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Medicine and Surgery Mushkies > Passmed Orthopaedics Mushkies > Flashcards

Passmed Orthopaedics Mushkies Flashcards

1
Q

What is the usual mechanism by which an AC joint injury typically occurs?

A

FOOSH

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2
Q

How are AC joint injuries graded?

A

from I to VI depending on the degree of separation

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3
Q

How are AC joint injuries managed?

A
  1. I and II = conservative rx with sling and immobilisation
  2. III = depends on individual circumstances
  3. IV, V and VI are rare and require surgical intervention
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4
Q

What is the initial imaging modality of choice for Achilles tendon rupture?

A

US

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5
Q

What are risk factors for achilles tendon disorders?

A
  1. Quinolone (e.g. ciprofloxacin) use

2. Hypercholesterolaemia (predisposes to tendon xanthoma)

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6
Q

What are the features of achilles tendinopathy?

A
  1. Gradual onset of posterior heel pain that is worse following activity
    2, Morning pain and stiffness common
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7
Q

How does one examine for achilles tendon rupture?

A

Simmond’s triad

  1. Abnormal angle of declination, with possible greater dorsiflexion of injured foot (Matles test)
  2. Gap in the tendon
  3. Foot will stay in neutral position when calf is squeezed (Thompson test)
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8
Q

What are features of lateral epicondylitis?

A
  1. Pain and tenderness localised to the lateral epicondyle
  2. Pain worse on resisted wrist extension with the elbow extended or supination of the forearm with the elbow extended
  3. Episodes last between 6 months and 2 years, with pts tending to have acute pain for 6-12 weeks
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9
Q

What are features of medial epicondylitis?

A
  1. Pain and tenderness localised to the medial epicondyle
  2. Pain is aggravated by wrist flexion and pronation
  3. Numbness/tingling in the 4th and 5th finger due to ulnar nerve involvement
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10
Q

What are features of radial tunnel syndrome?

A
  1. Symptoms similar to lateral epicondylitis, making it difficult to diagnose
  2. However, pain tends to be 4-5cm distal to the lateral epicondyle
  3. Symptoms worsened by extending the elbow and pronating the forearm
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11
Q

What is the most common cause of radial tunnel syndrome?

A

Most commonly due to compression of the posterior interosseous branch of the radial nerve

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12
Q

What is cubital tunnel syndrome?

A

Compression of the ulnar nerve as it passes through the cubital tunnel

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13
Q

What are features of cubital tunnel syndrome?

A
  1. Initially intermittent tingling in the 4th and 5th finger
  2. May be worse when the elbow is resting on a firm surface or flexed for extended periods
  3. Later numbness in the 4th and 5th finger associated with weakness
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14
Q

What are features of olecranon bursitis?

A
  1. Swelling over the posterior aspect of the elbow
  2. May be associated pain, warmth and erythema
  3. Typically affects middle-aged male patients
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15
Q

What demographic of pts does Perthes disease typically affect?

A

4-8 y/o, 5M:1F

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16
Q

What are some X-ray features of Perthes disease?

A

Widening of joint space and flattening of the femoral head

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17
Q

What are 5 red flags for lower back pain?

A
  1. Age = <20 y/o or >50 y/o
  2. Hx of malignancy
  3. Hx of trauma
  4. Night pain
  5. Systematically unwell (FLAWS)
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18
Q

What is the most likely cause of an asymptomatic, fluctuant swelling behind the knee in a child?

A

Baker’s cyst

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19
Q

What are Baker’s cysts?

A

They are not true cysts, but are in fact a distension of the gastrocnemius-semimembrnaosus bursa

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20
Q

How can you classify Baker’s cysts?

A
  1. Primary = no underlying pathology, typically seen in children
  2. Secondary = underlying condition such as osteoarthritis, typically seen in adults
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21
Q

How does one manage a Baker’s cyst?

A
  1. In children they typically resolve and do not require rx

2. In adults, the underlying cause should be rx where appropriate

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22
Q

What causes Osgood-Schlatter disease?

A

Multiple small avulsion fractures within the ossification centre of the tibial tuberosity at the inferior attachment of the patellar ligament

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23
Q

What is the structure that is divided in the surgical management of carpal tunnel syndrome?

A

The flexor retinaculum

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24
Q

What are the typical findings in a Hx of a pt with carpal tunnel syndrome?

A
  1. Pain/pins and needles in the thumb, index and middle finger
  2. Pt shakes their hand to obtain relief, typically at night
  3. Unusually, the symptoms may ‘ascend’ proximally
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25
Q

What may you find on examination of a pt with carpal tunnel syndrome?

A
  1. Weakness of thumb abduction (ABP)
  2. Wasting of thenar eminence (NOT hypothenar)
  3. Tinnel’s sign = tapping causes paraesthesia
  4. Phalen’s test = flexion of wrist causes pain
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26
Q

What are some causes of Carpal tunnel syndrome?

A
  1. Idiopathic
  2. Pregnancy
  3. Oedema e.g. HF
  4. Lunate fracture
  5. RhA
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27
Q

What do you find upon performing EP in carpal tunnel syndrome?

A

Motor and sensory prolongation of the action potential

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28
Q

What is the management for carpal tunnel syndrome?

A

1 .Corticosteroid injections

  1. Wrist splints at night
  2. Surgical decompression
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29
Q

What is compartment syndrome?

A

Raised pressure within a closed anatomical space, with the raised pressure eventually compromising tissue perfusion, resulting in tissue necrosis

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30
Q

What are the 2 main fractures carrying a risk of compartment syndrome?

A
  1. Supracondylar fractures

2. Tibial shaft injuries

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31
Q

How does one diagnose compartment syndrome?

A

By measurement of intracompartmental pressures = pressures >20mmHg are abnormal and >40mmHg are diagnostic

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32
Q

What is the management for compartment syndrome?

A

Prompt and extensive fasciotomies

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33
Q

What may have to be considered if muscle groups are frankly necrotic at fasciotomy?

A

Debridement and amputation

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34
Q

In what time frame does death of a muscle group start to occur?

A

4-6 hours

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35
Q

Why do pts with compartment syndrome require aggressive IV fluids?

A

Myoglobinuria may occur following fasciotomy and result in AKI

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36
Q

What is the management for an undisplaced, intracapsular hip fracture?

A
  1. No comorbidities = internal fixation (esp. if young)

2. Major comorbidities = hemiarthroplasties

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37
Q

What is the management for a displaced, intracapsular fracture in a pt with no co-morbidities?

A
  1. Age < 70 = internal fixation if possible

2. Age > 70 = total hip arthroplasty

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38
Q

What is the management for a displaced, intracapsular fracture in a pt with major comorbidities?

A

Hemiarthroplasty

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39
Q

What is the management for an extracapsular fracture (non-special type)?

A

Dynamic hip screw

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40
Q

What is the management for an extracapsular fracture (reverse oblique, transverse or sub-trochanteric)?

A

Intramedullary device

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41
Q

What is the more formal term for a Charcot joint?

A

Neuropathic arthropathy

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42
Q

What causes a Charcot joint?

A

Progressive degeneration of a weight-bearing joint due to loss of sensation

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43
Q

What is the most likely cause of a non-tender, swollen, erythematous, hot foot?

A

An acute Charcot joint

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44
Q

What are 3 causes of Charcot’s joints?

A
  1. DM
  2. Alcohol
  3. Syphilis (Tabes dorsalis)
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45
Q

What is the likely cause of knee pain in a 19 year old girl which is worse when walking down the stairs and when sitting still?

A

Chondromalacia patallae

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46
Q

What is the mainstay of management for chondromalacia patellae?

A

Physiotherapy

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47
Q

Knee pain after being hit with a hockey stick with a normal X ray?

A

Patellar dislocation - may spontaneously reduce when the leg is straightened`

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48
Q

What is the most common cause of heel pain in adults?

A

Plantar fasciitis

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49
Q

What is a Morton’s neuroma?

A

Thickening of the tissue around the nerve, usually between the 3rd and 4th toes

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50
Q

Where is pain most typically worst in plantar fasciitis?

A

Around the medial calcaneal tuberosity

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51
Q

What is the management of plantar fasciitis?

A
  1. Rest the feet where possible
  2. Wear shoes with good arch support and cushioned heels
  3. Insoles and heel pads may be helpful
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52
Q

Twisting sporting injury followed by delayed onset of knee swelling and locking are suggestive of a?

A

Menisceal tear

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53
Q

What is the usual management for a menisceal tear?

A

Arthroscopic meniscectomy

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54
Q

How does a ruptured ACL typically present?

A
  1. Mechanism = high twisting force applied to a bent knee

2. Typically presents with loud crack, pain, and rapid joint swelling (haemarthrosis)

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55
Q

How does a ruptured PCL typically present?

A
  1. Mechanism = hyperextension injuries

2. Tibia lies back on the femur with a paradoxical anterior draw test

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56
Q

How does a ruptured MCL present?

A
  1. Mechanism = leg forced into valgus via force outside the leg
  2. Knee unstable when put into valgus position
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57
Q

What are the 2 types of patellar dislocation?

A
  1. Direct blow to patella causing undisplaced fragments

2. Avulsion fracture

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58
Q

What are some features of a Tibial plateau fracture?

A
  1. Occur in the elderly (or young following significant trauma)
  2. Mechanism = knee forced into valgus/varus, but the knee fractures before the ligaments fracture
  3. Varus injury affects medial plateau and valgus injury affects lateral plateau
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59
Q

What classification system is used for tibial plateau fractures?

A

The Schatzker classification system

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60
Q

What are 5 types of paediatric fracture?

A
  1. Complete = both sides of cortex breached
  2. Toddlers = oblique tibial fracture in infants
  3. Plastic deformity = deformity without cortical disruption
  4. Greenstick = unilateral cortical breach only
  5. Buckle = incomplete cortical disruption resulting in periosteal haematoma only
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61
Q

What are the 5 Salter-Harris types?

A
  1. Through physis only
  2. Through physis and metaphysis
  3. Through physis and epiphysis
  4. Through metaphysis, physis and epiphysis
  5. Crush injury only involving physis
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62
Q

What are 2 conditions that can cause pathological fractures in young people?

A
  1. Osteogenesis imperfecta

2. Osteopetrosis

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63
Q

What is De Quervain’s tenosynovitis?

A

Inflammation of the tendons on the lateral aspect of the wrist and thumb, in the first dorsal compartment i.e. abductor pollicis longus and extensor pollicis brevis tendons

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64
Q

What test can be done to diagnose De Quervain’s tenosynovitis?

A

Finkelstein’s test = grab the thumb and ulnar deviate the hand sharply, leading to pain along the distal radius

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65
Q

How doe De Quervain’s tenosynovitis present?

A
  1. Pain on the radial side of the wrist
  2. Tenderness over the radial styloid process
  3. Abduction of the thumb against resistance is painful
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66
Q

What is the management of De Quervain’s tenosynovitis?

A
  1. Analgesia
  2. Steroid injection
  3. Immobilisation with thumb splint (spica) may be effective
  4. Surgical Tx is sometimes required
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67
Q

Where is the distal fragment displaced in a Colles fracture?

A

Dorsally

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68
Q

Where is the distal fragment displaced in a Smith’s fracture?

A

Anteriorly

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69
Q

What is a galeazzi fracture?

A

Fracture of the wrist with dislocation of the distal radioulnar joint

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70
Q

What are the 3 features of a classic Colles’ fracture?

A

1 .Transverse fracture of the radius

  1. 1 inch proximal to the radio-carpal joint
  2. Dorsal displacement and angulation
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71
Q

Foot drop after a low anterior resection, what nerve is damaged?

A

Peroneal nerve

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72
Q

Groin pain after inguinal hernia repair, what nerve is damaged?

A

Ilioinguinal nerve

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73
Q

Foot drop after a total hip replacement via a posterior approach, what nerve is damaged?

A

Sciatic nerve

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74
Q

What are the muscular components of the lower limb?

A
  1. Anterior compartment
  2. Peroneal compartment
  3. Superficial posterior compartment
  4. Deep posterior compartment
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75
Q

What are the muscles of the anterior compartment of the lower limb?

A
  1. Tibialis anterior
  2. Peroneus tertius
  3. Extensor hallucis longus
  4. Extensor digitorum longus
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76
Q

What nerve supplies the anterior compartment of the lower limb?

A

Deep peroneal nerve

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77
Q

What is the function of tibialis anterior?

A

Dorsiflexes ankle, inverts foot

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78
Q

What is the function of peroneus tertius?

A

Dorsiflexes ankle, everts foot

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79
Q

What is the function of extensor hallucis longus?

A

Dorsiflexes ankle, extends big toe

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80
Q

What is the function of extensor digitorum longus?

A

Dorsiflexes ankle, extends lateral 4 toes

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81
Q

What are the muscles of the peroneal compartment of the lower limb?

A

Peroneus longus and peroneus brevis

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82
Q

What nerve supplies the peroneal compartment of the lower limb?

A

Superficial peroneal nerve

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83
Q

What is the function of peroneus longus?

A

Everts foot, assists in ankle plantar flexion

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84
Q

What is the function of peroneus brevis?

A

Plantar flexes ankle

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85
Q

What are the muscles of the superficial posterior compartment of the lower limb?

A

Gastrocnemius and soleus

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86
Q

What nerve supplies the superficial posterior compartment of the lower limb?

A

Tibial nerve

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87
Q

What is the function of gastrocnemius?

A

Plantar flexes foot, may also flex knee

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88
Q

What is the function of soleus?

A

Plantar flexes foot

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89
Q

What are the muscles of the deep posterior compartment of the lower limb?

A
  1. Tibialis posterior
  2. Flexor hallucis longus
  3. Flexor digitorum longus
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90
Q

What nerve supplies the deep posterior compartment of the lower limb?

A

Tibial nerve

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91
Q

What is the function of flexor digitorum longus?

A

Flexes lateral 4 toes

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92
Q

What is the function of flexor hallucis longus?

A

Flexes the big boi

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93
Q

What is the function of tibialis posterior?

A

Plantar flexes foot, inverts foot

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94
Q

What are the bony components of the ankle joint?

A

Distal tibia and fibula and superior aspect of the talus

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95
Q

What is the only mortise and tenon joint in the body?

A

The talocrural joint (ankle joint)

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96
Q

What ligaments support the syndesmosis between the tibia and fibula?

A
  1. Anterior inferior tibiofibular ligament (AITFL)
  2. Posterior inferior tibiofibular ligament (PITFL)
  3. Interosseous ligament (IOL)
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97
Q

What ligament joints the distal fibula to the talus?

A

Anterior and posterior talofibular ligaments (ATFL and PTFL)

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98
Q

What ligament joins the calcaneus to the fibula?

A

Calcaneofibular ligament

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99
Q

What are the lateral collateral ligaments?

A

The ATFL, PTFL and calcaneofibular ligament

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100
Q

What ligament joins the distal tibia to the talus?

A

The deltoid ligament

101
Q

What is a sprain?

A

A stretching, partial or complete tear of a ligament

102
Q

How can you classify ankle sprains?

A

High ankle sprains and low ankle sprains

103
Q

What is a high ankle sprain?

A

Sprain involving the syndesmosis

104
Q

What is a low ankle sprain?

A

Involving the lateral collateral ligaments

105
Q

Which kind of ankle sprain is more common

A

Low ankle sprain (90%)

106
Q

Which ligament is most commonly injured in a low ankle sprain?

107
Q

What percentage of ankle sprains are associated with a fracture?

108
Q

What is the management for a low ankle sprain?

A
  1. RICE protocol
  2. Removable orthosis/cast/crutches for short term symptoms relief
  3. MRI +/- surgical intervention
109
Q

What is the common mechanism by which low ankle sprains occur?

A

Inversion injury

110
Q

What is the common mechanism by which a high ankle sprain occurs?

A

External rotation of the foot, causing the talus to push into the fibula laterally

111
Q

Which kind of ankle sprain is more associated with painful weight-bearing?

A

High ankle sprains

112
Q

What is Hopkin’s squeeze test?

A

A test for high ankle sprain

1. Pain when the tibia and fibula are squeezed together at the level of the mid-calf

113
Q

What may you see on plain radiograph of a high ankle sprain?

A

Widening of the tibiofibular joint or ankle mortise

114
Q

What is the management of a high ankle fracture?

A
  1. Widening of the tibiofibular joint –> operative fixation is usually warranted
  2. No widening of the tibiofibular joint –> non-weight-bearing orthosis or cast until pain subsides
115
Q

Which nerve is Froment’s sign testing?

A

Ulnar nerve palsy

116
Q

What muscle function is being tested with Froment’s sign?

A

Adductor pollicis

117
Q

What is Froment’s sign?

A

Hold a piece of paper between their thumb and index finger. The object is then pulled away. If ulnar nerve palsy, unable to hold the paper and will flex the flexor pollicis longus to compensate (flexion of thumb at interphalangeal joint)

118
Q

Which is more sensitive - Phalens or Tinels sign?

A

Phalen’s

119
Q

What nerve is most likely to be injured during a knee arthroplasty?

A

Common peroneal nerve

120
Q

What is an eponymous test used to assess a meniscal teat?

A

Thessaly’s test

121
Q

What is Thessaly’s test?

A

The patient is supported by doctor and is asked to stand on the affected leg, flexed to 20 degree. The test is positive if there is pain on twisting knee

122
Q

What is the most common cause of lumbar canal stenosis?

A

Degenerative disease

123
Q

What is the pathology of degenerative disease in the spine that causes lumbar spinal stenosis?

A

Degeneration is believed to begin in the intervertebral disk where biochemical changes such as cell death and loss of proteoglycan and water content lead to progressive disk bulging and collapse. This process leads to an increased stress transfer to the posterior facet joints, which accelerates cartilaginous degeneration, hypertrophy, and osteophyte formation; this is associated with thickening and distortion of the ligamentum flavum. The combination of the ventral disk bulging, osteophyte formation at the dorsal facet, and ligamentum flavum hyptertrophy combine to circumferentially narrow the spinal canal and the space available for the neural elements. The compression of the nerve roots of the cauda equina leads to the characteristic clinical signs and symptoms of lumbar spinal stenosis.

124
Q

What is the management of degenerative spinal canal stenosis?

A

Laminectomy

125
Q

What is a Bennett’s fracture?

A
  1. Intra-articular fracture of the first carpometacarpal joint
  2. Often due to impact on flexed metacarpal, caused by fist fights
126
Q

What is a Pott’s fracture?

A

Bimalleolar ankle fracture, usually caused by forced foot eversion

127
Q

What is morning stiffness >2 hours indicative of?

A

Inflammatory arthritis

128
Q

What score is used to assess severity of OA of the hip?

A

The Oxford Hip Score

129
Q

What are 4 reasons for revision of a THR?

A
  1. Aseptic loosening (most common)
  2. Pain
  3. Dislocation
  4. Loosening
130
Q

How does frozen shoulder present?

A

Through an initial painful stage followed by a period of joint stiffness (painful freezing phase –> adhesive phase –> recovery phase)

131
Q

What are two causes of rotator cuff tears in the elderly??

A
  1. Minor trauma

2. Longstanding impingement

132
Q

What is parsonage-turner syndrome?

A

An acute brachial neuropathy, the cause of which is unknown, but tends to result in autoimmune inflammation of the brachial plexus

133
Q

How does parsonage-turner syndrome typically present?

A

Severe shoulder or arm pain followed by weakness and numbness, often associated with winging of the scapula

134
Q

How is an impacted fracture of the surgical neck of the humerus usually managed?

A

Collar and cuff for 3w followed by physiotherapy

135
Q

What are 3 different anatomical types of shoulder dislocation?

A
  1. Glenohumeral (most common)
  2. Acromioclavicular
  3. Sternoclavicular (least common)
136
Q

What is the most sensitive test for detesting meniscal tears?

137
Q

What movement causes the worst pain with a meniscal tear?

A

Straightening the knee

138
Q

What may a displaced meniscal tear cause?

A

Knee locking

139
Q

How can you further subclassify extracapsular fractures of the hip?

A

Trochanteric or subtrochanteric

140
Q

What is the management for a child/teenager with unexplained bone swelling/pain?

A

Very urgent X-ray to assess for osteosarcoma

141
Q

What are sarcomas?

A

Malignant tumours of mesenchymal origin

142
Q

What are 3 types of bone sarcoma?

A
  1. Osteosarcoma
  2. Ewing’s sarcoma
  3. Chondrosarcoma
143
Q

What is a ‘ganglion’ in ortho?

A

A ‘cyst’ arising from a joint or tendon sheath, most commonly seen around the back of the wrist and are 3 times more common in women. They often disappear spontaneously after several months.

144
Q

What is a Dupuytren’s contracture?

A

Fixed flexion contracture of the hand where the fingers bend towards the palm and cannot be fully extended, due to fibrosis of the palmar fascia

145
Q

Which finger’s are most affected in Dupuytren’s?

A

Ring and little finger

146
Q

What are some causes of Dupuytren’s contracture?

A

LIAM PT

  1. Idiopathic
  2. Liver cirrhosis
  3. Alcoholism
  4. Manual labour
  5. Phenytoin
  6. Trauma
147
Q

What is the first line medication for back pain?

A

NSAID e.g. naproxen (PPIs co-prescribed if >45 y/o)

148
Q

What is the initial management of an open fracture?

A
  1. IV ABx
  2. Photographs
  3. Sterile soaked gauze and impermeable film
  4. Debridement
  5. Wound irrigation with 6L saline
  6. Stabilise fracture, an external fixator is often used in the first instance
149
Q

What classification system is used for open fractures?

A

Gustilo-Anderson Fractures

150
Q

What are the Grades of the Gustilo Anderson Classification of open fractures?

A
  1. Low energy wound <1cm
  2. > 1cm wound w/ moderate soft tissue damage
  3. > 1cm with extensive soft tissue damage
    3a. Adequate soft tissue coverage
    3b. Inadequate soft tissue coverage
    3c. Associated arterial injury
151
Q

What scoring system can be used to predict the need for primary amputation in Type IIIC GA open fractures?

A

MESS

Mangled extremity scoring system

152
Q

When should surgical treatment of Dupuytren’s contractures be considered?

A

When the MCP joints cannot be straightened and thus the hand cannot be placed flat on the table

153
Q

What is the triad of presentation of fat embolism syndrome?

A
  1. Respiratory distress
  2. Cerebral signs
  3. Petechial rash
154
Q

What is are 2 important differentials for back pain in an IVDU?

A
  1. Psoas abscess

2. Vertebral osteomyelitis

155
Q

What is the management of a psoas abscess?

A

Antiobiotic therapy +/- drainage

156
Q

What is the most common cause of osteomyelitis?

157
Q

What are some predisposing conditions for osteomyelitis?

A
  1. DM
  2. Sickle cell
  3. IVDU
  4. Immunosuppression (medication/HIV)
  5. Alcohol excess
158
Q

In a pt with PMR, what could cause avascular necrosis of the femoral head?

A

Long term steroid usage

159
Q

What are 4 causes of avascular necrosis of the femoral head?

A
  1. Long term steroid use
  2. Chemotherapy
  3. Alcohol excess
  4. Trauma
160
Q

What presents with a shortened and internally rotated leg?

A

Posterior hip dislocation

161
Q

What are the different types of hip dislocation?

A
  1. Posterior dislocation
  2. Anterior dislocation
  3. Central dislocation
162
Q

What kind of hip dislocation is most common?

A

Posterior dislocation (90%)

163
Q

How would an anterior hip dislocation present?

A

Abducted and externally rotated leg without shortening

164
Q

What are some complications of hip dislocation?

A
  1. Sciatic/femoral nerve injury
  2. Avascular necrosis
  3. Osteoarthritis
  4. Recurrent dislocation due to damage of supporting ligaments
165
Q

What kind of splint is used for a scaphoid fracture?

A

Futuro splint

166
Q

What is an oblique fracture?

A

One where the fracture lies obliquely to the long axis of the bone

167
Q

What is a communited fracture?

A

> 2 fragments

168
Q

What is a segmental fracture?

A

More than one fracture along a bone

169
Q

What is a transverse fracture?

A

Perpendicular to the long axis of the bone

170
Q

What is a spiral fracture?

A

Severe oblique fracture with rotation along the long axis of the bone

171
Q

What are 5 causes of Oslers nodes?

A
  1. Infective endocarditis
  2. SLE
  3. Gonorrhoea
  4. Typhoid
  5. Haemolytic Anaemia
172
Q

What eponymous test is used for a meniscal tear?

A

McMurray’s Test

173
Q

What is the most common demographic of adhesive capsulitis?

A

Middle aged females

174
Q

What condition is frozen shoulder associated with?

175
Q

Which movement of the shoulder is most affected by frozen shoulder?

A

External rotation

176
Q

What is the management of adhesive capsulitis?

A
  1. NSAIDs
  2. Physio
  3. Oral steroids
  4. Intra-articular steroids
177
Q

When and what kind of weight bearing should be sought after a hip fracture surgery?

A

Full weight bearing immediately post-operatively

178
Q

What is a Morton’s neuroma?

A

A benign neuroma affecting the intermetatarsal plantar nerve, most commonly in the third inter-metatarsophalangeal space. The female to male ratio is around 4:1.

179
Q

What are some features of Morton’s neuroma?

A
  1. Forefoot pain most commonly in 3rd inter-metatarsophalangeal space
  2. Worse on walking - ‘pebble in shoe’
  3. Loss of sensation distally in toes
  4. Mulder’s click = : one hand tries to hold the neuroma between the finger and thumb. The other hand squeezes the metatarsals together. A click may be heard as the neuroma moves between the metatarsal heads
180
Q

What is Foucher’s sign?

A

Increase in tension of the Baker’s cyst on extension of the knee

181
Q

What causes an Erb-Duchenne palsy?

A
  1. Damage of the upper trunk of the brachial plexus (C5,C6)
  2. May be secondary to shoulder dystocia during birth
  3. Arm hangs by the side and is internally rotated, elbow extended
182
Q

What causes a Klumpke injury?

A
  1. Due to damage of the lower trunk of the brachial plexus (C8, T1)
  2. May be due to secondary dystocia or sudden upw
183
Q

What are some respiratory signs of a fat embolism?

A
  1. Tachycardia
  2. Tachypnoea
  3. Dyspnoea
  4. Hypoxia
184
Q

What are some derm signs of a fat embolism?

A
  1. Red/brown impalpable petechial rash (25-50%)

2. Subconjunctival and oral haemorrhage/petechiae

185
Q

What are some CNS signs of fat embolism?

A
  1. Confusion and agitation

2. Retinal haemorrhages and intra-arterial fat globules on fundoscopy

186
Q

What is a Monteggia fracture?

A

Dislocation of the proximal radioulnar joint associated with an ulnar fracture

187
Q

Wwhat is a Galeazzi fracture?

A

Dislocation of the distal radioulnar joint associated with a radial shaft fracture

188
Q

What is the management for a subtrochanteric fracture?

A

Intramedullary nail

189
Q

What is the management for a trochanteric fracture?

A

Sliding hip screw

190
Q

What is the management for a displaced intracapsular fracture in a mobile pt?

191
Q

What is the management for a displaced intracapsular fracture in a not-independently mobile pt?

A

Hemiarthroplasty, cemented implants preferred

192
Q

What is the main neurovascular structure that is compromised in a scaphoid fracture?

A

Dorsal carpal branch of the radial artery

193
Q

What is the average age at which a scaphoid fracture occurs, and gender predominance?

A

22 years old, 7M:1F

194
Q

What are 5 signs of a scaphoid fracture?

A
  1. Point of maximal tenderness over the anatomical snuffbox.
  2. Wrist joint effusion1: Hyper acute injuries (<4hrs old), and delayed presentations (>4days old) may not present with joint effusions.
  3. Pain elicited by telescoping of the thumb (pain on longitudinal compression)
  4. Tenderness of the scaphoid tubercle (on the volar aspect of the wrist)
  5. Pain on ulnar deviation of the wrist
195
Q

How do you remember that Monteggia affects the Ulna?

A

Manchester United

196
Q

How do you remember that Galeazzi affects the radius?

A

Galaxy rangers

197
Q

What is Mallet thumb?

A

An injury to the end of the thumb which causes it to bend towards the palm

198
Q

What is the first line imaging tool in occult hip fractures?

199
Q

What is an iliopsoas abscess?

A

A collection of pus in the iliopsoas compartment (iliopsoas and iliacus)

200
Q

How can you classify the causes of an iliopsoas abscess?

A

Primary and Secondary

201
Q

What is the primary cause of iliopsoas abscesses?

A

Haematogenous spread of bacteria

202
Q

What are some secondary causes of iliopsoas abscesses?

A
  1. Crohns
  2. Diveriticulitis
  3. Colorectal Ca
  4. UTI, GU Ca
  5. Vertebral osteomyelitis
  6. Endocarditis
  7. Lithotripsy
203
Q

What is the gold standard tool for diagnosis of an iliopsoas abscess?

204
Q

What is the Weber classification used for?

A

Ankle fractures around the syndesmosis

  1. Type A = below syndesmosis
  2. Type B = at level of syndesmosis
  3. Type C = above the syndesmosis
205
Q

What is the Gartland classification used for?

A

Supracondylar fractures in children

206
Q

What should be done before definitive management of open fractures?

A

The soft tissues should have recovered = immediate wound debridement and application of spanning external fixation device

207
Q

How can symptoms of meralgia paraesthetica be reproduced?

A

Pelvic compression test = symptoms reproduced by deep palpation just below the ASIS

208
Q

What is the greek word for thigh?

209
Q

What is the greek word for pain?

210
Q

What is meralgia paraesthetics?

A

An entrapment mononeuropathy of the LCFN

211
Q

What is the most common site where osteomyelitis occurs along a long bone in children?

A

Metaphysis

212
Q

What are the Ottawa ankle rules?

A

X-rays are only necessary if there is pain in the malleolar zone and:

  1. Inability to weight bear for 4 steps
  2. Tenderness over the distal tibia
  3. Bone tenderness over the distal fibula
213
Q

What should you do with failed conservative management of plantar fasciitis?

A

Referral to orthopaedics

214
Q

What is syringomyelia?

A

A disorder in which a cystic cavity forms within the spinal cord

215
Q

What is the commonest variant of a syringomyelia?

A

Arnold-Chiari malformation, in which the cavity connects with a congenital malformation affecting the cerebellum

216
Q

Classically, what neurological deficit do you see with syringomyelia?

A

Only the spinothalamic tract affected, with loss of pain and temperature sensation

217
Q

What presents with a painful arc of abduction?

A

Subacromial impingement

218
Q

What degree of abduction is classically referred to as the ‘painful arc’?

A

90 to 120 degrees

219
Q

How does Leriche syndrome present?

A

The triad of:

  1. Claudication of the buttocks and thighs
  2. Atrophy of the musculature of the legs
  3. Impotence (due to paralysis of the L1 nerve)
220
Q

What causes Leriche syndrome?

A

An atherosclerotic occlusive disease involving the abdominal aorta and/or both of the iliac arteries

221
Q

What is the ulnar paradox?

A

Proximal lesions of the ulnar nerve produce a less prominent deformity than distal lesions

222
Q

What nerve supplies the palmar and dorsal interossei muscles and therefore finger abduction and adduction?

A

Ulnar nerve

223
Q

How can one explain the ulnar paradox?

A
  1. When the ulnar nerve is damaged at the wrist, the medial two lumbrical muscles are affected (the lateral two being supplied by the median nerve). Denervation of the lumbricals, which flex the metacarpal phalangeal joints (MCPJ) and extend the interphalangeal joints (IPJ), causes unopposed extension of the MCPJ by extensor digitorum longus and flexion of the IPJ by flexor digitorum profundus and superficialis. This gives the hand a claw like appearance.
  2. When the ulnar nerve is damaged at the elbow, the ulnar half of flexor digitorum profundus is also affected resulting in a less marked clawing due to reduced unopposed flexion at the IPJ
224
Q

What is the the most common upper limb injury in children under the age of 6?

A

Subluxation of the radial head

225
Q

What is the management of subluxation of the radial head?

A

Analgesia and passively supination of the elbow joint whilst the elbow is flexed to 90 degrees

226
Q

What could cause back pain in a pt with infective endocarditis?

227
Q

What is discitis?

A

An infection of the intervertebral disc space

228
Q

How can you classify the causes of discitis?

A
  1. Bacterial (Staph A)
  2. Viral
  3. TB
  4. Aseptic
229
Q

What are Kanavel’s signs of flexor tendon sheath infection?

A
  1. Fixed flexion
  2. Fusiform swelling
  3. Tenderness
  4. Pain on passive extension
230
Q

Insect bite and finger held in strict flexion, finger is also painful - what is the diagnosis?

A

Infective flexor tenosynovitis

231
Q

What FRAX score warrants a DEXA scan.

A

FRAX score >10%

232
Q

What is the most common complication of a posterior hip dislocation?

A

Sciatic nerve injury (10-20%)

233
Q

What is trigger finger?

A

A common condition associated with abnormal flexion of the digits, thought to be caused by a disparity between the size of the tendon and pulleys through which they pass

234
Q

What are 3 associations with trigger finger?

A
  1. Women
  2. RhA
  3. DM
235
Q

What is the management for trigger finger?

A
  1. Steroid injection successful in majority
  2. Finger splint
  3. Surgery if not responsive to steroid injections
236
Q

What imaging can be used to diagnose a Morton’s neuroma?

237
Q

What is a complication of discitis?

A

Epidural abscess

238
Q

What is the sensitivity of Ottawa rules for ankle X-rays?

A

Approaching 100%

239
Q

What are signs of a radial head fracture?

A
  1. Local tenderness over head of the radius
  2. Impaired movements at the elbow
  3. Sharp pain at the lateral side of the elbow and during pronation and supination
240
Q

What percentage of anterior glenohumeral dislocations are associated with a Hill-Sachs lesion?

241
Q

What is a Hill-Sachs lesions?

A

A cortical depression in the posterolateral head of the humerus. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly

242
Q

What tear is the most common of the rotator cuff tears?

A

A supraspinatus tear

243
Q

What is the correct term for clubfoot?

A

Talipes equinovarus

244
Q

What is the management for talipes equinovarus?

A

Manipulation and progressive casting starting soon after birth

245
Q

What is Medial tibial stress syndrome?

A

A repetitive-stress injury of the shin area, a.k.a. shin splints

246
Q

What is an important differential for tibial stress syndrome?

A

Stress fracture of the tibia

247
Q

What is gradual swelling of the knee suggestive of?

A

Meniscal injury

248
Q

What is a commonly used method of analgesia for pts with a NOF?

A

Iliofascial nerve block

Medicine and Surgery Mushkies (52 decks)

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