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Year 4 PassMed Incorrect Qs > Orthopaedics/ MSK > Flashcards

Orthopaedics/ MSK Flashcards

1
Q

Which is The most common site of metatarsal stress fractures?

A

2nd metatarsal shaft

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2
Q

What is De Quervain’s tenosynovitis

What is the specific test to identify it?

A

a common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed. It typically affects females aged 30 - 50 years old.

Finkelstein’s test: examiner pulls the thumb in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus

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3
Q

What shoulder problem has a big assoc. with diabetics?

A

Adhesive capsulitis (frozen shoulder)

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4
Q

What sign is seen in a scaphoid fracture

A

Pain on longitudinal compression of the thumb is a sign of a scaphoid fracture

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5
Q

What nerve is damaged to cause foot drop and tracking that nerve up what nerve can be affected in a knee replacement which can cause this presentation?

A

Tibialis anterior- Dorsiflex nd inversion

It is a branch of the deep peroneal nerve which is a branch of the common peroneal nerve which can be affected in a knee replacement as it runs through the popliteal fossa and wraps round head of fibula

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6
Q

What drug can increase risk of Dupuytrens contracture?

A

Phenytoin

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7
Q

Initial management of open fractures (10)

A

C- Catastrophic haemorrhage

  1. C-spine (patients with neck and head injury have c-spine injury until proven otherwise) + ABCDE assessment
  2. Haemorrhage control through direct pressure and PACKING! - tourniquet as last resort
  3. Neurovascular examination
  4. Analgesia
  5. Immobilise the wound using a splint, not external fixators
  6. ABx (e.g. co-amox, cefataxime, clindamycin), anti-tetanus prophylaxis
  7. Remove gross contaminants from wound
  8. Wound photography
  9. Dressing wound - moist saline gauze & adhesive dressing
  10. X-rays
    -Refer to ortho
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8
Q

Weber classification of fracture and the management

A

B

C

2 other reasons for surgery?

A
  1. Weber A- Below syndesmosis, intact and stable

patients with minimally displaced, stable fractures may bear weight as tolerated in a CAM boot 6-8 weeks and analgaesia

  1. Weber B- At level of syndesmosis, can be intact or partially torn
    Mx - if stable and no talar shift then conservative CAM boot and analgaesia
    Mx- If unstable/ talar shift… ORIF
  2. Weber C- Above syndesmosis, not intact
    Mx- ORIF Open reduction and Internal fix

Open fracture needs ORIF
Bi or trimalleolar displacement needs ORIF

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9
Q

What is the diag when typically present with hip/groin pain and a snapping sensation

patient able to weight bear with pain on external rotation

A

Acetabular labral tears

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10
Q

Difference in ACL and Meniscal tears in presentation (1)

A

Swelling much quicker in ACL tear causing haemoarthropy, meniscal tear is slower effusion.

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11
Q

Noonan syndrome features (4)

A

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

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12
Q

Malignant Bone tumours

Which is the most common primary bone tumour?

STEMS on xray:
Osteosarcoma

Ewing’s Sarcoma

Chondrosarcoma- No STEM
- Location?
- Who?

A

Osteosarcoma: Codman triangle (from periosteal elevation) and ‘sunburst’ pattern

Ewing’s Sarcoma: x-ray shows ‘onion skin’ appearance

Chondrosarcoma- No STEM
- Location- axial skeleton its tumour of the cartilage
- Who- middle-age

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13
Q

Malignant bone tumours- Osteosarcoma
- Key fact
- Who/ age?
- Where?
- STEM on xray? (2)
- 3 Key risk factors

A

Osteosarcoma
- Most common primary
- Children and teens
- metaphyseal region of long bones prior to epiphyseal closure
- STEM- Codman triangle (from periosteal elevation) and ‘sunburst’ pattern
- RF:
1. Retinblastoma gene mutation
2. Padgets disease of bone
3. Radiotherapy

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14
Q

What is the key rule for hemiarthroplasties in hip fractures?

A

If there is any displacement, partial or full, a hemi-arthroplasty is given. Or full if fit.

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15
Q

STEM for pain in facet joint pain? (2) and there is extra info that don’t need.

A
  • pain over the facets
  • pain is typically worse on extension of the back.

Can be acute or chronic, Pain usually worse in the morning and worse on standing

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16
Q

When is a DEXA scan not needed to diagnose osteoperosis?

A

Following a fragility fracture in women ≥ 75 years, a DEXA scan is not necessary to diagnose osteoporosis and hence commence a bisphosphonate

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17
Q

Flexor sheath tenosynovitis
- Surgical emergency
Cause?
- Kanavel’s signs: 2Fs and 2Ps

Management
1
2

A

Flexor sheath tenosynovitis
- Surgical emergency
- Caused by human and animal bites (metacarpal strikes a tooth)
- Kanavel’s signs:
F- fusiform swelling
F - tenderness over flexor sheath
P- semiflexed posture
P- pain on passive extension

Management
1. I.V antibiotics with elevation
2. Mx Surgical debridement
Can lead to fibrosis and contractures which can be very dissabling

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18
Q

Differentiating between L3 and L4 root lesion of movement deficits are the same (think derm)

A

L3- loss over anterior THIGH
L4- loss over anterior KNEE and down to medial malleolous

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19
Q

Golfers and Tennis elbow, how do you differentiate?

A

Tennis- lateral epicondyle, pain on desired ext. of wrist

Golfers- medial and pain on resisted pronation

20
Q

Acromioclavicular joint injury, grades and their management

A

I and II - manage conservatively with rest and sling

III- individual circumstance and debate

IV. V, VI- Surgical intervention

21
Q

We know what causes a SABER but what causes shortened and INTERNALLY rotated?

A

Posterior hip dislocations present with a shortened and internally rotated leg

22
Q

starting what drugs can causes achilles tendon rupture? and also what inherited condition?

Initial imaging?

A
  1. quinolone use (e.g. ciprofloxacin) is associated with tendon disorders
  2. hypercholesterolaemia (predisposes to tendon xanthomata)

USS

23
Q

Carap Tunnel Syn Associated conditions ARMPIT

A

Acromegaly
Rheumatoid (most cmmon RF of bilteral)
Myxoedema (hypothyroid)
Pregnancy
Idiopathic
Trauma- lunate fracture

24
Q

Presentation of fat embolism? triad

+ 1 extra

A
  1. Respiratory distress + nothing on CXR
  2. Neurological
  3. Petechial rash (tends to occur after the first 2 symptoms)
  4. RETINAL HAEMORRHAGE on fundoscopy
25
Q

Carpal Tunnel Investigation + result (1)

Management
Conservative - (2) how long?

Surgery (1)

A

Electrophysiology
motor + sensory: prolongation of the action potential

Management
6 week trial of conservative
- Splint
- Corticosteroid injection

Surgery if persists (flexor retinaculum division)

26
Q

Shoulder dislocation

Most common type is
associated with?

Less common but STEM
+ STEM of stem

A

Common- Anterior
FOOSH

Posterior- assoc with seizure/ electric shock (because all muscles are contracting)
- IT WILL BE LOCKED IN INTERNAL ROTATION

27
Q

Osteogeness imperfecta

cant produce… therefore…

radiology shows:

A

cant produce intercellular substances like osteoid, collagen and dentine therefore pathological fractures

  • translucent bones
  • multiple fractures, particularly of the long bones, - wormian bones (irregular patches of ossification) and a trefoil pelvis.
28
Q

Initial/ immediate management of ANY closed ankle fracture?

If open? (3)

A

Closed reduction- translucent bones, multiple fractures, particularly of the long bones, wormian bones (irregular patches of ossification) and a trefoil pelvis.

definitive management then depends on Webers staging

Open
- IV broad-spectrum antibiotic
- surgical debridement
- external fixation or plastic/vascular surgery input

29
Q

How do you best describe the clinical findings of a clubfoot? (3)

dont need imaging

Talipes equinovarus

Managment?

A

inverted (inward turning) and plantar flexed foot
not passively correctable

Ponseti method of recasting for 6-10 weeks + night time brace until 4yo

30
Q

What is the most common reason total hip replacements need to be revised

A

Aseptic loosening of the implant

31
Q

What is a buckle fracture in a kid?

A

Buckle = bulge
incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex

typically 5-10yo

self-limiting, sometimes splint and immobilise

32
Q

Salter Haris

A

SALTER
1 Straight through growth plate (no epi or meta)
2 Above growth plate (metaphysis)
3 Lower (below growth plate, epiphysis)
4 Through all 3 parts
5 ERasure of growth plate = compression

33
Q

classical ‘painful arc’ associated with

A

supraspinatus tendonitis
xray shows calcification from prolonged inflam

34
Q

Osteochondritis dissecans typically presents with (3)

cause

A

knee pain after exercise, locking and ‘clunking’

Overuse of joints due to sporting activity

35
Q

Oslers nodes not just assoc with IE can also present in: (4)

A

SLE, gonorrhoea, typhoid and haemolytic anaemia.

36
Q

WHat is charcot joint and what do you see on xray?

A

DM (can be neuropathy due to syphilis) - a joint which has become badly disrupted and damaged secondary to a loss of sensation

extensive bone remodeling / fragmentation involving the midfoot

CHARCOT:
C - Collapse of bones
H - Hyperemia (increased blood flow)
A - Afebrile (no fever)
R - Redness and warmth
C - Crepitation (crackling sound)
O - Osteoporosis (loss of bone density)
T - Trauma (often minor)

37
Q

STEM for chondromalacia (2)

you will see-

A

teenage girl with knee pain on walking down the stairs is (anterior knee pain)

following an injury to knee e.g. Dislocation

Tenderness, quadriceps wasting

38
Q

Management

A
  1. initially with rest, stretching and weight loss if overweight
39
Q

Tennis elbow- exam findings worse when…

A

Medial epicondylitis is typically aggravated by wrist flexion and pronation

40
Q

irst-line investigation for a suspected osteoporotic vertebral fracture

A

X-ray of the spine

41
Q

Pathogen for Blood and bone infections caused by gram -ve rods, linked to sickle cell and malaria and in kids

A

non-typhi salmonella (NTS)

42
Q

IMaging used for spinal stenosis and why?

A

MRI to confirm nd exclude other causes such as metastatic disease.

43
Q

Where is most common for comprtment syn? (2 fractures)

What can you get as a result of compartment syndrome and why?

A

supracondylar and tibial shaft fractures

AKI- myoglobin release/ rhabdomyloysis due to Increased pressure in the fascial compartment may lead to muscle breakdown

44
Q

Olecranon bursitis- present?

A

Swelling over the posterior aspect of the elbow.

middle aged men

45
Q

Monteggia fracture- what?
Galeazzi fracture- what?

A

Monteggia ulna (Manchester United)
a fracture of the proximal ulna, with an associated dislocation of the proximal radioulnar joint.

Galeazzi radius (Galaxy rangers)
distal radial fracture with an associated dislocation of the distal radioulnar joint.

46
Q

blood supply interupted in scaphoid fracture

A

dorsal carpal branch of the radial artery

47
Q

Greenstick fracture

A

common in children, a greenstick fracture would only have a unilateral breach of the cortex

Year 4 PassMed Incorrect Qs (37 decks)

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