Orthopedics Mock Flashcards
Of the list below, which is not a cause of avascular necrosis?
Steroids Sickle cell disease Radiotherapy Myeloma Caisson disease
MYELOMA Causes of avascular necrosis P ancreatitis L upus A lcohol S teroids T rauma I diopathic, infection C aisson disease, collagen vascular disease R adiation, rheumatoid arthritis A myloid G aucher disease S ickle cell disease Steroid containing therapy for myeloma may induce avascular necrosis, however the disease itself does not cause it. Caisson disease as may occur in deep sea divers is a recognised cause.
Which of the following fractures names best accounts for the injury seen in a 14 year old boy who jumps off a 10 foot wall and lands on both feet and whose imaging shows a bimalleolar fracture of the right ankle?
Pott's Barton's Galeazzi Colles Bennett
POTT’S
A 78 year old man complains of a long history of shoulder pain and more recently weakness. On examination, active attempts at abduction are impaired. Passive movements are normal. What is the most likely diagnosis?
Rotator cuff tear Osteoarthritis Metastatic malignancy Adhesive capsulitis Calcific tendonitis
ROTATOR
Rotator cuff tears are common in elderly people and may occur following minor trauma or as a result of long standing impingement. Tears greater than 2cm should generally be repaired surgically. The length of the history in this scenario is suggestive of a tear complicating impingement.
A footballer sustains a knee injury in a match and is being assessed in the outpatient department. On examination, he has a positive valgus stress test and minimal joint effusion. What is the most likely underlying injury?
Injury to the lateral collateral ligament
Injury to the medial collateral ligament
Injury to the anterior cruciate ligament
Injury to the posterior cruciate ligament
Injury to the patellar tendon
A knee injury in the footballer with a positive valgus stress test is usually associated with MCL injury.
A 65-year-old Asian female presents with an extracapsular neck of femur fracture. Investigations show:
Calcium 2.07 mmol/l (2.20-2.60 mmol/l)
Phosphate 0.66 mmol/l (0.8-1.40 mmol/l)
ALP 256 IU/l (44-147 IU/l)
What is the most likely diagnosis?
Bone tuberculosis Hypoparathyroidism Myeloma Osteomalacia Paget's disease
Osteomalacia
low: calcium, phosphate raised: alkaline phosphatase
The low calcium and phosphate combined with the raised alkaline phosphatase point towards osteomalacia.
A 30 year old man injures his ankle playing football. On examination, he has tenderness over both medial and lateral malleoli. X-ray demonstrates a bimalleolar fracture with a displaced distal fibula fracture, at the level of the syndesmosis and fracture of the medial malleolus with talar shift. The ankle has been provisionally reduced and splinted in the emergency department. What is the most appropriate management?
Application of external fixation device Application of compression dressing and physiotherapy Application of ankle boot Surgical fixation Below knee amputation
This is an unstable fracture pattern with a Weber B fracture of the distal fibula and a fracture of the medial malleolus. Talar shift indicates loss of ankle mortice congruity. This injury should therefore be treated with surgical fixation.
A 22 year man is shot in the back, in the lumbar region. He has increased tone and hyper-reflexia of his right leg. He cannot feel his left leg. What is the most likely explanation?
Epidural haematoma Osteomyelitis Transverse myelitis Brown-Sequard syndrome Tabes dorsalis
Brown -Sequard syndrome is caused by hemisection of the spinal cord. It may result from stab injuries or lateral vertebral fractures. It results in ipsilateral paralysis (pyramidal tract) , and also loss of proprioception and fine discrimination (dorsal columns). Pain and temperature sensation are lost on the contra-lateral side. This is because the fibres of the spinothalamic tract have decussated below the level of the cord transection.
Which of the following is not typically seen in patients with a femoral neck fracture?
Malunion Non union Avascular necrosis Shortening External rotation
Malunion would be unusual with a femoral neck fracture. Because it is a weight bearing joint, if the fracture is not united then it does not heal at all. It is for this reason that most femoral neck fractures are fixed. Avascular necrosis is a well recognised complication and a total hip replacement or hemiarthroplasty is usually considered in the elderly.
A 34 year old man presents with localised spinal pain over 2 months which is worsened on movement. He is known to be an IVDU. He has no history suggestive of tuberculosis. The pain is now excruciating at rest and not improving with analgesia. He has a temperature of 39 oC. What is the most likely diagnosis?
Transverse myelitis Osteomyelitis Potts disease of the spine Epidural haematoma Brown-Sequard syndrome
OSTEOMYELITIS
In an IVDU with back pain and pyrexia have a high suspicion for osteomylelitis. The most likely organism is staph aureus and the cervical spine is the most common region affected. TB tends to affect the thoracic spine and in other causes of osteomyelitis the lumbar spine is affected.
A 63 year nurse falls on an extended and pronated wrist. An x-ray shows a distal radial fracture with radiocarpal dislocation. Which type of fracture is most likely?
Bennett's Barton's Pott's Smith's Monteggia's
Barton’s fractures tend to have intra-articular involvement and dislocation may sometimes be present.
With which of the conditions listed below is a Hill- Sachs lesions classically associated?
Fracture of the surgical neck of the humerus Glenohumeral dislocation Supraspinatus tear Acromioclavicular dislocation Sternoclavicular dislocation
A Hill-Sachs lesion occurs when the cartilage surface of the humerus is in contact with the rim of the glenoid. About 50% of anterior glenohumeral dislocations are associated with this lesion.
A 64 year old man is involved in a motor vehicle accident and is found to have a fracture affecting the anatomical neck of his humerus which is displaced. What is the most appropriate management?
Place a collar and cuff for 3 weeks and then commence physiotherapy
Hemiarthroplasty
Place in a collar and cuff for 6 weeks and then commence physiotherapy
Reduce the fracture and place in an arm sling with repeat imaging at 14 days
Reduction under anaesthesia and place in collar and cuff system for 6 weeks
HEMIARTHROPLASTY
These injuries are at significant risk of avascular necrosis and consideration of surgery is important. A hemi arthroplasty may be needed.
Which of the following types of growth plate fractures may have similar radiological appearances?
Salter Harris types 1 and 5 Salter Harris types 4 and 5 Salter Harris types 3 and 5 Salter Harris types 1 and 2 Salter Harris types 1 and 3
1 - 5
Mnemonic: SALTER
S (Type 1): Straight through the growth plate
A (Type 2): Above - through growth plate and Above involving the metaphysis
L (Type 3): Lower -through growth plate and beLow involving the epiphysis
T (Type 4):Through - Through both metaphysis, epiphysis and growth plate
E (Type 5): Everything - Crush / compression injury
R (Type 5): Ruined
As recommended by one of our users
Salter Harris injury types 1 and 5 (transverse fracture through growth plate Vs. Compression fracture) may mimic each other radiologically. Type 5 injuries have the worst outcomes. Radiological signs of type 5 injuries are subtle and may include narrowing of the growth plate.
A 20 year old woman sustains a Holstein-Lewis fracture. Which nerve is at risk?
Ulnar Radial Median Musculocutaneous Axillary .
Since the distal humerus is affected, the radial is at risk
A 35 year old mechanic is hit by a fork lift truck. He sustains a Gustilo and Anderson type IIIA fracture of the shaft of the left femur. What is the most appropriate course of action?
Amputation
Debridement and external fixation
Open reduction and fixation
Debridement and placement of intramedullary nail
Debridement and placement of long leg plaster cast
OPEN - INFECTED - DEBR - EXTEERRRNAL
As there is no associated vascular injury the patient may be suitable for debridement of the area and external fixation. If debridement leaves a tissue defect then plastic surgical repair will be needed at a later stage. With open fractures, its best not to place intramedullary metalwork as this may become infected.
