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3B GH > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What sort of criteria would you require to perform hip replacement on pt

A 
Severe pain - Doesn’t respond to analgesia
Tried walking aids 
Had physio
E.g. can’t put on socks
Weight loss if needed
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2
Q

Knee replacement, continuing problems. Ix

A

Xray

Aspirate

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3
Q

which is valgus/varus?

A 
valgus = knock-kneed
varus = bow legged
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4
Q

4 xray features of OA

A

osteophytes
reduced joint space
subchondral sclerosis
bone/ subchondral cysts

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5
Q

is fibula medial or lateral?

A

lateral

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6
Q

what is trochanteric bursitis

A

inflammation of the bursa between greater trochanter and the iliotibial band/ tensor fascia lata

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7
Q

describe position of leg following NOF fracture

A

shortened, ext rotated

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8
Q

describe different management between intra and extracapsular NOF fracture

A 
intra-capsular = blood supply to head of femur affected so replace head
extra = blood supply intact so able to keep own head of femur
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9
Q

In +ve trendelenburg, which side is abductor weakness?

A

Opposite to dipped side

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10
Q

Describe Colles and smiths fractures

A

Colles - dorsal angulation (fell on extended wrist)

Smiths - opposite

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11
Q

What age group are rotator cuff tears/injuries most common

A

Elderly

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12
Q

How do you assess axiliary nerve (can be damaged in dislocation)

A

Sensation in regimental badge area. Can also pinch deltoid and ask to raise arm

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13
Q

Mx options for PIP OA

A

Splint
Steroid + local inj
Joint replacement
Permanent fusion

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14
Q

What is Tennis elbow and how can you simulate the discomfort O/E

A

Lateral epicondylitis

Tender over lat epichondial + cock wrist back (uses extensors which attach lat epi)

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15
Q

Carpal tunnel ix + Mx

A

Nerve conduction study,

Surgical Decompression

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16
Q

First movement to go in frozen shoulder

A

Ext rotation

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17
Q

What causes Numbness of little finger

A

Ulnar nerve entrapment at elbow

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18
Q

Mechanism of frozen shoulder + mx

A

Tightened capsule

Hydrodilatation / endoscopic cut capsule

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19
Q

bowel/ gynae/ urology surgical prophylaxis Abx

A

co-amoxiclav

[if penicillin allergic - cefuroxime + metro/ gent + metro]

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20
Q

thromboprophylaxis for ortho Pt on warfarin

A

stop warfarin day -4, replace with a LMW heparin e.g. tinzaparin

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21
Q

what action is taken during surgery for patients on steroids and why

A

give extra hydrocort [patients can’t produce own steroids to respond to surgical stress]

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22
Q

any HTN meds you need to stop pre-op and why

A

ACE inhib + ARBs

can interact w/ anaesthetic, leading to hypoTN

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23
Q

factors that increase bone healing time after fracture

A

^age
mid shaft
lower limb

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24
Q

what are the 3 main principles of fracture Mx? [pneumonic RMR]

A

reduction
maintainence
rehab

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25
Q

fractures common to elderly w/ osteoporosis

A

colles
NOF
spinal wedge fracture

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26
Q

forearm fracture, ORIF, cast. Pt now experiencing severe pain, paraesthesia, swelling. diagnosis/Mx?

A

cast too tight or compartment syndrome.

split cast volar side. If no improvement, take the theatre and split fascia to release pressure

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27
Q

mx of intracapsular NOF fracture in frail 90 yr old with reduced mobility

A

hemiarthroplasty

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28
Q

mx of intracapsular NOF fracture in fit Pt

A

total hip replacement

[or if not displaced, can sometimes keep head with DHS, then fit enough to undergo 2nd op if AVN occurs]

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29
Q

Mx of extracapsular NOF fracture

A

DHS or 2 nails, depending on intra/subtrochanteric

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30
Q

non-surgical Mx options for fractures

A

splint/brace
cast
traction - skin/skeletal

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31
Q

problems with skin traction

A

not much weight can be applied

skin sores

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32
Q

priniciples of immediate ortho trauma Mx

A

ABC, stabilise cervical spine, rule out life-threatening.

analgesia, neurovasc status,
splint, traction,
Abx, cross match.

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33
Q

damage to common perineal nerve causes what clinical sign

A

foot drop

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34
Q

causes of common perineal nerve damage

A 
varus knee = stretched nerve
squashed by cast/ stirrups
MS etc
disc prolapse
etc!
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35
Q

24 hrs post femur fracture. Pt presents w/ petechial rash, hypoxia, tachycardia. Whats happened

A

fat embolism syndrome [marrow > lung, like PE]

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36
Q

risk with scaphoid fractures

A

avn

due to poor blood supply (artery damaged with fracture)

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37
Q

patient falls on outstretched hand.

3 anatomical areas to examine for tenderness in suspected scaphoid fracture

A

anatomical snuffbox
longitudinal compression of thumb
push on scaphoid at base of thenar eminence

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38
Q

what are the aspects of 3 point immobilization of the neck

A

hard collar, sand bags, tape

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39
Q

alternative names for cervical vertebrae C1 and C2

A

C1 atlas

C2 axis

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40
Q

most important consequence of cervical spondylolisthesis

A

spinal cord compression

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41
Q

causes of spinal cord comporession

A 
bone displacemnt
disc prolapse
local tumour
abscess
hameoatoma
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42
Q

broadly speaking , what signs are seen at the level of, and below a spinal cord compression?

A

LMN signs at level
UMN signs below [spastic weakness, brisk refelxes, upgoing plantars]
sensory changes below [loss of coord/ joint position sense/ vibration/ temp + pain]

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43
Q

how could cervical prolapsed disc present?

A 
pain radiating to arm
stiff neck
muscle weakness
depressed reflexes
cord compression
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44
Q

Mx of cervical prolapsed disc

A

NSAIDs
collar
physio
(surg)

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45
Q

problems caused by cervical rib [congenital development of costal process of C7 vertebra]

+ Mx

A

brachial plexus compression
subclavian artery stenosis
[pain/numbness in hand/forearm, weakness/muscle wasting]
[weak radial pulse, forearm cyanosis]

physio to strengthen shoulder elevators, surg removal

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46
Q

whiplash Mx

A 
reassure serious injury is rare
prompt return to usual activity and occupation
active mobilization
prevent disuse > chronic
analgesia
NO collar/ rest
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47
Q

which intervertebral discs are most likely to rupture?

A

L4/L5, L5/S1

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48
Q

presentaiton in disc prolapse + exam features

A 
forward flexion, extension,+/- lateral flexion limited
lumbar pain, 
sciatica
calf pain
sudden severe pain on e.g. coughing
weak plantar flexion/hallux ext[depends which disc]
reduced ankle jerk
reduced sensation
cauda equina
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49
Q

Ix of choice in suspected disc prolapse

A

MRI [or ct]

50
Q

Mx of disc prolapse

A

brief rest, early mobilizaiton
analgesia

+/- physio

discectomy in cauda equina/ progressive muscle weakness, continuing pain

51
Q

what Ix.s would you do in back pain lasting >4 weeks, or red flag sx

A

FBC, ESR, LFT, bone profile
myeloma screen if >50
XR, CT, MRI, isotope bone scan, bone biopsy

52
Q

risk factors for discitis [or other pyogenic spine infection]

A

DM
imm supp
urinary surg
catheter

53
Q

causes of cauda equine

A 
disc prolapse
extrinsic tumour
primary cord tumour
spondylosis
spinal stenosis
54
Q

danger signs suggestive of cauda equina

A 
poor anal tone
severe back pain
saddle parasthesia
incontinence or retention of faeces or urine
paralysis +/- sensory loss
55
Q

problem with delay in cauda equine diagnosis?

A

permanent neuro damage to sexual, bladder and bowel fn

56
Q

what is osteomyelitis?

A

infection of bone

57
Q

common organisms for osteomyelitis

A

staph aureus
pseudomonas
e. coli
strep

58
Q

what are the 3 routes infection can get to a bone/ 3 categories of osteomyelitis?

A

acute haematogenous [through the blood]

local infection

direct inoculation from trauma or surg

59
Q

risk factors for osteomyelitis

A 
DM
prosthesis
vasc disease
imm comp
sickle cell
open fracture
60
Q

what is the gold standard investigaiton for pathogen identification or uncertain diagnosis in osteomyelitis

A

bone biopsy and culture

61
Q

Mx of osteomyelitis

A

surg - drain abscesses and remove sequestra

6 weeks vanc and cefotax

62
Q

complications of osteomyelitis

A

septic arth
fractures
deformity
chronic osteomyelitis

63
Q

in a painful shoulder, if all movements hurt what pathology do you consider? and if only some?

A

all - arthritis or capsulitis

some - impingement

64
Q

what position might you find the arm in on examination of a posterior shoulder [glenohumeral] dislocation?

and what might you see in anterior dislocation?

A

internal rotation

anteromedial mass

65
Q

name the 4 muscles of the rotator cuff

A

supraspinatus
infraspinatus
subscapularis
teres minor

66
Q

describe some tests for impingement

A

Neers [backstroke]

Hawkins [motion in the ocean]

67
Q

scarf test positive [forced adduction of arm across neck] suggests what pathology?

A

acromioclavicular joint disease

68
Q

what imaging for rotator cuff tears

A

US or MRI [US quicker and cheaper and tear or no tear, MRI for quantifying muscle wasting/prognosis]

69
Q

what is the pathology behind impingement syndrome/

A

the supraspinatus tendon catches under the acromion during abduction around 70-140 degrees

70
Q

you believe pt has impingement syndrome. Give 1 other cause of painful arc

A

supraspinatus tendinopathy or partial rupture

calcifying tendinopathy

acromioclavicular joint arthritis

71
Q

young weightlifter with painful arc. Diagnosis and management

A

acromioclavicular joint arthritis

rest, nsaids, steroid inj, [surg]

72
Q

rupture of long head of biceps management

A

repair rarely indicated as function remains

73
Q

disease associations of frozen shoulder

A

cervical spondylosis
DM
thyroid disease

so always check glucose and TFT

74
Q

frozen shoulder Mx

A

NSAIDs
physio
steroid IA inj for pain early on
arthroscopic arthrolysis

75
Q

what is usually the first movement restricted by hip disease?

A

int rotation

76
Q

test for fixed flexion deformity

A

thomas test [bend good leg + fixed flexion leg will lift off couch]

77
Q

special test for weak abductors + positive result

A

trendelenburg [sound side sags]

78
Q

what causes a trendelenburg gait?

describe it

A

weak abductors

waddling gait, trunk tilts over weak side

79
Q

causes of coxa vara [angle between neck and shaft of femur less than 125/ right angled - leading to leg shortening]

A 
congen
SCFE
#NOF malunion
trachanteric #
rickets/pagets/osteomalacia
80
Q

secondary causes of OA hip

A 
AVN
paeds hip disease
age
occupation
trauma
post-op
infection
malposition
mechanical instab
osteochondritis desicans
81
Q

differentials for painful hips in children

A

rule out SA

then consider:
perthes
SUFE
inflammatory arth
osteomyeltis

by exclusion: transient synovitis

82
Q

4 yr old presents with pyrexia and limp due to hip pain - 2 main differentials

A

SA

transient synov

83
Q

4 prognostic clinical signs for SA [if 3 or more present, 93% chance of SA]

A

temp
^WCC
^CRP
non-weight bearing

84
Q

if SA suspected in child w/ painful hip, 2 urgent Ix you’d do?

A

blood culture

US guided joint aspirate

85
Q

6 yr old with acute onset hip pain, recent viral illness. Pain in extremes of movement, bloods and radiology normal. Most likely diagnosis?

what about if other joints were involved?

A
  • transient synov

- consider JIA

86
Q

6 yr old boy, hip pain and limp. All hip movements are limited, especially int. rotation + abduction. Early XR shows joint space widening, later there is small patchy femoral head. DIagnosis?

A

perthes disease

87
Q

Mx of transient synovitis

A

self limiting w/ rest +/- analgesia

88
Q

Mx of perthes disease

A

bed rest, NSAIDs
XR surveillance
+/- joint replacement

89
Q

non-hip causes of limp in children

A 
leukaemia
discitis
rickets
reactive arthritis
JIA
90
Q

RFs for developmental dysplasia of hip

A 
breech
caesarean due to breech
other malformations
sibling w/
^birth weight
oligohydramnios
primip or old
postmaturity
91
Q

in babies who are high risk for developmental dysplasia of hip, or if neonatal exam suggests instability, what Ix should be done?

A

US

92
Q

treatment for developmental dysplasia of hip [remains unstable at 6 weeks]

A

long term splinting in Pavlik harness [in flexion-abduction]

closed reduction + immobilisation

open reduction if failed or 18 months +

93
Q

other than specific hips tests for developmental dysplasia, what are some other signs

A

unequal leg length
asymmetrical groin creases

limited abduction in flexion

older: delay in walking, waddling gait

94
Q

risk factors for elbow osteoarthritis

A

osteochondritis dissecans

fractures

95
Q

describe the pathology of osteochondritis dissecans

A

subchondral bone becomes avascular, may progress to fragments of bone + cartilage breaking away to form loose bodies [osteochondral fragments]

cause is unknown

96
Q

osteochondritis dissecans - typical site? and age of patient?

A

lateral side of medial femoral condyle

13-21

97
Q

what are the colloquial terms for medial and lateral epicondylitis ?

and which is more common?

A 
lateral = tennis elbow
medial = golfers elbow

tennis

98
Q

management of tennis elbow + prognosis

A

restrict activities which overload tendons

lasts 6-24 months, 90% recover within 1 yr

physio

[brace]

[surgical tendon release in severe unresponsive cases]

99
Q

what neuropathy is occasionally associated with medial epicondylitis [golfers elbow]?

A

ulnar

100
Q

causes of ulnar neuritis [cubital tunnel syndrome]

A

OA
RA
cubitus valgus

101
Q

presentation of ulnar neuritis [cubital tunnel syndrome]

A

reduced sensation of little finger and medial half of ring finger

clumsiness of hand

weakness of hand

102
Q

test and treatment for ulnar neuritis [cubital tunnel syndrome]

A

nerve cond studies

surgical decompression

103
Q

mx of dupuytrens contracture

A

early disease: injectible clostridium histolyticum, percutaneous needle fasciotomy

fasciectomy

104
Q

causes/ associations of dupuytrens contracture

A 
genetic [auto dom]
smoking
DM
antiepileptics
peyronies disease
105
Q

mx of ganglia

A

no Tx unless pain or pressure on median/ulnar nerve at wrist.
local pressure may disperse it

aspiration or surgical dissection

106
Q

disease which increases chance of getting trigger finger [when tendon nodule prevents re-straightening of finger after flexing]

A

DM

107
Q

Mx of trigger finger [when tendon nodule prevents re-straightening of finger after flexing]

A

rest, splinting

severe: steroid inj into region of nodule, or surgery

108
Q

symptoms and signs in carpal tunnelsyndrome

A

sx: tingling/pain in thumb/ index /middle finger, worse @night, flicks/shakes wrist to relieve pain, clumsiness
signs: wasted thenar eminence, reduced sensation to lateral 3 digits, phalens [reverse prayer] + tinnels [tap]

109
Q

what does tenderness over the lateral joint line of the knee suggest?

A

iliotibial band tendinitis

110
Q

causes of anterior knee pain

A

patellofemoral pain syndrome [runners]

patella tendinopathy [jumpers]

Hoffa’s fat pad syndrome [impingement]

Bursitis [housemaid’s/clergyman’s]

osgood-schlatter disease

bipartite patella

111
Q

what actions may bring on the pain of patellofemoral pain syndrome

how is it managed?

A

prolonged sitting
climbing/descending stairs
recent ^sport
trauma

rest
physio/strengthening exercises
NSAIDs for pain
[rarely surgery]

112
Q

management of patella tendinopathy [jumpers knee]

A

rest
NSAIDs
steroid inj around tendon
physio/exercises

113
Q

what surgical intervention in knee OA can delay a total knee replacement by 10 years

A

osteotomy

114
Q

where does aspiration of a prosthetic joint need to occur?

A

orthopaedic theatre, never in ED or clinic

115
Q

how would a meniscal cyst usually present ?

and how is it managed?

A

young man, previous trauma, pain over joint line, swelling

arthroscopic decompression

116
Q

examination special test for ACL tear

A

anterior draw

117
Q

examination special test for knee meniscal tears

A

McMurray’s

118
Q

imaging investigation of choice for knee meniscal tears or cysts

A

MRI

119
Q

preferred imaging technique in bakers cyst

A

US

120
Q

patient with pagets disease, anterior calf hot on examination.
XR shows lytic central lesion, ass. w/ erosion of cortical surface of tibia + soft tissue swelling. Likely diagnosis?

A

osteosarcoma

121
Q

when is a p value given in a study ?

A

can only be given if there is hypothsis testing

3B GH (16 decks)

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