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Orthopaedics Flashcards

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USMLE® Step 1 flashcards
1
Q

Examination - elbow

  1. Forearm flexor muscles origin
  2. Forearm extensor muscles origin
  3. Stigmata of systemic disease to look for (2)
  4. Golfer’s elbow =
  5. Tennis elbow =
  6. Functional problems - basic tests (3)
A
  1. Medial epicondyle
  2. Lateral epicondyle
  3. Psoriatic plaques, rheumatoid nodules
  4. Flexor tendonitis (medial epicondyle insertion)
  5. Extensor tendonitis (lateral epicondyle insertion)
  6. Both hands behind head, to mouth, behind bottom
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2
Q

Examination - foot

  1. Pes planus (flat foot) - can cause
  2. Pes cavus (high arch) - can cause
  3. Test for Achilles tendon integrity
A
  1. Foot pronation, valgus heel deformity
  2. Hind foot varus deformity
  3. Simmonds
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3
Q

Myotomes

  1. Hip flexion
  2. Hip extension
  3. Knee flexion
  4. Knee extension (+ reflex)
  5. Ankle dorsiflexion
  6. Ankle plantar flexion (+ reflex)
  7. Great toe extension
A
  1. L2/3
  2. L4/5
  3. L5, S1
  4. L3/4
  5. L4/5
  6. S1
  7. L5
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4
Q

Gait abnormalities - causes

  1. Trendelenburg - muscle and nerve involved
  2. High-stepping
A
  1. Loss of hip abductor function (superior gluteal nerve lesion)
  2. Peroneal or sciatic nerve palsy
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5
Q

Examination - shoulder

  1. Joints (4)
  2. Movements (6) + which muscles
  3. Jobes test - what, what for
  4. Lift off test - what, what for
  5. External rotation against resistance - muscles (2)
  6. Axilliary nerve (sensation) test where
  7. Usual direction of dislocation
A
  1. Sternoclavicular, acromiclavicular, glenohumeral, scapulothoracic
  2. Flex (biceps brachii (both heads), pectoralis major, anterior deltoid, coracobrachialis)
    Extend (posterior deltoid, latissimus dorsi, teres major)
    Abduct (supraspinatous for 15 degrees, middle fibres of deltoid to 90, trapezius + serratus anterior for >90)
    Adduct (pectoralis major, latissimus dorsi, teres major)
    Internal rotation (subscapularis, pectoralis major, latissimus dorsi, teres major, anterior deltoid)
    External rotation (infraspinatus, teres minor)
  3. Shoulder abduction against resistance, tests supraspinatus
  4. Medial rotation against resistance, tests subscapularis
  5. Teres minor, infraspinatous
  6. Regimental badge area
  7. Anterior
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6
Q

Examination - hand

  1. Median nerve - testing sensation/motor
  2. Ulnar nerve - testing sensation/motor
  3. Radial nerve - testing sensation/motor
  4. Function tests (3)
  5. Movements of hand
  6. Phalen test
  7. Tinnel test
A
  1. Lateral aspect of the index finger, thumb abduction
  2. Medial aspect of the little finger, little finger abduction
  3. Dorsal 1st IO space, wrist extension
  4. Pinch grip, power grip, fine motor control
  5. Pronation, supination, wrist/finger flexion/extension, finger abduction/adduction
  6. Wrist held in plantar flexion to reproduce CT symptoms
  7. Tap over the median nerve
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7
Q

Examination - hip

  1. True hip pain often felt where
  2. True leg length
  3. Apparent leg length
  4. Tibial discrepancy shown by
  5. Femoral discrepancy shown by
  6. Muscles - flexion (3)
  7. Extension (2)
  8. Abduction (3)
  9. Adduction (3)
  10. Lateral rotation (3)
  11. Medial rotation (4)
A
  1. Groin
  2. ASIS to MM
  3. Umbilicus to MM
  4. One knee higher than other
  5. One knee behind other
  6. Iliopsoas, rectus femoris, sartorius
  7. Gluteus maximus, hamstrings
  8. Gluteus medius + minimus, deep gluteals
  9. Adductor longus, brevis + magnus
  10. Biceps femoris, gluteus maximus, deep gluteals
  11. Semitendinosus, semimbranosus, Gluteus medius + minimus
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8
Q

Examination - back

  1. Schobers test - aim
  2. Femoral stretch test - which myotome, pain where
  3. Straight leg raise - which myotomes, pain where
A
  1. Quantify lumbar spine flexion
  2. L4, positive if pain in anterior thigh
  3. L5/S1, positive if pain in back of leg/buttock
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9
Q

Shoulder injuries

  1. Biceps tendonitis - position to test, pain where
  2. Adhesive capsulitis - presentaton
  3. First/most restricted movement
  4. Risk factors
  5. Acromioclavicular degeneration - presentation
  6. Subacromial impingement - presenation
  7. Rotator cuff tear - presentation
  8. Tendon which most commonly calcifies
  9. Frozen shoulder - which movement most reduced
A
  1. Shoulder in 60 degrees flexion, elbow in full extension, arm fully supinated - pain in bicipital groove
  2. Painful stiff shoulder with restriction of active and passive range of motion in abduction, internal and external rotation
  3. External rotation
  4. Female, DM, non-dominant hand
  5. Popping/swelling/clicking/grinding, positive scarf test
  6. Painful arc on abduction, worse at 90 - 120 degrees
  7. Specific trauma/chronic, weakness+ pain, maybe muscle wasting/tenderness, painful arc
  8. Supraspinatus
  9. External rotation
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10
Q

Childhood hip disorder

  1. Developmental dysplasia of hip - picked up when
  2. Risk factor
  3. Positive tests (2)
  4. Other signs
  5. Diagnostic imaging + treatment if < 6 months
  6. Transient synovitis of hip - commonest presentation
    Management, time to improve
  7. Perthe’s disease - definition
  8. Presentation
  9. X-ray changes
  10. Slipped upper femoral epiphysis (SUFE) - presentation
  11. Commoner in, management
  12. Reduced ROM where
  13. Juvenile idiopathic arthritis (JIA) - definition
  14. Pauciarticular JIA - features, associated symptoms
  15. Septic arthritis - presentation
A
  1. 6 week baby check (female)
  2. Breech delivery (do USS at 6 weeks if so)
  3. Ortoloni (reduce hip when abducted),
    Barlow (dislocates with adduction)
  4. Unequal skin folds/leg length
  5. USS, Pavlik harness (surgery if diagnosis > 6 months)
  6. 2-10 (5-6) yo, acute hip pain with viral infection (no fever) - commonest limp cause, diagnosis of exclusion
    Improves by itself over weeks/months (analgesia)
  7. Femoral head avascular necrosis
  8. Boys aged 4-8, progressive (over weeks) hip pain, limp, stiffness - leads to early hip OA. Treat supportively
  9. Wider joint space (early), small/flat femoral head (late)
  10. 10-50 yo, hip pain, limp, pain referred to the knee
  11. Boys, obese; surgical fixation
  12. Loss of leg internal rotation when flexed
  13. Arthritis <16, lasting >3 months
  14. <5 joints affected, limp, medium joint pain/swelling (e.g. knees, ankles, elbows), can ANA positive/link with anterior uveitis
  15. Acute, systemic (e.g. pyrexia), severe joint limitation
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11
Q

De Quervain’s Tendinosis

1. Test

A
  1. Finkelstein - place thumb against hand, make fist + close fingers over thumb, bend wrist toward little finger
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12
Q

Septic arthritis

  1. Risk factors
  2. Investigations
  3. CXR and CRP may be
  4. Kocher criteria
  5. 1st line ABX management
  6. If penicillin allergy/MRSA/prosthetic joint
  7. Commonest organism overall
  8. In infants
  9. Sexually active young adults
  10. Main cause of articular cartilage breakdown
  11. Commonest joints (2) + risk in 1
  12. Acutely hot swollen joint - other differentials
A
  1. Pre-existing joint disease (especially RA), DM, immunosuppression, recent joint surgery, prosthetic joint
  2. Urgent joint aspirate (stain, crystal microscopy, culture, ABX sensitivities), blood cultures, FBC, CRP/ESR
  3. Normal (or show pre-existing change e.g. in RA)
  4. Fever, raised CRP/ESR, raised WCC, won’t weight bear
  5. Flucloxacillin + rifampicin 3-6 weeks
  6. Vancomycin + rifampicin 3-6 weeks
  7. Staph. aureus
  8. H. influenzae
  9. N. Gonorrhoea
  10. Enzymes produced by leukocytes
  11. Knee, hip (avascular necrosis risk)
12. Gout (negatively birefringent urate crystals)
Pseudogout (positive, Ca2+ pyrophosphate crystals)
Reactive arthritis (urethritis/gastroenteritis trigger, associated with conjunctivitis
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13
Q

Osteomyelitis

  1. Commonest cause - overall
  2. Types (2), which commonest in children
  3. Bacteria settles where
  4. Risk factors - congenital (2)
  5. Acquired
  6. Presentation
  7. Examination - look for
  8. Cervical vertebral OM - presentation
  9. What type of abscess can form, consequence of this
  10. Best imaging (+ appearance at start)
  11. Appearance after 10 days
  12. In chronic OM
  13. Investigations - other
  14. ABX - 1st line (+ other management)
  15. Management - chronic (1st line)
A
  1. Staph. aureus
  2. Haematogenous (bacteraemia, acute commonest in children), contiguous (adjacent infection)
  3. Metaphysis of long bones
  4. Sickle cell disease, Haemophilia
  5. DM, renal failure, IVDU, malnutrition, penetrating injuries, surgical infection, immunosuppression,
  6. Reduced mobility, swelling (+ non-specific pain), low-grade fever, erythema, sinus/wound drainage
  7. Surgery scars, sinus, reduced ROM, deformity, pain
  8. Torticollis secondary to neck soft tissue infection
  9. Subperiosteal; bone death which harbours infection
  10. Plain X-ray; normal, may see osteopaenia
  11. New bone forming, periostal elevation, sclerotic lesion
  12. Sequestrum, with new bone around it
  13. Deep site swab culture, aspirate, blood culture
  14. Flucloxacillin 2-4 weeks, immobilise, analgesia
  15. Surgery to remove sequestrum
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14
Q

Open fractures

  1. Biggest risk
  2. First management
  3. Dressed with
  4. Prophylaxis (2)
  5. Management - theatre
A
  1. Bone infection leading to osteomyelitis
  2. Photographed then irrigated
  3. Saline soaked swabs
  4. ABX, tetanus
  5. Aggressive debridement, external/internal fixation
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15
Q

Fracture - definitions

  1. General
  2. Simple
  3. Comminuted
  4. Segmental
  5. Undisplaced
  6. Displaced
  7. Pathological fractures - causes (4)
A
  1. Loss of continuity of the cortex of the bone
  2. Bone fractured in two pieces
  3. Bone in 3 or more pieces
  4. Fracture at 2 levels of the same bone
  5. Anatomy entirely unchanged
  6. Bone components not in original anatomical position
  7. Tumours, infection, RA, metabolic bone disease
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16
Q

Trauma - imaging

  1. X-ray - planes (2)
  2. CT - used for
A
  1. AP, lateral

2. Complex fractures + to plan surgery

17
Q

Compartment syndrome

  1. Definition
  2. Early signs
  3. Late signs (2)
  4. What happens to muscles
  5. Management if suspected
A
  1. Excessive pressure in a closed fasical muscle compartment
  2. Excessive pain, increased on passive stretching of muscles in that compartment
  3. Paraesthesia, pulselessness
  4. Necrosis
  5. Emergency fasciotomy
18
Q

Fractured neck of femur (NOF)

  1. Examination
  2. X-rays (2)
  3. Classification (2)
  4. Management - extracapsular
  5. Intracapsular - elderly/frail
  6. Intracapsular - active, displaced
  7. Intracapcular - active, undisplaced
  8. Post-op management
  9. Can damage which nerve (+ presentation)
A
  1. Shortened, abducted, externally rotated, greater trochanter pain worse on rotation
  2. AP pelvis, lateral hip
  3. Intracapsular (higher risk of AN), extracapsular
  4. Dynamic hip screw (DHS)
  5. Hemiarthroplasty
  6. Total hip replacement
  7. DHS, cannulated screw
  8. Thromboprophylaxis, daily physio, review bone protection (Vit D, calcium, bisphosphonates)
  9. Femoral; weak knee extension, patella reflex lost, anteromedial thigh/lower leg numbness
19
Q

MSK X-ray - presentation (ABCS)

  1. Alignment
  2. Bone
  3. Cartilage
  4. Soft tissue

Fracture description - SOD

  1. Site
  2. Obliquity
  3. Displacement (distal piece in relation to proximal)
A
  1. Joints and bones (dislocation, subluxation)
  2. Cortex, bone fragment, texture between cortex
  3. Joint space, contour disruption, signs of disease
  4. Disruption, swelling, foreign body, calcification
  5. Which bone, intra/extra articular, position (which third)
  6. Completeness, direction (transverse, oblique, spiral, greenstick), surrounding damage (simple/complex, open/closed), bone condition (comminuted, segmental, multiple, stable/unstable)
  7. Translation, angulation, rotation, length shortening
20
Q

Carpal tunnel syndrome

  1. Nerve affected
  2. Presentation
  3. Examination
  4. Cause/associated disease
  5. Investigation
  6. Management
  7. Other muscles supplied by median
A
  1. Median
  2. Pain/pins and needles in thumb, index, middle finger, ascending proximally, shakes hand to improve at night
  3. Weak thumb abduction (abductor pollicis brevis), thenar wasting (not hypothenar), Tinel (tap)/Phalen (flex) signs
  4. Idiopathic, hypothyroid, DM, pregnancy, RA, acromegaly
  5. Electrophysiology: M+S prolonged action potential
  6. Steroid injections, night wrist splint, surgical decompression (flexor retinaculum division)
  7. 1st lumbricals, opponens pollicis, flexor pollicis brevis
21
Q

Other nerve lesions

  1. Ulnar nerve compression - where
  2. Presentation
  3. Radial nerve - supply which muscles
  4. Compress against what
  5. Presentation
  6. Superficial peroneal nerve - motor
  7. Sensory
  8. Sciatic nerve - presentation
  9. Obturator nerve - presentation
  10. Damaged how
  11. Tibial nerve injury (rare) - due to
A
  1. Olecranon groove
  2. Claw deformity, loss of sensation in 4-5th fingers
  3. Triceps, brachoradialis, supinator, wrist/finger extensors
  4. Humerus
  5. Wrist drop, loss of finger extension, loss of sensation over anatomical snuffbox
  6. Ankle evertors
  7. Skin on the lateral side of the lower leg
  8. Weakness in knee flexion and foot movements, pain and numbness from gluts to ankle
  9. Numb over medial thigh, weak hip adduction
  10. Anterior hip dislocation (posterior more common - short, adducted, internally rotated)
  11. Popliteal laceration
22
Q

Radiculopathy

  1. Definition
  2. Causes of compression (5)
  3. Red flags - infection (3)
  4. Fracture (3)
  5. Malignancy (2)
  6. Analgesia - 1st + 2nd line
  7. Muscle spasm
  8. Cervical myelopathy - gold-standard investigation
A
  1. Conduction block in axons of a spinal nerve or its roots
  2. Disc prolapse, spine degeneration, trauma, malignancy, infection (OM)
  3. Immunosuppression, IVDU, fever (unexplained)
  4. Steroid use, trauma, osteoporosis
  5. > 50, PMH of malignancy
  6. Amytriptyline, gabapentin
  7. Benzodiazepines e.g. diazepam
  8. Cervical MRI
23
Q

Anatomy - general

  1. Femoral triangle - borders (3) + floor
  2. Contents - NAVEL (lateral to medial)
  3. Femoral canal - borders (4)
  4. Femoral nerve - sensory branches (2)
  5. Obturator nerve - supplies
  6. Sciatic nerve - motor supply
  7. Motor branches (2)
A
  1. Inguinal ligament (superior), Sartorius (lateral), Adductor longus (medial), fascia lata (floor)
  2. Femoral: nerve, artery, vein, empty space, lymph canal
  3. Lacunar ligement (medial), femoral vein (lateral), inguinal ligament (anterior), pectineus (posterior)
  4. Anterior cuteaneous (anteromedial thigh),
    saphenous (medial leg + foot)
  5. Adductor muscles, medial thigh sensation
  6. Posterior thigh and hamstring portion of adductor magnus
  7. Tibial (posterior leg muscles AP/lateral leg/sole of foot senation), common fibular (antero (deep) / lateral (superficial) leg muscles, lateral leg/dorsum of foot sensation)
24
Q

Osteoporosis - general

  1. Definition
  2. Risk factors - most important
  3. Other
  4. Medication that may worsen
A
  1. Low bone density + abnormal bone structure - leads to compromised bone strength
  2. History of glucocorticoids, rheumatoid arthritis, active smoking, alcohol excess, low BMI, parent had #NOF
  3. Female, maternal FH of fragility, fractures, osteoporosis, older age, weight loss >10kg, post/premature menopause, endocrine/malabsorption conditions
  4. SSRI, AEDs, PPIs, glitazone
25
Q

Osteoporosis - management

  1. When to start
  2. Threshold if steroid-induced OP
  3. 1st line (+ MOA)
  4. Side effects
  5. Counselling points
  6. Lifestyle advice
  7. Alternatives to 1st line medication (2) if GI upset (25%)
A
  1. DEXA T score of -2.5 (2.5 SD below mean BMD) (may not have to do this if F >75 and post-fragility fracture)
  2. 1.5 SD below mean (repeat in 1-3 years if -0.5-1.5) - even if <65 (same if going to be on steroids for 3+ months)
  3. Alendronate (bisphosphonate - decreases bone demineralisation) + supplements (Vit D + calcium if F)
  4. Oesophagitis/ulcers, diarrhoea/constipation, jaw ON, maybe acute phase response (fever, myalgia, arthralgia)
  5. 1/week, before breakfast/other meds, swallow whole with glass of water, upright for 30 minutes, tablets should be swallowed whole with a glass of water, regular dentist
  6. Exercise (weight bearing), stop smoking, less alcohol, balancing exercises, Ca2+/vit- D rich diet (milk)
  7. Risederonate, etidronate
26
Q

Paget’s disease (bone)

  1. What is it
  2. Risk factors
  3. Bones most affected (3)
  4. Commonest presentation
  5. Examination findings if untreated
  6. Primary imaging + finding
  7. Blood test - abnormal result
  8. Management - main aim of treatment
  9. Treatment choices (2)
  10. Complications
A
  1. Chronic disorder - unbalanced bone turn over (focal reabsorption then excessive/chaotic bone deposition)
  2. Elderly, male, FH, northern latitude
  3. Femur, pelvis, skull
  4. Asymptomatic, sometimes long bone/face pain, or pathological fracture
  5. Skull bossing, bowed sabre tibia, bone enlargement
  6. Plain x-ray - abnormal sclerotic bone (skull: thickened vault, osteoporosis circumscripta, cotton wool pattern)
  7. ALP high (vitamin D, calcium, phosphate normal)
  8. Reduce osteoclast activity
  9. Bisphosphonates (PO risedronate / IV zoledronate), calcitonin
  10. Deafness (CN 8 entrapment), osteosarcoma, fractures, skull thickening, high-output cardiac failure
27
Q

Osteomalacia

  1. Definition
  2. Name if in growing children
  3. Causes
  4. Presentation - osteomalacia (4)
  5. Presentation - rickets
  6. Bloods - abnormal results (2)
  7. X-ray - findings
  8. Biopsy
  9. Management - dietary insufficiency
  10. Malabsorption/hepatic disease
  11. Renal disease / vit D resistance
A
  1. Normal bony tissue but decreased mineral content (after fusion of epiphyses)
  2. Rickets
  3. Low vitamin D (malabsorption, lack of sunlight, diet), renal failure, liver cirrhosis, anti-epileptic medication
  4. Bone pain, fractures, tender muscle, proximal myopathy
  5. Knock-knee, bow leg, features of hypocalcaemia
  6. ALP / PTH high, vitamin D / calcium / phosphate low
  7. Cupped, ragged metaphyseal surface (children); adults: translucent bands (Looser’s zones / pseudo-fractures)
  8. Incomplete mineralisation
  9. Calcium with vitamin D tablets (calcium D3)
  10. Vitamin D2 (ergocalciferol) / monthly calcitriol
  11. Alfacalcidol/calcitriol daily (monitor weekly for high Ca2+)
28
Q

Osteoporosis - investigation

  1. Tools for assessing risk
  2. When to assess
  3. When to recalculate
  4. When to go straight to DEXA
  5. FRAX - interpretation + management
  6. Bloosods (if osteoporosis/fragility fracture)
A
  1. QFracture or FRAX (10 year risk of fragility fracture)
  2. Women >65, men >75
  3. Change in risk factors, or borderline + >2 years since
  4. Starting sex hormone suppression, <40 + very high risk, post-fragility fracture
  5. Low risk (reassure, lifestyle advice), medium (DEXA), high (offer bone protection treatment)
  6. FBC, ESR/CRP, U+E, LFT, TFT, bone profile (Ca2+, albumin, phosphate, magnesium, ALP)
29
Q

Ankle injuries

  1. Ottawa ankle rules
  2. Weber classification of fibula fracture
  3. Sprain - commonest ligament affected
  4. Commonest injury
A
  1. X-rays only necessary if pain in malleolar zone + 1 of:
    no weight bear 4 steps/ distal tibia pain / distal fibula pain
2. Type A (below syndesmosis)
Type B (start at level of tibial plafond, may extend proximally to involve syndesmosis)
Type C (above the syndesmosis)
  1. Anterior talofibular
  2. Inversion injury
30
Q

Knee pain in older adults - descriptions

  1. Osteoarthritis
  2. Bursitis (infrapatellar/prepatellar)
  3. ACL injury
  4. PCL injury
  5. Collateral ligament
  6. Meniscal tear

Younger

  1. Osgood–Schlatter disease
  2. Patellar tendonitis
A
  1. > 50yo, overweight, severe pain, intermittent swelling, crepitus + reduced ROM
  2. Associated with kneeling (upright = housemaid’s)
  3. Twisting of bent knee, ‘popping’ noise, rapid effusion (haemarthrosis), positive anterior draw/Lachman’s tests
  4. From anterior force applied to proximal tibia (e.g. knee hitting dashboard during RTA) or hyperextension, paradoxical anterior draw
  5. Tenderness over ligament, potential effusion. Medial (forced into valgus), lateral (forced into varus)
  6. From twisting, locks/gives way, tender joint line
  7. Prominent tibial tuberosity and knee pain (sporty)
  8. Athletic teenage boys; chronic anterior knee pain that worsens after running, sub-patellar tenderness
31
Q

Hip pain in adults - descriptions

  1. Osteoarthritis
  2. Inflammatory arthritis
  3. Referred lumbar spine pain (femoral nerve compressed)
  4. Trochanteric bursitis
  5. Meralgia paraesthetica
  6. Avascular necrosis
  7. Pubic symphysis dysfunction
A
  1. Pain exacerbated by exercise and relieved by rest, reduced internal rotation, age, obese, other joint issues
  2. Pain/stiff in morning, systemic signs, inflammatory markers
  3. Positive femoral nerve stretch test
  4. F 50-70yo, from repeated movement of fibroelastic iliotibial band, lateral thigh pain/tenderness
  5. Anterolateral thigh burning sensation, lateral cutaneous nerve compression
  6. Gradual/sudden onset, high-dose steroids, previous hip fracture/dislocation
  7. Pregnancy, lax ligaments, pain over PS radiating to groin/medial thigh, waddling gait
32
Q

Back pain - descriptions

  1. Red flags

Lower - causes

  1. Spinal stenosis
  2. Ankylosing spondylitis
  3. Peripheral arterial disease
  4. Prolapsed disc
  5. Spinal metastases
  6. Cervical spondylosis
A
  1. < 20 / > 50 yo, PMH malignancy, night pain, trauma history, systemically unwell (weight loss, fever), CES symptoms, thoracic pain
  2. Gradual onset, uni/bilateral leg pain (+/- back), numbness, weakness, worse on walking, relieved by sitting/crouching down or leaning forward. ‘Aching’, crawling’. Normal clinical exam, requires MRI
  3. Young man, pain/stiffness, worse in morning, better with activity, peripheral arthritis likelier if female
  4. Pain on walking, relieved by rest, weak foot pulse, smoking/PVD PMH, other signs of limb ischaemia
  5. Leg pain worse than back, worse on sitting (give analgesia, physio, MRI if symptoms persist)
  6. Unrelenting lumbar back pain, thoracic/cervical pain, worse when sneezing/coughing/straining, nocturnal
  7. Post-OA, neck pain, headache, radiculopathy, myelopathy
33
Q

Spinal cord compression (SCC)

  1. Commonest cause for acute SCC
  2. Commonest primary malignancies (5)
  3. Traumatic causes (2)
  4. Infectious causes (2)
  5. Risk factors (things narrowing spinal canal) (3)
  6. Gold-standard imaging
A
  1. Metastatic
  2. Breast, prostate, thyroid, renal, lung
  3. Vertebral fracture, facet joint dislocation
  4. TB, fungal
5. Inflammatory conditions (RA, AS)
Degenerative conditions (spinal cord stenosis)
  1. MRI of the whole spine - within a day if cord compressed, within 7 days if spinal mets suggested
34
Q

Upper limb fractures

  1. Colles - following what, features
  2. Smith - following what, features
  3. If 1/2 with associated radiocarpal dislocation, name
  4. Bennett - following what, features, + on x-ray
  5. Commonest carpal fracture, post-FOOSH + signs
  6. Commonest radial fracture post-FOOSH + signs
  7. Galleazzi fracture - what it is
  8. Occur following
  9. Bruising/swelling/tenderness where
  10. X-ray findings
A
  1. Post-FOOSH, transverse distal radius, dorsal displacement + angulation (‘dinner fork deformity)
  2. Falling backwards onto outstretched hand / on flexed wrist. Palmar angulation of distal segment (‘garden spade deformity’)
  3. Barton’s fracture
  4. Intra-articular fracture of 1st CMC joint, caused by punching (flexed metacarpal), x-ray = triangular fragment at ulnar base of metacarpal
  5. Scaphoid fracture; swelling/tenderness in anatomical snuff box, pain on wrist movements/longitudinal thumb compression
  6. Radial head; local pain, low elbow ROM / rotation pain
  7. Radial shaft fracture, distal radioulnar joint dislocation
  8. Fall on hand with rotational force superimposed on it
  9. Lower end of forearm
  10. Displaced radius fracture + prominent ulnar head due to dislocation of the inferior radio-ulnar joint
35
Q

Salter Harris classification

  1. Classifies what
  2. Types (1-5) - ‘SALTR’
  3. Commonest type (75%)
  4. Physis/growth plate/epiphyseal plate - made from
  5. Name when fused

Other paediatric fractures

  1. Greenstick
  2. Buckle (torus)
  3. Growth plate issue causing short height (heterozygous)
  4. Other features
A
  1. Fractures through growth plates/physis (paediatrics)
  2. Straight across (physis only)
  3. Above (physis + metaphysis/shaft)
  4. Lower (physis + epiphysis/end to include joint)
  5. Through (physis, metaphysis, epiphysis)
  6. Ruined (crush injury)
  7. Type 2
  8. Hyaline cartilage
  9. Epiphyseal line
  10. Unilateral cortical breach only
  11. Partial cortical disruption; periosteal haematoma only
  12. Achondroplasia (so short proximal limb, digits, height)
  13. Frontal bossing, otitis media, small foramen magnum (CC compression, hydrocephalus), scoliosis, bow legs
36
Q

Back pain history

  1. Key questions - cauda equina
  2. Malignancy
  3. Previous medication
  4. Symptom indicating spinal stenosis
  5. Populations predisposed to osteomyelitis (2)
  6. Red flags
  7. Bedside tests (2)
  8. Blood tests
  9. Imaging - do plain x-ray if suspecting
  10. MRI if suspecting
  11. Mechanical back pain rare after what age
A
  1. Saddle anaesthesia, bladder / bowel incontinence (new onset), leg weakness / numbness / tingling
  2. B symptoms (weight loss, fever, night sweats), LOA
  3. Long-term steroids (OA)
  4. Bilateral limb claudication
  5. IVDUs, immunosuppressed
  6. Aged <20/>50, specific pain (at night, lying flat, thoracic), history of cancer, malignancy/CE symptoms, significant trauma, alcohol/drug use
  7. PR (cauda equina), urinalysis (pyelonephritis)
  8. FBC, CRP/ESR, U+Es, LFTs, calcium, phosphate, myeloma (bence jones, Ig), cultures (osteomyelitis)
  9. Osteoarthritis, minor disc narrowing
  10. Malignancy, soft tissue injury
  11. 60
37
Q

Disc prolapse

  1. Definition
  2. Usual age of presentation
  3. Clinical presentation
  4. Management
A
  1. Nucleus pulposus herniates into annulus fibrosus
  2. 35-55
  3. Leg pain worse than back, worse on sitting
  4. Give analgesia, physio, MRI if symptoms persist

Medical School (28 decks)

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