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PLABABLE 2.0 > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

11- year old boy + limping + affected leg is shorter than the other + externally rotated hip that increases with hip flexion + painful knee/hip/thigh/groin

A

SUFE (slipped upper femoral epiphysis)

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2
Q

What is the likely foot bone to fracture in a vertical fracture?

A

calcaneus

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3
Q

The likely affected foot bone in a stress fracture?

A

Metatarsals

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4
Q

Bone pain in young people unrelated to activity + responds quickly to NSAIDs (aspirin)

A

Osteoid osteoma

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5
Q

Sensory loss responsible in the groin and pelvic girdle

A

L1

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6
Q

Sensory loss responsible in the anterior thigh

A

L2

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7
Q

Responsible for sensory loss in the anterior thigh

A

L2

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8
Q

Responsible for sensory loss in the inner (medial) thigh and distal anterior thigh

A

L3

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9
Q

Responsible for sensory loss in the inner shin

A

L4

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10
Q

Responsible for sensory loss in the lateral shin and dorsum of the foot

A

L5

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11
Q

Responsible for sensory loss in the lateral foot

A

S1

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12
Q

Known case of prostate cancer + perianal/groin numbness (saddle paresthesia) + inability to initiate voiding + back pain

A

Cauda equina syndrome

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13
Q

Sciatica + saddle paresthesia + urinary retention + fecal incontinence
Diagnostic?

A

Urgent MRI
Urgent referral to orthopedic surgeon
Urgent surgical decompression

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14
Q

Severe low back pain radiating to the leg + positive straight leg raising test + when getting up from a lying position INCREASES PAIN + lying down relieves pain
Diagnosis?
Next step?

A

Lumbosacral Disc Herniation
Reassure
(MRI spine if with red flags)

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15
Q

Shooting electric shock pain moving down a leg

Treatment?

A

Sciatica

Amitriptyline (then Gabapentin, Pregabalin)

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16
Q

Shoulder weakness + pain esp on raising arm above the shoulder

A

Supraspinatus tendinitis

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17
Q

Elderly with osteoporosis + history of fall + painful hip + shortened, externally rotated leg
Likely diagnosis?

A

Fracture of the NECK of the femur

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18
Q

Young male 11-15 years old + limping + shortened leg + externally rotated leg
Diagnosis?

A

Slipped Upper Femoral Epiphysis

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19
Q

Young girl + breech presentation + limping + painless leg that is shorter than the other = unequal skin folds
Diagnosis?

A

Developmental dysplasia of the hip

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20
Q

Painful base of thumb + tender anatomic snuffbox + pronation followed by ulnar deviation produced pain
Diagnosis?
Diagnostic?
Treatment?

A

Scaphoid Fracture

X-ray

POSITIVE X-ray - scaphoid cast for 6 weeks
NEGTIVE X-ray - cast and repeat X-ray in 2 weeks

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21
Q

Management of developmental dysplasia of the hip

A

Spontaneously stabilise - 3-6 weeks of age
Pavlik harness - for children younger than 4-5months
Surgery - older children

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22
Q

T

A
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23
Q

What is Thompson test and what is its significance?

A

Ask the patient to lie prone with their feet dangling over the edge of bed.
Gently squeeze the calf muscle.
Normal response is plantar flexion. Absence of plantar flexion upon squeezing the calf muscle is positive for THOMPSON TEST.
It is present in achilles tendon rupture

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24
Q

Audible pop in the ankle + sudden onset of significant pain in the calf or ankle + inability to walk or continue sport
What’s next?

A

Same-day referral to ortho (achilles tendon rupture)

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25
Q

Unable to extend and straighten 4th and 5th fingers + firm nodule found in the distal palmar crease + father has the same condition
Likely diagnosis?
Likely mechanism?
Management?

A

Dupuytren’s contracture
Formation of thickened fibrous tissue within the palmar fascia
Fasciotomy

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26
Q

More common in the thumb, middle or ring finger + stiffness of a finger + snapping or clicking sound when extending a flexed digit

A

Trigger finger (stenosing tenosynovitis)

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27
Q

Monoarthritis + pain following use + improves with rest + unilateral symptoms + no systemic upset

A

Osteoarthritis

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28
Q

Inovlves more than 1 joint + morning stiffness + improves with use + bilateral symptoms + systemic upset

A

Rheumatoid arthritis

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29
Q

X-ray findings: loss of joint space + Osteophytes forming at joint margins + subchondral sclerosis + subchondral cysts

A

Osteoarthritis

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30
Q

First-line management of osteoarthritis

A

Paracetamol + Topical NSAIDS

***second line is oral NSAIDS or COX-2i plus PPI; consider codeine if pain persists

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31
Q

Differentiate Colles fracture from Smith fracture.

A

Both Colles and Smith fracture are both fracture of the distal radius.
Colles = dinner fork deformity = distal radius is posteriorly displaced
Smith = garden spade deformity = reverse Colles = distal radius is anteriorly displaced

*** Si P Diddy ay may Colles (PD - posteriorly displaced, D - dinner fork deformity; Colles)
Si Smith ay may member ng ADG, nagpapractice sa garden. (ADG - anteriorly displaced; garden spade deformity; Smith fracture)

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32
Q

Child presenting with painful hip + mild fever + normal or mildly elevated WBC and ESR + happy and systemically well child

A

Transient synovitis

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33
Q

Child with painful hip + fever + leukocytosis + elevated ESR + tenderness, redness and swelling of hip and leg + systemically unwell

A

Septic Arthritis

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34
Q

In any fracture, if there is
1. Absence of pulses = neurovascular compromise
2. Obvious deformity
Next action?

A

Urgent reduction under sedation or analgesia

***Then refer to neurovascular/orthopedics

35
Q

Following a femur fracture, the absence of proximal and distal pulses in a lower limb indicates an injury in this structure:

A

Femoral artery

36
Q

Differentials for elevated ALP:

A

BBP

Bone + Biliary Tract + Pregnancy

Bone: Pagets, Osteomalacia, hyperparathyroidism, bone mets

37
Q

X-ray findings in Paget’s disease of the bone

A

Mutifocal SCLEROTIC patches
Blade of grass lesion (V-shape pattern bet healthy and diseased long bone)

***Remember sclerotic lesions of Paget’s disease of the bone vs. lytic (punched-out) lesions of multiple myeloma

38
Q

Bone pain + elevated alkaline phosphatase + normal Ca and Phosphate + multifocal patches on X-ray + heart failure

A

Paget’s Disease of the bone

***Remember the presence of hearing loss and heart failure with bone manifestations favours the diagnosis of Paget’s disease of the bone

39
Q

Dislocation of the head of the radius + fracture of the proximal 1/3 of the ulna
Likely structure affected?
Diagnosis?

A

Radial nerve

Monteggia fracture

40
Q

Dislocation of the radio-ulnar joint + fracture of the distal 1/3 of the radius

A

Galeazzi fracture

41
Q

Painful swelling/bruises + weakness and pain when grasping things with the thumb + tenderness over MCP joints
Diagnosis?
Mechanism?

A

Gamekeeper’s thumb

Injury to ulnar collateral ligament

42
Q

Important management of colles fracture in the elderly

A

Closed reduction followed by plaster of paris cast below elbow

43
Q

Bone marrow biopsy finding seen in multiple myeloma

A

Abundant plasma cells

44
Q

Findings in a serum protein electrophoresis of multiple myeloma

A

Increased spike of monoclonal Ig

45
Q

Findings in a urine protein electrophoresis of multiple myeloma

A

Bence Jones protein

46
Q

Findings in blood film of multiple myeloma

A

Rouleaux formation

47
Q

Wrist drop

Structure affected?

A

Radial nerve

48
Q

Structure affected in foot drop

A

Common peroneal or sciatic nerve

49
Q

Structure affected in claw hand

A

Ulnar nerve

50
Q

Structure affected in paresthesia of thumb, index and middle finger

A

Median nerve

51
Q

Structure affected in paresthesia of little and ring finger

A

Ulnar nerve

52
Q

Paresthesia of the dorsal aspect of the thumb +/- a small area over the (dorsal) area between 1st and 2nd index fingers

A

Radial nerve

53
Q

Numbness on superior aspect of upper arm just below the shoulder joint

A

Axillary nerve

54
Q

Fibular neck fracture - likely structure affected?

A

Common peroneal nerve

55
Q

Femur neck fracture - structure that is likely affected?

A

Sciatic nerve

56
Q

Fracture of the acetabulum - structure that is likely affected

A

Sciatic nerve

57
Q

Posterior dislocation of the hip - which structure must have been affected?

A

Sciatic nerve

58
Q

Fracture of the humeral shaft - which structure is likely affected?

A

radial nerve

59
Q

Colles fracture - structure likely affected?

A

Median nerve

60
Q

Most initial test for metastasis to bone?

A

Calcium (it would show hypercalcemia)

61
Q

Most appropriate test for metastasis to bone

A

Bone scintigraphy (or MRI)

***remember that DEXA is for osteoarthritis while skeletal survey is for multiple myeloma

62
Q

Chronic use of steroids + history of multiple fractures

Best modality?

63
Q

Young boy + painful knee + gait abnormality + tender, smooth, fixed mass over a side of the knee

A

Osteosarcoma

64
Q

Young boy + painful knee + gait abnormality + tender, smooth, fixed mass over a side of the knee + other systemic symptoms (fever, weight loss, tiredness)

A

Ewing sarcoma

***Remember osteosarcoma (most common) + systemic symptoms

65
Q

Lateral elbow swelling + limited ROM of elbow + passive rotation of elbow

More common in adults? How about in children?

A

Radial head fracture - in adults

Radial neck fracture - in children

66
Q

Femur fracture + deteriorating level of consciousness and o2 saturation 24-72 hours after surgery

A

Fat embolism

67
Q 
Fracture of distal radius + posteriorly displaced (dorsal angulation) fragments
Diagnosis?
Likely injured structure?
Rx in the elderly
Rx in the young?
A

Colles fracture
Median nerve
Elderly - Closed reduction followed by POP casting below elbow
Young - above the elbow backslab cast

68
Q

Numbness and tingling of the thumb, index and middle fingers
Diagnosis?
Structure likely affected?
Treatment?

A

Carpal Tunnel Syndrome
Median nerve (due to compression of the transverse carpal ligament)
Cut the transverse carpal ligament or Release flexor retinaculum

***Also remember median nerve association with colles fracture (dinner fork deformity)

69
Q

Pregnant with Carpal Tunnel Syndrome

A

Wear wrist splints until delivery

70
Q

Most common cause of septic arthritis?

A

Staphylococcus aureus

71
Q

Fever, pain, swelling and limited movement of the knee + risk factor: DM, steroid, HIV, rheumatoid arthritis

Diagnosis?
Cause?
Diagnostic?
Management?

A

Septic Arthritis
Staphylococcus aureus

Aspiration of synovial fluid
Blood culture

Management: Flucloxacillin (Clindamycin if allergic)

72
Q

Seronegative + no fever + young adult + following a urogenital infection or dysenteric infection + migratory OLIGOarthritis

A

Reactive arthritis

73
Q

Child (4-10 years old) fell on his outstretched arm + absent radial/brachial pulse
Diagnosis?
Likely structure damaged?

A

Angulated supracondylar fracture of the humerus

Brachial artery

74
Q

Meniscal tears are best seen by

75
Q

A player jumps and lands on a slightly twisted knee, presents with locking or locked leg

A

Meniscal tear

76
Q

A player jumps and lands on a slightly twisted knee, presents with positive Apley and McMurray test

A

Meniscal Tear

77
Q

A player jumps and lands on a slightly twisted knee, presents with popping

A

ACL injury

78
Q

A player jumps and lands on a slightly twisted knee, presents with immediate swelling

A

ACL injury

79
Q

A player jumps and lands on a slightly twisted knee, presents with delayed swelling

A

Meniscal Tear

80
Q

Direct impact to the lateral side, which ligament is most likely injured?

A

Medial collateral ligament injury

81
Q

Direct impact to the lateral side, which stress test turns positive?

A

Valgus

***Remember valgus = lateral side = MCL

82
Q

Direct impact to the medial side of the knee. Likely structure to be involved?

A

Lateral Collateral Ligament Injury

83
Q

Direct impact to the medial side of the knee. Which stress test is likely positive?

A

Varus stress test

***Remember: medial side = LCL = varus stress test

84
Q

3-9 years of age + Hip pain (progressive over the weeks) + limping + stiffness with decreased ROM + X-ray: flattening and radiolucency of the proximal metaphysis

A

Perthes disease

PLABABLE 2.0 (33 decks)

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