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AHP Semester > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

The superficial femoral artery passes through what canal in the thigh?

It then exits the canal and becomes the popliteal artery at what structure?

A

Hunter’s canal (also called adductor canal, subsartorial canal)

The adductor hiatus (hole made between adductor magnus hamstring part and femur)

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2
Q

What are the compartments of the thigh, and their innervation? (include exceptions)

A

Anterior - femoral nerve

Posterior - sciatic nerve

Medial - Obturator nerve (except adductor magnus hamstring part (tibial n.) and pectineus (femoral n.)

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3
Q

What are the compartments of the leg, and their innervation?

A

Anterior - deep fibular nerve

Posterior - tibial nerve

Lateral - superficial fibular nerve

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4
Q

What ligaments make up the lateral collateral ligament of the ankle?

A

Anteriortalofibular +posterior talofibular + calcaneofibular ligament

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5
Q

What tendons make up the pes anserinus?

A

Sartorius + Gracilis +Semitendinosus

Say Grace before Tea

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6
Q

What is a maisonneuve fracture?

A

Proximal fibula # associated with an unstable ankle injury (deltoid ligament injury or tear in distal tibiofibular syndesmosis + med malleolus #)

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7
Q

What ligaments make up the medial collateral ligament of the ankle?

What is another name for this complex?

A

Anterior tibiotalar + posterior tibiotalar + tibiocalcaneal + tibionavicular ligaments

Deltoid ligament

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8
Q

Which gene is frequently associated with rheumatoid arthritis?

A

HLA-DR4

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9
Q

What are the 4 pathological stages of RA?

A

1) Preclinical: raised ESR, CRP, RF detectable before clinicial Sx
2) Synovitis: synovial membrane inflammation & thickening. Painful, swollen joints
3) Destruction: persistent inflamm causing joint & tendon destruction, articular cartilage & bone erosion, pannus, synovial effusion
4) Deformity: articular destruction + capsular stretching + tendon rupture -> progressive instability and deformity

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10
Q

The classic ‘rheumatoid’ deformities are (radial/ ulnar) deviation of the fingers and (radial/ ulnar) deviation of the wrist

A

Ulnar deviation of fingers

Radial deviation of wrist

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11
Q

Juvenile Chronic Arthritis is also known as ______ disease

A

Still’s disease

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12
Q

True or false: in children, malunion can sometimes be partly corrected by growth

A

True

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13
Q

What organisms are implicated in triggering reactive arthritis?

A

GI or GU infections: Salmonella, Yersinia, Chlamydia, Shigella, Campylobacter

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14
Q

What is Kienbock’s disease?

A

Avascular necrosis of the lunate. Most common in 20-40yo males, exact cause unknown

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15
Q

What gene is associated with the seronegative spondyloarthropathies?

A

HLA-B27

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16
Q

Describe the pathological steps of ankylosing spondylitis

A

Inflammation -> granulation tissue formation -> erosion of cartilage/ bone -> replacement with fibrous tissue -> ossification of fibrous tissue -> ankylosis

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17
Q

Which disease is diagnosed based on needle-shaped crystals with strong negative birefringence?

A

Gout (urate crystals)

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18
Q

Which disease is diagnosed based on rhomboid-shaped crystals with weakly positive birefringence

A

Pseudogout aka calcium pyrophosphate dihydrate deposition disease (calcium crystals)

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19
Q

__% of monosodium urate is derived from endogenous purine metabolism and __% from purine-rich foods in the diet

A

70%

30%

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20
Q

What are the side effects of colchicine?

A

Diarrhoea, N&V

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21
Q

What are 4 MSK complications of RA?

A

Infection
Tendon rupture
Joint rupture
Secondary OA

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22
Q

Infliximab, etanercept and adalimumab are all _____[drug class]

A

TNF inhibitors

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23
Q

Which type (mechanism) of pelvic fracture is associated with the largest amount of blood loss?

A

Ant-post compression (APC)

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24
Q

What are the 2 classification systems for pelvic fractures?

A

1) Young-Burgess based on mechanism
APC (ant post compression), LC (lat compression), VS (vertical shear), combined
2) Tile Classification of severity
Stable, partially stable, unstable

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25
Q

_____ hormone stimulates bone growth whilst ____ hormone promotes stable physeal fusion

A

Pituitary growth hormone

Gonadal hormone

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26
Q

What percentage of Paget’s disease undergoes malignant transformation into osteosarcoma?

A

Approx 1%

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27
Q

Describe the difference between Paget’s disease of bone, osteomalacia and osteopetrosis

A

Paget’s disease of bone = disorganised bone remodelling with increased osteoclastic & osteoblastic activity aka problem with bone STRUCTURE
Osteomalacia = defective bone mineralisation d/t loss of inorganic material, producing brittle, soft, weak bones aka problem with bone MINERALISATION
Osteopetrosis = genetic disorder decreasing bone resorption, producing abnormally dense bones aka problem with bone RESORPTION

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28
Q

Name two drugs used for Paget’s disease of bone

A

Any of:
NSAIDs for analgesia
Bisphosphonates (reduce bone turnover)
Calcitonin (reduce osteoclast activity)

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29
Q

Patients with sickle cell anaemia are prone to an osteomyelitis infection by ______ (organism)

A

Salmonella typhi

30
Q

What organism is the most common cause of osteomyelitis? (in adults & children) Which antibiotic is routinely given?

A

Staph aureus

Flucloxacillin

31
Q

Septic arthritis usually affects (small/ large) joints?

A

Large

32
Q

Mycobacterium tuberculosis has a predilection for ______ & _________ joints

A

vertebral bodies & large synovial joints

33
Q

What are the high-risk injuries for the development of compartment syndrome?

A

Fractures of the elbow, forearm bones, prox 1/3 of tibia ad multiple hand/ foot #s (Apley’s pg 354)

34
Q

Patellar dislocation usually happens (medially/laterally)

A

Laterally
Because knee is normally angled in slight valgus, there is natural tendency for the patella to pull towards the lat side when the quadriceps muscle contracts (Apley’s p446)

35
Q

Patellar dislocation can be associated with torn ____ and ____

A

Medial retinacular fibres (part of quadriceps expansion) and med patellofemoral lig (MPFL)

36
Q

What factors (4) predispose to recurrent patellar dislocation

A

Generalised joint laxity
Marked genu valgum
Unduly high or small patella
Under-development of lat femoral condyle + flattening of intercondylar groove

37
Q

List 6 conditions that predispose to pathological fractures

A
  1. Osteoporosis/ osteopaenia
  2. Osteomalacia
  3. Paget’s disease of bone
  4. Osteogenesis imperfecta
  5. HyperPTH
  6. Neoplasm (myeloma, osteosarcoma)
38
Q

What are the 4 stages of fracture bone healing?

A

1) Haematoma (wk 1)
2) Soft pro-callus (wk1-2): uncalcified fibrous tissue/ cartilage
3) Hard bony callus (wk2-4): spongy woven bone
4) Remodelling (>wk4): lamellar bone, weight-bearing

39
Q

Arterial injury is associated with what 2 fracture locations? (joint + bone for each)

A

Knee/ femur

Elbow/ humerus

40
Q

What are 4 injuries at high-risk of developing compartment syndrome?

A 
Elbow #
Forearm #
Prox 1/3rd tibial #
Multiple #s of hand/ foot
(Apley's p354)
41
Q

Muscle dies after ____ hrs of ischaemia

A

4-6 hours

42
Q

Nerve injury is more likely to be complete in (open/ closed) fractures?

A

Open

43
Q

Malalignment of a fracture >___ degrees in any plane may cause asymmetrical loading of the join & 2oOA

A

15 degrees

44
Q

Any fracture with an intra-articular step of the radiocarpal joint >___mm is also advised to be surgically corrected.

A

> 2mm

45
Q

Explain the Gustilo & Anderson Classification System

A

Used to classify open fractures
I: clean wound <1cm, minimal muscle contusion
II: 1-10cm wound, soft tissue damage but minimal/ moderate crushing
IIII: >10cm wound, extensive soft tissue damage affecting neurovascular/ muscular/ skin tissue
- A: adequate soft tissue flap
- B: needs soft tissue flap
- C: vascular injury requiring repair or high E trauma/ segmental #/ contaminant exposure

46
Q

The treatment of cauda equina syndrome is _____

A

urgent surgical decompression <48hrs via discectomy or laminectomy. The sooner this is performed, the better the outcomes. Unfortunately, bladder dysfunction may not be completely resolved.

47
Q

What is the classification system for AC joint injury?

A

Rockwood Classification

  • I: AC lig sprain (clavicle not elevated wrt acromion)
  • II: AC lig tear + CC lig sprain (clavicle elevated but not above sup border of acromion, CC distance <25%)
  • III: AC + CC lig tear; clavicle elevated above sup border of acromion, CC distance 25-100%
  • IV: AC + CC lig tear; clavicle displaced posteriorly into trapezius
  • V: AC + CC lig tear; clavicle elevated, CC distance >100%
  • VI: AC + CC lig tear; clavicle displaced inferiorly behind coracobrachialis/ biceps
48
Q

What is Wolff’s law?

A

States that bone in a healthy person or animal will adapt to the loads under which it is placed i.e. if loading increases, the bone will remodel to become stronger

49
Q

The most common malignant lesions in bone are ____

A

Metastatic tumours

Mostly Prostate, breast, Kidney, Lung, Thyroid (‘Pb KTL’)

50
Q

What is the most useful imaging technique for ?bone tumour

A

Plain X-rays (Apley p101)

But may not be relied upon for definitive diagnosis

51
Q

On plain Xray, stippled calcification inside a vacant area is characteristic of _____ tumours

A

Cartilage tumours

52
Q

What are the common sites for osteosarcoma? (3) Where does it often metastasize

A

1) Distal femur
2) Proximal tibia
3) Proximal humerus
Mets to lung (~10% already present at time of Dx)

53
Q

Chondrosarcoma most commonly affects the ____ and ____

A

Pelvis and scapula

54
Q

Osteochondromas are also known as _____

A

Cartilage-capped exotosis

55
Q

True or false: chondrosarcomas are responsive to chemo/ radiotherapy

A

False - they don’t respond to either

56
Q

What is the classic presenting triad in fat embolism syndrome and over what time frame does it usually develop?

A

Hypoxaemia/ resp compromise + confusion + petechial rash

Develops over 24-72hrs post-injury

57
Q

Cancellous bone heals a) (faster/ slower) than cortical bone.
Transverse fracture heals b) (faster/ slower) than spiral fracture

A

a) faster

b) slower

58
Q

What are the risk factors for DDH?

A 
'BOFFF'
> Breech position (>34/40)
> Oligohydramnios
> Female
> FHx
(> First born)
59
Q

Congenital scoliosis is defined as a lateral curvature of the spine with a Cobb angle of ____

A

≥10 degrees
Cobb’s angle: lines drawn along the endplates of the uppermost and lowest end vertebrae of the curve deformity & angle between their intersection is measured

60
Q

Spinal stenosis is classically aggravated by a) _____ and relieved by b) _____

A

a) Standing & walking

b) Sitting & bending forwards

61
Q

The most common curvature in adolescent idiopathic scoliosis is ____

A

Right thoracic

62
Q

List at least 4 conditions associated with neuromuscular scoliosis. Describe the typical deformity

A 
Any of:
1) Poliomyelitis
2) Syringomelia
3) Muscular dystrophy
4) Cerebral palsy
5) Friedreich's ataxia
6) Lower MND
Typical deformity is long, convex curve towards weaker side
63
Q

What are Ennekings 4 rules?

A

Used to determine likelihood of bone lesion being malignant
Asks 4 Questions
1) Where is the lesion?
2) What is it doing to the bone?
3) What is the bone doing to it?
4) Are there any clues to its histological Dx (what is its matrix)?

64
Q

Babies with talipes equinovarus (‘club foot’) should always be checked for _____ (2 other conditions)

A

Congenital hip dislocation and spina bifida

Unclear aetiology, but FHx is a risk factor. 50% are bilateral, M>F

65
Q

What are 3 causes of stiff (‘rigid’) flat feet?

A

1) Inflammatory disorder of joint
2) Neuromuscular disorder
3) Tarsal coalition

66
Q

Hallux valgus is usually a) unilateral or b) bilateral

A

B) bilateral

67
Q

Which joint is most commonly affected in diabetic neuropathic joint?

A

Midtarsal

followed by MTP and ankle

68
Q

What is the first ROM lost in OA of the hip?

A

Internal rotation

69
Q

Genu varum (bow legs) is normal under the age of ___ and usually corrects by age ___

A

Normal <2yo

Corrects by 3yo

70
Q

Cauda equina syndrome presents as an a) UMN or b) LMN disorder

A

b) LMN

AHP Semester (4 decks)

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