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AMC > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

vitamin D normal serum value

A

75-250 nanomole/L

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2
Q

Normal BMD T-score

A

> -1

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3
Q

osteopenic BMD T-score

A

-1 to -2.5

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4
Q

Osteoporotic BMD T-score

A

< -2.5

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5
Q

NEXUS Criteria

A
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6
Q

Finkelstein’s test

A

De Quervain tenosynovitis

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7
Q

Tinel sign

A

Carpal tunnel syndrome

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8
Q

Fromenr’s sign

A

Ulnar nerve injury

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9
Q

Thompsons test

A

Achilles tendon lesion/rupture

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10
Q

Lachmans test

A

ACL

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11
Q

Drawers test

A

anterior: ACL
posterior: PCL

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12
Q

Bulb sign

A

Posterior dislocation of shoulder

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13
Q

most useful test for evaluation of osteoporosis

A
  • DEXA
  • 25-hydroxy vitamin D
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14
Q

corticosteroid use in osteoporosis

A

at least 3 months

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15
Q

Back pain without neurological symptoms

A

pulled muscle/muscle spasm
- analgesia + normal activity

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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.

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17
Q

Back pain diagnosis

A

chronic back pain persisting longer than 3 months, have to exclude:
- central canal stenosis
- nerve root compression

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18
Q

Signs of cauda equina compression

A
  • loss of bladder
  • loss of bowel control
  • paraparesis/paraplegia
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19
Q

bilateral leg pain + worse on erect posture + responds to exercise

A

Spinal stenosis

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20
Q

Back pain around the anus, scrotum or vagina

A

saddle anaesthesia
- investigate by MRI

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21
Q

Acute herniation of an intervertebral disk that will require emergency surgery

A

crushed cauda equina

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22
Q

shooting radiating pain through the posterior thigh and posterior leg to little toe + anterior + posterior motor symptoms

A

Sciatica

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23
Q

pain radiating to the hip + anterior thigh + medial aspect of knee + calf + diminished knee jerk

A

L4 radiculopathy

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24
Q

posterolateral buttock + posterior thigh + lateral leg +

A

L5 radiculopathy

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25
Q

posterolateral buttock + posterior thigh + lateral leg posterior calf + lateral foot + diminished Ankle jerk

A

L5-S1 radiculopathy

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26
Q

pain radiates through posterior buttock + posterior calf +
lateral foot + diminished Ankle jerk

A

S1 radiculopathy

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27
Q

weakness of eversion and dorsiflexion + sensory loss of dorsum of foot + hc of colon cancer surgery

A

Common peroneal nerve damage

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28
Q

weakness of foot plantar flexion + inversion

A

Tibial nerve

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29
Q

Hip pain management

A
  • walking stick on the contralateral hand
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30
Q

hip joint degeneration affected movement

A

Internal rotation

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31
Q

osteoporosis most common site fracture

A

Vertebrae

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32
Q

Osteoporosis risk factors

A

– Menopause
– Age over 70
– Corticosteroid use longer than three months
– Rheumatoid arthritis
– Alcoholism
– Smoking
– Anorexia nervosa.
– Inflammatory Bowel Disease

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33
Q

pain in the distal interphalangeal joints + carpometacarpal joints + hard/bony swelling + evening stiffness

A

Osteoarthritis (OA)

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34
Q

Osteoarthritis treatment

A

symptomatic pain treatment

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35
Q

Osteoarthritis not responding to pain

A

Severe
- orthopaedic consult for knee replacement

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36
Q

Osteoporosis treatment

A
  • 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
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37
Q

Osteoporosis treatment not going to plan, what to do

A
  • 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

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38
Q

Most common pelvic bone tumour in young adult

A

Metastatic tumor

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39
Q

non-healing diabetic foot ulcer concern

A

osteomyelitis
- Do MRI

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40
Q

child + fever + limp + raised ESR

A

Acute osteomyelitis

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41
Q

osteomyelitis in children

A
  • S aureus
  • secondary to deep cellulitis
    -MRI investigation
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42
Q

pain in the proximal interphalangeal joints + carpometacarpal joints + soft/tender swelling + morning stiffness > 30 minutes

A

Rheumatoid arthritis (RA)

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43
Q

Diagnosis of rheumatoid arthritis (RA)

A

-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)

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44
Q

Rheumatic arthritis treatment

A

NSAIDs + DMARDS

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45
Q

asymmetrical large joint monoarthritis/oligoarthritis + rash + uveitis + enthesitis

A

Reactive arthritis

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46
Q

Distal interphalangeal joints are most commonly seen in

A

Psoriatic arthritis

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47
Q
A

septic arthritis

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48
Q

septic arthritis management

A
  • IV antibiotics (flucloxacillin) for 2 weeks
  • Oral antibiotics after 6 weeks
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49
Q

positive rhomboid-shaped birefringent crystals

A

Pseudogout

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50
Q

Negative needle shaped birefringent crystals

A

Gout

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51
Q

Gout causes

A
  • Alcohol (increase urate)
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52
Q

Gout investigation

A

Diagnostic: joint aspiration

53
Q

sclerosis of sacroiliac joint

A

sacroiliitis

54
Q

sacroiliitis ddx

A

– Psoriasis.
– Reactive arthritis.
– Ankylosing spondyloarthropathy.
– Arthritis related to inflammatory bowel disease

55
Q

sacroiliitis causes

A

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
Q

Ankylosing spondylitis features

A
  • 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
Q

Ankylosing spondylitis management

A

1st line: NSAIDs
2nd: TnF alpha inhibitors
- Infliximab
- Adalimumab
- rituximab

58
Q

Bisphosphonates prerequisites

A

Vitamin D level (symptomatic hypocalcaemia)
renal function test (creatinine > 35mL)

59
Q

Bisphosphonates side-effects

A
  • oesophagitis
  • jaw osteonecrosis
60
Q

Scaphoid fracture

A
  • proximal pole fracture 20%
  • Distal pole fractures are 10%
  • Most common site of fracture is waist of the bone 70%
61
Q

Most common type of scaphoid fracture

A

proximal pole fracture 20%

62
Q

blood supply to the scaphoid

A

distal to proximal

63
Q

Scaphoid fracture complication

A

– Non-union.
– Avascular necrosis.
– Carpal instability.
– Osteoarthritis.

64
Q

Scaphoid fracture investigation

A

CT scan

65
Q

Scaphoid fracture prognosis

A

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
Q

age 3-8 + viral illness + acute hip/thigh Pain + limp + hip decreased range decreased range of motion

A

transient synovitis transient synovitis (TS),

67
Q

transient synovitis transient synovitis (TS) management

A

ibuprofen

68
Q

medial deviation of the forefoot with a normal neutral position of the hindfoot

A

Metatarsus adductus (MA)
- corrects spontaneously;

69
Q

rigid positioning + medial/upward deviation of forefoot & hindfoot + hyperplantar flexion of foot

A

congenital clubfoot

70
Q

congenital clubfoot management

A

serial manipulation and casting
-surgery if dire

71
Q

knee X-ray is required when a child presents after an injury

A

– 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
Q

subluxed, dislocated femoral heads + knees are at unequal heights when hips and knees are flexed + asymmetric skin folds + limited abduction

A

Developmental dysplasia of the hip

73
Q

Developmental dysplasia of the hip risk factors

A
  • female
  • breech presentation
  • positive family history of hip dysplasia
74
Q

Developmental dysplasia of the hip screening

A
  • < 6 months: Hip examination (Ortolani), US
  • > 6 months: X-ray
75
Q

athlete + overuse apophysitis of the tibial tubercle + pain upon quadriceps contraction

A

Osgood-Schlatter disease

76
Q

4-10 years + avascular necrosis of the femoral head

A

Legg-Calve-Perthes Disease

77
Q

Overweight adolescent + limping + hip stiffness + hip pain radiating to antero-medial thigh and knee

A

Slipped capital femoral epiphysis

78
Q

Slipped capital femoral epiphysis management

A

Percutaneous pin fixation

79
Q

injuries warranting knee X-ray in children

A

– 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
Q

by trauma, as a result of a fall, or by the direct pressure and friction of repetitive kneeling

A

Acute prepatellar bursitis (housemaid’s knree)

81
Q

Acute prepatellar bursitis management

A
  • NSAIDs
  • glucocorticoid injection
82
Q

Absolute contraindication to total knee
replacement

A

Septic knee

83
Q

‘pop’ at time of knee injury + severe pain + effusion (hemarthrosis) + instability of the knee changing direction

A

anterior cruciate ligament (ACL) injury

84
Q

‘twinge’ or sudden pain + Medial Joint line tenderness + able to continue activity with some discomfort

A

Medial meniscus tear

85
Q

Medial meniscus tear investigation

A
  • 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
Q

hx of type 2 DM + severe global passive movement restriction affecting all planes of movement + bilateral pain

A

Adhesive capsulitis (Frozen shoulder)

87
Q

adhesive capsulitis movement restriction

A

all planes of movement but especially internal rotation

88
Q

Adhesive capsulitis features

A
  • bilateral 20%
  • Diabetic 80%
  • painful freezing phase, adhesive phase and a recovery phase 6months-2years
89
Q

Adhesive capsulitis management

A

– 1st line: NSAIDS.
– 2nd line: - Intra-articular steroids
- Physiotherapy /Occupational Therapy
– Oral steroids (prednisolone) if NSAIDs not working

90
Q

Winging of the scapula nerve impingmeent

A

Long thoracic nerve

91
Q

shoulder pain + shoulder abduction weakness + external roation weakness

A

suprascapular nerve entrapment (SNE)
- shoulder abduction (supraspinatus)
- external rotation (infraspinatus)

92
Q

Muishaft humeral fracture will cause what nerve injruy

A

radial nerve

93
Q

prominent acromion + loss of deltoid contour + slightly abducted and externally rotated

A

anterior shoulder dislocation

94
Q

anterior shoulder dislocation nerve injury

A

Axillary nerve

95
Q

Adhesive capsulitis management

A

prednisolone 30 mg daily for 3 weeks
- wean after 6 weeks

96
Q

most common complication of Colles
fracture

A

Malunion

97
Q

earliest complication of Colles fracture

A

Ischemic Volkmann contracture

98
Q

Most common elbow fracture in children

A

supracondylar fracture

99
Q

most serious complication of supracondylar fractures

A

Volkmann ischemic contracture
- permanent damage to nerves and muscles of the forearm leading to contractures

100
Q

Radial nerve injury

A

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
Q

Median nerve injury

A
  • Colles fracture
  • acute carpal tunnel syndrome
  • impaired thumb abduction
  • paraesthesia
102
Q

Colles fracture nerve injury

A

median nerve

103
Q

Colles fracture cast management

A

the wrist should be in 10° flexion and 10° ulnar deviation 4-6 weeks

104
Q

lower limbs trauma or surgery + 24 to 72 hours after injury + altered mental state + dyspnoea + petechiae + eye/torso haemorrhage

A

fat embolism

105
Q

sudden onset of severe calf pain + limping + absent plantar reflex

A

Achilles tendon rupture

106
Q

Achilles tendon rupture investigation

A

Thompson Test
- absent plantar reflex

107
Q

Calcaneal fracture can give rise to what injury

A

spinal injury
- do Spinal x-ray series

108
Q

serious complication after cast application

A

compartment syndrome

109
Q

compartment syndrome diagnostic symptom

A

throbbing pain increasing after wiggling fingers/toes

110
Q

compartment syndrome complications

A

permanent nerve damage or loss of limb due to decreased circulation and oxygen to the tissue

111
Q

bone pain + tibia bowing + enlarged skull with frontal bossing

A

Paget’s disease

112
Q

Paget’s disease features

A

-Elevated alkaline phosphatase (early finding)
- bone pain (most common symptom)

113
Q

Paget’s most common location

A

Pelvis 70%

114
Q

Paget’s disease management

A

IV Zoledronic acid
Bisphosphonate, Alendronate
- paracetamol, NSAIDs
- vitamin D and calcium supplementation (prevent hypocalcaemia and secondary hyperparathyroidism)

115
Q

wrist movements is most likely to reproduce the pain in a patient with lateral epicondylitis

A

Resisted extension

116
Q

lateral epicondylitis management

A

Band support below the elbow

117
Q

pain worsens on thumb and wrist + grasping + tenderness on proximal to radial styloid

A

De Quervain tenosynovitis

118
Q

thickened fascia of 4th digit + joint stiffness + a loss of full extension

A

Dupuytren’s contracture

119
Q

Dupuytren’s contracture cause

A
  • Alcohol
  • DM
  • epilepsy
  • male
120
Q

Dupuytren’s contracture management

A

depends on severity
low/moderate: Steroid injection
severe: Open fasciectomy

121
Q

pain and numbness in the fingers + HIV + multiple loose bodies in the ulnar bursal fluid

A

Mycobacterial tenosynovitis due to Mycobacterium avium complex

122
Q

volleyball and baseball injury + flexion deformity + inability to actively extend finger

A

Mallet finger

123
Q

Mallet finger management

A

Maintain hyper-extension of the distal interphalangeal joint for 6-8 weeks

124
Q

most common joint affected in diabetic neuropathy

A

tarsus and tarsometatarsal joints(midfoot)

125
Q

severe burning pain between the third and fourth toe + gets better walking barefoot + gets worse on weight bearing + localised tenderness

A

Morton Neuroma

126
Q

Heel pain + medial tuberosity tenderness + worse getting out of bed + relieved by walking

A

Plantar Fasciitis

127
Q

treatment for plantar fasciitis

A
  • 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
Q

Major Branches of Brachial Plexus

A
  • 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

AMC (7 decks)

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