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AA Y4 Finals cards NE > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

Name 4 risk factors for septic arthritis?

A
  1. PWID
  2. Immunocompromised
  3. Previous joint disease
  4. Diabetes
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2
Q

What is the most common causative of septic arthritis?

A

Staph aureus

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3
Q

What is the most common causative of septic arthritis in young adults?

A

Gonorrhoea

Make sure to refer them to the sexual health clinic

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4
Q

What is the most common causative in septic arthritis in kids <5?

A

H. Influenza

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5
Q

Septic arthritis normally presents as a mono-arthritis. If a patient presents with a clinical picture of septic arthritis but in multiple joints, what should you consider?

A

Endocarditis

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6
Q

What is the 1st line AB for septic arthritis?

A

Flucloxacillin 2g QDS

If penicillin allergic: Clindamycin 600mg QDS

Both should be given IV for 1st 2 weeks, then oral for 2-4 weeks following

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7
Q

In prosthetic joint infection, compare likely causatives in early post op infections vs delayed post op infections?

A

Early post op infection (0-3mths): Staph aureus

Delayed post op infection (2-24mths): Staph epidermidis

Late (>2 years): staph aureus, E.Coli

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8
Q

Blood cultures for a prosthetic joint infection show Gram -ive bacteria. What antibiotic will be used?

A

Gram -ive cover: Ciprofloxacin

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9
Q

Blood cultures for a prosthetic joint infection show staph sensitive bacteria. What antibiotic will be used?

A

Staph sensitive bacteria: Rifampicin

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10
Q

Which respiratory condition can cause chronic osteomyelitis?

What is the name given when this disease affects the spine?

A

TB - it can be the causative for chronic osteomyelitis

Pott’s disease - describes TB of the spine - can result in crush fracture of thoracic vertebrae

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11
Q

What is the most common acute cause of osteomyelitis?

A

Staph aureus

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12
Q

Describe 4 clinical features of a presentation of osteomyelitis?

A
  1. Low grade fever
  2. Pain, swelling and fever overlying site of infection
  3. Extreme pain on palpation of affected bone
  4. Fatigue and malaise
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13
Q

Which imaging technique is useful when assessing osteomyelitis?

A

MRI

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14
Q

Describe the management of acute osteomyelitis?

A
  1. Drainage of abscess
  2. IV flucloxicillin 6 weeks (clindamycin if penicillin allergic)
  3. MRSA - IV vancomycin
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15
Q

Which condition presents with pain out of proportion to the inflammation?

A

Necrotizing fasciitis and also compartment syndrome

Severe pain is felt at the site of infection with only mild inflammation

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16
Q

How is necrotising fasciitis managed?

A

Debridement and antibiotics

1st line: IV benzylpenicillin and clindamycin

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17
Q

What is the causative ing gas gangrene? What is its gram staining?

A

Clostridium perfringes

Gram positive bacillus that is strict aerobe

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18
Q

Name the antibiotics given in gas gangrene

A

Penicillin and metronidazole

Gram +ive bacillus that is strict aerobe

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19
Q

Describe clostridium tetani? What ABs are used to treat it?

A

Causative in tetanus

Gram +ive bacillus - strict aerobe

Penicillin and metronidazole

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20
Q

Which benign bone tumour is most common in <20’s?

A

Osteochondroma

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21
Q

Which benign bone tumour presents with intense pain especially at night, but is relieved by NSAIDs?

A

Osteoid osteoma

Tumour of osteoblasts

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22
Q

Compare the usual locations of osteoid osteomas vs osteochondromas?

A

Osteochondromas: occur around the knee or proximal femur or humerus

Osteoid osteoma: metaphysis of long bones

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23
Q

Which benign bone tumour is more common in middle aged women and has a soap-bubble appearance?

A

Giant cell tumours

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24
Q

Which malignant bone tumour is a tumour of osteoblasts?

A

Osteosacroma

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25
Q

Describe the radiological features of an osteosarcoma?

A
  1. Occur in the metaphysis of long bones, especially around the knee
  2. Sunray speculation
  3. Codman’s triangle of reactive bone
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26
Q

Compare the locations of chondrosarcomas with osteosarcomas

A

Chondrosarcomas: affect axial skeleton, especially proximal femur or pelvis

Osteosarcomas: affect metaphysis of long bones, especially around the knee

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27
Q

Which malignant bone cancer is resistant to both chemotherapy and radiotherapy?

A

Chondrosarcoma

It therefore requires surgery

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28
Q

Describe the treatment of an osteosarcoma?

A

Chemotherapy and surgery

It is resistant to radiotherapy

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29
Q

Which malignant bone cancer presents as a warm swelling with raised inflammatory markers?

A

Ewing’s sarcoma

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30
Q

Which malignant bone cancer shows an onion ring sign on XR?

A

Ewing’s sarcoma

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31
Q

Compare the origins of sclerotic lesions with that of lytic lesions?

A

Sclerotic: prostate, breast

Lytic: thyroid, breast, small cell lung

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32
Q

What is the difference between sclerotic and lytic lesions?

A

Sclerotic: lesions have an increased bone density

  1. Lytic: lesions have a reduced bone density
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33
Q

What is Mirel’s score?

A

A scoring system used in patients with malignant bone tumours.

It identifies those at high risk of fracture and who would benefit from prophylactic internal fixation

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34
Q

Which 3 factors make up Mirel’s score?

A
  1. Site
  2. Is the lesion sclerotic or lytic?
  3. Size
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35
Q

Name the empirical antibiotic treatment given for open fractures?

A

Co-amoxiclav + Metronidazole IV

Co-Trimoxazole + Metronidazole IV if allergic

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36
Q

Should internal or external fixation devices be used for open fractures?

A

External fixation

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37
Q

Which 2 fractures most commonly predispose to compartment syndrome?

A

Tibial shaft or supracondylar

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38
Q

What intra-compartment pressure is diagnostic of compartment syndrome?

A

> 40mmHg

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39
Q

Name a possible complication of compartment syndrome?

A

Volkmann’s ischemic contracture (hand bent up)

Due to irreversible muscle necrosis and fibrosis of shortening muscles in forearm

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40
Q

Damage to which nerve presents with loss of sensation over badge patch?

A

Damage to axillary nerve

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41
Q

How will damage to the radial nerve present?

A

Wrist drop

loss of sensation in 1st dorsal web space

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42
Q

Describe a Galeazzi fracture?

A

“Glasgow Rangers, Galeazzi Radius”

Fracture of the radius shaft with distal radio-ulnar joint dislocation

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43
Q

Describe a Monteggia fracture?

A

Fracture of the ulnar shaft with proximal radio-ulnar joint dislocation

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44
Q

What is the name of an extra articular fracture of the distal radius?

By what mechanism does it most commonly occur?

A

Colle’s fracture

FOOSH is most common mechanism

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45
Q

Describe the presentation of a Colle’s fracture?

A

‘Dinner fork deformity’

Displacement of the radius upwards (posteriorly)

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46
Q

Describe the difference between Colles and Smiths fracture?

A

Colle’s: FOOSH with wrist extension

Smith’s: FOOSH with wrist flexion

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47
Q

Name 3 complications of a Colle’s fracture?

A
  1. Median nerve compression
  2. Extensor pollicis longus rupture
  3. Sudecks dystrophy
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48
Q

What name is given to a Smith/Colle’s fracture that also has dislocation of the radiocarpal joint?

A

Barton’s fracture

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49
Q

Which fracture is most commonly seen following fist fights?

A

Bennett’s fracture

Intraarticular fracture of 1st carpometacarpal joint (at base of thumb)

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50
Q

How are scaphoid fractures treated?

A

Plaster cast, if displaced then ORIF

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51
Q

Using the Garden classification for hip fractures, which types cause disruption to the blood supply?

A

Garden types 2 and 3

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52
Q

How are extra capsular hip fractures treated? Why?

A

Management: fixation using a dynamic hip screw

There is no risk of AVN due to fracture being away from blood supply

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53
Q

A tibial plateau fracture can affect what nerve? How does this present?

A

Common peroneal nerve

If damaged, this causes a foot drop

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54
Q

Which bones make up the ankle joint?

A

Tibia, fibula, talus

The talus acts as a hinge joint between the tibia and fibula

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55
Q

Where does a Pilon fracture occur? How are they managed?

A

It is a distal tibial fracture that involves the articular surface of the ankle

Managed as a surgical emergency- External fixation ASAP

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56
Q

Where is the most common location for a metatarsal stress fracture to occur?

A

2nd metatarsal shaft

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57
Q

Which nerve is most likely to be damaged in a hip fracture?

A

Sciatic nerve

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58
Q

Which nerve is commonly damaged in PCL and lateral meniscus injuries?

A

Common peroneal nerve

Presents as foot drop

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59
Q

Compare the most likely location for an extensor mechanism rupture to occur depending on the age of the patient?

A

<40y/o: patellar

> 40 y/o: Quadriceps

60
Q

Which test can be used to identify extensor mechanism rupture?

A

Straight leg raise

61
Q

Describe the vascular supply to the menisci?

A

Only the outer 1/3 of the menisci is vascularised

62
Q

What is a Baker’s cyst and why does it occur?

A

Occurs in the popliteal fossa due to herniation of synovial fluid

63
Q

Name 2 conditions that predispose to a Baker’s cyst?

A
  1. OA

2. RA

64
Q

How are possible Baker’s cysts investigated and managed?

A

U/S to rule out DVT

Usually self-limiting - treat the underlying cause

65
Q

How is trochanteric bursitis managed?

A

Analgesia, physio and steroid injections

66
Q

What is the gold standard management for Hallux rigidus?

A

Arthrodesis (fusion)

67
Q

Which 2 neurological conditions can cause pes cavus (high arch in foot)

A

Cerebral palsy

Spina bifida

68
Q

Which test is used to assess for achilles rupture?

What would it show in a case of rupture?

A

Simmond’s test

No plantar flexion on squeezing the calf

69
Q

How is achilles rupture managed?

A

8 weeks of serial plaster casts +/- surgery

70
Q

Which artery supplies around 80% of the blood supply to the scaphoid?

Which artery is this a branch of?

A

The Dorsal carpal branch, in a retrograde manner

A branch of the radial artery

71
Q

Which degrees of movement are painful in impingement syndrome/ supraspinatus tendinitis)?

A

Painful on active abduction between 60-120 degrees

No pain associated with movement outwith this range

72
Q

Name 4 causes of impingement syndrome?

A
  1. Calcific tendinosis
  2. Supraspinatous tendonitis
  3. Subacromial bursitis
  4. AC joint OA
73
Q

In terms of movements, how can impingement syndrome and adhesive capsulitis be differentiated?

A

Impingement syndrome has no pain on passive movement

Adhesive capsulitis does have pain on passive movement

74
Q

Name 2 risk factors for adhesive capsulitis?

A
  1. Diabetic

2. . Female

75
Q

Describe the presentation of adhesive capsulitis?

A
  1. Progressive, severe pain that is worse at night
  2. Reduced ROM on abduction and external rotation
  3. Progressive stiffness following resolution of pain
76
Q

Which 2 movements are particularly affected by adhesive capsulitis?

A

ABduction and external rotation

77
Q

How is adhesive capsulitis treated?

A

Self limiting - takes 2-9 months to resolve

Conservative: analgesia, physio and steroid injections

Surgical: capsular release

78
Q

Name 5 causes of fluid retention that can cause carpal tunnel syndrome?

A

Obesity, pregnancy, acromegaly, hypothyroidism, CKD and diabetes

79
Q

Does carpal tunnel syndrome have thenar or hypothenar wasting?

A

Thenar wasting

80
Q

Which fingers are supplied by the median nerve?

A

Thumb and lateral 2.5 of fingers

81
Q

What is the name of the connective tissue band that is divided in carpal tunnel surgery?

A

Flexor retinaculum

82
Q

Compare carpal and cubital tunnel syndrome: What nerves are involved and what area of muscle wasting is seen?

A

Carpal tunnel - median nerve, thenar wasting

Cubital tunnel- ulnar nerve, hypothenar wasting

83
Q

Compare tennis and golfers elbow: when is the pain elicited?

A

Tennis (lateral) elbow: pain on resisted extension

Golfer’s (medial) elbow: pain on pronation and wrist flexion

84
Q

Which fingers are usually affected by dupuytren’s contracture?

A

Little and ring fingers

85
Q

Which condition presents with a positive table top test?

A

Dupuytren’s contracture- the fingers cannot flatten out when placed flat on a table

86
Q

What causes trigger finger?

A

Nodular enlargement of a flexor tendon distal to the A1 pully due to tendonitis

87
Q

In trigger finger, when is there a ‘trigger’ sensation?

A

When the finger goes from flexed to straight.
The nodule will move proximal to the pully when the finger is flexed

The nodule will then have to move back under the pully when finger is straightened

88
Q

When is pain usually felt in trigger finger?

A

Pain felt on extension of finger

89
Q

Which 2 fingers are usually affected by trigger finger?

A

Middle and ring fingers

90
Q

Which condition has a positive Finkelstein’s test?

A

De Quervain’s tenosynovitis

91
Q

Which tendons are inflamed in De Quervain’s tenosynovitis?

A

Tendons of the thumb

Extensor pollicis brevis
Abductor pollicis longus

92
Q

What is 1st line tx for De Quervain’s tenosynovitis?

A

Rest, spica thumb splint, NSAIDs

93
Q

Which nerve roots are involved in sciatica?

A

L4, L5, S1, S2 and S3

94
Q

IN sciatica, which disks are most likely to prolapse?

A

L4/L5

L5/S1

95
Q

If there is a disk prolapse of L5/S1, which nerve root will be trapped?

A

S1

It is always the lower nerve root that is trapped

96
Q

Which nerve root is trapped if there is weakness on knee extension and reduced knee jerk?

A

L4

97
Q

Which nerve root is trapped if there is reduced dorsiflexion and extension of big toe?

A

L5

98
Q

Which nerve root is trapped if there is weakness in ankle jerk?

A

S1

99
Q

Which 2 conditions predispose to C1/C2 subluxation?

A

Downs syndrome

Rheumatoid arthritis

100
Q

What is the underlying problem in developmental dysplasia of the hip?

A

The child has a shallow acetabulum due to failure of the components of the hip to maintain close apposition

101
Q

In DDH, what is the difference between Ortolani’s test and Barlow’s test?

A

Ortolanis - aims to relocate the femoral head

Barlow’s- aims to dislocate an articulated femoral head

102
Q

How is DDH investigated?

A

<5mths: U/S

> 5mths: XR

103
Q

In DDH, what can be tried prior to surgery in patients aged 0-6mths?

A

Pavliks harness

104
Q

What is the most common cause of paediatric hip pain?

How is it managed?

A

Transient synovitis

It is self limiting inflammation of the synovium

Tx with NSAIDs and rest and review

105
Q

In transient synovitis, what is the most important diagnosis to rule out?

How do you go about doing this?

A

Septic arthritis

Bloods, blood culture and look for systemic illness

106
Q

Which cause of paediatric hip pain most commonly occurs following a viral URTI?

A

Transient synovitis

107
Q

Which paediatric hip condition most commonly affects short, active boys aged 4-9?

A

Perthes disease of the hip

108
Q

What is Perthe’s disease?

A

An idiopathic osteochondritis of the femoral head

Results in transient loss of blood supply to the femoral head and eventual avascular necrosis and abnormal growth

109
Q

How is Perthe’s managed in kids?

A

Conservatively- bed rest, analgesia, avoidance of regular exercise and regular monitoring

Surgery really only indicated if severe subluxation and deformity of femoral head

110
Q

What happens in SUFE?

A

The femoral head slips down from the bone

111
Q

Who is a typical patient in SUFE?

A

An obese male aged 10-16

Any teenager who is unable to weight bare is a SUFE until proven otherwise!

112
Q

What is the diagnostic sign on XR of SUFE?

What views on XR are needed?

A

Trethowans sign

Means that the line of Klein drawn along the upper edge of the femoral neck does not intersect with the femoral head

AP and lateral views

113
Q

Name 3 causes of Genu Varum?

A

Rickets
Trauma
Osteochondroma

114
Q

What is inflammation of the tibial tuberosity in kids called?

How can the pain be elicited?

A

Osgood schlatter disease

A straight leg raise

115
Q

What type of Salter-Harris fracture is most common?

A

Type 2

116
Q

Which part of the bone is involved in a salter Harris type 2?

A

The physis and metaphysis

117
Q

Which part of the bones are involved in a Salter Harris type 3?

A

Physis and epiphysis

118
Q

Which parts of the bone are involved in a Salter Harris type 4?

A

Physis, metaphysis and epiphysis

119
Q

Which type of Salter Harris fracture affects the physis only?

A

Type 1

120
Q

Which paediatric fracture arises due to bending of the forearm, with the fracture occurring on the convex (bulging) side?

A

green stick fracture

121
Q

Which nerve roots are damaged in Erb’s palsy?

How does this present?

A

Damage to C5/C6

Internally rotated and hand out (waiters tip)

122
Q

What causes erb’s palsy?

A

Occurs during shoulder dystocia

123
Q

Which nerves are damaged in Klumpke’s palsy?

A

C8/T1

124
Q

Compare the nerves damaged in a humeral neck fracture/dislocation with those damaged in a humeral mid shaft fracture?

A

Humeral neck fracture/dislocation: Axillary nerve (C5/C6)

Humeral mid shaft fracture: Radial nerve (C5-8)

125
Q

How does damage to the radial (C5-8) nerve present?

A

Wrist drop

126
Q

What is Paget’s disease?

A

Rapid bone resorption followed by chaotic bone deposition

ie- bone lost then put back in a chaotic way

127
Q

Describe the biochem of Paget’s?

A

All normal other than Alk Phos - it is raised

Alk Phos is a marker of osteoblasts (bone deposition)

128
Q

Describe 3 symptoms of Paget’s disease?

A

Prone to fractures
Hearing loss (if bones in ear affected)
Osteosarcoma

129
Q

Which bones are affected by Paget’s?

A

Skull, spine, pelvis and femur

130
Q

How is Paget’s treated?

A

Biphosphonates

131
Q

Describe Alk Phos and calcium levels in osteoporosis?

A

Normal levels of ALk Phos and calcium

132
Q

Describe the action of biphosphonates?

A

Reduce osteoclastic activity

133
Q

How is osteoporosis treated?

A

Calcium
Vit D
Biphosphonates

134
Q

What risk scores are used to assess for osteoporosis?

Who should be routinely assessed?

A

FRAX

QRISK

Women > 65
Men < 75

135
Q

Compare the biochem profiles of osteomalacia and osteoporosis

A

Osteoporosis: normal Ca and Alk Phos

Osteomalacia: LOW Ca and phosphate, HIGH Alk Phos

136
Q

Which test is done for carpal tunnel syndrome?

A

Tinel’s test

137
Q

Which condition is most commonly associated with Dupuytren’s contracture?

A

Alcohol abuse

138
Q

Which condition is most likely to cause carpal tunnel syndrome and extensor tendon rupture at the wrist?

A

Rheumatoid arthritis

139
Q

What condition can be associated with osteomalacia or rickets?

A

Chronic renal failure

140
Q

What risk factor is most commonly associated with AVN of the hip?

A

Long term corticosteroid use

141
Q

Which nerve may be damaged in an anterior hip dislocation?

A

Obturator nerve

142
Q

Which nerve is responsible for foot plantar-flexion and inversion?

A

Tibial nerve

143
Q

Which nerve is responsible for foot dorsiflexion and eversion?

A

Common peroneal nerve

144
Q

Damage to what nerve results in +ive trendeleburg sign?

A

Superior glut nerve

145
Q

Which nerve causes hip extension and is injured in sciatica?

A

Inferior glut nerve

146
Q

How is osteoporosis treated?

A

Vit D, calcium, biphosphonates

AA Y4 Finals cards NE (40 decks)

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