for all patients with a displaced hip fracture?

A

Hemiarthroplasty

Total Hip Replacement ( If low risk patient)

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10
Q

What is the imaging of choice for an Achilles Tendon rupture?

A

Calf US

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11
Q

What are the g Ps of Compartment Syndrome?

A

Pain
Pulseless
Paresthesia
Pallor
Paralysis
Perishingly cold

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12
Q

What does a painful passive leg raise indicate?

A

Sciatic nerve compression

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13
Q

Subtrochanteric hip fracture treatment?

A

Intramedullary nail

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14
Q

Trochanteric hip fracture treatment?

A

Sliding hip screw

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15
Q

Intracapsular hip fracture, displaced , not independently mobile?

A

Hemiarthroplasty, cemented implants preferred

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16
Q

Intracapsular hip fracture displaced, independently mobile?

A

Total Hip Replacement

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17
Q

What are features of a meniscal tear?

A

Pain worse on straightening the knee
knee may ‘give way’
Displaced meniscal tears may cause knee locking
tenderness along the joint line
Thessaly’s test - weight bearing at 20 degrees of knee Flexion, patient supported by doctor, positive if pain on twisting knee

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18
Q

How does a Scaphoid Fracture present?

A

Pain over the anatomical snuffbox
Cannot be seen on XRAY

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19
Q

What is a Colles Fracture?

A

Following FOOSH
Distal radius fracture with dorsal displacement of fragments
Dinner fork type deformity

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20
Q

What are the risk factors for a congenital hip dislocation?

A

Female gender
Breech presentation
Family history
Firstborn
Oligohydramnios

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21
Q

What is fat embolism syndrome?

A

Fat embolism due to fat fragments entering the circulatory system and lodging in small vessels further along, often occurs following a long bone fracture.

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22
Q

What are the symptoms of a fat embolism?

A

The signs and symptoms of fat embolism are largely determined by the site of embolization:

Pulmonary: Breathlessness, hypoxia, tachycardia, tachypnea, and fever
Neurologic: Altered mental status, seizures, focal deficits, or coma
Dermatologic: Petechial rash predominantly on the upper body

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23
Q

What is a burst fracture?

A

Vertebra is crushed in all directions
Following high energy axial loading

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24
Q

What is a Maisonneuve injury

A

It’s a complex and severe fracture involving a spiral fracture of the proximal fibula and an associated unstable ankle injury

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25
Q

Which type of fracture cannot be seen on xray?

A

Scaphoid fracture

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26
Q

What tendons are affected by De Quervain’s tenosynovitis?

A

Extensor Pollicis Brevis
Abductor Pollicis Longus

My guy Finkelstein De Quervain is flipping pancakes with his thumb in his fingers , hand down

Eat Pancakes Bitch And Put Lemon

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27
Q

What is SUFE ( Slipped Upper Femoral Epiphysis )

A

Common adolescent hip disorder caused by weakness in the proximal femoral growth plate leading to displacement of the capital femoral epiphysis.

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28
Q

What do patients with SUFE present with?

A

Hip pain
Limping
Reduced range of hip movement
Positive Trendelenburg gait

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29
Q

What positions exaggerate Tennis Elbow ( Lateral Epicondylitis)?

A

Gripping
Wrist extension
Supination

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30
Q

What organism is Gas Gangrene most commonly caused by?

A

Clostridium perfringens

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31
Q

What is Perthes Disease?

A

Avascular Necrosis of the femoral head in children

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32
Q

What are the symptoms of Perthes Disease?

A

Gradual onset of limp
Hip pain, which may also be referred to the knee
Lasts over 4 weeks

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33
Q

What is a Pathological fracture?

A

Fracture sustained when patient already has an underlying condition causing bone weakness so they are more prone, e.g even minor trauma can cause it

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34
Q

Which conditions can cause a pathological fracture?

A

Tumours: These can be Primary or Secondary (metastatic, the most common cause of pathological fractures)
Osteoporosis
Hyperparathyroidism
Paget’s disease

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35
Q

What is a Boxer’s Fracture?

A

Fracture of the neck of the 5th metacarpal and usually occurs due to punching a hard object with a closed fist

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36
Q

What is the treatment for a Boxer’s fracture?

A

Ulnar Gutter Splint

If Significant rotation or angulation of the affected fingers.
Articular involvement of the fracture.
Multiple metacarpal fractures.
Open fractures.
Then surgical intervention is recquired

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37
Q

How does a Radial nerve injury present?

A

Weakness or paralysis of the muscles innervated by the radial nerve (e.g., triceps brachii, brachioradialis, and extensor muscles of the forearm)
Numbness, tingling, or pain in the sensory distribution of the radial nerve (posterior forearm, lateral aspect of the dorsum of the hand, and dorsal surface of the lateral 3 1/2 digits)

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38
Q

What is the method of action of Bisphosphonates?

A

Inhibition of osteoclasts

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39
Q

What is Osgood-Schlatter’s Disease?

A

Tibial osteochondritis causing inflammation at the point of patella tendon insertion at the tibial tuberosity

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40
Q

What tests are useful on examination for Cruciate Ligament Tears?

A

Anterior Drawer Test , positive = Anterior Cruciate Ligament Tear

Posterior Drawer Test , positive = Posterior Cruciate Ligament tear

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41
Q

What is a Primary Trauma Survey?

A

CABCDE

C= Catastrophic haemorrhage
A= Airway management with C spine assessment
B = Breathing
C = Circulation
D = Disability

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42
Q

What is the treatment for Osteomyelitis?

A

Long-term antibiotic therapy (4-6 weeks)
I.V Flucloxacillin plus fusidic acid/rifampicin, with vancomycin used if MRSA is suspected.

If chronic, antibiotics for 12 weeks and surgical debridement if necessary

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43
Q

What is the treatment for Septic Arthritis?

A

Give High Flow O2
I.V Large bore cannula and fluids
ABG - Lactate
Catheterise - urine output
Send blood cultures
Knee joint fluid cultures
Initiate intravenous flucloxacillin

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44
Q

What type of cell is responsible for repairing and maintaining cartilage?

A

Chondrocyte

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45
Q

What name is given to the bulky enlargements of the DIP joints in OA?

A

Heberden’s Nodes

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46
Q

What name is given to the bulky enlargements of the PIP joints in OA?

A

Bouchard’s Nodes

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47
Q

What is the saddle joint at the base of the thumb?

A

The Carpometacarpal joint ( CMP )

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48
Q

At what age can OA be diagnosed without any investigations with typical symptoms and no red flags?

A

Over 45

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49
Q

What effect do NSAIDs have on BP?

A

Increase it

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50
Q

How do NSAIDs increase BP?

A

They inhibit COX in the kidneys , which reduces vasodilatory prostaglandins. This leads to vasoconstriction of the afferent nephron arteriole. This causes decreased blood flow and therefore decreased GFR. This activates the RAAS system to cause Aldosterone release which leads to sodium retention, as well as causing an increase in ADH which causes more water reabsorption at the collecting duct.

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51
Q

What is the most common indication for elective joint replacement surgery?

A

OA

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52
Q

What are the options for elective joint replacement surgery?

A

Total joint replacement
Hemiarthroplasty
Partial joint resurfacing

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53
Q

What are the options for fitting a prosthesis into the shaft of the femur ?

A

Cemented
Uncemented

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54
Q

What are the options for fitting a prosthetic socket into the pelvic joint?

A

Cement
Screws

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55
Q

The articular surfaces of which bones are replaced in a total knee replacement?

A

Femur and tibia

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56
Q

What is the name of the shoulder socket that articulates with the head of the humerus

A

Glenoid socket

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57
Q

What important process is undertaken before surgery to ensure correct limb is operated on?

A

Marking the limb

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58
Q

What medication may be used during elective joint replacement surgery to minimse blood loss?

A

Tranexamic Acid

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59
Q

What Ix are required shortly after joint replacement surgery?

A

XRAY
FBC

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60
Q

What duration of LMWH is recommended after elective hip replacement?

A

28 days

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61
Q

What duration of LMWH is recommended after elective knee replacement?

A

14 days

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62
Q

What organism is the most common cause of prosthesis infection?

A

Staph Aureus

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63
Q

What is a Colles Fracture?

A

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

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64
Q

What description is used for a Colles Fracture deformity?

A

Dinner fork deformity

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65
Q

What is the usual cause of a Colles Fracture?

A

FOOSH

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66
Q

What is the usual cause of a Scaphoid Fracture?

A

FOOSH

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67
Q

Where do you find tenderness in a Scaphoid Fracture?

A

Anatomical Snuffbox

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68
Q

What is the key complications of Scaphoid Fracture?

A

Avascular Necrosis
Non union

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69
Q

What classification is used for classification of a Lateral Malleolus Fracture?

A

Weber Classification

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70
Q

Which bone is affected in a lateral malleolus fracture?

A

Fibula

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71
Q

What anatomical feature is the Weber classification based on?

A

A - below the syndesmosis ( doesn’t disrupt it)
B - at the level of the syndesmosis ( partial tear or no disruption )
C - above the syndesmosis ( disrupts it )

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72
Q

What term describes a fracture associated with an underlying tumour?

A

Pathological fracture

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73
Q

What are bone common cancers that metastasise to bone?

A

Prostate
Renal
Thyroid
Breast
Lung

PRTBL

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74
Q

What term describes a fracture associated with OA?

A

Fragility fracture

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75
Q

What tool is used to describe a patient’s likelihood of having a fracture in the next 10 years?

A

FRAX tool

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76
Q

What Ix calculates bone mineral density?

A

DEXA scan

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77
Q

What guidelines recommend management related to a patient’s risk of fractures related to OA?

A

NOGG guidelines

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78
Q

What are the first line medical treatments for reducing the likelihood of a fracture related to OA?

A

Vitamin D Supplements
Calcium
Bisphosphonates

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79
Q

What monoclonal antibody can be used to reduce risk of fragility fratures?

A

Denosumab

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79
Q

How does Denosumab work?

A

Blocking the activity of osteoclasts

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80
Q

What term describes a fracture where the bone has shattered into multiple pieces?

A

Comminuted

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81
Q

Which type of fractures occur mainly in children?

A

Greenstick
Buckle
Salter-harris

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82
Q

What is the initial imaging when fracture is suspected?

A

X Ray with two views

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83
Q

What are the options for achieving mechanical alignment of a fracture

A

Closed reduction
Open reduction

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84
Q

What term describes slow healing of a fracture?

A

Delayed union

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85
Q

What term describes misaligned healing of a fracture?

A

Malunion

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86
Q

What term describes the failure of a fracture to heal?

A

Nonunion

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87
Q

What term describes tightening of the soft tissues leading to reduced ROM or deformity of a joint?

A

Contracture

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88
Q

What is the target timeline for operating on a hip fratcue?

A

Within 48 hours

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89
Q

What landmark distinguishes intracapsular and extracapsular fractures?

A

Intertrochanteric line

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90
Q

What classification is used for intracapsular hip fractures?

A

Garden classification

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91
Q

What are the surgical options for managing a displaced intracapsular fracture?

A

Total hip replacement
Hemiarthroplasty ( if high risk/older)

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92
Q

What is the surgical option for managing an intertrochanteric hip fracture?

A

Dynamic hip screw

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93
Q

What is the surgical option for managing a subtrochanteric hip fracture?

A

Intramedullary nail

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94
Q

What is the typical position a patient presents in with a hip fracture?

A

Shortened leg
Abducted
Externally rotated

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95
Q

What is the name for the continous curving line present on an AP x ray of the hip formed by the medial border of the femoral neck and continuing to the inferior border of the superior pubic ramus?

A

Shenton’s line

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96
Q

What is the significance of Shenton’s line?

A

Disruption indicates a NOF fracture

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97
Q

What are the two most notable types of acute injury that lead to compartment syndrome?

A

Fracture
Crush injuries

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98
Q

What investigation can be used to measure the pressure in a compartment?

A

Needle manometry

99
Q

What bacteria most commonly cause Osteomyelitis?

A

Staph Aureus

100
Q

What is the best imaging for establishing a diagnosis of Osteomyelitis?

A

MRI scan

101
Q

What is the main ABx for treating Osteomyelitis?

A

Flucloxacillin for 6 weeks

If penicillin allergic - Clindamycin

If MRSA suspected - Vancomycin

102
Q

What is the most common type of bone cancer?

A

Osteosarcoma

103
Q

What type of cancer originates from the cartilage?

A

Chondrosarcoma

104
Q

What type of cancer causes raised red/purple skin lesion commonly seen in HIV?

A

Kaposi’s Sarcoma

105
Q

What virus causes Kaposi’s Sarcoma?

A

Human Herpesvirus 8

106
Q

Which investigation is the initial for suspicious bony lumps?

A

XRAY

107
Q

Which investigation is the initial one for suspicious soft tissue lumps?

A

US

108
Q

What is Spondylolisthesis?

A

Anterior displacement of a vertebrae out of line with the one below

109
Q

What condition causes a patient to wake up with a unilateral stiff and painful neck due to muscle spasm?

A

Torticolis

110
Q

What spinal nerves join to form the sciatic nerve?

A

L4-S3

111
Q

Where does the Sciatic Nerve exit the pelvis?

A

The Greater Sciatic Foramen

112
Q

Where is the Greater Sciatic Foramen?

A

At the posterior part of the pelvis in the buttock area

113
Q

What nerves does the Sciatic nerve divide into at the knee?

A

The tibial nerve
The common peroneal nerve

114
Q

What areas receive sensory innervation from the Sciatic nerve?

A

Lateral lower leg and foot

115
Q

What are the most common causes of unilateral sciatica?

A

Disc herniation
Spondylolisthesis
Spinal stenosis

116
Q

What is Sciatica?

A

Its a symptom
pain, weakness, numbness, or tingling in the leg

117
Q

What should bilateral sciatica raise concerns about?

A

Cauda Equina Syndrome

118
Q

What clinical test can be used to diagnose Sciatica?

A

Straight Leg Raise

Lift leg up and dorsiflex foot , positive test is indicated by exacerbation of pain in buttocks of posterior thigh

119
Q

What investigations are indicated for Cauda Equina Syndrome?

A

Post void Bladder Scan - indicates retention due to pudendal nerve pathology
Spinal MRI

120
Q

What tool can be used to stratify risk of patient with acute back pain developing chronic back pain?

A

STarT Back

121
Q

What analgesia is use first line in patients presenting which acute back pain?

A

NSAIDS

122
Q

What are some examples of NSAIDs

A

Aspirin
Ibuprofen
Naproxen
Diclofenac
Celecoxib

123
Q

What is the MOA of NSAIDs?

A

Inhibition of the COX 1 and 2. COX is required to convert arachidonic acid into thromboxanes, prostaglandins, and prostacyclins.

Can be more COX 1 or COX 2 selective but all still inhibit both.

124
Q

What procedure may be indicated in patients with chronic lower back pain originating in the facet joints?

A

Radiofrequency denervation

125
Q

What medications are available for persistent symptoms of Sciatica?

A

Amitriptyline
Duloxetine

126
Q

What is the most common cause of CES?

A

Disc herniation

127
Q

To what does the Cauda Equina provide parasympathetic innervation?

A

Bladder
Rectum

128
Q

What areas does the Cauda Equina provide sensory innervation?

A

Perineum
Bladder
Rectum

129
Q

What areas does the Cauda Equina provide motor innervation?

A

Anal sphincters
Urethral sphincters

130
Q

What are the three types of spinal stenosis and what are they?

A

Central - narrowing of the central spinal canal
Lateral - narrowing of the nerve root canals
Foraminal - narrowing of intervertebral foramina

131
Q

What is the key presenting feature of lumbar spinal stenosis with narrowing of central canal?

A

Psuedoclaudication

132
Q

What movements exacerbate the pain felt in lumbar spinal stenosis with narrowing of central canal?

A

Standing up straight
Walking

133
Q

What movements relieve the pain felt in lumbar spinal stenosis with narrowing of central canal?

A

Bending forwards

134
Q

What is radiculopathy?

A

Compression of the nerve roots as they exit the spinal cord leading to motor and sensory problems

135
Q

What nerve is affected in Meralgia Paresthetica?

A

Compression of the Lateral femoral cutaneous nerve

136
Q

Which movement of the hip exacerbates Meralgia Paresthetica?

A

Extension of hip on affected side

137
Q

What are bursa

A

Sac created by synovial membrane filled with synoviL fluid

138
Q

What movements are restricted in Trochanteric Bursitis?

A

Hip abduction
Internal rotation
External rotation

139
Q

What special test can be used alongside restricted movements to diagnose Trochanteric bursitis?

A

Trendelenburg Test

140
Q

What are the 4 ligaments in the knee?

A

Anterior Cruciate Ligament
Posterior Cruciate Ligament
Medial Collateral Ligament
Lateral Collateral Ligament

141
Q

What is the usual first line imaging investigation for a suspected meniscal tear?

A

MRI scan

142
Q

What is the gold standard for diagnosis of a Meniscal Tear?

A

Arthroscopy

143
Q

What tool can used to determine if a patient needs an xray for a suspected knee fracture?

A

Ottawa Knee Rules

144
Q

Where does the ACL originate and insert?

A

Originates at lateral aspect of intercondylar notch of the femur
Inserts at the anterior intercondylar area of the tibia

145
Q

What is the role of the ACL?

A

It stops the tibia from sliding forward in relation to the femur

146
Q

What tests can assess for ACL tear?

A

The anterior drawer test
Lachman Test

147
Q

What can be used as a graft for repair of the ACL?

A

Hamstring tendon
Quadriceps tendon

148
Q

What is the most common age for presentation of Osgood-Schlatters disease?

A

10-15

149
Q

Where does the patella ligament insert?

A

The tibial tiberosity

150
Q

Where are Baker’s Cysts located?

A

The popliteal fossa

151
Q

What is Foucher’s Sign

A

The patient stand and extend the knee full; this is when the mass should be most prominent. When the knee is flexed to 45 degrees, the mass often either softens or fully disappears

152
Q

What is the usual first line investigation for a Baker’s Cyst?

A

US

153
Q

What are the two types of achilles tendinopathy?

A

Insertion tendinopathy
Mid section tendinopathy

154
Q

What test is used to assess for Achilles Rupture?

A

The Simmon’s Calf Squeeze Test

155
Q

Why are steroid injection avoided in Achilles Tendinopathy?

A

There is a risk of rupture

156
Q

What key class of medicine is associated with Achilles Tendinopathy and Rupture?

A

Fluoroquinolone

157
Q

What are two examples of Fluoroquinolones?

A

Ciprofloxacin
Levofloxacin

158
Q

Where does the plantar fascia insert at the heel of the foot ?

A

Calcaneous

159
Q

What condition is caused by an abnormal nerve between the 3rd and 4th metatarsal?

A

Morton’s Neuroma

160
Q

What is the medical term for a bunion?

A

Hallux Valgus

161
Q

What investigation can be used to determine the extent of the deformity in Hallux Valgus?

A

Weight-bearing Xray

162
Q

What joint in the foot is most commonly affected by gout?

A

MTP at the base of the big toe

163
Q

What will be seen in aspirate fluid of a joint affected by Gout?

A

Needle shaped crystals that are negatively birefringent to polarised light

Monosodium Urate crystals

164
Q

What is the first line treatment for an acute flare of Gout?

A

NSAIDs

165
Q

What medication might be used in a patient with kidney disease that has an acute flare of Gout?

A

Colchicine

166
Q

What are side effects of Colchicine?

A

Nausea
Diarrhoea

167
Q

What medication is used for the prophylaxis of Gout?

A

Allopurinol

168
Q

WHat is the MOA of Allopurinol?

A

Xanthine oxidase inhibitor that reduces urate levels

169
Q

What is Frozen Shoulder?

A

Adhesive Capsulitis

170
Q

What existing condition is the most notable risk factor for Frozen Shoulder?

A

Diabetes

171
Q

What are the three phases of Frozen Shoulder?

A

Painful phase
Stiff phase
Thawing phase

172
Q

How long does each phase of Frozen Shoulder last?

A

6 months

173
Q

Which joints in the shoulder can be affected by OA?

A

Acromioclavicular joint
Glenohumeral joint

174
Q

What clinical test is used to assess for Supraspinatus Tendinopathy?

A

The empty can test ( Jobe Test)

175
Q

What are the 4 rotator cuff muscles and what actions do they perform?

A

Supraspinatus - abducts arm
Infraspinatus - externally rotates arm
Teres minor - externally rotates arm
Subscapularis - internally rotates arm

SITS mnemonic

176
Q

What imaging is used to assess for a Rotator Tear Cuff Tear?

A

US or MRI

177
Q

What is the name of a partial dislocation of the shoulder?

A

Sublaxation

178
Q

What are they key causes of a posterior shoulder dislocation?

A

Electric shocks
Seizures

179
Q

What are Bankart lesions?

A

Tear of the anteroinferior aspect of the glenoid labral complex. Usually due to anterior dislocation of the shoulder.

180
Q

What is a Hill-Sachs lesion?

A

A compression fracture of the posterolateral part of the head of the humerus. Usually due to anterior dislocation of the shoulder.

181
Q

What nerve is most commonly damaged by an anterior shoulder dislocation?

A

Axillary Nerve

182
Q

What sensory distribution is lost when there is damage to the axillary nerve?

A

Regimental Badge area

183
Q

Motor weakness can occur in which muscles when there is damage to the axillary nerve?

A

Deltoid
Teres Minor

184
Q

What test is used to assess for shoulder instability in the anterior direction?

A

The Apprehension Test

185
Q

What imaging investigation is most helpful in assessing the shoulder for damage in someone with a previous shoulder dislocation?

A

Magnetic Resonance Arthrography

186
Q

What would the aspirate look like from the Olecranon Bursa in someone with Gout or Pseudogout?

A

A milky fluid

187
Q

What is the medical term for Tennis Elbow?

A

Lateral Epicondylitis

188
Q

Where is the tenderness in a patient with lateral epicondylitis?

A

At the lateral epicondyle

189
Q

What movement at the wrist do the muscles that insert at the lateral epicondyle perform?

A

Extend the wrist

190
Q

What two clinical tests can be used to assess for Tennis Elbow?

A

Mill’s Test
Cosen’s Test

191
Q

What is the medical term for Golfer’s Elbow?

A

Medial Epicondylitis

192
Q

Where is the tenderness in a patient with medial epicondylitis?

A

Medial Epicondyle

193
Q

What movement at the wrist do the muscles that insert at the medial epicondyle perform?

A

Flexion of the wrist

194
Q

What tendons are affected in De Quervain’s Tenosynovitis?

A

Abductor Pollicis Longus
Extensor Pollicis Brevis

195
Q

What test can be used to assess for De Quervain’s Tenosynovitis?

A

Finkelstein’s Test

196
Q

What is the most commonly affected tendon sheath in trigger finger?

A

A1 at the MCP joint

197
Q

What finger is most often affected by Dupuytren’s Contracture?

A

Ring finger

198
Q

What test is used to assess for Dupuytren’s Contracture?

A

The tabletop test

199
Q

What are the three surgical options for treating Dupuytren’s Contracture?

A

Needle fasciotomy
Limited fasciectomy
Dermofasciectomy

200
Q

What nerve is affected in Carpal Tunnel Syndrome?

A

Median nerve

201
Q

What areas are affected by sensory symptoms in Carpal Tunnel Syndrome?

A

The palmar aspects and full finger tips of thumb, index and middle finger and the lateral half of the ring finger

202
Q

What are the muscles of the thenar eminece?

A

Abductor Pollicis Brevis
Opponens Pollicis
Flexor Pollicis Brevis

203
Q

What are the special tests for Carpal Tunnel Syndrome?

A

Phalen’s Test
Tinel’s test

204
Q

What is the primary investigation for establishing a diagnosis of Carpal Tunnel Syndrome?

A

Nerve conduction studies

205
Q

What is the usual initial intervention in someone with Carpal Tunnel Syndrome?

A

Wrist splints that maintain a neutral position of the wrists at nightime

206
Q

What structure is cut during surgery for Carpal Tunnel Syndrome?

A

Flexor Retinaculum

207
Q

What does osteomyelitis show on X-ray?

A

Periosteal reaction, focal cortical loss and regional osteopenia

208
Q

What is the guidance for VTE prophylaxis following an elective total hip replacement?

A

Starting 6-12 hours following surgery

LMHW Heparin for 10 days followed by Aspirin 75/150mg for 28 days

209
Q

What is the guidance for VTE prophylaxis following a knee replacement?

A

Aspirin (75 or 150 mg) for 14 days

210
Q

What is the guidance for VTE prophylaxis following a Fragility fractures of the pelvis, hip and proximal femur?

A

LMWH starting 6-12 hours after surgery

211
Q

What does a femoral nerve injury present like?

A

Weakness in knee extension, loss of the patella reflex, numbness of the thigh

212
Q

What does a Sciatic nerve injury present like?

A

Weakness in knee flexion and foot movements, pain and numbness from gluteal region to ankle

213
Q

What does an obturator nerve injury present like?

A

Weakness in hip adduction, numbness over the medial thigh

214
Q

How would a L2 nerve root compression present?

A

Weakness in hip flexion
Pain or numbness in the anterior thigh region

215
Q

How would a L3 nerve root compression present?

A

Weakness in knee extension and difficulty walking up stairs or inclines
Sensory changes would be expected over the medial aspect of the knee

216
Q

How would a L4 nerve root compression present?

A

Weakness in ankle dorsiflexion
Sensory changes overlying the medial malleolus or medial calf area
Decreased patellar reflexes

217
Q

How would a L5 nerve root compression present?

A

Loss of foot dorsiflexion
Sensory loss dorsum of the foot

218
Q

How would a S1 nerve root compression present?

A

Weakness in plantar flexion of the foot
Pain radiating down to the posterior thigh and calf region
Loss of Achilles tendon reflex
Sensory changes overlying the lateral foot or heel area

219
Q

What nerve is most likely to be damaged during a knee arthroplasty?

A

Common peroneal nerve

220
Q

How do you differentiate between Chondrosarcoma of the pelvis and a metastatic bone cancer?

A

Increasing pain at rest, together with increased serum calcium and alkaline phosphatase are most likely to represent metastatic tumour to bone.

Chondrosarcomas do occur in the pelvis but are not associated with increased serum calcium and typically have a longer history.

221
Q

How does Paget’s disease appear on investigation?

A

X-ray is thickened and sclerotic
Serum ALP is elevated
Calcium is within normal limits

222
Q

How does neurogenic shock happen due to spinal cord transection?

A

Loss of sympathetic innervation or increased parasympathetic innervation leads to widespread vasodilation, leading to hypotension

Presents flushed with warm peripheries (Distributive shock)

223
Q
A
224
Q

What is Osgood-Schlatters disease?

A

The primary cause is mechanical stress due to repetitive traction on the tibial tubercle from the patellar tendon during rapid growth periods in adolescenc

225
Q

What is Erb’s palsy caused by?

A

Damage to C5 and C6 myotomes

Presents with waiter’s tip

flexed wrist, extended forearm and internally rotated, adducted arm.

226
Q

What are the myotomes?

A

C5 - shoulder abduction
C6 - elbow flexion
C7 - elbow extension
C8 - finger flexion
T1 - finger abduction

L2 - hip flexion
L3 - knee extension
L4 - ankle dorsiflexion
L5 - great toe extension
S1 - ankle plantarflexion

227
Q

What is the Nexus criteria to exclude a C-Spine injury?

A

Normal level of alertness
No evidence of intoxication
No painful distracting injuries
No focal neurological deficit
Absence of midline cervical tenderness

228
Q

What is a better way to maintain a patient’s airway in a patient with suspected C-Spine injury?

A

Jaw thrust rather than head tilt and chin lift

229
Q

How should Bisphosphonates be taken?

A

Empty stomach
Sit upright for 30 minutes

230
Q

What is the treatment for Plantar Fasciitis?

A

Weight loss
Resting foot
Simple stretch exercises

231
Q

What is a Monteggia fracture?

A

Dislocation of the proximal radioulnar joint in association with an ulnar fracture

232
Q

What is a Galeazzi fracture?

A

Fracture of the distal radius with an associated dislocation of the distal radioulnar joint

233
Q

What is the management for a non-displaced Scaphoid fracture?

A

Cast for 6-8 weeks

234
Q

What is the immediate management for septic arthritis?

A

Analgesia
Take cultures ( aspirate and blood) before antibiotics

235
Q

What organism is more likely in SA if you have a prosthetic joint?

A

Staph Epidermis

236
Q

What muscle takes over abduction after 15 degrees ( After SUpraspinatus)?

A

Deltoid

237
Q

What muscles are supplied by the axillary nerve?

A

Teres Minor
Deltoid

238
Q

What might you suspect is there is dullness to percussion in a tension pneumothorax?

A

Massive haemothorax - wanna to a thoracostomy with chest drain

239
Q

What tendon can be used to graft an ACL tear?

A

Patella
Quadriceps
Hamstring

240
Q

What is the blood supply to the NOF?

A

Retinacular arteries
Artery of the Ligamentum Teres
Intramedullary vessels

241
Q

What is a Bier’s Block?

A

A tourniquet is applied to the proximal part of the limb and local anesthetic is injected IV, the procedure can be done and the tourniquet released after 20-30 mins

242
Q

How long does a Colles Fracture take to heal?

A

6-8 weeks

243
Q

What is the treatment for compartment syndrome?

A

Urgent decompression via open fasciotomy

244
Q

What are complications of open fractures?

A

Wound infection
Tetanus infection
Osteomyelitis
Vascular damage
Malunion
Sepsis
DVT
Death

245
Q

What are indications for joint arthroplasty in OA?

A

Not responding to conservative or medical management
Reduced QOL

Surgery Extra Questions (9 decks)

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