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Orthopaedics Flashcards

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1
Q

Management of buckle fracture?

A

Typically self limiting - splinting and immobilization

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2
Q

What movement causes the pain in lateral epicondylitis (tennis elbow)?

A

Pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended

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3
Q

Definition of osteoporosis

A

Bone mineral density of less than 2.5 SD below the young adult mean density

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4
Q

What areas of the body does the DEXA scan look at?

A

Hip and lumbar spine

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5
Q

What does the FRAX or QFracture Score assess?

A

The 10 year risk of a patient developing a fragility fracture

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6
Q

Blood test results in osteoporisis

A

Normal

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7
Q

Management of osteoporosis

A

Calcium + Vitamin D supplements
Oral Bisphosphonates are first line
Denosumab is second line

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8
Q

What movement is most affected when patients have a frozen shoulder?

A

External rotation

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9
Q

What is the most common reason for total hip replacement revision?

A

Aseptic loosening

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10
Q

What nerve is compressed in carpal tunnel syndrome

A

Median

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11
Q

Describe the examination findings in carpal tunnel syndrome

A

Weakness of thumb abduction
Wasting of the thenar eminence
Tinnels sign (tapping causes paraesthesia)
Phalens sign (flexion of the wrist causes symptoms)

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12
Q

X Ray changes in rheumatoid arthirits

A

Loss of joint space
Juxta articular osteoporosis
Soft tissue swelling
Periarticular erosions
Subluxation

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13
Q

X ray appearance of psoriatic arthritis

A

Periostitis
Erosive changes and new bone formation
Pencil in cup appearance

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14
Q

X Ray findings in osteosarcoma

A

Codman triangle (a triangluar area of new subperiosteal bone) with an associated sunburst appearance

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15
Q

What is the most common primary malignant bone tumour

A

Osteosarcoma

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16
Q

Conditions associated with ankolysing spondylitis

A

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilled tendonitis
AV node block
Amyloidosis

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17
Q

Antobodies assictaed with limited cutaneous systemic sclerosis

A

Anti centromere antibodies

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18
Q

Symptoms of limited cutaneous systemic sclerosis

A

Raynauds
Scleroderma affecting face and distal limbs predominately
CREST syndrome - Calcinosis, Raynauds, Oesophageal dysmotility, sclerodactyly and talangiectasia

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19
Q

Antibodies associated with diffuse cutaneous systemic sclerosis

A

ANti SCL 70

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20
Q

Most common cause of death in cutaneous systemic sclerosis

A

Respiratory involvement (ILD and pulmonary hypertension)

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21
Q

Compression of what nerve causes cubital tunnel syndrome

A

Ulnar nerve

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22
Q

Clinical examination findings in ankolysiing sponydlitis

A

Reduced lateral flexion
Reduced forward flexion (schobers test)
Reduced chest expansion

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23
Q

HLA type associated with ankolysisng spondylitis

A

HLA B27

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24
Q

What blood needs o be regularaly checked when patients are taking methotrexate? What is the monitoring schedule

A

FBC, U & E, LFTs before starting treatment and then weekly unil therapy stabilised.

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25
What drus must be avoided when people are taking methotrexate?
Trimethoprim and Co trimoxazole
26
What are the ottowa ankle rules?
Ankle X Ray is only required if there is pain in the malleolar zone + any one of the following findings 1. Bony tenderness at the lateral malleolar zone 2. Bony tenderness at the medial malleolar zone 3. Inability to walk 4 weight bearing steps immediately after the injury and in the emergency department.
27
When should urate lowering therapy be started?
Should be offered to all patients after their first attack of gout
28
What symptoms does L3 root compression cause?
Sensory loss over anterior thigh Weak hip flexion, knee extension and hip adduction Reduced knee reflex Positive femoral stretch test
29
What symptoms does L4 nerve root compression cause?
Sensory loss over anterior aspect of the knee and medial malleolus Weak knee extension and hip adduction Reduced knee reflex Positive femoral stretch test
30
What symptoms does L5 nerve root compression cause?
Seonsory loss over dorsum of foot Weakness in foot and big toe dorsiflexion Normal reflexes Positive sciatic nerve stretch test
31
What symptoms does S1 nerve root compression cause?
Seonsory loss of the posterolateral aspect of the leg and lateral aspect of the foot Weakness in plantar flexion of the foot Reduced ankle reflex Positive sciatic nerve stretch test
32
What is de quervains tenosynovitis?
The sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed. Causes pain on the radial side of the wrist.
33
How is spinal stenosis diagnosed?
MRI scan
33
Blood results in pagets disease
Normal calcium and phosphate Significantly raised ALP
34
What is pagets disease of bone?
A disease of increased but uncontrolled bone turnover. Excessive osteoclastic resorption followed by increased osteoblastic activity.
35
Treatment of pagets disease?
Bisphosphonates
36
Most sensitive antibody for rheumatoid arthritis
Anti CCP
37
What nerve is most likely to be accidentally damaged during a total knee replacement?
Common peroneal nerve
38
How long do symptoms have to have been present to make a diagnosis of chronic fatique syndrome?
3 months
39
What does the radial nerve control?
Forearm, wrist, finger and thumb extension
40
What nerve is most likely to be damaged in a humeral midshaft fracture?
Radial nerve If damaged will cause a wrist drop
41
What nerve is most likely to be damaged in a humeral neck fracture/dislocation
Axillary nerve.
42
What muscles does the median nerve do?
Innervates LOAF muscles (Lateral 2 lumbricals, opponens pollis, abductor pollic brevis, flexor pollis brevis) Sensation to the palmar aspect of the lateral 3.5 fingers (Thumb, index, middle and half of the ring finger)
43
What does the ulnar nerve do?
Innervates the intrinsic hand muscles except LOAF Wrist flexion Sensation to medial 1.5 fingers (pinky and half of ring finger)
44
Damage to which nerve causes a winged scapula?
Long thoracic
45
What is the treatment for proximal scaphoid pole fractures?
Surgical fixation
46
What is a mallet finger?
An injury to the extensor tendon mechanism at the DIP joint usually caused by forced flexion while attemmpting to extend the fingertip
47
What is trigger finger?
Abnormal flexion of the digits caused by a disparity between the size of the tendons and pulley through which they pass
48
What position is the hip in following a posterior dislocation?
Shortened, adducted and internally rotated
49
What blood tests need to be checked before starting azathioprine?
TPMT levels. If levels are low of absent the the patient is as risk of bone marrow supression
50
Antibody associated with dermatomyositis
Anti Jo 1
51
Treatment for ankolysing spondylitis
Regular exercise Physiotherapy DMARDS - only useful if there is peripheral joint involvement. Anti TNF medications if there is persistently high disease activity
52
Definition of an intracapsular hip fracture
Fracture from the edge of the femoral head to the insertion of the capsule hip joint
53
Management of a stable intertrochanteric hip fracture
Dynamic hip screw
54
What is pseudogout?
Deposition of calcium pyrophosphate dihydrate crystals in the synovium.
55
What is seen on an x ray of pseudogout?
Chondrocalcinosis - linear calcifications of the meniscus and articular cartilage
56
What is seen in the joint aspiration of a patient with pseudogout?
Weakly positively birefringent rhomboid shaped crystals
57
What is chondromalacia patellae?
Anterior knee pain caused by abnormal softening of the cartilage on the underside of the patella. Causes anterior knee pain worse after sitting for a prolonged period of time.
58
What is osgood schlatter disease?
Common cause of knee pain in adolscents. Caused by the overuse of the quadriceps putting strain on the patellar ligament attachment to the tibia. Main symptoms is pain inferior to the patella which is worse for activity and better for rest.
59
What is a colles fracture?
A fracture of the distal radius within 2.5cm of the wrist joint. Distal radius is dorsally displaced and dorsally angulated.
60
What is a smith fracture?
Fracture of the distal radium that occurs due a fall on the back of the hand. Distal fragment is displaced anteriorly (to the volar aspect)
61
What is a bennets fracture?
Fracture to the base of the metacarpal of the thumb. It causes pain and swelling to the thenar eminence and an inability to move the thumb.
62
What do X rays show in osteomalacia?
Linear areas of low density (loosers zones)
63
What are the blood results in osteomalacia?
Low calcium Normal phosphate Raised ALP
64
What is cANCA associated with?
Granulomatosis with polyangitis
65
What is pANCA associated with?
Eosonophillic granulomatosis Ulcerative colitis Primary sclerosis cholangitis Anti GBM disease Crohns disease
66
What does PTH do?
1. Stimulated bone to break down minerals - increased Ca and Phosphate 2. Activated Vitamin D - This also stimulates the bone. Inhibits PTH. Increases calcium and phosphate absoprtion from the gut. Increases reabsoprtion from the kidneys.
67
What is the management of a displaces intracapsular hip fracture?
Intramedullary nail or hemiarthroplasty
68
What is the management of an intertrochanteric hip fracture?
Dynamic hip screw
69
What is the management of subtrochanteric hip fracture?
Intramedullary nail
70
What does the femoral nerve do?
Knee extension, thigh flexion Sensory innervation to the anterior and medial aspect of the thigh and lower leg.
71
What doe sthe obturator nerve do?
Thigh adduction. Sensory innervation of the medial thigh.
72
How is the femoral nerve damaged?
Hip and pelvic fractures
73
How is the obturator nerve damaged?
Anterior hip dislocation
74
What does the tibial nerve do?
Foot plantarflexion and inversion. Sensory to the sole of food
75
What does the common peroneal nerve do?
Foot doriflexion and eversion. Extensor hallucus longus. Sensory innervation to the dorsum of the foot and lower lateral part of the leg.
76
How is the common peroneal nerve injured?
Injury often occurs at the neck of the fibula. (eg tightly applied lower limb plaster cast) Injury causes foot drop

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