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AKT > Orthopaedics 2 > Flashcards

Orthopaedics 2 Flashcards

1
Q

Red flags back pain (5)

A

<20yo >50yo
Hx of malignancy
Night pain
History of trauma
Systemically unwell

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2
Q

Stiffness usually worse in the morning and improves with activity. Young man with lower back pain =

A

Ank spond

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3
Q

Spinal stenosis
Sx (3)

A

Gradual onset
Unilateral or bilateral leg pain
Numbness and weakness

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4
Q

Spinal stenosis
Worse when?
Relieved by?

A

Worse on walking/downhill
Relieved by sitting/ leaning forwards/ crouching/ walking uphill

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5
Q

Spinal stenosis examination
Ix
Rx

A

NAD
MRI
Rx laminectomy

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6
Q

PAD sx

A

Pain on walking, relieved by rest
Absent or weak pulses

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7
Q

Lower back pain (non specific)
Ix (2)

A

Lumbar spine XR
MR

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8
Q

Lower back pain
When should an MR be offered?

A

If it will change management OR if malignancy/ infection/ fracture/ cauda equina or ank spond is suspected

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9
Q

Lower back pain Mx
1st line mx

A

NSAIDs with PPI if >45yo

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10
Q

Lower back pain
Should paracetamol be offered?

A

Paracetamol should not be offered as monotherapy

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11
Q

Features of prolapsed disc (2)

A

Leg pain worse than back pain
Clear dermatomal leg pain

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12
Q

L3 nerve root compression features (4)
Sensory
Motor
Reflexes
Stretch test

A

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

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13
Q

L4 nerve root compression
Sensory loss ?
Weak ?
Reflexes
Stretch test

A

Sensory loss anterior aspect of knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

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14
Q

L5 nerve root compression
Sensory
Motor
Reflexes
Stretch test

A

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

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15
Q

S1 nerve root compression
Sensory
Motor
Reflexes
Stretch test

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

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16
Q

Mx prolapsed disc (2)

A

Analgesia, physio

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17
Q

Prolapsed disc - when to refer for MR?

A

If symptoms persist after 4-6 weeks

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18
Q

Femoral nerve
Motor
Sensor
Mechanism of injury

A

M knee extension, hip flexion
S Anterior and medial aspect of thigh and lower leg
Hip and pelvic fractures/ stab and gun shot wounds

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19
Q

Obturator nerve
Motor
Sensory
Mechanism of injury

A

Thigh adduction
Medial thigh
Anterior hip doslocation

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20
Q

Lateral cutaneous nerve of the thigh
Motor
Sensory
Mechanism of injury

A

M - none
S Lateral and posterior thigh
Compression of the nerve can lead to meralgia paraesthetica

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21
Q

Tibial nerve
Motor
Sensory
Mechanism of injury

A

Plantarflexion and inversion
Sole of the foot
Not commonly injured, popliteal lacerations and posterior knee dislocations

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22
Q

Common peroneal nerve
Motor
Sensory
Mechanism of injury

A

Dorsiflexion and eversion + Extensor hallucis longus
Dorsum of the foot and lower lateral part of the leg
Neck of fibula injury
Tight lower limb cast
Foot drop

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23
Q

Superior gluteal nerve
Motor
Sensory
Mechanism of injury

A

M Hip abduction
S None
Misplaced IM injection/ hip surgery, pelvic fracture, posterior hip dislocation
Positive Trendelenburg

24
Q

Inferior gluteal nerve
Motor
Sensory
Mechanism of injury

A

M hip extension and lateral rotation
S None
Injury to sciatic nerve
Difficult in rising from seated position.
Cannot jump or climb stairs.

25
Q

Lumbar spinal stenosis can be caused by? (3)

A

Degenerative changes
Prolapsed disc
Tumour

26
Q

pain and tenderness localised to the medial epicondyle
pain is aggravated by wrist flexion and pronation
symptoms may be accompanied by numbness / tingling in the 4th and 5th finger due to ulnar nerve involvement

A

Golfers elbow/ Medial epicondylitis

27
Q

Meralgia paraesthetica originated from which L segment
Age range
Gender
Unilat versis bilat
More common in those with which condition?

A

L2/L3
30-40
M>F
Can be bilat
DM

28
Q

Meralgia paraesthetica
RF (7)

A

DM
Obesity
Pregnancy
Tense ascites
Trauma
Surgery
Sports

29
Q

Meralgia paraesthetica aggravated by/ relieved by

A

Aggravated Standing, extension of the hip
Relieved Sitting

30
Q

Ix meralgia paraesthatica
Rx

A

Pelvic compression test
Rx local anaesthetic

31
Q

What is Morton’s neuroma?

A

Neuroma most commonly in the third inter-metatasophalangeal space

32
Q

Morton’s neuroma
Gender
Sx (4)

A

F>M
Sx
Forefoot shooting or Burning pain
Worse on walking
Pebble in the shoe feeling
Loss of sensation in the toes

33
Q

Morton’s neuroma
Ix
Mx (2)
When to refer?

A

US
Mx - avoid high heels, metatarsal pads
If symptoms persist for >3 months

34
Q

RF OA hand (3)

A

Previous trauma
Obesity
Hypermobility

35
Q

How does stiffness in OA hand differ from RA

A

OA hand - stiffness after periods of inactivity, which resolves after a few minutes unlike RA

36
Q

Heberden’s and Bouchard’s locations?

A

DIP, PIP (osteophyte formation)

37
Q

XR findings OA (2)

A

Osteophytes
Joint space narrowing

38
Q

Red flags for hip pain

A

Rest pain
Night pain
Morning stiffness >2 hours

39
Q

Hip pain Ix
Mx (3)

A

Clinical if typical features
Otherwise XR
Mx analgesia, injections, THR

40
Q

Posterior dislocation rotation

A

Internal rotation and shortening

41
Q

Most common type of hip replacement?
How long will sticks/ crutches be used after op?

A

Cemented hip replacement
6 weeks

42
Q

Advice to give post hip replacement (4)

A

Avoiding flexing the hip > 90 degrees
Avoid low chairs
Do not cross your legs
Sleep on your back for the first 6 weeks

43
Q

Osteochondritis dissecans impact what age group?

A

Children and young adults

44
Q

Knee pain and swelling after exercise
Catching and locking/ giving away
Clunk on flexing or extending knee (involvement of lateral femoral condyle)

Joint effusion
Tenderness on palpation of the articular cartilage medial femoral condyle when knee is flexed

A

osteochondritis dissecans

45
Q

Osteochondritis dissecans Ix (2) + finding on each
Mx (1)

A

XR subchondral crescent sign or loose bodies
MR cartilage evaluation, loose bodies

Mx ortho referral

46
Q

Who should be assessed for osteoporosis?
F age
M age
Then how often after that?

A

F >=65yo
M >=75yo

Then 2 yearly after this

47
Q

Which younger people should be assessed for fragility fractures? (7)

A

Younger if
- previous fragility fracture
- steroid use
- hx of falls
- FH hip fracture
- low BMI
- smoking
- ETOH >14units

48
Q

Risk assessment for osteoporosis tool

When to do a DEXA? (2)

A

FRAX or QFracture

Before starting treatments which have an effect on bone density e.g hormone deprivation

> 40yo with a major risk fracture

49
Q

Interpretation of FRAX without a BMD (DEXA)

A

Low risk: lifestyle advice and reassure
Intermediate risk: offer BMD
High risk: bone protection treatment

50
Q

Ewing’s sarcoma
Gender
Age of onset
Commonest site
Mets
Rx (2)

A

M>F
10-20yo
Femoral diaphysis
Blood
Rx chemo and surgery

51
Q

Osteosarcoma
Gender
Age
Rx (2)

A

20% of all primary bone tumours
M >F
Age 15-30
Limb preserving surgery + chemo

52
Q

Liposarcoma
Age
Location
Growth speed

A

> 40yo
Retroperitoneum
Slow growing

53
Q

Most common sarcoma in adults

A

Malignant Fibrous Histiocytoma

54
Q

What is talipes equinovarus?

A

Club foot - inverted and plantar flexed foot

55
Q

Talipes equinovarus
Gender
When is it diagnosed?

A

M>F
Newborn examination

56
Q

Talipes equinovarus
Mx
Resolves by:
What is normally required under local?

A

Ponseti method - soon after birth, normally corrected by week 6-10 + night time braces until aged 4yo
Achilles tenotomy

AKT (52 decks)

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