1
Q
Osteochrondroma
- Benign
- bony outgrowth with cartilagenous cap
- local pain
A
Surgical removal
2
Q
Endochondroma
- Benign
- intramedullary and metaphyseal cartilaginous tumour caused by failure of normal enchondral ossification
A
Curettage + bone graft
3
Q
Simple Bone cyst
- benign
- asymptomatic, found on proximal humerus and femur.
A
Curettage + bone graft
4
Q
Osteoid Osteoma
- benign
- small collection of immature bone surrounded by an intense sclerotic halo
- constant pain, worse at night
A
Self-resolving
NSAIDS
CT guided radiofrequency ablation
5
Q
Brodie’s Abscess
- benign
- subacute osteomyelitis
A
Currettage
6
Q
Osteosarcoma
- most common malignant bone tumour
- produces bone
- in knees of young patients
A
Chemotherapy
7
Q
Ewings Sarcoma
- malignant tumour of primitive cells in the marrow
- “onion skin” appearance on XR
- fever, warm swelling, raised inflammatory markers
- common in teens
- chromosome 22, EWS gene
A
Radiotherapy
Chemotherapy
Surgery
8
Q
Osteogenesis Imperfecta
- brittle bone disease
- blue sclera
- multiple fractures
- defect of type 1 collagen
- loss of hearing
A
Splintage
Traction
Stabilisation (Sofield procedure)
9
Q
Achondroplasia
- short stature
- prominent forehead
- widened nose
- lax joints
- normal mental IQ
A
Deformity correction
Limb lengthening
Growth hormone therapy
10
Q
Ehler-Danlos Syndrome
- abnormal elastic and collagen formation
- hypermobility
- vascular fragility (easily bruised)
A
Surgery (for dislocating joints)
11
Q
Duchenne Muscular Dystrophy
- progressive muscle weakness in boys
- trendelenburg positive + Gowers sign positive
- resp and cardio failure related death in 20s
- raised CK
- X linked, dystrophin gene- calcium linked
A
Physiotherapy
Splintage and deformity correction
Surgery (for scoliosis)
12
Q
Beckers Muscular Dystrophy
- similar to DMD but live into their 40s
A
Physiotherapy
Splintage and deformity correction
Surgery (for scoliosis)
13
Q
Erb’s Palsy
- obstetric injury
- waiters tip posture
- C5-6 nerves
- associated with scoliosis, ptosis and horners syndrome
A
Physiotherapy
Nerve transfer
Subscapularis releases
Latissimus Dorsi Tendon Transfers
14
Q
Klumpke’s Paralysis
- C8-T1 nerves
- paralysis of forearm and hand muscles
A
Physiotherapy
15
Q
Developmental Dysplasia of the Hip (DDH)
- perinatal dislocation of the hip
- shortened limb
A
Pavlik Harness
16
Q
Transient Synovitis
- inflammation of the synovium of a joint following a viral infection
A
Self-limiting
Rest + NSAIDS
17
Q
Perthes Disease (Legg-Calvé-Perthes)
- idiopathic osteochondritis of the femoral head
- age 4-9, commonly boys
- pain, limb, Trendelenburg positive
- AVN of femoral head
A
Self-healing (18+ months)
NSAIDS
Physiotherapy (Swimming etc)
If non-healing: Osteotomy
18
Q
Sipped Upper Femoral Epiphysis (SUFE)
- inferiorly slipped neck of femur due to growth plate not being able to cope with weight
- pain in knee, groin
- loss of internal rotation
A
Immediate internal fixation in-situ using screws to prevent slippage
Chronic slipping: Osteotomy
19
Q
Talipes Equinovarus (Club Foot)
- feet are rotated medially and inferiorly
- congenital deformity
A
Ponseti technique splintage (4-6 week blocks)
20
Q
Shoulder Impingement Syndrome
- tendons of the rotator cuff are compressed in the tight subacromial space during movement
- pain between 60-120 degrees on extension
A
NSAIDS, Analgesia, Physiotherapy
Subacromial steroid injection
Subacromial decompression
21
Q
Tarsal Coalition
- abnormal bridge between calcaneus, navicular and talus
A
Splintage
Resistant: Surgery to remove connection
22
Q
Rotator Cuff Tear
- pain and weakness in shoulder muscles
A
Surgery
Physiotherapy
23
Q
Adhesive Capsulitis (Frozen Shoulder)
- pain and stiffness of shoulder between 40-60 degrees on abduction
- loss of external rotation
A
Self-limiting (18-24months)
Physiotherapy + NSAIDS
Steroid injections
MUA (Manipulation under anaesthetic)
24
Q
Medial Epicondylitis (Golfer's Elbow) - painful and tender on flexion
A
Rest + NSAIDs
Steroid injection
Brace
25
```
Lateral Epicondylitis (Tennis Elbow)
- painful and tender on extension
```
Rest + NSAIDs
Steroid injection
Brace
26
Tendonitis
| - inflammation of a tendon
Self-limiting
| Steroid/ anaesthetic injection
27
Torn tendon of biceps (Popeye's deformity)
Self-healing
Rest
Sometimes: surgical repair
28
Dupuytren's Contracture
- proliferation of type 3 collagen fibres
- begins in palm, works outwards
- thickens tendons in palm
- ring finger is most common
- common in alcoholics, Peyronie's disease and diabetics
Fasciectomy
Fasciotomy
Needle aponeurotomy
Amputation of finger(s)
30 degrees is tolerated
Table top test= positive= treatment
29
Trigger Finger
- tendonitis of flexor tendon with nodular enlargement
- gets caught on A1 pulley
- clicking sensation on straightening finger
- 3rd/4th digit
Steroid injection
| Surgery
30
Ganglion Cyst
- cyst at synovial joint
- transilluminates
Recurrent: Aspiration/ excision
31
Trochanteric Bursitis
- inflammation of a bursae at a joint
- caused by over activity
Rest, analgesia, NSAIDS, Physiotherapy
32
Anterior Cruciate Ligament Rupture
- painful sports injury
- twisting movement on planted feet with "pop"
- instant haemarthrosis and swelling
- positive Lachman's test and anterior drawer test
ACL reconstruction/ tendon graft (using patellar tendon)
Rehab
1 year out of sport
33
Posterior Cruciate Ligament Rupture
- head on blow to the shin
- instability on going down stairs
- doesn't swell as much as ACL
- posterior sublaxation of the tibia, positive posterior drawer test
Reconstruction
34
De Quervain's Tenosynovitis
- spontaneous swelling and pain in the thumb
- common in middle-aged women, RA and pregnancy
NSAIDS
Splint/ rest
Steroid injection
Decompression surgery
35
Medial Collateral Ligament Rupture
| - pain on medial stress
Knee brace
36
Lateral Collateral Ligament Rupture
- pain on lateral stress
- more unstable than MCL
Reconstruction
37
Patellar Instability
- due to direct blow/ twist
- usually dislocated laterally
- spontaneous reduction
Physiotherapy to strengthen quadriceps
Recurrent: Surgery and reconstructed medial palatofemoral ligament
38
Compartment Syndrome
- internal bleeding and exudate from fracture and injury
- rise in internal pressure
- compression of the venous system, causing congestion within muscle
- secondary ischaemia as arterial blood cannot supply the congested muscle
- severe pain
- nerves are compressed resulting in parasthesia and sensory loss
Emergency fasciotomy
39
Giant Cell Tumour
- benign
- locally destructive
- around knee and distal radius
- multinucleated giant cells
- "soap bubble" appearance on XR
Excision
| Phenol/ bone cement/ liquid nitrogen
40
Fibrous Dysplasia
- common in adolescents, head and neck
- defective mineralisation
- affected bone is wider with thin cortices, can stress fracture
- shepherd's crook deformity in the proximal femur
Biphosphonates- reduce pain
ORIF + cortical graft
High recurrence: Excision
41
Chondrosarcoma
- malignant
- cartilage producing bone tumour
- in their 40s, pelvis and femur
Surgery
Doesn't respond to chemo/radio therapy
42
Myeloma
- a type of cancer that develops from cells in the bone marrow called plasma cells
- age 45-65
- recurrent infection
- deposition of AL amyloid
- weakness, back pain, bone pain,
Solitary plasmacytoma: radiotherapy
| Multiple myeloma: chemotherapy
43
Lipoma
| - a benign neoplastic proliferation of fat
Excision
44
Baker's Cyst
| - swelling of synovial fluid in the popliteal
Leave alone
| Recurrence: Excision
45
Abscess
| - cellulitis in wound / blocked sweat gland / cyst
Self-limiting
| Incision + drainage
46
Implantation Dermoid
- Epithelial Cells in subcutaneous tissue
- Cyst with pseudocapsule and grey fluid
Excision
47
Angiosarcoma
| - Malignant tumour of the blood vessels
Chemotherapy: Doxorubicin
| Surgery
48
Osteochondritis
| - An area of bone that has lost blood supply leading to cartilage chipping off
Detaching cartilage: Pin back in place
Detached: Fix or remove
Sometimes spontaneously self-heals
49
Avascular Necrosis
Drilling into the bone to decompress it
50
Osteoporosis
- Vitamin D, Calcium, weight bearing exercises, balanced diet, sun exposure
- Biphosphonates (alendronate, risedronate, etidronate)
- Desuromab
- Strontium
Post-menopause: Raloxifene
Annual Zoledronic injection (biphosphate)
51
Osteomalacia
- Vitamin D, Calcium, weight bearing exercises, balanced diet, sun exposure
- Biphosphonates (alendronate, risedronate, etidronate)
52
Paget's Disease
- Biphosphonates (alendronate, risedronate, etidronate)
| - Calcitonin
53
IPEX Syndrome
| Extremely prone to infections
Supportive
Immunosuppressants
Total parental nutrition
54
Osteoarthritis
- Loss of joint space
- Osteophytes
- Sclerosis (hardening of bone)
- Subchondral cysts
Analgesia + NSAIDS
Opiates + intraarticular steroids (short term)
Physiotherapy + occupational therapy + weight loss
Glucosamine phosphate supplement
Joint replacement
55
Osteoarthritis of hands/fingers
- PIP and DIP joints
- Base of thumb
- Heberden's nodes
- Bouchard's nodes
Analgesia + NSAIDS
Opiates + intraarticular steroids (short term)
Physiotherapy + occupational therapy + weight loss
Glucosamine phosphate supplement
Fusion of joints
56
Rheumatoid Arthritis
- MCP + PIP joints
- Swan neck deformity
- Boutonniere's deformity
```
DAS28 Score:
<2.6: remission
2.7-3.2: Low disease activity
3.3-5.1: Moderate
>5.1: High
```
Patients with newly diagnosed active RA start a combination of DMARDs (including methotrexate and at least one other DMARD, plus short-term glucocorticoids.
Short term: Analgesia, NSAIDS, Steroids (injection/oral)
Long term:
- DMARDS (methotrexate, sulphasalazine, hydroxychloroquine, leflunomide)
If >5.1 DAS28 Score
- Anti-TNFs (etanercept, infliximab, adalimumab)
- Biologics (rituximab, abatacept)
57
Ankylosing Spondylitis
| - chronic inflammation of the spine and sacroiliac joints
Physiotherapy + exercise
NSAIDS
Anti-TNF
58
Psoriatic Arthritis
Methotrexate
Doesn't respond: Anti-TNF
Still severe: Joint replacement/ fusion
59
Enteropathic Arthritis (IBD Arthritis)
Analgesia
Steroids
DMARDS
Anti-TNF (Infliximab, adalimumab)
60
Reactive Arthritis
- In response to infection (usually genitourinary)
- Associates with Reiter's syndrome
Self-limiting
Treat underlying disease
Steroids (injection)
Chronic: DMARDS
61
Systemic lupus erythematosus (SLE)
- Systemic autoimmune disease
- Type III hypersensitivity
Skin and arthralgia: hydroxychloroquine, topical steroids + NSAIDS
Inflammatory arthritis/ organ involvement: Azathioprine, mycophenolate, corticosteroids
Severe organ disease: IV Steroids/ cyclophosphamide
Unresponsive cases: IV Ig, rituximab
62
Sjogren's Syndrome
```
Lubricating eye drops
Dental care
Pilocarpine
Hydroxychloroquine
DMARDS
```
63
Systemic Sclerosis
Raynauds: CCBS, iloprost, bosentan
Renal: ACE inhibitors
GI: PPIs
ILD: DMARDS + cyclophosphamide
64
Anti-phospholipid Syndrome
Warfarin
| LMWH
65
Gout
Acute:
- NSAIDS (indomethacin)
- corticosteroids, opiate analgesia
- Colchicine
Recurrent/ presence of gout tophi: Alluprinol
66
Pseudogout
| Calcium pyrophosphate dihydrate (CPPD)
Acute: NSAIDS, Colchicine
Recurring: Hydroxychloroquine, methotrexate
67
Polymyalgia Rheumatics
| - myalgia of hip and shoulder of elderly
Prednisolone
| Screen for GCA
68
Giant Cell Arteritis
- Large Cell Vasculitis
- Transmural inflammation of arteries
- >50 year olds
- Multinucleated giant cells
- Visual problems, headaches, jaw claudication, scalp tenderness
Prednisolone
| Methotrexate/ azathioprine
69
Dermatomyositis
- V-shaped rash over chest
- Heliotrope rash
- Gottron's papules
Prednisolone
| Methotrexate/ azathioprine
70
Polymyositis
| - symmetrical proximal muscle weakness "trouble climbing stairs"
Prednisolone (slow response)
| Methotrexate/ azathioprine
71
Fibromyalgia
- widespread muscle pain + fatigue
- Associated with RA (25% have FM) and SLE (50% have FM)
Self-management therapy
Amitriptyline
Gabapentin
Pregabalin
72
Takayasu Arteritis
| - Large cell arteritis
Prednisolone
| Methotrexate/ azathioprine
73
Granulomatosis with polyangitis
(Wegner's)
- ANCA Associated Small Vessel Vasculitis
- ENT symptoms (epitaxis, deafness, sinusitis, nose collapse)
- Resp symptoms (haemoptysis, cavitating lesions)
IV steroids + cylophosmamide
74
Eosinophilic granulomatosis with polyangitis
(Churgg-Strauss Syndrome)
- ANCA Associated Small Vessel Vasculitis
- late onset asthma
- increased eosinophils in blood
- mononeuritis multiplex
IV steroids + cylophosmamide
75
Microscopic Polyangitis
- ANCA Associated Small Vessel Vasculitis
- causes glomerulonephritis
IV steroids + cylophosmamide
76
Henoch-Schonlein purpura
- Non-ANCA Associated Small Vessel Vasculitis
- a disease of the skin, mucous membranes, and sometimes other organs that most commonly affects children
- the disease causes palpable purpura (small, raised areas of bleeding underneath the skin), often with joint pain and abdominal pain
- kidney involvement
- following an infection
Self-limiting
77
Cerebral Palsy
Spastic: Damage to motor cortex, upper motorneurons or corticospinal tract. Causing: weakness and spasticity.
Ataxis: Damage to the cerebellum. Reduces co-ordinatino and balance.
Athetoid: Damage to pyramidal motor system, pyramidial tract, and basal ganglion. Causes writhing and speech difficulty.
```
Physiotherapy + splintage
Baclofen injection into subacromial space
Botox injection to spastic muscles
Rhizotomy
Surgical release and fusion of joints
```
78
Spina Bifida
- 2 halves of the posterior vertebral arch fail to fuse
- Spina bifida occulta: Mild- high arched foot/toe claws/ back dimple with tuft of hair
- Spina bifida cystica: Severe- herniation of meninges. If myelomeningocele, there may be a neurological deficit. Below region will not function properly.
Cannot cure nerve damage
Closed within 48 hours- surgery
Shunt to reduce hydrocephalus
Systemic evaluation
79
Polio
- Viral infection that affects the anterior motor horn cells in spinal cord
- Enters via GI tract
- Muscle paralysis in limbs within 2-3 days (sensation is preserved)
Residual paralysis: Splintage
Shortened limb: Shoe raise
Paralysis: Tendon transfers/ fusion
80
Internal Tibial Torsion
Self resolves by age 6
81
Metatarsus Adductus
| - front half of the foot turns inwards
Self resolves
| Casting may help
82
Femoral Neck Anteversion
Of no consequence- leave be
83
Genu Varum
Leave be
| Osteotomy
84
Genu Valgus
Leave be
| If young and severe: growth plate manipulation surgery
85
In-toeing
Due to:
- femoral neck anteversion
- internal tibial torsion
Self-resolving
86
Pes Planus (Flat feet)
Flexible: tibialis posterior tendon dysfunction, normal in kids
Rigid: tarsal coalition
No treatment needed
87
Patellar tendonitis
Self-limiting
88
Apophysitis
- inflammation of tubercle where tendon attaches
Osgood-Schlatter's disease: tibial tuberosity
Sindig-Larsen-Johansson syndrom: inferior pole of the patella
Self-limiting
| Rest and physiotherapy
89
Adolescent knee paint
Self-limiting
| Physiotherapy
90
Osteochondritis dissectans
| - Hyaline cartilage broken off at a joint
Leave or remove fragments
91
Scoliosis
| - lateral curvature of the spine
Mild: leave
Severe: Surgery
92
Spondylolisthesis
- slippage of vertebrae over one another
- L4/5/S1
- overweight adolescents
- lower back pain
Minor degree of slippage: rest + physiotherapy
| Severe: stabilization + reduction
93
Mechanical back pain
Analgesia + physiotherapy
Return to work (no bed rest)
Self resolving
94
Sciatica
- disc tear
- impingement of nerve roots
- L4/5/S1
Gabapentin
Maintaining mobility
Physiotherapy
Discectomy
95
Spinal stenosis
- multiple nerve entrapment
- burning pain in legs on walking
Physiotherapy and weight loss
| Surgery- decompress + increase space
96
Cauda Equina Syndrome
Emergency surgical decompression
97
Carpal Tunnel Syndrome
- median nerve
- paraesthesia in thumb and radial 2.5 fingers
Splints to reduce flexion
Corticosteroid
Surgical decompression- disection of transverce carpal ligament
98
Cubital Tunnel Syndrome
- ulnar nerve
- paraesthesia in little finger and 1/2 ring finger
Surgical release
99
Knee arthritis
Isolated OA: unicompartmental knee replacement
| Severe: TKR
100
Meniscal tears
Steroid injection
| Self-resolving
101
Ankle Arthritis
Cheilectomy (removal of osteophytes causing impingement)
| Elderly: Ankle prosthesis
102
Hallux Valgus
| - lateral deviation of big toe
Cheilectomy
| Arthrodesis
103
Mortons neuroma
Insoles
Steroid/ anaesthetic injection
Excision if continued pain
104
Achilles Tendonitis
Rest, physiotherapy
Self-limiting
DO NOT USE STEROIDS- Causes rupture
105
Achilles Tendon Rupture
Surgical repair and 8 weeks in cast
106
Plantar Fascitis
- pain on walking
- due to stress on aponeurosis
```
Rest
Stretching exercises
Corticosteroid injection
Surgical release of plantar fascia
Self-limiting
```
107
Tibialis posterior tendon dysfunction
Medial arch support
| Tendonectomy
108
Pes Cavus (High arch foot)
Soft tissue release
Tendon transfer
Calcaneal osteotomy
Arthrodesis
109
Claw Toes
| - hyperextension of MTP and hyperfelxion of PIP and DIP
Tenotomy
Tendon transfer
Arthrodesis of PIP
Amputation
110
Hammer Toes
| - hyperextension at MTP, hyperflexion at PIP, hyperextension at DIP
Tenotomy
Tendon transfer
Arthrodesis of PIP
Amputation
111
Tetanus
| - spastic paralysis due to neurotoxin
Surgical debridement
Antitoxin
Supportive measures
112
Neuropraxia
| - nerve conduction block/ demyelination due to compression or stretch
Self healing (28 days)
113
Axonotmesis
| - Death of axons distal to injury (Wallerian degeneration)
Self-healing (1 month)
| 1mm per day
114
Neurotmesis
| - transection of nerve
No recovery unless surgical repair
115
Complex Regional Pain Syndrome (CRPS)
| - heightened chronic pain syndrome after injury
```
Analgesia
Amitriptyline
Gabapentin
Steroids
Physiotherapy
Lidocaine
```
116
Soft tissue injury
RICE
Rest
Ice
Compression
Elevation
117
Aneurysmal bone cyst
- benign
- painful, filled with blood, multiple bones, local destruction and cortical expansion
Curettage + bone graft
118
Paget's
- hearing loss
- skull
- back pain
Biphosphonates:
- tiludronate
- aldronate
