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Plab1 2023 > Orthopaedics Ver 3.9 > Flashcards

Orthopaedics Ver 3.9 Flashcards

1
Q

SUFE
Slipped upper femoral epiphysis

A
  • 11-15 years
  • limping
  • affecting leg shorter
    -externally rotated hip with increased hip flexion
    -painful knee/ hip /thigh/groin
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2
Q

Fall vertically, likely bone to be affected/#

A

Calcaneum
Spinal fractures

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3
Q

Stress #

A

Metatarsals

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4
Q

Long bone pain (femur/ tibia)
Unrelated to activity
In young people
Responds well to aspirin

A

Osteoid osteoma
Benign long bones tumor

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5
Q

Sensory loss responsible nerve roots
L12345 S1

A

L1 - groin and pelvis girdle
L2 - anterior thigh
L3 - medial and distal anterior thigh
L4 - inner/medial shin
L5 - outer/ lateral shin and dorsum foot
S1 - lateral foot

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6
Q

Cauda equina

A

Bundle of nerve roots at the lower end of spinal cord
Conus medullaris - an end T12
T12- L1- cauda equina

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7
Q

Cauda equina syndrome

A

1 Sciatica - pain along the nerve (back, buttock, hip, leg)
2 ** saddle paraestheisa** (anal, peri anal, groin numbness)
3 Urinary retention ( inability to void)
4 Fecal incontinence (involuntary soiling)

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8
Q

Causes of Cauda equina syndrome

A

Central disc prolapse
Postage cancer metastasis
It is * surgical emergency*

MRI spine / urgent referral to orthopedic surgeon

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9
Q

Lumbosacral Disc herniation/ prolapse
Leg raising test result?
Pain?

A

+ve straight leg raising test
- pain
Sitting from supine
Prong standing or walking
- Relieve by lying down
- sciatic nerve involve - electric shock like pain

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10
Q

Intervertebral disc prolapse
Not lambosacral (L5- S1, L4-L5)

A

Pain plus loss of sensation at affected area plus loss of deep tendon reflex at affected area

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11
Q

Shoulder weakness
Pain on raising arm above shoulder pain at night
Volleyball- tennis- badminton player- swimmer
Carrying heavy objects- recent move to a new house

A

Supraspinatous tendinitis

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12
Q

Shoulder weakness
Pain on raising arm above shoulder
Over head activities (volleyball, tennis, badminton, swimmer)

A

Supraspinatous tendinitis

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13
Q

Elderly + history of fall + painful hip + shortened, externally rotated leg

A

neck of femur (not head)

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14
Q

A Child girl limping
First born
Oligohydramnions
Birth weight > 5kg
Breech presentation
FHx
Painless leg
Shortened
Unequal skin folds
congenital calcaneovalgus foot deformity

A

DDH
Developmental Dysplasia of the Hip
Congenital dislocation of the Hip

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15
Q

One of the comment fracture
Secondary to falling on “outstretched hand”

A

Scaphoid fracture

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16
Q

Painful thumb base
Tender anatomical snuff-box
Pronation followed by ulnar deviation produces pain

A

Scaphoid #

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17
Q

Management of scaphoid#
X ray +ve
X ray -ve

A

+ve - scaphoid cast for 6weeks
-ve - 2 weeks and repeat X-ray in 2weeks

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18
Q

DDH
Sex and side preference
Diagnosis Invx

A

Female 6times more common, 80%
Left hip more common
USG to confirm Dx

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19
Q

DDH clinical examination
2tests

A

Barlow- attempts to dislocate the articulated femoral head
Ortilani- relocate the dislocated head

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20
Q

DDH Mx

A
  • 3-6 weeks - spontaneously stabilize
  • < 4-5 months - Pavlik harness (dynamic flexion-abduction orthosis)
    Older children - Sx
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21
Q

Simmon’s triad

A

1) Abnormal angle of declination
2) feel for a gap in the tendon
3) gently squeeze the calf muscles (Thompson Test) - No/ Negative plantar flexion, remained dorsiflex

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22
Q

Sudden, audible pop in the ankle
Like someone has kicked my leg from behind
Sudden significant pain

A

Achilles Tendon Rupture
Acute (same day) referral to orthopaedics

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23
Q

Stiffness of a finger,
Snapping (click) sound when extending a flexed digit
Nodule is felt at the base of the finger
Common in thumb ring n middle fingers

A

Trigger finger
Stenosing tenosynovitis

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24
Q

Bouchard nodule/swelling

A

nodules at PIP in OA

25
Q

Heberden nodule

A

Nodule/swelling at DIP in OA

26
Q

Mx of OA

A

1) para
2) topical NSAID
3) oral NSAID
4) opioid (Corrine)

27
Q

Distal radius posteriorly displaced

A

Collie’s #
Dinner fork deformity
Median nerve injury (osteoporosis)

28
Q

Distal radius anteriorly displaced

A

Reverse Colle’s #
Smith’s #
Garden spade deformity

29
Q

Finger bends at IP joint
Hit by a ball to his finger
Avulsion of extensor digitorum tendon

A

Mallet finger

30
Q

Avulsion if flexor tendon at IP joint

A

Jersey finger

31
Q

Pain when grasping things with thumb
Tenderness over MCP joints

A

Gamekeeper thumb
Skier’s thumb

32
Q

Monteggia # (Man U)

A

Proximal Ulnar #
Dislocation of head of radius

33
Q

Galeazzi’s # (Galacticos Rising)

A

Distal radius #
Distal radio-ulnar joint dislocation

34
Q

1) Ca, PO4, ALP - normal
2) Ca, PO4 - normal, ALP ⬆️
3) ⬇️ Ca, PO4, ALP ⬆️

A

1) osteoporosis
2) Pager’s disease of bone
3) Osteomalacia

35
Q

Bone manifestation
Heart failure
Hearing loss
⬆️ Ca ( even that)
⬆️ALP

A

Pager’s disease

36
Q

X ray in paget

A

Coarse trabecular pattern
Cotton wool pattern - multi focal sclerotic patches
V shape pattern - blade of grass lesion
(Cortical) sclerotic lesions

37
Q

Lyric (punch out) lesion on Xray

A

MM
Multiple myleoma

38
Q

⬆️ALP causes (2Bs + P)

A

Bone
Biliary
Pregnancy

39
Q

⬆️Ca
Polyadipsia
Polyuria
Bone pain
Constipation
Confusion
ECG- short QT interval

A

Bone metastasis (prostrate, breast)
SCC of lungs
Multiple myeloma
Primary hyper parathyroid

40
Q

Bone pain
⬆️Ca
Anaemia
(Recurrent infection, renal failure)

A

MM
Multiple myeloma
(Plasma cell cancer, over growth of non- functioning Igs)

41
Q

Absence of pulse
Neuro vascular compromise
Obvious deformity
Mx?

A

ABCD
Then urgent reduction under sedation or analgesia
IV midazolam

42
Q

Femur # if patient is stable(SBP - >100), Mx?

A

Thomas splint

43
Q

Acetabulum #
Nerve?

A

Sciatic nerve

44
Q

Bone metastasis cases,
1) Initial test
2) The most appropriate test

A

1) serum Ca
2) MRI f/b bone scintigraphy

45
Q

1) Osteoporosis
2) MM
Ix?

A

1) Dexa scan (Dural Energy Xray Absorptiometry)
2) skeletal survey , bone biopsy

46
Q

Long term use of steroids

A

Osteoporosis
Cataract
Peptic ulcers
Hyper glycaemia

47
Q

A young boy, painful knee, fixed mass over knee side, no systemic features

A

Osteosarcoma
(The Most common bone tumor in children)

48
Q

A young boy, painful knee, tender fixed mass over knee side, systemic features such as fever, weight loss, tenderness

A

Ewing sarcoma
(2nd most common bone tumor in children)

49
Q

Long bone fracture (femur)
Open surgery - 24 to 72 hours
O2⬇️
Consciousness ⬇️

A

Fat embolism

50
Q

Carpal tunnel syndrome in pregnancy Mx?

A

Wrist splint until delivery
Fail- cut the transverse carpal ligament

51
Q

Overstretched or trauma
Severe pain, rapid swelling, bruising, difficult to move
No # on X-ray

A

Sprain (torn ligament)

52
Q

Mix of torn ligament (sprain)

A

PRICE
High arm sling for 3 days

53
Q

Septic arthritis RFs

A

RA
DM
HIV
Steroids

54
Q

Septic arthritis
1) Commoners organism
2) Dx
3) Tx

A

1) staph aureus/ young sexually active- gono
2) aspiration of synovial fluid, blood culture
3) flucloxacillin, clindamycin in pen allergic - 4wks to 6am a
If not staph or gono, cedotaxime /ceftrisone
If not okay, repeat percutaneous aspiration
IV 1 wk, if all resolves, oral 4 wks

55
Q

Reactive arthritis
(Seronegative arthritis)

A

Cannot see
Cannot pee
Cannot climb a tree
No fever
Migratory oligo arthritis
Young adult after STI or GI infection

56
Q

Reactive arthritis Tx

A

Analgesia, NSAID, intraarticular steroids
Sulfasalazine
Methotrexate
Symptoms rarely lasts more than 12 months

57
Q

Toddler (1-3)years #
X-ray no deformity

A

Spiral

58
Q

Child (4-10) year
Fall on outstretched hand,
Absent radial/brachial pulse

A

Supracondylar # of humerus (brachial artery injury)
If not given, green stick #

Plab1 2023 (2 decks)

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