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Orthopaedics Flashcards

1
Q

How does compartment syndrome present? Which signs occur late?

A

Pain - out of proportion, on passive stretch
Parasthesia
Pallor
Swelling

Late - pulseless, perishingly cold, paralysis

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2
Q

Describe the pathophysiology of compartment syndrome

A

Pressure within a muscle compartment rises, due to fracture and swelling. Osseofascial pressure rises to more than venous pressure, forcing the veins to close and restricting venous drainage. This causes stasis of blood within the compartment and aviscious cycle of increased pressure.
Ischaemia occurs because the oxygen and metabolites are used up and the pressure is too high for arterial blood to perfuse the tissue.

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3
Q

Which 2 fractures most commonly cause compartment syndrome?

A

Tibial shaft

Supracondylar

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4
Q

What is the treatment for compartment syndrome?

A

Fasciotomy.

2 incisions either side of the tibia to reach all 4 compartments.

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5
Q

Which structures are at risk during a fasciotomy for tibial compartment syndrome?

A

Superficial peroneal nerve

Saphenous vein and nerve

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6
Q

What are the red flag symptoms of cauda equina?

A 
Bilateral pain
Saddle anaesthesia
Bowel incontinence and bladder retention
Reduced reflexes - anal wink, bulbocavernosus
Reduced anal tone
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7
Q

What causes cauda equina?

A

Space occupying lesion eg tumour or disc prolapse compresses nerve root L1 or below. This affects all of the nerve roots below this point

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8
Q

What would you order if you suspected cauda equina?

A

Urgent MRI

Discectomy within 48 hours

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9
Q

What is the differential for a single acute painful joint?

A

Septic arthritis
Gout
Malignancy

Pseudogout
Bursitis
Transient synovitis (child)
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10
Q

What is the work up for a single acute painful joint?

A

FBC
CRP
Blood culture
Aspirate - culture, histology and crystal analysis
(For septic arthritis, malignancy and gout/pseudogout)

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11
Q

Which bacteria are associated with septic arthritis

A

Staph aureus
Neisseria gonorrhoea
Pseudomonas aeruginosa (immunocompromised)

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12
Q

Which bacteria are associated with an infected animal bite?

A

Pasturella multocida

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13
Q

What bacteria are associated with an infected human bite?

A

Staph aureus

Eikenella corrodens

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14
Q

What is the treatment for a bite wound?

A

Allow to heal by secondary intention.

7 days co amox or metro+doxy

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15
Q

Which nerve is at risk following a supracondylar fracture? How is it tested?

A

Anterior interosseous.

Can’t make ok sign because radial half of flexor digitorum profundus and flexor pollicis longus

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16
Q

What artery is at risk following a supracondylar fracture?What sign would you look for to check it?

A

Brachial artery

Check pulses

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17
Q

What is a major complication of a supracondylar fracture? What signs would you look for?

A

Volkmann’s ischaemic contracture.

Skin puckering - indicates puncture of brachialis

Signs of compartment syndrome: Pain out of proportion, passive stretch, swelling, parasthesia (pulse, cold, paralysis)

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18
Q

What is the difference between a buckle fracture and a greenstick fracture?

A

(Both are partial thickness breaks due to the pliability of paediatric bones)

Buckle - break is a crush on opposite side to the tension
Greenstick - break is a snap on the side of the tension

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19
Q

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

A

Both - low energy (think elderly women) extra articular distal radius fracture

Colles - dorsally displaced
Smiths - volarly displaced

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20
Q

How would you manage a minimally displaced distal radial fracture?

A

Surgical fix because risk to pronation and supination even if slightly displaced.

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21
Q

How would you assess whether a distal radial fracture was displaced?

A

Volar tilt >11 degrees

Dorsal tilt >22 degrees

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22
Q

Which nerve is at risk in a distal radial fracture?

A

Median nerve - acute carpal tunnel syndrome

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23
Q

Which tendon is at risk in a distal radial fracture?

A

Extensor pollicis longus

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24
Q

How does a SUFE present?

A

11-14 years
Overweight
Hip pain (can present as knee pain)
FABER position - flexed, abducted and in external rotation

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25
Q

What complications are associated with a SUFE?

A

Avascular necrosis of the femoral head

Arthritis

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26
Q

How is a SUFE treated?

A

Single percutaneous screw

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27
Q

What is the blood supply to the femoral head?

Which is most likely to be occluded in avascular necrosis?

A

Medial and lateral circumflex arteries (from the deep femoral)
Obturator artery through the ligament to the head of the femur

MEDIAL circumflex

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28
Q

How would you investigate a possible SUFE?

A

Frog leg lateral hip xray

Easily missed on AP

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29
Q

Describe the Salter Harris classification.

A

I - Slip through the growth plate
II - Above. Through growth plate and up through metaphysis
III - Lower. Through the growth plate and down through the epiphysis
IV - Through both metaphysis, growth plate and epiphysis
V - Crush

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30
Q

What is the most common type of Salter Harris fracture?

A

II

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31
Q

What is the differential for a child with a limp?

A

Infection - osteomyelitis, septic arthritis, transient synovitis
Malignancy
Trauma/fracture

SUFE (11-14)
Perthes (3-11)
DDH (0-3)

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32
Q

How does most hip pathology present?

A

FABER position and shortened
Flexed, abducted, externally rotated

(Except dislocation which is internally rotated)

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33
Q

How does Perthes disease present?

A

Scrawny, chav child (3-11 years)

Decreased ROM, pain, Faber position

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34
Q

What is Perthes disease?

A

Idiopathic avn of femoral head in a child

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35
Q

How does AVN of femoral head look on an x ray?

A

Decreased epipyseal height

Increased density

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36
Q

How does developmental hip dysplasia occur?

A

Lax joint and shallow acetabulum causes the femoral head to develop outside the acetabulum in utero.

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37
Q

What is the treatment for DDH?

A

Developmental dysplasia of the hip.

Pavlik harness

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38
Q

Describe the tests performed on neonates to screen fro DDH

A

Ortolani - Out. Flex to 90 and abduct legs out. Push thigh up to reduce. Click is positive
Barlow - Back. Flex to 90 and legs together. Push back to dislocate. Click is positive.

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39
Q

What are the 4 defects involved with clubfoot?

A

C - midfoot cavus
A - forefoot adductus
V - hindfoot varus
E - hindfoot equinus

Not passively correctable

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40
Q

Where do the nerve roots emerge in relation to the vertebral disc in

a) The cervical spine
b) The rest of the spine

A

a) nerve root emerges above
b) nerve root emerges below

This is because there are 7 cervical vertebrae and 8 cervical nerve roots.

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41
Q

Which nerve root is being tested by the biceps reflex?

A

C5

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42
Q

Which nerve root is being tested by the supinator reflex?

A

C6

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43
Q

Which nerve root is being tested by the triceps reflex?

A

C7

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44
Q

How would you test the sensation and movement of C5?

A

Sensation - lateral shoulder

Movement - elbow flexion

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45
Q

How would you test the sensation and movement of C6?

A

Sensation - lateral forearm

Movement - wrist extension

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46
Q

How would you test the sensation and movement of C7?

A

Sensation - middle finger

Movement - elbow extension

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47
Q

How would you test the sensation and movement of C8?

A

Sensation - little finger

Movement - finger flexion

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48
Q

How would you test the sensation and movement of T1?

A

Sensation - medial forearm

Movement - finger abduction

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49
Q

How would you test the sensation and movement of L2?

A

Sensation - medial thigh/ groin

Movement - hip flexion

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50
Q

How would you test the sensation and movement of L3?

A

Sensation - medial and anterior thigh

Movement - knee extension

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51
Q

How would you test the sensation and movement of L4?

A

Sensation - medial calf

Movement - dorsiflexion (foot drop)

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52
Q

How would you test the sensation and movement of L5?

A

Sensation - Big toe round to lateral calf

Movement - toe extension

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53
Q

How would you test the sensation and movement of S1?

A

Sensation - Posterior calf

Movement - plantarflexion

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54
Q

Which nerve root is being tested by the knee reflex?

A

L3/4

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55
Q

Which nerve root is being tested by the ankle reflex?

A

S1

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56
Q

How would you test the sensation and movement of S4?

A

Sensation - Perineum

Movement - Anal tone, incontinence

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57
Q

What nerve might be damaged by axillary node clearance? What effect would it have?

A

Long thoracic
Serratus anterior
Winged scapula
Press hands on wall and it pokes out

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58
Q

What nerve might be damaged by fracture of the neck of the humerus or dislocation of the shoulder? What effect would it have?

A

Axillary
Deltoid
Arm abduction 15-90 degrees
Numbness in regimental badge area

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59
Q

What are the signs of damage to the long thoracic nerve?

A

Serratus anterior - winged scapula

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60
Q

What are the signs of damage to the axillary nerve?

A

Weakness in arm abduction 15-90 degrees

Numbness in regimental badge area

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61
Q

What are the signs of damage to the thoracodorsal nerve?

A

Latissimus dorsi weakness

Can’t use a crutch

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62
Q

What are the signs of damage to the median nerve?

movement and sensation

A 
Thenar wasting
Weakness in thumb adduction - palm on table and raise up 
Ok sign (anterior interosseous branch)

Carpal tunnel

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63
Q

What are the signs of damage to the ulnar nerve?

movement and sensation

A

1st webspace wasting
Weakness in abduction of fingers together

Ulnar claw - from damaged lumbricals
Pain/numbness in medial hand

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64
Q

What are the signs of damage to the radial nerve?

movement and sensation

A

Wrist drop

Pain/numbness on back of hand

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65
Q

What are the signs of damage to the anterior interosseous nerve?

A

Weakness in ok sign

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66
Q

What are the signs of damage to the superior gluteal nerve? (movement and sensation)

A

Trendelenberg gait

Pain over buttock

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67
Q

What are the signs of damage to the ilioinguinal nerve?

A

Pain from abdomen to groin

Illicited by pressing inguinal ligament

68
Q

What are the signs of damage to the obturator nerve?

movement and sensation

A

Weakness in leg adduction

Pain in groin

69
Q

What are the signs of damage to the common peroneal nerve?

movement and sensation

A

Foot drop

Pain around knee (common)
Circle between big and second toe (deep)

70
Q

What are the signs of damage to the tibial nerve?

A

Weakness in plantarflexion

71
Q

What are the signs of damage to the saphenous nerve?

A

Pain on medial/posterior calf

72
Q

What are the signs of damage to the long cutaneous nerve of the thigh?

A

Pain on lateral and anterior thigh

73
Q

What are the signs of damage to the superficial peroneal nerve?

A

Pain on anterior calf

74
Q

What are the signs of damage to the sural nerve?

A

Pain on lateral/posterior calf

75
Q

What are the signs of damage to the musculocutaneous nerve? (movement and sensation)

A

Pain/numbness on lateral forearm

Weakness in BBC muscles (brachialis, bicep brachii and coracobrachialis)

76
Q

What nerve might be damaged by fracture of the shaft of the humerus? What effect would it have?

A

Radian nerve in the spiral groove
Wrist drop
Weakness in finger extension

77
Q

What are the nerve roots of the long thoracic nerve?

A

C5 C6 and C7 (raise your hands up to heaven)

78
Q

What are the nerve roots of the pudendal nerve

A

S2 S3 and S4 (poo and wee off the floor)

79
Q

What are the nerve roots of the musculocutaneous, axillary, median, radial and ulnar nerves?

A 
Musculocutaneous - C5, 6, 7
Axillary - C5, C6
Radial - C5, C6, C7, C8, T1
Median - C5, C6, C7, C8, T1
Ulnar - C8, T1
80
Q

What are the signs of damage to the femoral nerve?

A

Weakness in knee extension, hip flexion

Pain/ numbness in anterior and medial aspect of the thigh and lower leg

81
Q

What are the nerve roots of the femoral nerve?

A

L2-4

82
Q

What are the nerve roots of the sciatic nerve?

A

L4 to S3

83
Q

Which drug is useful in back pain, to reduce muscle spasm?

A

Baclofen

84
Q

What are the causes of pathological fractures?

A 
Osteoporosis
Malignancy - primary or mets
Paget's disease of the bone
Metabolic bone disease
Hyperparathyroid
Osteogenesis imperfecta
Infection - osteomyelitis
85
Q

Name and describe some fracture patterns.

A 
Transverse - straight across
Oblique - diagonal
Spiral
Intra articular
Segmental - 2 breaks leave a flail segment
Comminuted - crushed into lots of pieces
86
Q

How would you work up a suspected fracture?

A

2 planes x ray - AP and lateral usually
CT if comminuted

If repeated fractures/elderly
Calcium
Vitamin D
PTH
?Biopsy
MRI for nerve compromise
87
Q

What are the contraindications for reducing a fracture

A

Undisplaced

Vertebral

88
Q

Give some immediate fracture complications.

A

Nerve palsy
Ischaemia
Haemorrhage

89
Q

Give some early (but not immediate) fracture complications.

A

Compartment syndrome
Infection
DVT
Fat embolus

90
Q

Give some late fracture complications.

A 
Non union
Malunion
Stiffness
AVN
CRPS - complex regional pain syndrome
91
Q

How do you describe an x ray of a fracture?

A

Name age and date of x ray
This is a (lateral, AP, PA ..) of the …
The most obvious abnormality is..

Which bone
Where (epiphysis, metaphysis, diaphysis)
Pattern (transverse, oblique, spiral, segment, comminuted)

Displacement?
Angulated?
Shortened?
Rotated?

92
Q

How do you describe an x ray of a bone lesion?

A

Name age and date of x ray
This is a (lateral, AP, PA ..) of the …
The most obvious abnormality is..

Which bone
Where (epiphysis, metaphysis, diaphysis)
Lytic or sclerotic
Cortex or medulla
Through the periosteum?
Well defined border?
Periosteal thickening?
93
Q

What is the name for a radiculopathy of the lateral cutaneous nerve of the thigh?

A

Meralgia paraesthetica

94
Q

What are the risk factors for dupuytrens contracture?

A 
Manual labour
Phenytoin 
Alcoholic liver disease
Trauma
FHx
95
Q

What is the treatment for an intracapsular NOF?

A

Mobile - total hip replacement

Not mobile - hemiarthroplasty (cement)

96
Q

What is the treatment for an intertrochanteric NOF?

A

Dynamic hip screw

97
Q

What is the treatment for a subtrochanteric NOF?

A

Intramedullary nail

98
Q

How does De Quervains tenosynovitis present?

A

Swollen side of wrist

Pain over ther radial styloid on forced abduction/flexion of the thumb.

99
Q

Describe the parts of an intervertebral disc. What type of collagen makes up each part?

A 
Annulus fibrosus (outside) - type 1 collagen
Nucleus pulposus (inside) - type 2 collagen
100
Q

Which direction does an intervertebral disc normally herniate? Why?

A

Posterolaterally

Because the posterior longitudinal ligament is the weakest

101
Q

Describe the layers of the back that the needle of a spinal anaesthetic must pass through.

A 
Supraspinous ligament
Interspinous ligament
Ligamentum flavum 
(Epidural here)
Dura mater
Arachnoid mater
(Spinal here)
(Then
Pia mater
The cord
Other sides of the meninges
Posterior longitudinal ligament
Vertebral body/disc
Anterior longitudinal ligament)
102
Q

At what spinal level do most episodes of cauda equina occur?

A

L4/5
Pressing on L5 nerve root (toe extension)

L5/S1
Pressing on S1 nerve root (plantarflexion)

103
Q

What are the main causes of radiculopathy?

A

Disc herniation
Degenerative - spondylosis
Arthritic osteophytes
Diabetes (microvascular damage to nerves)

104
Q

Describe the first 2 vertebrae

A

Atlas - C1. A ring shape

Axis - C2 Has the dens which slots into C1 to allow rotation of the head

105
Q

Describe the femoral and sciatic stretch tests. What do they identify?

A

Sciatic - passive straight leg raise in dorsiflexion
Femoral - passive hip extension with knee in flexion

Stretch the nerves to illicit radiculopathy pain

106
Q

Describe some special x ray views

A

Frog leg lateral - for SUFE

Scaphoid view - scaphoid fracture

107
Q

Give a differential for back pain

A

Mechanical - muscular, disc herniation, arthritic changes (spondylosis), inflammatory (spondylitis), compression fracture

Systemic - discitis, malignancy, connective tissue disease

Referred - renal colic, AAA, pancreatitis

108
Q

What are the borders of the anatomical snuff box?

A

Extensor pollicis longus

Extensor pollicis brevis
Abductor pollicis longus (b for thumB)

109
Q

What complications are associated with a scaphoid fracture? Why?

A

Non union
AVN

Blood supply travels distal to proximal

110
Q

What are the risk factors for a NOF?

A

Female
Age
Osteopenia/osteoporosis

111
Q

Why do we measure lactate in trauma/sepsis?

A

Marker of uncompensated hypoperfusion.
Therefore marker of morbidity/AVN in fractures/ischaemia risk
Associated with poor outcomes

112
Q

The consultant asks you to prep a patient for theatre for a total hip replacement. What do you do?

A

Fbc, u and e, group and save 2 units, lactate

Fluid
Nil by mouth
Reverse Warfarin and place on Rivaroxaban (for knee and hip surgery, all others use LMWH)
Place on sliding scale if insulin dependent
Bactoban and hibiscrub for MRSA prophylaxis

113
Q

Describe Gardner’s classification for NOFs.

A

I - Incomplete
II - Complete, undisplaced
III - Complete, partially displaced
IV - Complete fully displaced

114
Q

Describe the Nottingham Hip fracture score.

A

Risk of 30 day mortality high if 7/10

Age - 66-85 3 points, over 85 4 points
Sex M more likely to die even though F more likely to fracture
Mental state
Hb
In a home
Comorbidities
Cancer
115
Q

What is the 1 year mortality following a NOF?

A

30%

116
Q

What are the complications associated with an untreated intracapsular NOF?

A

AVN
Non union because no periosteum in femoral neck therefore no callus

Pain
Disability
Mortality 30%

117
Q

What are the complications associated with a hip arthroplasty?

A 
Any op - 
Infection
Bleeding
NV damage
Chronic pain
Anaesthetic reaction

Specific-
Leg length discrepancy
Stiffness
Dislocation

118
Q

What are the complications associated with an untreated extracapsular NOF?

A

Pain
Disability
Mortality 30%

119
Q

How does ankylosing spondylitis present?

A

Lower back pain and stiffness of insidious onset
Stiffness worse in the morning and improves with exercise
Night pain

Reduced lateral flexion
Reduced forward flexion - Schober's test - a line is drawn 10 cm above and 5 cm below the back dimples. The distance between the two lines should increase by more than 5 cm when the patient bends as far forward as possible
Reduced chest expansion
Bamboo spine
Sacroilitis
120
Q

What are the risk factors for an spond?

A

Male

HLA-B27

121
Q

How is ank spond treated?

A

Regular exercise such as swimming
Physiotherapy
NSAIDs are the first-line treatment
‘Anti-TNF therapy should be given to patients with persistently high disease activity despite conventional treatments’ (etanercept and adalimumab)

122
Q

How does osteoarthritis present?

A 
Gradual onset
Assymetric joint pain
Knee, hip, pip and dip
Less than 1 hour morning stiffness
Relieved by rest
123
Q

What are the radiological features of osteoarthritis?

A

L - loss of joint space
O - osteophytes
S - subchondral cysts
S - sclerosis

124
Q

What is the treatment of osteoarthritis?

A 
Weight loss
Physio
Paracetamol
NSAIDs
Steroid injections
Joint replacement
125
Q

What complications of osteoarthritis?

A 
Gout 
Pseudogout
Chondrolysis and loose bodies
Stress fractures
Radiculopathy
126
Q

What are the risk factors for osteoarthritis?

A 
Obesity
Varus/valgus deformities
Repetitive microtrauma (pneumatic drill)
Gout 
Pseudogout
Menopause
127
Q

What are the indications for a joint replacement for osteoarthritis?

A 
Pain - 
Steroid injections no longer effective
Night pain
Pain when resting
Startup pain

Affecting activities of daily living

128
Q

What are Heberdens and Bouchards nodes?

A

Heberden - at the end - DIP joint
Bouchard - PIP joint

Both associated with osteoarthritis
Hard bony outgrowths caused by osteophytes

129
Q

Which type of bone is most affected by osteoporosis?

A

Cancellous spongy bone

130
Q

What is the difference between normal and osteoporotic bone?

A

Decreased density, especially in the cancellous bone. Thin trabeculae and increased numbers of Haversian canals (parallel to the length of the bone)

131
Q

What are the main risk factors for osteoporosis?

A

FRAX factors:

Female
Fractured hip
Rheumatoid arthritis
Alcohol
Age
Smoking
Steroids
Low BMI

Endocrine - hyperthyroid, parathyroid, premature menopause, acromegaly
Early menopause
CKD

132
Q

What is the FRAX score?

A

FFRAASSL

Female
Fractured hip
Rheumatoid arthritis
Alcohol
Age
Smoking
Steroids
Low BMI

Risk of fracture in osteporosis

133
Q

When is a DEXA scan indicated?

A

Fracture plus

Minor trauma
Steroids
Rheumatoid arthritis
Early menopause
Post menopause and low BMI
134
Q

What is the treatment for osteoporosis?

A

Bisphosphonates (alendronic acid)

Adcal

135
Q

What is the mechanism of action of bisphosphonates?

A

Cause apoptosis of osteoclasts

136
Q

What are the side effects of bisphosphonates?

A

GORD (acidic)
Hypocalcaemia
Osteonecrosis of the jaw

137
Q

What is the bone profile blood result likely to show in osteoporosis?

A

Normal

138
Q

What is the difference between the pain presentation of osteoporosis and osteomalacia?

A

OsteoPorosis hurts part of the time, osteoMalacia hurts most of the time.

139
Q

Which types of bone are at most at risk of fracture in osteomalacia?

A

Flat bones - pubic rami, scapula, ribs

140
Q

What is the bone profile blood result likely to show in osteomalacia?

A

Low vit D
Thererfore Low Ca
Therefore High PTH and High Alk phos

141
Q

What is the pathophysiology of Paget’s disease of the bone?

A

Large multi nucleated osteoclasts
Increased breakdown of bone, stimulates increased osteoblastic activity.
Lots of thick bone - sabre tibia and skull
Due to high demand, the bone produced is low quality, weak, vascular.

142
Q

What complications are associated with Paget’s disease of the bone?

A

Fractures
Arthritis
Osteosarcoma (high bone turnover)
Deformity

143
Q

What is the bone profile blood result likely to show in Paget’s disease of the bone?

A

High Alk Phos (high bone turnover)

144
Q

What is the bone profile blood result likely to show in bone mets?

A

High alk phos (high turnover)

Enough to increase Ca

145
Q

What is the bone profile blood result likely to show in primary hyper PTH?

A

High PTH

Therefore high Ca

146
Q

What is the bone profile blood result likely to show in secondary hyper PTH?

A

Low Ca

Therefore high PTH

147
Q

What are the most common cancers to metastasise to the bone?

A

Prostate
Breast
Lung/bronchial

(and the rest of the hexagon)
Thyroid
Kidney

148
Q

Which bone mets are more likely to be lytic and which are more likely to be sclerotic?

A

Lytic - thyroid, bronchial, renal

Sclerotic - Prostate, breast

149
Q

How do bone mets develop?

A
  1. Cancerous cells have less e-cadherin on the membrane. This leads to reduced adhesion between cells.
  2. Cancer cells recruit niche cells to release lots of protease to lyse the surrounding stroma.
  3. Cancer cells enter the blood/lymph/coelom
  4. Cancer cells release integrins to aid adhesion to the endothelium in the bone.
  5. Cancer cells release VEG-F to increase angiogenesis at the bone.
  6. Lytic cancer releases GF to stimulate blasts to stimulate clasts.
  7. Sclerotic cancer releases ET-1 to increase blasts.
150
Q

Which bones do malignant lesions commonly develop in?

A

Thoracic spine

Proximal femur

151
Q

What are the red flag signs and symptoms for a bone met?

A 
Night pain 
Progressive pain
Pathological fracture
Neurological deficit - spinal cord compression
Hypercalcaemia

Weight loss
Appetite loss
Smoker

152
Q

What are the early symptoms of hypercalcaemia?

A

Stones…
Polyuria
Renal stones

Moans…
Pancreatitis
Constipation
Vomiting

Groans….
Depression
Fatigue

153
Q

What are the late symptoms of hypercalcaemia?

A

Cardiovascular
Short QT -> arrhythmia

Renal tubular damage - electrolyte disturbance, AKI

154
Q

What is the differential for causes of hypercalcaemia?

A

Malignancy
Paget’s disease of the bone

HyperPTH

Sarcoid
TB
CKD
Lithium

155
Q

How is hypercalcaemia treated?

A

Loop diuresis + fluid

Bisphosphonates

156
Q

What tests would you order if you suspected a bone met?

A

Fbc - anaemia of chronic disease, polycythaemia from EPO secreting renal cell cancer, neutrophilia
LFT - Alk phos
Bone profile - PTH, serum calcium
PSA, U&E, serum thyroxine - to hunt the primary

CXR
X ray limb in 2 planes

CT chest abdo pelvis
Technitium bone scan
MRI if neuro compromise

Biopsy - carried out by resecting surgeon

157
Q

What test can most sensitively identify bone mets?

A

Technitium bone scan

Identifies hotspots

158
Q

What is the most common primary bone tumour?

A

Osteoid osteosarcoma

159
Q

How does osteoid osteosarcoma present?

A

Young adult
Distal femur

On xray
Sclerotic
Elevation of periosteum
Sunray spicules

160
Q

How does Ewings’ sarcoma present?

A

Child
Flat or long bones

On x ray
Lytic

161
Q

What are the causes of duypeytren’s contracture?

A

Thickening of the palmar fascia

Idiopathic (FHx)
Cirrhosis
Phenytoin
Trauma
Manual labour
162
Q

How does tenosynovitis present?

A

Pain over radial styloid on forced flexion of the thumb

Finkelstein test

163
Q

How does tennis elbow present?

A

Lateral epicondylitis

Pain on wrist extension when elbow flexed

164
Q

How does golfer’s elbow present?

A

Medial epicondylitis

Pain on wrist flexion when elbow flexed

165
Q

Which bursa is affected by Housemaid’s knee?

A

Prepatellar

166
Q

Which bursa is affected by Clergyman’s knee?

A

Infrapatellar

167
Q

Why does damage to the radial nerve in the spiral groove only cause mild weakness of elbow extension?

A

The branches to the long and medial heads arise proximal to the radial groove

Junior blocks (12 decks)

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