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MSRA > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Runners knee
lateral pain
worse on 30o flexion
relieved by rest
what is it?

A

Iliotibial band syndrome
(tenderness 2-3cm above the lateral joint line)

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2
Q

tibial apophysitis, would typically cause pain and swelling over the tibial tubercle
more common in kids

A

Osgood-Schlatter disease

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3
Q

locking and swelling of the knee joint as well as tenderness.

A

Osteochondritis dissecans

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4
Q

pain at patella site of knee
pain post exercise

A

Patellar tendonitis

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5
Q

management of ITB syndrome

A

activity modification and iliotibial band stretches
if not improving then physiotherapy referral

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6
Q

shortened and internally rotated leg

A

POSTERIOR hip dislocation
common In RTC

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7
Q

pain on walking or palpation, instability, neurovascular deficits in the limb and signs of damage to pelvic organs e.g. haematuria or PR bleeding.

A

Pelvic fractures

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8
Q

abducted and externally rotated leg. There may be a palpable bulge of the femoral head. They are less common than posterior dislocations but are classically associated with hip prostheses.
No leg shortening.

A

Anterior hip dislocations

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9
Q

management of hip dislocation

A

ABCDE approach.
Analgesia
A reduction under general anaesthetic within 4 hours to reduce the risk of avascular necrosis.
Long-term management: Physiotherapy to strengthen the surrounding muscles.

(takes 2-3 months to heal)

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10
Q

complications of hip dislocation

A

Sciatic or femoral nerve injury
Avascular necrosis
Osteoarthritis: more common in older patients.
Recurrent dislocation: due to damage of supporting ligaments

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11
Q

Scaphoid fracture:
management (1)
when to fix (2)

A

cast 6 weeks

Sugircal fiction if:
-proximal pole fracture (as –> avascular necrosis)
- displaced

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12
Q

ulnar deviation of the wrist PAIN indicates

A

scaphoid fracture

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13
Q

telescoping of the thumb (pain on longitudinal compression)

A

scaphoid fracture

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14
Q

when to do CT for scaphoid fracture

A

CT&raquo_space;> Xray
ongoing clinical suspicion, planning operative management, or to determine the extent of fracture union during follow-up.

MRI definitive:
NICE guidance from 2016 suggested the MRI should be considered the first-line imaging following clinical examination. However, this is still not common practice in the UK
however, MRI is much more commonly used second-line when radiographs are inconclusive

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15
Q

complications scaphoid fracture (2)

A

non-union → pain and early osteoarthritis
avascular necrosis

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16
Q

Achilles tendonitis management

A

rest, NSAIDs, and physio if symptoms persist beyond 7 days

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17
Q

ibuprofen and asthma

A

Avoid !

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18
Q

most common cause of posterior heel pain

A

Achilles tendon disorders
Possible presentations include tendinopathy (tendinitis), partial tear and complete rupture of the Achilles tendon.

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19
Q

risk factors Achilles tendon disodrers:
drug (1)
blood test (1)

A

Quinolone (ciprofloxacin)
Hypercholesterolaemia (predisposes to tendon xanthomata)

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20
Q

gradual onset of posterior heel pain that is worse following activity
morning pain and stiffness are common

A

achilles tendinopathy (tendinitis)

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21
Q

Simmond’s triad

A

for achilles tendon rupture
lie prone with their feet over the edge of the bed. The examiner should look for an abnormal angle of declination; Achilles tendon rupture may lead to greater dorsiflexion of the injured foot compared to the uninjured limb. They should also feel for a gap in the tendon and gently squeeze the calf muscles if there is an acute rupture of the Achilles tendon the injured foot will stay in the neutral position when the calf is squeezed.

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22
Q

achilles tendon rupture imaging of choice

A

US

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23
Q

suspected achilles tendon rupture mnagement

A

An acute referral should be made to an orthopaedic specialist following a suspected rupture.

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24
Q

cauda equina late sign

A

urinary incontinence

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25
Q
A

A positive sciatic stretch test just tells you that the patient has some irritation or compression of the sciatic nerve. It does not indicate spinal cord compression.

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26
Q

cauda equina- bilateral or unilateral pain

A

BILATERAL sciatica

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27
Q

typically an overweight adolescent boy with knee / hip problems, pain in the thigh (which can be referred from the hip), and pain worse with activity

A

Slipped upper femoral epiphysis -limited and painful internal rotation of the hip whilst maintaining flexion is particularly characteristic of SUFE

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28
Q

children (aged 3-8 years), relatively acutely, and is often preceded by an upper respiratory tract infection

A

Transient synovitis

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29
Q

Often picked up on newborn examination
Barlow’s test, Ortolani’s test are positive
Unequal skin folds/leg length

A

Development dysplasia of the hip

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30
Q

a degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years. It is due to avascular necrosis of the femoral head

Features
hip pain: develops progressively over a few weeks
limp
stiffness and reduced range of hip movement
x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening

A

Pethers disease
5x more common in boys
10% bilateral

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31
Q

painful arc of abduction of arm

A

pain around the midpoint of shoulder abduction describes a painful arc (classically causing pain between 60 to 120 degrees of abduction) which indicates subacromial impingement as the cause of his pain.

Rotator cuff injury

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32
Q

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, postive if pain on twisting knee

A

meniscal tear

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33
Q

red flag features for back pain

A

thoracic back pain, age > 50 years or <18 , unexplained weight loss, local spinal tenderness and focal neurology (e.g. urinary or faecal incontinence or lower leg weakness).

age < 20 years or > 50 years
history of previous malignancy
night pain
history of trauma
systemically unwell e.g. weight loss, fever

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34
Q

Usually gradual onset
Unilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking. Resolves when sits down. Pain may be described as ‘aching’, ‘crawling’.
Relieved by sitting down, leaning forwards and crouching down
Clinical examination is often normal
Requires MRI to confirm diagnosis

A

spinal stenosis

35
Q

Typically a young man who presents with lower back pain and stiffness
Stiffness is usually worse in morning and improves with activity
Peripheral arthritis (25%, more common if female)

A

Ankylosing spondylitis

36
Q

pain on walking, relieved by rest
Absent or weak foot pulses and other signs of limb ischaemia
Past history may include smoking and other vascular diseases

A

PAD

37
Q

loss of foot dorsiflexion + sensory loss dorsum of the foot

A

L5

38
Q

Prolpased disc

A

leg pain usually worse than back
pain often worse when sitting

39
Q

Disc compression: L3 nerve root compression

A

Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

40
Q

L4 nerve root compression

A

Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

41
Q

L5 nerve root compression

A

sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

42
Q

S1 nerve root compression

A

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

43
Q

when to refer disc prolapse for MRI?

A

pain after 4-6weeks

44
Q

direct blow to the medial knee, which this man has not experienced. The injury will result in an acute onset of lateral knee pain and cessation of activity. On examination, there is swelling of the knee and tenderness over the lateral joint line.

A

lateral collateral ligament

45
Q

usually caused by a hyperextension injury or by a direct blow to the proximal tibia with the knee in flexion. Typical features are posterior knee pain, mild swelling, and a reduced range of knee flexion.

A

POSTERIOR cruciate

46
Q

In discitis due to Staphylococcus look for..

A

Endocarditis (ECHO)
The most common cause is septic emboli from endocarditis and systemic bacteraemia with Staphylococcus aureus has a high rate of development of endocarditis due to the bacterial ability to attach to structures and form biofilms. Therefore an echocardiogram must be performed to look for evidence of valvular injury or vegetations in all cases of Staphylococcus aureus-positive cultures.

47
Q

Discitits can lead to..

A

can lead to serious complications such as sepsis or an epidural abscess.

48
Q

best imaging for discitits

A

MRI
CT-guided biopsy may be required to guide antimicrobial treatment

49
Q

Spinal stenosis- best imaging? (1)
management (1)

A

MRI - MRI scanning is the best modality for demonstrating the canal narrowing. Historically a bicycle test was used as true vascular claudicants could not complete the test.

Laminectomy

Degenerative disease is the commonest underlying cause. Degeneration is believed to begin in the intervertebral disk where biochemical changes such as cell death and loss of proteoglycan and water content lead to progressive disk bulging and collapse. This process leads to an increased stress transfer to the posterior facet joints, which accelerates cartilaginous degeneration, hypertrophy, and osteophyte formation; this is associated with thickening and distortion of the ligamentum flavum. The combination of the ventral disk bulging, osteophyte formation at the dorsal facet, and ligamentum flavum hyptertrophy combine to circumferentially narrow the spinal canal and the space available for the neural elements. The compression of the nerve roots of the cauda equina leads to the characteristic clinical signs and symptoms of lumbar spinal stenosis.

50
Q

rheumatoid nodule

A

hard, painless and rarely in isolation

51
Q

Olecranon bursitis AKA

A

students elbow

trauma, infection, or systemic conditions such as rheumatoid arthritis or gout

52
Q

ACL/ PCL tear vs meniscus tear: how quick does the swelling come on?

A

Gradual swelling of the knee is suggestive of effusion which often occurs due to meniscal injury. An ACL or PCL tear would more commonly present with rapid joint swelling due to bleeding within the joint capsule (haemarthrosis).

ACL = RAPID swelling (haemjoarthrosis)

53
Q

ACL vs PCL mechanism

A

ACL= TWISTING injury
PCL= hyperextension, Paradoxical anterior draw test

54
Q

Occur in the elderly (or following significant trauma in young)
Mechanism: knee forced into valgus or varus, but the knee fractures before the ligaments rupture
Varus injury affects medial plateau and if valgus injury, lateral plateau depressed fracture occurs
Classified using the Schatzker system (see below)

A

Tibial plateau fracture

55
Q

right ring finger when she flexes it. On one occasion she reports it became ‘stuck’. Clinical examination is unremarkable other than a palpable nodule at the base of the finger. What is the most likely diagnosis?

A

trigger finger

56
Q

trigger finger management

A

steroid injection is successful in the majority of patients. A finger splint may be applied afterwards
surgery should be reserved for patients who have not responded to steroid injections

57
Q

compression of the ulnar nerve and can present with tingling/numbness of the 4th and 5th finger

A

Cubital tunnel syndrome

58
Q

positive straight leg test

A

can be spinal disc prolapse

59
Q

digital mucous cysts, are benign lesions that typically occur on the fingers or toes, particularly around the nail bed. A/W osteoarthritis and degenerative joint diseases

A

Myxoid cyst

60
Q

a cyst commonly found on the face, neck or trunk and they often contain keratinous material

A

epidermoid cyst

61
Q

infectious condition caused by a parapoxvirus that primarily affects sheep and goats. Humans can contract it through direct contact with infected animals or contaminated fomites

A

off

62
Q

firm subcutaneous nodules that commonly occur in patients with severe RA; they are typically found over pressure points such as elbows or knuckles rather than toes

A

rheumatoid nodule

63
Q

meralgia paraesthetica

A

lateral cutaneous nerve of thigh compression

Risk factors 3
Obesity
Pregnancy
Tense ascites
Trauma
Iatrogenic, such as pelvic osteotomy, spinal surgeries, laparoscopic hernia repair and bariatric surgery. In some cases, may result from abduction splints used in the management of Perthe’s disease.
Various sports have been implicated, including gymnastics, football, bodybuilding and strenuous exercise.
Some cases are idiopathic.

64
Q

De Quervain’s tenosynovitis

A

pain on the radial side of the wrist
tenderness over the radial styloid process
abduction of the thumb against resistance is painful
Finkelstein’s test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus

65
Q

Rotator cuff syndrome vs adhesive capsulitis

A

rotator cuff = painful on ACTIVE movement
Adhesive capsulitis= ACTIVE AND PASSIVE

66
Q

adhesive capsulitis RF

A

A bit random.
diabetes, MI, lung disease, neck disease
female
40-60yr
non-dominant hand

67
Q

The nerve most likely to be injured during knee arthroplasty

A

common peroneal nerve

68
Q

dupuytrens contracture RF

A

manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand

69
Q

deformity with little and ring fingers are slightly flexed, with no apparent weakness

A

dupuytrens contracture

70
Q

pain/pins and needles in thumb, index, middle finger
unusually the symptoms may ‘ascend’ proximally
patient shakes his hand to obtain relief, classically at night

A

carpal tunnel syndrome

71
Q

carpal tunnel Mx

A

NICE recommends a 6-week trial of conservative treatments if the symptoms are mild-moderate
corticosteroid injection
wrist splints at night: particularly useful if transient factors present e.g. pregnancy
if there are severe symptoms or symptoms persist with conservative management:
surgical decompression (flexor retinaculum division)

72
Q

morning stiffness in joints- how long to be cocnerning

A

> 2 hr (inflammatory arthritis)l

73
Q

plantar fascitis

A

Pain is worse when you ask them to walk on their toes.

74
Q

the most common reason for total hip replacement revision. This often presents with pain in the hip or groin region radiating down to the knee.

A

aseptic loosening

75
Q

Inverted + plantar flexed foot which is not passively correctable.

A

club foot

76
Q

‘housemaid’s knee’,

A

pre patellar bursa inflammation

77
Q

Foucher’s sign

A

They are more likely to develop in patients with arthritis or gout and following a minor trauma to the knee. Foucher’s sign describes the increase in tension of the Baker’s cyst on extension of the knee.

78
Q

Infrapatellar bursitis
(Clergyman’s knee)

A

Associated with kneeling

79
Q

Tennis and golfers elbow

A

Golfer’s elbow or medial epicondylitis produces tenderness over the medial epicondyle and medial wrist pain on resisted wrist pronation.
Tennis elbow or lateral epicondylitis produces tenderness over the lateral epicondyle and lateral elbow pain on resisted wrist extension.

80
Q

intertrochanteric proximal femur fracture

A

Dynamic hip screws

81
Q

osteomyelitis most common bacteria
exception (1)
imaging (1)

A

Staph. aureus is the most common cause except in patients with sickle-cell anaemia where Salmonella species predominate
MRI

82
Q

hip fracture

A

Intracapsular femoral fracture - hemiarthroplasty
extracapsular femoral fracture - dynamic hip screw

83
Q

painful arc of abduction

A

Subacromial impingement

MSRA (19 decks)

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