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Year 4 Overview/Random tests > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Most common benign bone tumour?

A

Osteochondroma

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2
Q

Pathophysiology of enchondroma?

A

Failure of normal enchondromal ossification at growth plate

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3
Q

On x-ray ‘soap bubble’ appearance

A

Giant cell tumour

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4
Q

Other benign tumours?

A

Brodie’s abscess - subacute osteomyelitis
Osteoid osteoma
Fibrous dysplasia - both adolescent
Bone cyst - simple or aneurysmal

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5
Q

Metastatic cancer bone pain?

A

Constant, severe, worse at night

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6
Q

Most common form of malignant primary bone tumours?

A

Osteosarcoma

60% around knee

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7
Q

Other malignant bone tumours?

A

Chondrosarcoma, fibrosarcoma (abnormal bone), ewing’s sarcoma etc

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8
Q

Marrow tumour?

A

Ewing’s sarcoma

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9
Q

Most common mets to bone?

A 
Breast
Prostate
Lung
Renal cell
Thyroid adenocarcinoma
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10
Q

Problem with renal cell mets?

A

Very vascular ‘blow out’ lesions

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11
Q

Malignant soft lesion neoplasm indicators?

A

Larger, rapid growth in size, solid, ill-defined, irregular surface, associated lymphadenopathy and systemic upset.

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12
Q

Most common site of the giant cell tumour of tendon sheath?

A

Flexor tendon sheath of a finger

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13
Q

Ganglion cysts - clinical features and underlying pathophysiology?

A

Well-defined, firm and transilluminate
From from herniation/out-pouching of a weak part of joint capsule/tnedon sheath
Weakness: arthritis/joint damage

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14
Q

Osteochondritis?

A

Young people - repetitive stress -> bleeding/oedema -> compression of capillaries -> necrosis -> can seperate bone etc

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15
Q

Common places for osteochondritis?

A 
2nd metatarsal head
Navicular bone
Lunate of the carpus
Elbow capitellum
Vertebral compression
Hip
Tibial tubercle
Calcaneus
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16
Q

Freiburg’s disease?

A

2nd metatarsal head osteochondritis

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17
Q

Kohler’s disease?

A

Navicular bone osteochondritis

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18
Q

Kienbock’s disease?

A

Lunate of the carpus osteochondritis

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19
Q

Panner’s disease?

A

Elbow capitellum osteochondritis

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20
Q

Scheuermann’s disease?

A

Vertebral compression due to osteochondritis

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21
Q

Perthes disease of the hip?

A

Compression osteochondritis of the developing hip

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22
Q

Osgood Schlatter disease?

A

Traction osteochondritis at the tibial tubercle

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23
Q

Sever’s disease?

A

Traction osteochondritis at the calcaneus

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24
Q

Osteochondritis dissecans?

A

Fragmentation with separation of bone and cartilage within a joint

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25
Q

Avascular Necrosis common sites?

A 
Femoral head
Femoral condyles
Head of the humerus
Capitellum
Proximal pole of scaphoid
Proximal talus
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26
Q

Common risk factors for AVN?

A

Alcohol
Steroids
Primary hyperlipadaemia
Coag type disorders - anti phospholipid deficiency, thrombophilia, sickle cell

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27
Q

Caisson’s disease?

A

Decompression sickness -> AVN through nitrogen gas bubbles/scuba diving

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28
Q

Osteoporosis - type of defect? / definition?

A

Quantitive

Less than 2.5 SDs from the mean peak value of young adults of same race/sex

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29
Q

Osteopenia?

A

1 - 2.5 SDs less than mean

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30
Q

Risk factors for primary osteoporosis?

A

early menopause, smoking, alcohol, lack of exercise, diet

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31
Q

Risk factors for secondary osteoporosis?

A

Chronic disease
Inactivity
Less sun exposure

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32
Q

Osteomalacia - type of disease defect? Same as?

A

Qualitative - abnormal softening (less mineralization of osteoid - less calcium and phosphate)
Rickets

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33
Q

Most osteomalacia - caused by?

A

Insufficient calcium absorption - lack dietary calcium or resistance to action of D3

34
Q

Hyperparathyroid hormone - action?

A

Increases bone resorption
through phosphate excretion and renal calcium resorption (less lost through kidneys, more from bones)
ie more calcium in blood.

35
Q

Primary hyperparathyroidism?

Causes and outcomes?

A

Benign adenoma, hyperplasia or rarely malignancy
Hypercalcaemia -> symptoms/signs
Serum PTH raised

36
Q

Secondary hyperparathyroidism?

A

Physiological overproduction of PTH secondary to hypocalcaemia.
This hypocalcaemia - usually due to it D deficiency/CKD.

37
Q

Tertiary hyperparathryroidism?

A

Chronic secondary hyperparathyroidism, develop an adenoma, produce too much PTH despite biochem correction

38
Q

Bone changes due to CKD?

A

Reduced phosphate excretion and inactivate of vitamin D -> secondary hyperparathyroidism -> osteomalacia, bone sclerosis and soft tissue calcification

39
Q

What is Paget’s disease?

A

Thickened, brittle mis-shapen bones.

increased osteoclast and osteoblast activity

40
Q

Blood results of Paget’s disease?

A

Raised serum alkaline phosphate and normal calcium/phosphate

41
Q

What is spondylosis?

A

intervertebral discs lose water content due to age -> less cushioning and increased pressure on the facet joints

42
Q

What indicates disc tear likely?

A

Worse on coughing etc - pressure

43
Q

Nerve roots for sciatic nerve?

A

L4/L5/S1

44
Q

What does pain below knee tell you?

A

Not back pain radiation - sciatic nerve

45
Q

L3/4 prolapse signs/symptoms?

A

L4 root entrapment > pain down to medial ankle (L4), loss of quadriceps power, reduced knee jerk

46
Q

L4/5 prolapse pattern?

A

L5 root entrapment > pain down dorsum of foot, reduced power Extensor Hallucis Longus and tibialis anterior

47
Q

L5/S1 prolapse pattern?

A

S1 root entrapment > pain to sole of foot, reduced power planarflexion, reduced ankle jerks

48
Q

Why are nerve root patterns not always reliable?

A

Genetic variation etc

If very lateral -> root below as well

49
Q

How does spinal stenosis come about?

A

spondylosis and a combination of bulging discs, bulging ligamentum flavum and osteophytosis

50
Q

How to differentiate PVD from spinal stenosis?

A

the claudication distance is inconsistent
the pain is burning (rather than cramping)
pain is less walking uphill (spine flexion creates more space for the cauda equina)
pedal pulses are preserved

51
Q

Commonest cause of caudal equine syndrome?

A

Very large central disc prolapse -> compress all the nerve roots of the caudal equine

52
Q

Red flags for back pain?

A

If <20
New if >60
Nature - constant, severe, worse at night
Systemic upset

53
Q

Who is at risk of developing atlanto-axial dislocation/instability?

A

RA

Down’s

54
Q

Causes of painful shoulder impingement?

A

Tendonitis subacromial bursitis
Acromioclavicualr OA with inferior osteophyte
A hooked acromion rotator cuff tear

55
Q

Which rotator cuff muscle is normally involved in tears?

A

Supraspinatus

56
Q

Principal clinical sign of frozen shoulder?

A

Loss of external rotation

57
Q

Most common traumatic shoulder instability?

A

Anterior
80% re-dislcoation rate in under 20s
20% in over 30s

58
Q

What can do for recurrent shoulder dislocations?

A

Bankart repair - reattches labrum/capsule to anterior glenoid

59
Q

Popeye deformity?

A

Biceps tendon rupture

60
Q

Anterior shoulder pain with pain on resisted biceps contraction?

A

Biceps tendonitis

61
Q

SLAP lesions?

A

Glenoid labrum tears, where long biceps tendon attaches

62
Q

Non-MSK causes of shoulder pain?

A

Diaphragmatic irritation - biliary colic, hepatic or subphrenic abscess

63
Q

Carpal tunnel formed by?

A

Carpal bones and flexor retinaculum

64
Q

Tinnel’s test?

A

Percussing over median nerve

65
Q

Phalen’s test?

A

Wrists held hyper-flexed

66
Q

Where is compression of cubital tunnel syndrome?

A

Ulnar nerve at elbow being the medial epicondyle

67
Q

Supination performed by?

A

Biceps and supinator

68
Q

Pronation performed by?

A

Pronator teres (proximally) and pronator quadratus (distally)

69
Q

Two joints in the elbow?

A

Humero-ulnar joint and radio-capitallar joint

70
Q

Triceps insertion on elbow?

A

Olecranon process

71
Q

Brachialis insertion on elbow?

A

Coronoid process

72
Q

Biceps insertion on elbow?

A

Bicipital tuberosity of radius

73
Q

Extensor origin of elbow arises from?

A

Lateral epicondyle

74
Q

Flexor origin of elbow arises from?

A

Medial epicondyle

75
Q

Tennis elbow?

A

Lateral epicondylitis

extension at wrist

76
Q

Golfer’s elbow?

A

Medial epicondylitis - repeated flexion (less common than tennis)

77
Q

Why injection to resolve golfer’s elbow risky?

A

Risk ulnar nerve damage

78
Q

Pathophysiology of dupuytren’s contracture?

A

Proliferative connective tissue disorder of palmar fascia -> contracts MCP/PIP

79
Q

Pyrenees’ disease?

A

Fibromatoses of penis

80
Q

Ledderhose disease?

A

Plantar fibromatoses affecting feet

81
Q

Trigger finger?

A

Flexor tendonitis -> usually distal to A1 pulley (over the metacarpal pulley)

82
Q

Hip pain - knee presentation solely typical in what?

A

SUFE

Year 4 Overview/Random tests (11 decks)

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