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Pass Med finals pack > Orthopaedics 2 > Flashcards

Orthopaedics 2 Flashcards

1
Q

32 y/o basketball player.

he reports hearing a ‘popping’ sound then experienced sudden onset severe pain in back of his left leg.

OE

  • swelling of left calf
  • no movement of his left foot whilst squeezing corresponding calf

indicatie of:

A

achilles tendon rupture

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2
Q

risk factors fo tendinitis

A
  • quinolone use (e.g. ciprofloxacin)

- hypercholesterolaemia (predisposes to tendon xanthomata)

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3
Q

which imaging is used for suspected achilles tendon rupture?

A

USS

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4
Q

describe achilles tendinopathy?

A

aka tendinitis

features

  • gradual onset
  • posterior heel pain
  • worse post activity
  • morning pain and stiffness common
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5
Q

management of achilles tendinopathy

A

typically supportive

  • simple analgesia
  • reduction in precipitating activities
  • calf muscle eccentric exercises
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6
Q

Leriche syndrome characterised by what triad of symptoms:

A
  1. claudication of buttocks and thigh
  2. atrophy of the musculature of the legs
  3. impotence (due to paralysis of the L1 nerve)
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7
Q

What is leriche syndrome?

A
  • atheromatous disease
  • involving iliac vessels
  • blood flow to pelvic viscera compromised
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8
Q

50 y/o diabetic lady pc left shoulder pain.

stiff shoulder, more painful at night, difficulty dressing, doing bra

OE

  • no point tenderness
  • weakness on external rotation

indicative of:

A

adhesive capsulitis
- up to 20% of diabetics may have episode of frozen shoulder

external rotation affected more than internal rotation or abduction

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9
Q

management of adhesive capsulitis

A

NSAIDS

physio

oral corticosteroids

intra-articular corticosteroids

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10
Q

what type of fracture typically arises as a result of fall onto an outstretched hand

A
  • scaphoid fracture
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11
Q

why is it important to recognise scaphoid fractures?

A
  • unusal bs of scaphoid bone
  • 80% bs derived from dorsal carpal branch of radial artery, retrograde
  • interruption of bs
  • increases risk of avascular necrosis of scaphoid
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12
Q

blood supply to scaphoid bone

A
  • retrograde
  • via dorsal carpal branch
  • of radial artery
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13
Q

majority of simple rib fractures are managed…

A

conservatively

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14
Q

fracture of distal radius aka

A

Colle’s fracture

  • dinner fork deformity
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15
Q

volar angulation of distal radius fragment

A

garden spade deformity

Smith’s fractures

caused by falling backwards onto palm of outstretched hand

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16
Q

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

A

conteggia fracture

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17
Q

intra-articular fracture at base of thumb metacarpal

impact on flexed metacarpal, caused by fist fights

X-RAY: triangular fragment at base of metacarpal

indicative of:

A

Bennet’s fracture

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18
Q

distal radius fracture with associated radiocarpal dislocation

A

Barton’s fracture

fall onto extended and pronated wrist

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19
Q

leg is shortened and externally rotated with :

A

hip fracture

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20
Q

leg shortened, internally rotated with:

A

hip dislocation

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21
Q

what tool used to evaluate fracture risk in patients:

A

FRAX

  • fracture risk assessment tool
22
Q

patient with suspected caudal-equina should have an urgent:

A

MRI SPINE

23
Q

summarise some causes of caudal-equina

A
  • central disc prolapse (L4/5, L5/S1)
  • tumours: primary or metastatic
  • infection: abscess, disci tis
  • trauma
  • haematoma
remember surgical sieve:
V: vascular
I: infective
T: traumatic
A: autoimmune
M: metabolic
I: iatrogenic
N: neoplastic
C: congenital
D: degenerative
E: endocrine
F: functional
24
Q

rapid joint swelling, right sided knee effusion and positive Lachmans test indicates:

A

anterior cruciate ligament rupture

rapid joint swelling: can occur due to ACL or PCL

tackled from behind suggests ACL

25
Q

what injury results most commonly due to direct blows to lateral aspect of leg:

A

MCL injury

  • strain on MCL ligament
  • joint effusion
  • medial joint line tenderness
26
Q

benign neuroma affecting the intermetatarsal plantar nerve, most commonly in the third inter-metatarsophalangeal space. The female to male ratio is around 4:1.

indicative of:

A

Morton’s neuroma

27
Q

A 30-year-old intravenous drug user is diagnosed as having osteomyelitis of the right tibia. What is the most likely causative organism?

A

staph aureus

28
Q

immediate priority for open fractures is:

A

urgent intravenous antibiotics and debridement in theatre

29
Q

you suspect osteoarthritis in a patient: which of the following would prompt further investigations for an alternative diagnosis

  • 6 month history of patients
  • history of developmental dysplasia
  • morning stiffness lasting 4hours
A

morning stiffness lasting 4 hours

  • could be indicative of inflammatory arthritis
30
Q

compartment syndrome 6Ps

A

pain, poikilothermia, pallor, paresthesia, pulselessness, and paralysis

31
Q

62 y/o with poorly controlled diabetes and long standing foot ulcers presents with

  • fever
  • increasing pain
  • redness over first MTP joint
  • serum urate is normal

most likely diagnosis?

A

osteomyelitis

32
Q

imaging modality of choice for osteomyelitis

A

MRI

33
Q

Fracture:

Bimalleolar ankle fracture

Forced foot eversion

A

Pott’s fracture

34
Q

76 y/o

  • pain in buttocks
  • pain comes on after 500 yard
  • resolves when he stops walking

pmh
- COPD, IHD

neuro exam
- normal

pulses difficult to feel in both feet

indicative of :

A

peripheral arterial disease

35
Q

pain on passive stretch could be indicative of:

A

compartment syndrome

36
Q

tender, purple/red raised lesions with a pale centre

known as

A

osler nodes

37
Q

osler nodes occur as a result of:

A

immune complex deposition

38
Q

swelling of the distal interphalangeal joint with deviation of the finger tip

A

heberdens nodes

39
Q

4 causes of avascular necrosis of the hip

A
  • long term steroid therapy
  • chemo therapy
  • alcohol excess
  • trauma
40
Q

initial imaging modality of choice for suspected Achilles tendon rupture

A

ultrasound

41
Q

58 y/o

pmh: T2DM, CKD3
pc: lower back pain
obs: 38.3, hr 95, rr 20, bp 140/82

OE: patient lying on left side with hips slightly flexed

  • pain worse when he flexes his hip
  • pain on hyperextension
  • abdo SNT

indicative of:

A

psoas abscess

42
Q

initial approach for poas abscess

A

percutaneous drainage

43
Q

65 y/o

  • bilateral leg pain
  • brought on by walking

pmh: peptic ulcer disease, OA, can walk around for 5 mins before It develops

leaning forwards or crouching improves pain.

msk and vascular examination is unremarkable

likely diagnosis?

A

differentials

  • spinal stenosis
  • PAD

spinal stenosis, not PAD because vascular examination normal

44
Q

which part of bone is commonly affected in children with osteomyelitis?

A

metaphysis

45
Q

A 78-year-old man complains of a long history of shoulder pain and more recently weakness. On examination active attempts at abduction are impaired. Passive movements are normal.

indicative of:

A

rotator cuff tear

46
Q

A 63-year-old lady undergoes an axillary clearance for breast cancer. She makes steady progress. However, 8 weeks post operatively she still suffers from severe shoulder pain. On examination she has reduced active movements in all planes and loss of passive external rotation.

A

adhesive capsulitis

47
Q

first line investigation for suspected osteoporotic vertebral fracture

A

x-ray of spine

48
Q

44 y/o
pc: painful ring finger, swelling of entire digit, stops at distal palmar crease. pain on palpation and passive extension of digit.

was bitten by an insect on the same hand

indicative of:

A

infective flexor tenosynovisitis

Kanavel’s signs of flexor tendon sheath infection are fixed flexion, fusiform swelling, tenderness and pain on passive extension

49
Q

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

indicative of:

A

achilles tendinopathy

50
Q

Signs of systemic sepsis with changing lower limb neurology

may indicate

A

possible epidural abscess

  • causing compression of caudal equina

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