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Phase 3 > T And O > Flashcards

T And O Flashcards

1
Q

What is skiers thumb?

A

Formerly gamekeepers thumb

Injury to base of thumb resulting in damage/rupture of ulnar collateral ligament

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2
Q

What is the management for skiers thumb?

A

Complete tear - surgical repair

Partial rupture - immobilisation in thumb spica

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3
Q

Which is the most common skeletal neoplasm?

A

Osteochondroma

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4
Q

When do osteochondromas most commonly occur?

A

First two decades of life

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5
Q

Where are osteochondromas most commonly found?

A

Long bones

Especially distal femur, proximal tibia

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6
Q

What are Brown tumours?

A

Osteolytic lesions due to hyperparathyroidism

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7
Q

What are possible complications of a supracondylar fracture?

A

Vascular
Nerve injury
Compartment syndrome
Malunion

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8
Q

What is the initial management of a displaced supracondylar fracture in which there is vascular compromise?

A

Analgesia
Emergency reduction of fracture into good anatomical position with percutaneous pinning
If blood flow not restored, surgical exploration of brachial artery - sutures/vein graft

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9
Q

What is the Milch classification for lateral condyle fractures?

A

Milch 1: fracture line lateral to capitello-trochlear groove, relationship between humerus and forearm intact, elbow stable
Milch 2: fracture passes through capitello-trochlear groove, elbow is unstable

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10
Q

What is the Gartland classification of supracondylar fractures?

A

Type 1: non displaced
Type 2: extended but not completely translated with some cortical contact
Type 3: circumferential break in cortex with displacement of fracture fragments

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11
Q

What are causes for immediate onset of knee swelling after trauma?

A 
Haemarthrosis:
ACL/PCL rupture
Patella dislocation
Ostechondral
Medial meniscal tear 
Hoffas syndrome 
Bleeding diathesis
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12
Q

What are key features of a meniscal injury?

A

Deceased range of movement
Joint line tenderness
Effusion
Typical history

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13
Q

What are the cardinal signs of suppurative flexor tenosynovitis?

A

Flexed posture
Fusiform swelling
Pain on passive extension
Flexor sheath tenderness

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14
Q

What characterises complex regional pain syndrome?

A 
Localised or diffuse pain
Swelling 
Trophic changes
Vasomotor disturbance 
Allodynia
Hyperhydrosis
Nail or hair growth changes 
Tremor
Spasm
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15
Q

What is a Bennetts fracture?

A

Intra articular fracture of the base of the first metacarpal

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16
Q

What is a galeazzis fracture?

A

Radial shaft with dislocation of distal radioulnar joint

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17
Q

What is a colles fracture?

A

Distal radial fracture with dorsal displacement of distal fragment

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18
Q

What type of joint is the frontal coronal suture?

A

Fibrous

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19
Q

What is the only pivot joint in the body?

A

Dens of axis and atlas

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20
Q

What type of joint is between trapezium and first metacarpal?

A

Saddle

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21
Q

What type of joint is a saddle joint?

A

Can move in a range of directions by gliding over one another

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22
Q

What type of joint is found between shafts of radius and ulna?

A

Syndesmosis

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23
Q

What are some systemic causes of avascular necrosis?

A 
Sickle cell disease
Scleroderma
SLE
Infective endocarditis
Alcoholism
Extensive burns
Radiation
Diabetes mellitus
Steroid therapy
Cushings disease
Gaucher's disease
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24
Q

What are some local causes which predispose to avascular necrosis?

A

RA
Trauma
Severe OA
Psoriatic arthropathy

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25
Q

How does transient synovitis of the hip present?

A

Child less than 5
Discomfort, limited range of movement and a limp following an URTI
Mild symptoms, self resolving

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26
Q

Who is generally affected by a slipped capital femoral epiphysis?

A

Overweight boys approaching puberty

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27
Q

What are symptoms of a slipped capital femoral epiphysis?

A

Pain
Limping
Restriction of medial rotation, abduction and flexion

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28
Q

What is perthes disease?

A

Avascular necrosis of the femoral head

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29
Q

A 65 year old woman presents to ED with inability to extend the MCP joints of her right hand and wrist drop. She tripped over and fell and injured her arm. She also has altered sensation over the region of the anatomical snuffbox. The triceps reflex is absent. What has happened?

A

Injury to the radial nerve at the level of the mid shaft of the humerus

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30
Q

Why does ulnar nerve damage result in a claw?

A

Action of unopposed long flexors

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31
Q

Why is pinching difficult with ulnar nerve damage?

A

Paralysis of adductor pollicis and first palmar interossei

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32
Q

What is froments sign?

A

Flexion of the thumb due to unopposed action of flexor pollicis longus particularly demonstrated when asked to grasp a card between thumb and index finger

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33
Q

From which cell does a Ewings tumour arise?

A

Mesenchymal cell

Long bone

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34
Q

How does ewings tumour present?

A

Pyrexia
Pain
Elevated ESR
Usually pelvis

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35
Q

What is the classical appearance of a Ewings tumour?

A

Lamellated series of periosteal reactions showing an onion skin appearance
Codmans triangle appearance due to elevated periosteum

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36
Q

What are causes of charcots arthropathy?

A 
Diabetes mellitus
Tabes dorsalis
Cauda equina 
Leprosy
Syringomyelia
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37
Q

What is the treatment for mallet finger?

A

Splinting the affected finger to the adjacent one for 6 weeks

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38
Q

What causes mortons metatarsalgia?

A 
Increased pressure on the metatarsal heads due to: 
Intense training or activity
High arch
Foot deformities
Excess weight
Poorly fitting shoes
High heels
Stress fractures
Morton's neuroma
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39
Q

What can cause osteomalacia?

A 
Vitamin D deficiency due to:
Malabsorption 
Renal disease (familial hypophosphataemic rickets)
Chronic renal failure
Anticonvulsant therapy
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40
Q

What are Loosers zones?

A

Wide transverse lucencies traversing part way through a bone usually at right angles to the involved cortex
Associated with osteomalacia and rickets
Type of pseudofracture

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41
Q

How does osteomalacia often present?

A

Bone pain and proximal myopathy

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42
Q

What can malunion of a Colles fracture result in?

A

Deformity
Limited movement
Delayed rupture of extensor tendon due to attrition by rough dorsal aspect of fracture line
Carpal tunnel syndrome
Stiffness of fingers and wrist
Sudecks atrophy (complex regional pain syndrome)

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43
Q

What is sudecks atrophy?

A

Complex regional pain syndrome
Severe pain in hand and wrist
Swelling and circulatory disturbance in hand with oedema
Painful stiffness of all joints of hands

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44
Q

What blood results would you expect in Ankylosing spondylitis?

A

Serum calcium normal
Alkaline phosphatase normal
ESR elevated

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45
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 (6cm)
  3. Bone tenderness over the distal fibula (6cm)
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46
Q

What is the Weber classification for fibular fractures?

A

Type A is below the syndesmosis
Type B fractures start at the level of the tibial plafond and may extend proximally to involve the syndesmosis
Type C is above the syndesmosis which may itself be damaged

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47
Q

What is a Maisonneuve fracture ?

A

Spiral fibular fracture that leads to disruption of the syndesmosis with widening of the ankle joint, surgery is required

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48
Q

What structure is damaged in a child with pulled elbow/nursemaids elbow?

A

Subluxation of radial head leading to damage to the annular ligament

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49
Q

Which part of the bone is affected by osteosarcoma?

A

Metaphyses of long bones

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50
Q

Where are osteosarcomas most commonly seen?

A

Knee and proximal humerus

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51
Q

What disease state predisposes to osteosarcoma formation?

A

Paget’s disease

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52
Q

How do osteosarcomas usually present?

A

Bone pain and palpable lump

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53
Q

What does an X-ray show in osteosarcoma?

A

Periosteal elevation (codmans triangle) and sunburst appearance due to soft tissue involvement

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54
Q

What route of metastatic spread occurs with osteosarcoma?

A

Haematogenous

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55
Q

What are symptoms of a medial meniscus tear?

A

Pain along joint line or through whole knee
Inability to extend knee fully
Locking
Swelling

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56
Q

What is the gold standard investigation for excluding a septic joint?

A

Joint aspiration

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57
Q

What are some causes of pathological fractures?

A

Neoplasia
Osteomalacia
Osteomyelitis

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58
Q

At what time frame is a clinical review required with a scaphoid fracture if there is concern despite apparently normal initial films?

A

7-10 days

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59
Q

What biochemical changes are suggestive of Paget’s disease?

A

Alkaline phosphatase raised

Urinary hydroxyproline raised

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60
Q

What are some complications of Paget’s disease?

A

Pain
Deformity
Sarcomatous change

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61
Q

What is Milchs technique?

A

For reduction of anterior shoulder dislocation
External rotation and abduction of shoulder so arm is in overhead position
Direct pressure placed over humeral head to force it back into glenoid fossa

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62
Q

What is the kocher method?

A

For reduction of anterior shoulder dislocation

Traction to elbow with external rotation of humerus and adducting the elbow toward the chest

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63
Q

What are complications of kocher method for reduction of anterior shoulder dislocation?

A

Neurovascular complications

Proximal humerus fractures

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64
Q

What is Barlow’s manoeuvre?

A

Test for developmental dysplasia of the hips
Place index finger on lateral aspect of femur and thumb on knee
Apply posterior force
Dislocatable hip will click posteriorly as the hip comes out of the acetabulum

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65
Q

What are symptoms of a scaphoid fracture?

A

Deep dull pain in radial side of wrist made worse by gripping
Swelling
Bruising
Fullness of anatomical snuffbox - effusion

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66
Q

What is routine management of a scaphoid fracture?

A

Plastering

Bring patient back to fracture clinic in two weeks for scaphoid X-ray

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67
Q

A 75 year old female presents with weakness, fatigue and pelvic pains. On examination she has a proximal myopathy. An X-ray reveals pseudofractures in the pelvis. What is the diagnosis?

A

Osteomalacia - vitamin d deficiency

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68
Q

What is the difference between osteochondroma and osteosarcoma?

A

Osteochondroma is benign

Osteosarcoma is malignant

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69
Q

Why is a Pagets leg likely to feel warm to touch?

A

Increased blood flow through the bone

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70
Q

What muscles form the rotator cuff?

A

Teres minor
Supraspinatus
Infraspinatus
Subscapularis

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71
Q

What factors maintain the integrity of the shoulder joint?

A

Glenohumeral joint capsule
Cartilagenous glenoid labrum
Muscles of the rotator cuff

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72
Q

What is the most common type of shoulder dislocation?

A

Anterior

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73
Q

Which nerve is most commonly injured due to shoulder dislocation?

A

Axillary

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74
Q

A 46 year old man presents after penetrating injuries to his arm and forearm. He is unable to extend his fingers. There is no sensory disturbance and there is no vascular injury. Which nerve has been damaged?

A

Posterior interosseous
Supplies all extensor muscles except brachioradialis, extensor carpi radialis brevis and longus. It has no cutaneous branch

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75
Q

When is Simmonds test positive?

A

Achilles tendon is ruptured

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76
Q

What is Simmonds test?

A

Test for achilles tendon rupture

Reduced plantar flexion of ankle on squeezing calf muscle

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77
Q

How is Achilles tendon rupture usually treated?

A 
Rest 
Ice 
Elevation
Physiotherapy
Surgery
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78
Q

What is often the cause of gastrocnemius and soleus tears?

A

Sudden unaccustomed exercise

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79
Q

What are risk factors for DVT?

A 
Hospitalisation
Immobility
Increasing age
Pregnancy
Oral contraceptive pill
Surgery - orthopaedic or pelvic
Malignancy 
Hx of DVT and thrombophilia
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80
Q

What are clinical features of DVT?

A 
Redness
Swelling
Pain
Calf tenderness
Dilated superficial veins
Low grade pyrexia
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81
Q

When is a DVT most likely to occur post operatively?

A

After 7- 10 days

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82
Q

What is usually the cause of an acute swelling in the knee joint after trauma if there is no evidence of fracture?

A

Damage to cruciate ligaments or menisci

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83
Q

If there is a joint effusion with severe pain, what can be done to relieve the acute symptoms?

A

Aspiration of the knee joint under local anaesthetic

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84
Q

What is speeds test and what is it used to diagnose?

A

Elbow extended, forearm supinated and humerus elevated to 60 degrees. Examiner resists humeral forward flexion
Biceps tendonitis. Positive test if pain located to bicipital groove

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85
Q

What are some causes of a positive trendelenburg test?

A

Gluteal paralysis or weakness
Pain in hip causing gluteal inhibition
Coxa vara
Congenital dislocation of the hip

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86
Q

What is the contents of the carpal tunnel?

A

Median nerve
Four flexor digitorum profundus tendons
Four flexor digitorum superficialis tendons
Flexor pollicis longus

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87
Q

What is Popeye sign a feature of?

A

Rupture of long head of biceps

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88
Q

Where does the long head of biceps originate?

A

Supraglenoid tubercle

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89
Q

Why does rupture of the long head of biceps usually occur?

A

At bony attachment due to inflammation from impingement in subacromial region

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90
Q

What type of dislocation classically shows a light bulb appearance on X-ray?

A

Posterior shoulder dislocation

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91
Q

A 49 year old female has developed insidious pain, weakness and loss of movement in her shoulder. The pain is exacerbated by abduction. What is the diagnosis?

A

Impingement syndrome

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92
Q

What is impingement syndrome?

A

Irritation of the tendons of the rotator cuff as they pass through the subacrcomial space usually by osteoarthritic spurs

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93
Q

What are some causes of avascular necrosis?

A 
HTN
Sickle cell disease
Caisson disease
Radiation induced arteritis
Corticosteroid therapy 
Connective tissue disease
Alcohol abuse
Marrow storage disease (gauchers)
Dyslipoproteinaemia
94
Q

What is the major difference between synovial fluid and other body fluids derived from plasma?

A

High content of hyaluronic acid (mucin)

95
Q

How does slipped upper femoral epiphysis present?

A 
Obese adolescent boys with positive family history 
Externally rotated hip
Antalgic gait
Decreased internal rotation
Thigh atrophy depending on chronicity 
Hip, thigh and knee pain
96
Q

What are the classical signs of scaphoid fracture?

A

Swelling
Pain on wrist movement
Tenderness on direct palpation 2cm distal to listers tubercle of the radius (in anatomical snuffbox) and on proximal pressure on extended thumb or index finger

97
Q

What is the treatment for suspected scaphoid fracture which is not proven on X-ray?

A

Plaster cast for 2 weeks
Repeat X-ray
If still inconclusive, bone scan

98
Q

What is done to manage non union of a scaphoid fracture?

A

Bone graft

Herbert screw fixation

99
Q

What is severs disease?

A

Pain in one or both heels upon walking or standing caused by a disturbance or interruption to the growth plates at the back of the calcaneous
Affects children age 8-13
Extreme pain when placing heel on ground, alleviated when walking on tip toes

100
Q

What is Klippel Feil syndrome?

A

Congenital fusion of any of the cervical vertebrae

Caused by failure in normal segmentation or division of cervical vertebrae during early weeks of foetal development

101
Q

What are signs of Klippel feil syndrome on examination?

A

Short neck
Low hairline at back of head
Restricted mobility of upper spine

102
Q

Which abnormalities are associated with Klippel Feil syndrome?

A 
Scoliosis 
Spina bifida
Anomalies of kidneys and ribs 
Cleft palate
Respiratory problems
Heart malformations
103
Q

A 40 year old lady presents to clinic complaining of an 18 month hx of dorsoradial wrist pain. She is a keen tennis player. On examination she has tenderness localised to the dorsoradial aspect of the wrist and passive motion of the thumb causes crepitus in the same region. Finkelstein’s test is positive. What is the likely diagnosis?

A

De Quervains tenosynovitis

104
Q

What is a frax assessment tool?

A 
Assess individuals 10 year risk of fracture 
Age
Sex 
Weight
Height
Previous fracture
Parent fractured hip
Smoker
Glucocorticoids
RA
Secondary osteoporosis
Alcohol 3 or more units/day 
Femoral neck BMD
105
Q

What are risk factors for osteoporosis development?

A 
Glucocorticoid use
RA
Alcohol excess
History of parental hip fracture
Low body mass index
Current smoker 
Sedentary lifestyle
Premature menopause
106
Q

What form of tumour generates a soap bubble appearance on X-ray of the knee?

A

Osteoclastoma

107
Q

What conditions can cause Charcots arthropathy?

A

Diabetes Mellitus
Syringomyelia
Syphilis

108
Q

What is the medical name for bunions?

A

Hallux valgus deformity sometimes with bursa

109
Q

What does a low calcium and phosphate combined with raised alkaline phosphate suggest?

A

Osteomalacia

110
Q

What are different types of osteomalacia?

A 
Vitamin D deficiency: malabsorption, lack of sunlight, diet
Renal failure
Drug induced: anticonvulsants
Vitamin D resistant: inherited
Liver disease
111
Q

What are features of osteomalacia?

A

Bone pain
Fractures
Muscle tenderness
Proximal myopathy

112
Q

What are features of rickets?

A

Knock knee
Bow leg
Features of hypocalcaemia

113
Q

How do you investigate osteomalacia?

A

Low calcium, phosphate, vitamin D
Raised alkaline phosphatase
X-ray: children - cupped ragged metaphyseal surfaces. Adults - translucent bands (loosers zones/pseudofractures)

114
Q

How are simple undisplaced fractures of the small toes?

A

Analgesia
Padded buddy strapping
Elevation

115
Q

What is the Weber classification for ankle fractures?

A

Describes level of fibular fracture in relation to syndesmosis
Gives idea of stability of fracture. C is least stable
A: below syndesmosis
B: at the level of syndesmosis
C: above level of syndesmosis

116
Q

What is a Potts fracture?

A

Medial malleolus avulsion fracture after inverting ankle

117
Q

What is Tietzes syndrome?

A

Benign condition of unknown aetiology
Non specific inflammation and swelling of one or more costal cartilages
Local tenderness on palpation of the lump

118
Q

What is Severs disease?

A

Pain in one or both heels upon walking or standing caused by disturbance or interruption to growth plates at back of calcaneus
Usually affects children aged 8-13

119
Q

What is chondromalacia patellae?

A

Softening of the cartilage of the patella
Common in teenage girls
Anterior knee pain on walking up and down stairs and rising from prolonged sitting
Usually responds to physio

120
Q

What is osgood schlatter disease?

A

Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle
Tibial apophysitis

121
Q

What is osteochondritis dissecans?

A

Pain after exercise

Intermittent swelling and locking

122
Q

What is patellar tendonitis?

A

More common in athletic teenage boys
Chronic anterior knee pain worsens after running
Tender below the patella on examination

123
Q

Which conditions are associated with trigger finger?

A

Rheumatoid arthritis

Diabetes mellitus

124
Q

What is the management of trigger finger?

A

Steroid injection
Finger splint
Surgery if no response

125
Q

Which movement of the shoulder is mainly affected in adhesive capsulitis?

A

External rotation

126
Q

What is Fouchers sign?

A

Increase in tension of bakers cyst on extension of knee

127
Q

What is a bakers cyst?

A

Swelling behind the knee filled with synovial fluid commonly if underlying problem like OA
Can mimic DVT if it ruptures

128
Q

What are features of adhesive capsulitis?

A

External rotation affected more than internal rotation or abduction
Active and passive movements affected
Painful freezing phase, adhesive phase and recovery phase
Typically lasts between 6 months and 2 years

129
Q

What is kochers criteria?

A 
For likelihood of septic arthritis
Non weight bearing
ESR over 40
Fever over 38.5
WCC over 12
If all 4, 99% chance septic arthritis
130
Q

What is a jersey finger?

A

Traumatic avulsion of the flexor digitorum profundus from its insertion into the distal phalanx

131
Q

What is a mallet finger?

A

Injury to extensor tendon at its insertion into distal phalanx

132
Q

What is a Seymour fracture?

A

Fracture of distal phalanx associated with a nail bed injury

133
Q

What is a lisfranc injury?

A

Injury of foot whereby one or more metatarsal bones are displaced from tarsus when excessive kinetic energy is placed to the midfoot

134
Q

What is hallux rigidus?

A

Degenerative arthritis causing bone spurs at the metatarsophalangeal joint of the hallux making the big toe painful and stiff

135
Q

What is a jones fracture?

A

Fracture in mid diaphyseal junction of fifth metatarsal of the foot

136
Q

What are the stages of frozen shoulder?

A

Freezing stage: pain/stiffness
Frozen stage: persistent stiffness
Thawing stage: improved mobility

137
Q

Which movement is particularly affected in frozen shoulder?

A

External rotation

138
Q

What is the most common complication of fracture of the clavicle?

A

Malunion - angulation, shortening, poor appearance

139
Q

What are 3 main complications of a colles fracture?

A

Malunion
Stiffness of fingers and wrist
Sudecks atrophy

140
Q

What is sudecks atrophy?

A

Severe pain in hand and wrist, swelling, circulatory disturbance in hand with oedema
Resulting in painful stiffness of all joints of hands

141
Q

What is a lisfranc injury?

A

Injury of the foot whereby one or more metatarsal bones are displaced from the tarsus seen when excessive kinetic energy is directly or indirectly placed on the mid foot such as in a traffic collision

142
Q

What is a jones fracture?

A

Fracture in meta diaphyseal junction of 5th metatarsal of foot

143
Q

What is Parsonage Turner syndrome?

A

Brachial neuritis

Peripheral nerve disorder causing severe pain which can complicate viral illness

144
Q

What are the most common causative organisms in osteomyelitis?

A

Staphylococcus
Haemophilus influenzae
Salmonella

145
Q

What are serious side effects of bisphosphonates?

A

Osteonecrosis of the jaw
Atypical fracture
Oesophagitis

146
Q

What are causes of spinal stenosis?

A 
Ligamentum flavum hypertrophy
Osteophytes
Disc prolapse
Degenerative disc disease
Facet joint degeneration
Osteoporotic fracture
OA
RA
Spondylolisthesis
Tumour
147
Q

What are the Ottawa foot rules?

A

Foot X-ray required if pain in mid foot and:
Bone tenderness at navicular bone
Bone tenderness at base of 5th metatarsal
Inability to weight bear immediately and in the emergency department

148
Q

What are the Ottawa ankle rules?

A

Ankle X-ray required only if pain in malleolar zone and any findings:
Boney tenderness at lateral malleolus to 6cm posterior fibula
Boney tenderness at medial malleolus to 6cm posterior tibia
Inability to walk four weight bearing steps immediately after the injury and in ED

149
Q

What are the Ottawa knee rules?

A 
X-ray indicated if:
Over 55
Tenderness at head of fibular
Isolated patella tenderness
Inability to flex knee to 90
Inability to walk 4 steps immediately after and in ED
150
Q

What is vertebroplasty?

A

Cement injected percutaneously in order to fix a fractured vertebra
Usually osteoporotic wedge fracture

151
Q

Which conditions pre dispose to osteomyelitis?

A 
Diabetes Mellitus
Sickle cell anaemia
IV drug user
Immunosuppression 
Alcohol excess
152
Q

Within what time frame after an elective total hip replacement should low molecular weight heparin be commenced?

A

6-12 hours after surgery

153
Q

What is a galeazzi fracture?

A

Displaced fracture of radius and prominent ulnar head due to dislocation of inferior radio ulnar joint

154
Q

What is a hill Sachs lesion?

A

Posterolateral humeral head compression fracture secondary to anterior shoulder dislocation as the humeral head comes to rest against anteroinferior part of glenoid

155
Q

What is osteitis fibrosa cystica?

A

Advanced bony changes seen in patients with primary or secondary hyperparathyroidism
Increased osteoclastic activity with bone resorption and peritrabecular fibrosis

156
Q

What is a brown tumour on X-ray?

A

Osteitis fibrosa cystica

Manifestation of hyperparathyroidism

157
Q

What are the 4 components of describing bone displacement?

A

Bone Length
Angulation
Rotation
Translation

158
Q

What are the 4 Rs of fracture management?

A

Resuscitation: ABCDE approach
Reduction: Correct any displacement of fracture, either open (in operating theatre) or closed (manipulating two ends of the bone back into position non-operatively)
Restriction: Keep two ends of bone aligned correctly so they can heal, either non-operatively e.g. traction, braces, backslab, slings or operatively e.g. internal fixation, or external fixation (usually for open fractures)
Rehabilitation: Physiotherapy and occupational therapy to help return to baseline

159
Q

What exam findings might you expect to find with an anterior shoulder dislocation?

A 
Squaring of shoulder
Pain
Immobility
External rotation
Abduction
Anterior displacement
160
Q

What is the management for anterior shoulder dislocation?

A

Resuscitation
Axillary Nerve C5/C6 testing before and after reduction
Restriction in broad arm sling
Rehabilitation

161
Q

What are the different types of anterior shoulder dislocation?

A

Sub-coracoid: Most common, humeral head is anterior to glenoid fossa and inferior to coracoid process
Sub-glenoid: 2nd most common, humeral head is inferior to glenoid fossa and coracoid process

162
Q

What is a bankart lesion?

A

Injury of anterior glenoid labrum secondary to anterior dislocation which can lead to recurrent dislocations and pain

163
Q

What is a hill Sachs lesion?

A

Fracture indentation of the posterolateral humeral head secondary to anterior dislocation of the shoulder

164
Q

What are causes of posterior shoulder dislocation?

A

electrocution or seizure

165
Q

What is diagnosed with a light bulb sign?

A

Posterior Dislocations are diagnosed with the light bulb sign on a Y view shoulder X-ray

166
Q

What is the classification system for AC joint dislocation?

A

Rockwood

167
Q

What exam findings may you expect with AC joint dislocation?

A

Positive Scarf Test (Active shoulder cross adduction)

168
Q

What is the management for AC joint dislocation?

A 
Broad arm sling and early mobilization (rockwood I-II)
Surgical repair (rockwood III+)
169
Q

What is the salter Harris classification of fractures?

A

For paediatric fractures, classify them based on their relation to the growth plate (physis)
Type 1: transverse through physis
Type 2: through physis and metaphysis, sparing epiphysis
Type 3: through physis and epiphysis, sparing metaphysis
Type 4: through all elements of bone
Type 5: compression of growth plate

170
Q

Which is the most common type of salter Harris fracture?

A

Type 2

171
Q

Which classification system is used for supracondylar fractures?

A

Gartland
Type 1: hairline crack
Type 2: displaced anterior wall, intact posterior hinge
Type 3: complete displacement, both anterior and posterior

172
Q

What is a Barton’s fracture?

A

Intraarticular distal radius fracture

173
Q

What should be done if clinical suspicion of scaphoid fracture but it is not visible on X-ray?

A

Scaphoid series +/- clenched fist view

Repeat in 7-10 days or CT/MRI

174
Q

Which part of the scaphoid is most susceptible to AVN when fractured?

A

More proximal the #, the higher the risk of AVN and non-union (30-50%)

175
Q

What is the terry thomas sign with a scaphoid fracture?

A

Widening of the scapholunate interval due to associated injury of the scapholunate ligament

176
Q

What is a monteggia fracture?

A

Proximal 1/3 ulna fracture with proximal radial head-humeral capitulum joint dislocation

177
Q

What is a galleazi fracture?

A

Distal 1/3 radial fracture with distal radio-ulnar joint dislocation

178
Q

What is shentons line?

A

Imaginary curved line drawn along inferior border superior pubic ramus and inferomedial neck of femur
Should be smooth
If disrupted - NOF fracture

179
Q

What is the garden classification of NOF fractures?

A

Garden 1: incomplete impacted
Garden 2: complete fracture, undisplaced
Garden 3: displaced, capsule intact
Garden 4: displaced

180
Q

What are the 4 signs of OA on knee X-ray?

A

Loss of joint space (medial more common –causes varus deformity)
Osteophytes
Subchondral sclerosis
Subchondral cysts

181
Q

What are the Ottawa ankle rules?

A

In A+E – Xray ankle if:
bony tenderness along distal 6cm of posterior edge of tibia or fibula
Or, bony tenderness in either malleolar tip,
Or, inability to weight bear 4 steps

182
Q

What is the Weber classification of ankle fractures?

A

Level of fibular fracture relative to syndesmosis
Weber A: below syndesmosis
Weber B: level with syndesmosis
Weber C: above level of syndesmosis

183
Q

What are signs of ligamentous instability in an ankle fracture?

A

Talar shift, talar tilt, distal tibiofibular interval

184
Q

What are the 3 views of ankle X-rays that should be taken?

A

AP
Mortise
Lateral

185
Q

What are the different Weber B ankle fractures?

A

Webers B1: Usually Spiral
May involve medial malleolus fracture as well (B2, bimalleolar
fracture)
If involves posterolateral tibia (B3, trimalleolar fracture)

186
Q

What is a maissoneuvre fracture?

A

A type of weber C ankle fracture
Spiral proximal fibula fracture and unstable ankle injury (distal tibiofibular syndesmosis and/or deltoid ligament disruption, or fracture of the medial malleolus)

187
Q

What is a Potts fracture?

A

Dislocation of the ankle joint seen by talar shift
Fracture of the fibular 6-7cm above the lateral malleolus (Webers C)
Rupture of distal tibiofibular ligaments/distal syndesmosis, or, medial malleolar fracture

188
Q

Which is the most common primary bone malignancy in children?

A

Osteosarcoma

189
Q

Where do osteosarcomas occur?

A

metaphyses of long bones

Most common sites are around knee (75%) or proximal humerus

190
Q

Where does osteosarcoma mainly metastasise to?

A

Lungs

191
Q

What is Ewing’s sarcoma?

A

Primitive neuroectodermal tumour thought to arise from mesenchymal stem cells

192
Q

How does Ewing’s sarcoma present?

A

Mass or swelling, most commonly in long bones of arms and legs, pelvis or chest but also in the skull and flat bones of trunk

193
Q

What does an X-ray of a Ewing’s sarcoma show?

A

Bone destruction with overlying onion-skin layers of periosteal bone formation

194
Q

What are the most common primaries that metastasise to bone in childhood?

A

Wilm’s tumour

Neuroblastoma

195
Q

What is non specific back pain?

A

NO red flags and not in high risk group

196
Q

What are nice guidelines for management of non specific back pain?

A 
Paracetamol
Weak opioids
NSAIDs +/- PPI
Low dose tricyclic antidepressant eg amityptyline
Short-term use only strong opioids
Graded exercise programme
Manual therapy
Acupuncture for up to 12 weeks duration
197
Q

What is the modified New York criteria for diagnosis of Ankylosing spondylitis?

A

Clinical criteria: Low back pain, for more than 3 months, improved by exercise, not relieved by rest. Limitation of lumbar spine motion in both sagittal and frontal planes. Limitation of chest expansion relative to normal values for age and sex
Radiological criterion: sacroiliitis on X-ray
Definite AS is diagnosed if radiological criterion is present plus at least one clinical criterion and probable AS if 3 clinical criteria present, or if radiological criterion is present but no clinical criteria are present

198
Q

What initial investigations should be done for Ankylosing spondylitis?

A 
X-ray sacro-iliac joints
MRI SI joints in early disease
FBC 
CRP
HLA B27
199
Q

What are presenting features of myeloma?

A 
Bone destruction 
Bone marrow failure
Hyperviscosity symptoms
Hypercalcaemia
Renal impairment
200
Q

What are indications for a spinal MRI?

A

Routine referral for MRI spine is indicated after 6-12 weeks of genuine radiculopathy with no improvement on conservative therapy
Urgent referral is for patients with acute and severe radiculopathy or low back pain within high risk group (<20 or >55 years, osteoporosis, alcoholism, HIV, drug abuse, steroid therapy, adolescent athletic injury, malignancy (suspected or diagnosed). Red flag signs or symptoms

201
Q

What are absolute contraindications to MRI?

A 
Pacemaker or cardiac defibrillator 
Cochlear implant 
Neurostimulator 
Orbital or spinal metallic foreign body
Untested intracranial aneurysm clips 
Infusion pumps 
Implanted drug infusion ports
202
Q

What are symptoms of lateral disc protrusion?

A

Pain in buttock, and down the back of the thigh and the leg
aggravated by coughing, sneezing and straining, is more intense that any associated backache
Numbness or tingling in the distribution of the affected root

203
Q

What are clinical findings of an L4 deficit?

A

Quadriceps wasting and weakness
Impaired knee jerk
Sensory impairment over medial calf

204
Q

What are clinical findings of an L5 deficit?

A

Wasting and weakness of dorsiflexors of foot (with some degree of foot drop), extensor digitorum longus and extensor hallucis longus
Wasting of extensor digitorum brevis
Sensory impairment over lateral calf and dorsum of foot

205
Q

What are clinical findings of an S1 deficit?

A

Sensory impairment over outer aspect of the foot
Impaired ankle jerk
Possible wasting and weakness of the plantar flexors, but may remain strong due to S2 supply

206
Q

What is the management of a prolapsed disc?

A

90% of acute sciatica attacks improve with conservative
management
Indication for surgical treatment: altered bladder and bowel function, progressive neurological deficits such as motor weakness or sensory deficit in lower extremities, Consider in patients with radicular pain that persists after an adequate course of conservative management

207
Q

What are causes of osteoporosis?

A 
Endocrine
Metabolic
Smoking
Alcohol excess 
Malabsorption eg IBD 
Immobility
Iatrogenic – medication; especially corticosteroids
Genetic – family history
208
Q

What are risk factors for osteoporosis?

A

Previous fragility fracture
Current use or frequent past use of oral glucocorticoids
History of falls
Family history of hip fracture
Other secondary causes of osteoporosis
Low body mass index (BMI) (less than 18.5 kg/m2)
Smoking more than 10 cigarettes per day
Alcohol intake of more than 4 units per day

209
Q

What are presenting symptoms of cauda equina?

A

Leg weakness bilateral
Sensory disturbance perineal – saddle anaesthesia
Urinary and faecal disturbance, progressing to incontinence

210
Q

What are clinical indicators of pathology in a child with back pain?

A 
Age under four years
Symptoms persisting for more than four weeks
Interference with function
Systemic features (fever, weight loss)
Worsening pain
Neurological features
Recent onset of scoliosis
Stiffness
211
Q

What are risks of bisphosphonates?

A

Inflamed gastric / oesophageal mucosa
GI upset
Osteonecrosis of the jaw
Atypical femoral fractures

212
Q

In which patients should caution be used with bisphosphonates?

A

Previous gastric surgery
Active dyspepsia / peptic ulcer disease
Abnormalities of oesophagus
High doses, recent dental surgery, cancer patients

213
Q

What symptoms should patients on methotrexate report?

A 
Neutropenia: streptococcal sore throat
Bruising
Mouth ulcers
Shortness of breath
Cough
Fever
Nausea
Vomiting
Dark urine
Abdominal discomfort
Stomatitis
214
Q

What are problems with NSAIDs?

A

Dypepsia, smaller risk of ulcerating disease, GI bleed
CVS risk: double risk of heart failure and acute LVF AND
increased risk thrombotic event (MI)
Renal: afferent arteriole dilation reduces renal perfusion pressure –causing AKI. Rare cases of RTA
Preterm labour and miscarriage
Worsened asthma

215
Q

What are side effects of corticosteroids?

A 
Diabetogenic
Hypertension
Cataracts
Osteoporosis
HPA suppression: growth suppression in childhood, menstrual irregularity
Cushingoid features: weight gain, 
Deranged electrolytes, calcium, triglycerides
Dyspepsia
216
Q

What classification system is used for open fractures?

A

Gustilo and Anderson system

217
Q

What are risk factors for septic arthritis?

A 
Intra articular injections
RA
Diabetes
Immunosuppression
Penetrating injury
Infections elsewhere e.g. Gonococcal
218
Q

Which bug causes septic arthritis in patients with joint replacement?

A

Staphylococcus epidermis

219
Q

Where does supraspinatus attach onto the humerus?

A

Greater tubercle

220
Q

What classification system is used for open fractures?

A

Gustilo and Anderson

221
Q

What is the termination of the spinal cord called?

A

Conus medullaris

222
Q

Where does the spinal cord terminate in adults and neonates?

A

Adults: L3/4
Neonates: L4/5

223
Q

What are conservative management steps for fractures?

A

Splinting
Cast
Traction
Do nothing

224
Q

When does external fixation get done?

A

Soft tissue damage

Open fracture

225
Q

Who is eligible for THR after fractured NOF?

A

Can walk a mile, no frame

226
Q

What are the 3 important principles of fracture management?

A

Reduce
Immobilise/fix
Rehabilitate

227
Q

What are the 4 different fracture deformities?

A

Displacement
Angulation
Rotation
Shortening

228
Q

What is the most common salter Harris fracture?

A

Type 2

229
Q

Which tumours metastasise to bone?

A 
Lung
Breast
Thyroid
Kidney
Prostate
230
Q

What X-ray view is important in a SUFE?

A

Frog leg lateral

231
Q

What is the blood supply to the femoral head?

A

Ligamentum teres artery from obturator (degenerates over time)
Medial circumflex from deep femoral - retinacular arteries
Lateral circumflex

Phase 3 (23 decks)

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