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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
Avascular Necrosis common sites?
``` Femoral head Femoral condyles Head of the humerus Capitellum Proximal pole of scaphoid Proximal talus ```
26
Common risk factors for AVN?
Alcohol Steroids Primary hyperlipadaemia Coag type disorders - anti phospholipid deficiency, thrombophilia, sickle cell
27
Caisson's disease?
Decompression sickness -> AVN through nitrogen gas bubbles/scuba diving
28
Osteoporosis - type of defect? / definition?
Quantitive | Less than 2.5 SDs from the mean peak value of young adults of same race/sex
29
Osteopenia?
1 - 2.5 SDs less than mean
30
Risk factors for primary osteoporosis?
early menopause, smoking, alcohol, lack of exercise, diet
31
Risk factors for secondary osteoporosis?
Chronic disease Inactivity Less sun exposure
32
Osteomalacia - type of disease defect? Same as?
Qualitative - abnormal softening (less mineralization of osteoid - less calcium and phosphate) Rickets
33
Most osteomalacia - caused by?
Insufficient calcium absorption - lack dietary calcium or resistance to action of D3
34
Hyperparathyroid hormone - action?
Increases bone resorption through phosphate excretion and renal calcium resorption (less lost through kidneys, more from bones) ie more calcium in blood.
35
Primary hyperparathyroidism? | Causes and outcomes?
Benign adenoma, hyperplasia or rarely malignancy Hypercalcaemia -> symptoms/signs Serum PTH raised
36
Secondary hyperparathyroidism?
Physiological overproduction of PTH secondary to hypocalcaemia. This hypocalcaemia - usually due to it D deficiency/CKD.
37
Tertiary hyperparathryroidism?
Chronic secondary hyperparathyroidism, develop an adenoma, produce too much PTH despite biochem correction
38
Bone changes due to CKD?
Reduced phosphate excretion and inactivate of vitamin D -> secondary hyperparathyroidism -> osteomalacia, bone sclerosis and soft tissue calcification
39
What is Paget's disease?
Thickened, brittle mis-shapen bones. | increased osteoclast and osteoblast activity
40
Blood results of Paget's disease?
Raised serum alkaline phosphate and normal calcium/phosphate
41
What is spondylosis?
intervertebral discs lose water content due to age -> less cushioning and increased pressure on the facet joints
42
What indicates disc tear likely?
Worse on coughing etc - pressure
43
Nerve roots for sciatic nerve?
L4/L5/S1
44
What does pain below knee tell you?
Not back pain radiation - sciatic nerve
45
L3/4 prolapse signs/symptoms?
L4 root entrapment > pain down to medial ankle (L4), loss of quadriceps power, reduced knee jerk
46
L4/5 prolapse pattern?
L5 root entrapment > pain down dorsum of foot, reduced power Extensor Hallucis Longus and tibialis anterior
47
L5/S1 prolapse pattern?
S1 root entrapment > pain to sole of foot, reduced power planarflexion, reduced ankle jerks
48
Why are nerve root patterns not always reliable?
Genetic variation etc | If very lateral -> root below as well
49
How does spinal stenosis come about?
spondylosis and a combination of bulging discs, bulging ligamentum flavum and osteophytosis
50
How to differentiate PVD from spinal stenosis?
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
Commonest cause of caudal equine syndrome?
Very large central disc prolapse -> compress all the nerve roots of the caudal equine
52
Red flags for back pain?
If <20 New if >60 Nature - constant, severe, worse at night Systemic upset
53
Who is at risk of developing atlanto-axial dislocation/instability?
RA | Down's
54
Causes of painful shoulder impingement?
Tendonitis subacromial bursitis Acromioclavicualr OA with inferior osteophyte A hooked acromion rotator cuff tear
55
Which rotator cuff muscle is normally involved in tears?
Supraspinatus
56
Principal clinical sign of frozen shoulder?
Loss of external rotation
57
Most common traumatic shoulder instability?
Anterior 80% re-dislcoation rate in under 20s 20% in over 30s
58
What can do for recurrent shoulder dislocations?
Bankart repair - reattches labrum/capsule to anterior glenoid
59
Popeye deformity?
Biceps tendon rupture
60
Anterior shoulder pain with pain on resisted biceps contraction?
Biceps tendonitis
61
SLAP lesions?
Glenoid labrum tears, where long biceps tendon attaches
62
Non-MSK causes of shoulder pain?
Diaphragmatic irritation - biliary colic, hepatic or subphrenic abscess
63
Carpal tunnel formed by?
Carpal bones and flexor retinaculum
64
Tinnel's test?
Percussing over median nerve
65
Phalen's test?
Wrists held hyper-flexed
66
Where is compression of cubital tunnel syndrome?
Ulnar nerve at elbow being the medial epicondyle
67
Supination performed by?
Biceps and supinator
68
Pronation performed by?
Pronator teres (proximally) and pronator quadratus (distally)
69
Two joints in the elbow?
Humero-ulnar joint and radio-capitallar joint
70
Triceps insertion on elbow?
Olecranon process
71
Brachialis insertion on elbow?
Coronoid process
72
Biceps insertion on elbow?
Bicipital tuberosity of radius
73
Extensor origin of elbow arises from?
Lateral epicondyle
74
Flexor origin of elbow arises from?
Medial epicondyle
75
Tennis elbow?
Lateral epicondylitis | extension at wrist
76
Golfer's elbow?
Medial epicondylitis - repeated flexion (less common than tennis)
77
Why injection to resolve golfer's elbow risky?
Risk ulnar nerve damage
78
Pathophysiology of dupuytren's contracture?
Proliferative connective tissue disorder of palmar fascia -> contracts MCP/PIP
79
Pyrenees' disease?
Fibromatoses of penis
80
Ledderhose disease?
Plantar fibromatoses affecting feet
81
Trigger finger?
Flexor tendonitis -> usually distal to A1 pulley (over the metacarpal pulley)
82
Hip pain - knee presentation solely typical in what?
SUFE

Year 4 Overview/Random tests (11 decks)

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