Week 4 - MSK Regional Adult Orthopaedics Formative Flashcards
A 60 year old lady presents with a complaint of right foot pain. On closer questioning, she tells you she first noticed it a month ago and it’s been getting worse since. She feels it on the instep of her foot (medial arch) and it’s worse if she does a lot of walking. On examination, she is acutely tender over the calcaneal tuberosity at the posterior end of the medial arch. What is the most likely diagnosis? Select one: * a. Calcaneal stress fracture * b. Plantar fasciitis * c. Peroneal tendonitis * d. Achilles tendonitis
Plantar fasciitis is a self‐limiting repetitive stress / overload or degenerative condition of the foot. Pain with walking is felt at the origin of the plantar aponeurosis on the distal plantar aspect of the calcaneal tuberosity with localized tenderness. Diabetes, obesity and frequent walking on hard floors with poor cushioning in shoes may be causative factors. The cushioning heel fat pad atrophies with age.
The hands are the site where rheumatoid arthritis seems to cause the greatest number of problems and is most visible. Patients with longstanding disease will eventually develop deformed, painful and occasionally malfunctioning hands. These deformities are easily identified on examination: Describe each
- * Volar MCPJ subluxation / MCPJ ulnar deviation
- * Swan neck deformity
- * Boutonniere deformity
- * Z-shaped thumb
Volar MCPJ subluxation / MCPJ ulnar deviation - ulna deviates anteriorly
Swan neck deformity - hyperextension at the PIPJ and flexion at the DIPJ
Boutonniere deformity - flexion at the PIPJ with hyperextension at the DIPJ
Z-shaped thumb - fixed flexion at the MCP joint with hyperextension at the IP joint
Froment’s test may form part of your examination of the ulnar nerve. A positive test reflects ulnar nerve dysfunction. Weakness of which muscle will give rise to a positive Froment’s test? Select one: * a. Adductor pollicis * b. Abductor pollicis brevis * c. Extensor digitirum * d. Adductor digiti minimi * e. Flexor pollicis longus
Adductor pollicis weakness gives rise to froment’s test
Dupuytren’s is a proliferative connective tissue disorder where the specialized palmar fascia undergoes hyperplasia with normal fascial bands forming nodules and cords progressing to contractures at the MCP and PIP joints. There is proliferation of myofibroplasts and abnormal collegen is produced. What type of collagen is produced in Dupuytren’s contracture? Select one: * a. Type I * b. Type II * c. Type III
Type III (normal collagen is type 1)
Dupuytren’s can also occur with other fibromatoses affecting other areas of the body. Patient’s with this condition at other areas as well as in the palm of the hand are siad to have Dupuytren’s diathesis. Young patients and patients with Dupuytren’s diathesis tend to have more aggressive forms of the disease. State the area affected in each of the other fibromatoses * Ledderhose disease * Peyronie’s disease
Ledderhose disease → Plantar aspect of the foot, Peyronie’s disease → Penis (Ledderhose disease (LD) refers to plantar fibromatosis affecting the plantar fascia, whereas Peyronie disease (PD) involves fibromatosis of the tunica albuginea.)
In relation to the knee, match the term to it’s correct definition: Alignment of the knee in which the distal end of the tibia is angling towards the axis of the femur/midline. There is an increased gap between the knees complared to the ankles Alignment of the knee in which the distal end of the tibia is angled away from the axis of the femur/midline. There is an increased gap between the ankles complared to the knees
Alignment of the knee in which the distal end of the tibia is angling towards the axis of the femur/midline. There is an increased gap between the knees complared to the ankles - genu varum Alignment of the knee in which the distal end of the tibia is angled away from the axis of the femur/midline. There is an increased gap between the ankles complared to the knees - genu valgum
Knee ‘locking’ is a very specific finding on examination. Match this term to it’s correct description and causative pathology: Select one: * a. A spongy block of usually 10-15 degrees to active and passive knee extension due to a displaced bucket handle meniscal tear * b. Temporary jamming of the knee which the patient can shake free, due to a loose body within the joint becoming stuck in the joint line * c. Tenderness over the joint line, due to a meniscal tear
a. A spongy block of usually 10-15 degrees to active and passive knee extension due to a displaced bucket handle meniscal tear
From the list below, select the five important ‘red flag’ symptoms in relation to back pain: * a. Neurological lower limb symptoms with bowel or bladder dysfunction * b. Back pain in young patients ( 60 years) * d. Back pain following a road traffic accident * e. Constant back pain, worse at night * f. Back pain worse on movement * g. Unilateral back pain * h. Back pain with systemic symptoms of upset
a. Neurological lower limb symptoms with bowel or bladder dysfunction b. Back pain in young patients ( 60 years) e. Constant back pain, worse at night h. Back pain with systemic symptoms of upset
What is the most common pulley at which the nodule becomes stuck and, therefore, is surgically divided during a trigger finger release?
A1 pulley
The thickest hyaline cartilage in the body is found on the articular surface of which bone? Select one: * a. Talar dome * b. Patella * c. Radial head * d. Femoral head * e. Tibial plateau
Patella
https://s3.amazonaws.com/classconnection/403/flashcards/11907403/jpg/pjpgpng-173CA3FD57E66DA8A7C.jpg
Steroid injection to reduce inflammation of the tendon
Limb malalignment: A varus malalignment of the knee will predispose the patient to early osteoarthritis of which compartment of the knee? Select one: * a. Medial * b. Patello-femoral * c. Lateral
Medial
State the anatomical structure which is impinged in the following conditions or syndromes Hip imingement Shoulder impingement Carpal tunnel syndrome Cubital tunnel syndrome
Hip impingement - acetabular labrum Shoulder impingement- rotator cuff tendon Carpal tunnel syndrome - median nerve Cubital tunnel syndrome - ulnar nerve
https://s3.amazonaws.com/classconnection/403/flashcards/11907403/png/pjpgpngjpgpngjpg-173CA439DBF61FE4442.png
Hallux valgus surgery should be performed for pain and restriction of function Advice for this patient may include wearing more accommodating footwear
True or false: Bed rest is often helpful in mechanical back pain and should form part of first-line treatment for such patients, along with analgesia and explanation. Select one: True False
False - Bed rest is not advised as this will lead to stiffness and spasm of the back which may exacerbated disability.
