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MRCS Part A (KF edition) > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What are features of Paget’s disease and how is it managed?

A

Caused by focal bone resorption followed by excessive bone deposition. Simultaneous osteoblast and osteoclast activity leads to thick brittle bones

  • Affects (in order): spine, skull, pelvis, femur
  • Raised ALP
  • Thickened sclerotic bone on XR
  • risk of cardiac failure

Managed by Bisphosphonates

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2
Q

How is osteoporosis managed?

A

Bisphosphonates, Vit D and calcium supplements

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3
Q

What bone appearance does prostate and breast cancer metastases cause?

A

Prostate ca: Sclerotic appearance

Breast ca: Lytic appearance

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4
Q

What is scurvy?

A

Vitamin C deficiency

Causes defective collagen

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5
Q

What are features of rickets?

A
  • Bow leg
  • Hypocalcaemia
  • Knock-knee
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6
Q

What are some of the causes of osteomalacia?

A
  • Vit D deficiency (malabsorption, lack of sunlight)
  • Renal failure
  • Drug induced (anti convulsants)
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7
Q

What are the managements of an extra capsular NOF fracture and what is the management dependent on?

A

Extracapsular fractures are categorised into Intertrochanteric and Subtrochanteric

Intertrochanteric: DHS
Subtrochanteric: Intramedullary nail

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8
Q

What are differences in serum calcium, phosphate and ALP found in Osteoporosis, Osteomalacia and Paget’s disease?

A

Osteoporosis: all would be normal

Osteomalacia: Reduced calcium and phosphate, increased ALP

Paget’s: Calcium and phosphate would be normal. ALP would be increased significantly

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9
Q

What is pseudogout and what are its features?

A

Form of microcrystalline synovitis caused by deposition of calcium pyrophosphate dihydrate

Features;
- knee, wrist and shoulders mostly affected
- Weakly positive birefringent rhomboid shaped crystal
- Chrondrocalcinosis on XR

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10
Q

How is pseudogout managed?

A
  • Aspiration to exclude septic arthritis
  • NSAIDs or steroids
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11
Q

What is the birefringent of gout?

A

Negatively birefringent needle shaped crystals

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12
Q

What are features of Chronic suprspinatus tendonitis / Subacromial impingement?

A

Pain on abduction 6-120 degree (middle 1/3 arc)

Extremes of movement are painless

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13
Q

What causes shoulder pain in osteoarthritis?

A

Presence of osteophytes causes pain in last degrees of shoulder abduction

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14
Q

What is the most common type of shoulder dislocation?

A

Anterior dislocation

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15
Q

What are features of an anterior shoulder dislocation?

A
  • Loss of shoulder contour
  • Sulcus sign
  • Humeral head felt anteriorly

Managed by relocation by Hippocratic/Milch/Stimson technique

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16
Q

What are causes of posterior shoulder dislocation and what are its features ?

A
  • 50% trauma
  • Classically post-seizure or electrocution

Features:
- arm locked in internal rotation
- XR may show lightbulb appearance

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17
Q

What is Bankart lesion?

A

Avulsion of anterior glenoid labrum with an anterior dislocation

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18
Q

What is the management of Subacromial impingement?

A
  • Physio + NSAIDS
  • Subacrominal steroid injection
  • Arthroscopic subacromial decompression
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19
Q

What is calcific tendonitis/Supraspinatus tendonitis and what the 3 stages involved in this disease?

A

Calcific deposits within tendons, commonly in rotator cuffs causing subacromial impingement and pain, especially above 120 degrees

Stages:
- Formative phase: calcific deposits
- Resting phase: deposits are stable but presents with impingement symptoms
Resorptive phase: phagocytic resorption. Most painful stage

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20
Q

What is adhesive capsulitis and what are the 3 stages of disease progression?

A

Pain and loss of movement of shoulder join caused by fibroblastic proliferation of capsular tissue. This causes tissue scarring and contracture.

  • Stage 1: Freezing and painful stage
  • Stage 2: frozen and stiff stage
    Stage 3: thawing stage, where shoulder movement slowly improves

Can take up to 2years to resolve

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21
Q

What is the Gustilo and Anderson classification?

A

Grade 1: Skin opening <1cm, clean, simple transverse or short oblique fractures

Grade 2: Laceration >1-10cm with extensive soft tissue damage, flaps or avulsion. simple transverse or short oblique fractures

Grade 3: >10cm laceration with extensive soft tissue damage (often high velocity injury)
- 3a: Adequate bone coverage, segmental fractures, gunshot injury

  • 3b: Periosteal stripping and bone exposure, associated with massive contamination. Requires soft tissue coverage
- 3c: Vascular injury requiring repair
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22
Q

What is the management of open/compound fractures?

A
  • Pain relief
  • Abx immediately
  • Splinting and immobilisation of affect bone
  • Tetanus prophylaxis
  • Washouts outside of theatre (e.g. in ED) are not indicated. Only handle wound for gross decontamination
  • Debridement in theatre:
    1) Immediately if highly contaminated or where there Is vascular compromise
    2) Within 12hrs for solitary high energy fractures
    3) Within 24hrs for other low energy open fractures
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23
Q
A
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24
Q

How is the management of an intracapsular NOF fracture divided?

A

Undisplaced (ANY age): Int fixation or cannulated screws

Displaced:
- <50yrs: Cannulated screws
- 50 - 60yrs: THR
- >60yrs + Mobile: THR
- >60yrs + Immobile: Hemiarthroplasty

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25
Q

What is the mechanism of ACL injury and how is it managed?

A

Sports related, High twisting force applied to flexed knee

PC: Loud crack/pop, pain and rapid joint swelling, knee giving way

Ix: Lachman test / Ant drawer test

Mx: Physio + Surgery

26
Q

What is the mechanism of a PCL injury and what test is used to investigate this?

A

Hyperextension injuruies

Ix: Posterior drawer test

27
Q

How does a meniscal tear present and what clinical test is used to investigate this?

A
  • Delayed knee swelling
  • Joint locking
  • Episodes of effusions

Ix: McMurray’s test

28
Q

What condition is associated with pain on walking down stairs and more commonly affects teenage girls?

A

Chondromalacia patellae

29
Q

Is a patient able to weight bare with a fractured patella?

A

Yes

30
Q

What is the Weber class-action and management of each type?

A

Classification of ankle fractures

A = below syndesmosis
B = level of syndesmosis
C = above level of syndesmosis

Management:

  • A: stable. WB. Ankle boot cast for 6 weeks
  • B: same as A if stable and unimalleolar. If part of trimalleolar fracture, will need ORIF
  • C: usually unstable. Will need ORIF
31
Q

What is the difference between a Colles’ fracture and Smith’s fracture?

A

Both are caused by FOOSH

Colles’: dorsal displacement and angulation of radius (dinner fork deformity)

Smith’s: Volar displacement and angulation of radius

32
Q

What is a Barton’s fracture?

A

Like a Colles’ fracture, there is displacement of the radius, however there will also be extension of the fracture to the articular surface of the radius

33
Q

What is a Galeazzi fracture?

A

Radial shaft fracture with associated dislocation of distal radioulnar joint

34
Q

What is a Monteggia’s fracture?

A

Ulna fracture with dislocation of proximal radioulnar joint

35
Q

What occurs to the hand in Dupuytren contracture?

A
  • Semi-flexion of ring finger and little finger
  • Thickening of the overlying skin over these digits and palmar area
36
Q

How is Dupuytren’s contracture managed?

A

Angle of deformity <30 degrees: Steroid injections and Collagenase injections

Angle of deformity >30 degrees: surgery (fasciectomy)

37
Q

What fractures in paediatric patients should raise suspicion of NAI?

A
  • Skull fractures
  • Rib fractures
  • Scapular fractures
  • Sternal fractures
  • Metaphysical fractures
  • Femur fractures
38
Q

What type of bone fracture pattern is most common in metastatic bone disease?

A

Transverse fracture

39
Q

What is the Gartland classification?

A

Classifies types of Supracondylar fractures

Type 1: Non-displaced

Type 2: Displaced, posterior cortex and periosteal hinge intact

Type 3: Completely displaced

40
Q

What is the Salter Harris Classification?

A

For fractures involved the growth plates in children

SALTER

Typer 1 - S: Slip - transverse fracture through the growth plate
Type 2 - A: Above - fracture through the growth plate and extends upwards in the metaphysis
Type 3 - L: Lower - fracture of growth plate extending downwards into the epiphysis
Type 4 - TE - Through everything - fracture extending through growth plate, epiphysis and metaphysis
Type 5 - R: Ruined (crushed): crush fracture of growth plate (poorest outcome)

41
Q

If you are treating a tibial fracture conservatively, what cast would be used?

A

Groin to toe cast

OR

Above knee to toe cast

42
Q

How can developmental dysplasia of the hip be detected in infancy?

A

By Ultrasound up to 3 months of age

  • child will also have a skin crease over the groin
43
Q

What is the Xray finding seen in the Perthes disease and how is it managed?

A

Flattened femoral head

Normally self limiting. Physio

44
Q

Who is most often affected by Slipped upper femoral epiphysis and how does present?

A

Obese male adolescents

  • limited internal rotation
  • femoral head displaced inferolaterally
45
Q

What is Barlow and Ortolani manoeuvre?

A

Barlow: Adduction of hip with posterior force on the knee to cause DISLOCATION

Otolani: Abduction of hip with anterior force on the femur to cause RELOCATION

46
Q

What is the mechanism of disease of Perthe’s disease and how is it managed?

A

Idiopathic avascular necrosis of the femoral epiphysis of the femoral head. This leads to bone infarction. The bone either heals or subchondral fractures occur.

PC: limp + hip pain, 2-12yrs

Staged by the Catterall staging (1-4)

Mx:
- If <6yrs, observation
- >6yrs: surgical management

47
Q

What pathogen is associated with septic arthritis in a sickle cell aneamic patient?

A

Salmonella

However, Staph aureus is still a cause of septic arthritis in patients with this condition

48
Q

What is Kocher criteria?

A

Criteria for suspecting Septic arthritis

Criteria:
- NWB on affected side
- ESR >40
- Fever
- WBC >12,000

If 4/4 99% chance of septic arthritis

49
Q

What is Still’s disease?

A

Systemic form of juvenile arthritis (autoimmune) causing:

  • pyrexia
  • salmon pink rash
  • aches + pains in joints and muscles
  • hepatosplenomegaly
50
Q

What is Osgood-Schlatter disease?

A

Tibia tubercle becomes painful and swollen due to traction injury of apophysis (insertion of patellar tendon)

Mx: Rest + plaster immobilisation for 6-8 weeks

51
Q

What is the typical presentation complaint of plantar fasciitis?

A
  • Middle aged woman
  • Heel pain
  • Tender passive dorsiflexion of toe
  • Pain while tip toeing
52
Q

Where is a Morton neuroma found?

A

Causes pain in dorsal of foot between cleft of 3rd and 4th toes

53
Q

What are the symptoms of Kohler’s disease?

A

Tenderness over medial longitudinal arch

Osteochondritis of navicular bone

54
Q

What is pain during the Finkelstein Test a positive indicator for?

A

de Quervain’s syndrome

55
Q
A
56
Q
A
57
Q

What type go bone tumour is an Osteoid osteoma and where are they usually found?

A

Benign tumour. Causes pain WORSE at NIGHT.

Found in cortex of long bones

Mx by NSAIDs

58
Q

What are risk factors associated with osteosarcomas and how is this disease managed?

A
  • Elderly
  • <20 years old
  • Paget’s disease

Affects metaphysis of long bone. Causes elevation of periosteum (Codman’s triangle)

Mx:
- Surgery
- Chemotherapy

59
Q

Who does Giant cell tumours usually affect and what type of tumour is it?

A

Benign tumour affecting 20-40 year olds

60
Q

Who is most at risk of developing Ewing’s sarcoma

A

Common in caucasian males:
- <15yrs
- Fever + loss of weight
- Immunocompromised

Develop onion skin appearance

61
Q

What is the triad of symptoms that makes up Rieter syndrome?

A

CUP

  • Conjunctivitis
  • Urethritis
  • Polyarthritis

MRCS Part A (KF edition) (18 decks)

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