Orthopedics

Question 1

Jefferson fracture and common cause

Answer 1

Fracture of the anterior and posterior arches of the cervical spine. Often caused by downward force on the head like diving

Question 2

Commonly affected vertebra in hangman’s fracture and effect on cord

Answer 2

C2, shearing of the spinal cord

Question 3

Criteria for 1h head CT

Answer 3

Any non-accidental injury
Suspicion of fracture
>1 episodes of vomiting 
Focal neurological deficits
Presence of bruise, swelling or >5cm laceration on head.

Question 4

Common organisms causing otitis externa

Answer 4

Commonly caused by pseudomonas aeruginosa (can cause malignant otitis with temporal bone osteomyelitis) or staphylococcus species.

Question 5

Typical associations of otitis media

Answer 5

Typically associated with a recent viral URTI and in children aged 3-6

Question 6

Angioedema causes and management

Answer 6

Swelling of subdermis or mucous membranes such as face, lips, mouth, upper airway, genitals and extremities. Majority are idiopathic, followed by hereditary, ACE inhibitors and certain foods.

Question 7

3 causes of vertigo and differential

Answer 7

PPPV: vertigo in the absence of other symptoms
Ménière’s disease: characterised by episodic sudden onset vertigo, hearing loss and tinnitus.
Labyrinthitis: usually associated with recent URTI, with varying degree of hearing loss.

Question 8

Common site of clavicular fracture

Answer 8

Usually middle third of the clavicle.

Question 9

Common nerve damaged in shoulder dislocation/ neck of humerus fracture

Answer 9

Damage to the axillary nerve and artery.

Question 10

What is Erb’s palsy and symptoms

Answer 10

Erb’s Palsy is an injury to the upper trunks of C5-6 nerves. It causes waiter tip deformity, winging scapula, horner’s syndrome

Question 11

Nerve damaged in winged scapula

Answer 11

Long thoracic nerve.

Question 12

Define monteggia and galeazzi fractures

Answer 12

Monteggia: pros 1/3 ulnar fracture with dislocation or radial head
Galeazzi: distal radial fracture with distal radio-ulnar dislocation

Question 13

Colle’s vs Smiths fracture

Answer 13

Colles: fracture of distal radius with dorsal displacement of distal fragment
Smith: fracture of distal radius with ventral displacement of distal fragment

Question 14

Piriformis syndrome signs

Answer 14

Wallet sign - men can no longer sit on their wallets. It is caused by an entrapment of the sciatic nerve by piriformis.

Question 15

Segond fracture

Answer 15

A fracture where a tendon pulls off a piece of bone from the lateral aspect of the tibial plateau and is very frequently associated with disruption to the anterior cruciate ligament.

Question 16

Tear of the ACL MOI

Answer 16

Twisting motion with foot fixed on the ground.

Question 17

Function of the ACL and PCL

Answer 17

ACL: prevents anterior movement of tibia relative to femur
PCL: prevents posterior movement of tibia relative to femur

Question 18

Damage to medial meniscus MOI

Answer 18

Twist of a flexed knee

Question 19

Unhappy triad

Answer 19

tear to medial meniscus, medial collateral and anterior cruciate ligaments

Question 20

Difference between ACL and medial meniscus tear in swelling

Answer 20

ACL: straight away

Medial meniscus: after hours

Question 21

Commonest ankle sprain direction and ligament involvement

Answer 21

80% are inversion - with involvement of the anterior talofibular ligament.

Question 22

A burn involving epidermis, erythema, normal cap refil and pain would be

Answer 22

Superficial burn

Question 23

A burn with red, cap refil present, exudate +- blisters and pain would be

Answer 23

Superficial partial thickness burn

Question 24

A burn with cherry red/ white, slow cap refil and variable sensation would be

Answer 24

Deep dermal

Question 25

A burn with white black or brown skin, dry and leathery, no cap refil and no sensation would be a

Answer 25

Full thickness burn

Question 26

Formula for fluid resus in burns, how you give it and type of fluid

Answer 26

4mls/4g/% burn. Give half over first 8h, then rest over 16h. Administer warm hartmans

Question 27

Innervation of the median nerve

Answer 27

Ventrally, sensory to the first 3 digits and 1/2 of the 4th and palm Dorsally, sensory to the fingertips of first 3 digits Motor to lateral two lumbricals, opponens policies, abductor policis breves, flexor policies brevis (LOAF)

Question 28

Innervation of the radial nerve

Answer 28

Sensory to the dorsal lateral half of the hand and motor to extensor muscles in forearm

Question 29

Ulnar nerve innervation

Answer 29

Motor to most intrinsic muscles of the hand (other than those inner ate dinner by median nerve) Sensory to dorsum and ventral aspect of the 5th and 1/2 of 4th digit and associated palm.

Question 30

Scaphoid fracture risk

Answer 30

A vascular necrosis if scaphoid tubercle is fractured.

Question 31

Management of an Achilles’ tendon tear

Answer 31

Equinus cast (plaster of Paris with plantar flexed foot) and foot is slowly returned to normal position over several weeks. Surgical reconstruction is also an option

Question 32

Nerve causing wrist drop

Answer 32

Radial nerve

Question 33

Common nerve injury in anterior dislocation of shoulder and symptoms

Answer 33

Axillary nerve: weak abduction and external rotation (due to trees minor and deltoid), sensory loss in shoulder area

Question 34

Damage to C5 spinal cord causes

Answer 34

Upper arm abduction weakness (axillary), lateral upper arm sensory loss, weakness in elbow flexion

Question 35

Lytic lesion appearance on x-ray and main causes

Answer 35

They will appear translucent on x-ray. Can be due to multiple myeloma or metastatic causes or osteomyelitis

Question 36

Froment’s sign

Answer 36

Ulnar nerve palsy unable to hold paper between thumb and index