PLAB 1 August 2024 > Orthopaedics > Flashcards

Orthopaedics Flashcards

(129 cards)

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1
Q

Describe the causes of Achilles tendon rupture?

A
  • Middle aged man;
  • Infrequent sports goer;
  • Repetitive jumping motion.
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2
Q

Describe the Simmond’s triad for the diagnosis of Achilles tendon rupture?

A

Patient in prone position:
- Affected leg rests in a dorsiflexed position;
- Palbable gap at the heel;
- No plantar flexion when calf is squeezed.

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3
Q

What is the management of Achilles tendon rupture?

A

Same day referral to orthopaedics.

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4
Q

What medications can contribute to Achilles tendon rupture?

A

Fluoroquinolones
- Increases the risk of tendinitis and tendon rupture.

Ex: ciproflocxacin.

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5
Q

Describe the Thompson test for Achilles tendon rupture?

A

Calf is squezeed ➝ reduced/absent plantar flexion.

Indication of tendon discontinuity.

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6
Q

What are the muscles group affected in Achilles tendon rupture?

HIGH YIELD

A
  • Gastrocnemius
  • Soleus
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7
Q

Describe the presentation of Baker’s cyst / popliteal cyst.

A
  • Popliteal mass;
  • Occasional pain;
  • Cyst rupture ➝ calf sweeling and pain.
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8
Q
A
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9
Q

How is the diagnosis of Baker’s cyst / popliteal cyst done?

A

Ultrasound.

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10
Q
A
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11
Q

What are the symptoms of frozen shoulder / adhesive capsulitis?

A
  • Pain;
  • Stiffness of the shoulder;
  • Restriction of active and passive shoulder movements;
  • Inability of doing passive external rotation.
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12
Q

What is the cause of frozen shoulder / adhesive capsulitis?

A
  • Thickened and contraction of the glenohumeral joint capsule;
  • Formation of adhesions.
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13
Q

What is the Rx of frozen shoulder / adhesive capsulitis?

A
  • Paracetamol and NSAIDs
  • Physiotherapy
  • Steroid injection
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14
Q

What is the commonest cause of shoulder pain?

A

Rotator cuff disorders.

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15
Q

Name the 4 rotator cuff muscles.

A
  • Supraspinatus;
  • Infraspinatus;
  • Teres minor;
  • Subscapularis.
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16
Q

What is the cause of Rotator cuff disorders?

A
  • Rotator cuff tears;
  • Calcific tendonitis;
  • Subacromial impingement.
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17
Q

What is the Rx of rotator cuff disorders?

A
  • Pain relief;
  • Physiotherapy;
  • Steroid injections (max 2);
  • Surgery.
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18
Q

What are the symptoms of shoulder impingement syndrome?

A
  • Pain on shoulder movement ;
  • Weakness on shoulder movement;
  • Restriction of activity;
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19
Q

What is the cause of shoulder impingement syndrome?

A
  • History of repetitive overhead activity or of carrying heavy objects;
  • It will cause narrowing of the subacromial space leading to supraspinatus tendinitis.
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20
Q

DDx between:
- Supraspinatus tendinitis
- Adhesive capsulitis

A

Supraspinatus tendinitis
- Difficulty lifting arm above shoulder;
- Painful arc test positive;
- Associated with injury of heavy lifting;

Adhesive capsulitis (stiff shoulder)
- Reduced active movements;
- Reduced passive glenohumeral joint movements;
- Difficulty to put on a jacket (external rotation impaired);
- Associated with DM.

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21
Q

What is the presentation / symptoms of Colles fracture?

A
  • Radial fracture (with or w/out ulnar fracture);
  • Dinner-fork deformity: Distal fragment of radius deviated backwards and laterally.

➔ Elderly patient who has fallen on an outstretched hand.

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22
Q

What is the management & Rx of Colles fracture?

A
  • X-ray;
  • Analgesia: haematoma block with lidocaine;
  • Closed reduction and immobilisation with a cast;
  • X-ray post reduction.
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23
Q

Describe the presentation of Smith’s fracture.

A
  • Reverse colles fracture;
  • Garden spade deformity;
  • Anterior displacement of the distal fragment.

Garden spade = pá de jardinagem/machamba.

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24
Q

Describe the presentation of scaphoid fracture.

A

➜ Most common carpal bone fracture.
- Fall on an outstreched hand;
- Tenderness on the anatomical snuffbox.

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25
Describe the `complications` of **scaphoid fracture**.
High risk of avascular necrosis.
26
What are the `investigations` done in **scaphoid fracture**?
**X-ray** - One immediately - One in 10-14 days if the first one doesn't show the fracture line.
27
What is the **`Rx`** done in **scaphoid fracture**?
**Fracture visible on x-ray** - Scaphoid cast for 6 weeks; **Fracture not visible:** - Cast of the wrist for 2 weeks, review with x-ray.
28
**DDx between:** - Galeazzi fracture; - Monteggia fracture.
**Galeaz`z`i fracture** - `Z is distal` ➝ fracture of distal 1/3 of radius shaft; - Distal radioulnar joint dislocation; **Monteggi`a` fracture** - `A is proximal` ➝ fracture of proximal 1/3 of ulna. - **`Radial nerve damage`**; - Dislocation of the head of radius.
29
What are the **complications** of `fracture`?
➔ **Fat embolism syndrome** - Fracture of long bones; - Petechial rash; - Chest pain & dyspnoea; - Oliguria & haematuria; ➔ **Compartment syndrome** ➔ **Gunstock deformity** - Cubitus varus following supracondylar fracture of the humerus; ➔ **Myositis ossificans** - Formation of new bone in muscle after the fracture.
30
What are the `symptoms` of **osteosarcoma**?
- Knee pain worse at night; - Fracture even with minor trauma; - Swelling ➔ Distal femur & proximal tibia commonly affected. ➔ Adolescents & old adults.
31
What are the `investigations` done in **osteosarcoma**?
◉ **X-ray:** - Sunburst appearance; - Codman's triangle. ◉ **CT scan** ◉ **Bone biopsy**
32
What is the `Rx` of **osteosarcoma**?
Radical resection of the tumour.
33
**DDx between**: - Osteosarcoma - Ewing sarcoma
**Osteosarcoma** - Teenage boy with knee pain **Ewing sarcoma** `Teenage boy with:` - Bone pain; - Tiredness; - Fever; - Weight loss.
34
What are the `symptoms` of **osteoid osteoma**?
- Unilateral leg pain; - Worse at night; - Relieved by NSAID.
35
What are the `symptoms` of **transient synovitis**?
- Acute onset hip pain; - Limp; - Fever (mild).
36
DDx of **elbow fracture**.
`◆ Child` ⟶ radial neck. `◆ Adult` ⟶ radial head.
37
What is the **most common type** of `ELBOW fracture in children`?
Supracondylar fracture of humerus.
38
What are the `structures damaged` in **elbow fracture**?
**Most likely:** - Brachial artery **Others:** - Median nerve - Ulnar nerve - Radial nerve
39
What is the most commom origin of a `bone metastasis`?
`◆ Male` ⟶ Prostate > lung. `◆ Female` ⟶ Breast > lung.
40
What is the **most common type** of `childhood fracture`?
- Torus fracture / buckling fracture; - Distal radius.
41
What are the `symptoms` of **Ewing sarcoma**?
- Bone pain; - Fever; - Weight loss; - Fractures; ➔ Common in the `2nd decade` of life; ➔ `Location:` diaphysis of femur, pelvis, tibia.
42
What is the `Rx` of **Ewing sarcoma**?
**Highly metatastic** - Chemo & - Surgery or - Radiotherapy & - Surgery
43
What are the `symptoms` of **sciatica**?
- Shooting pain from buttocks down the leg; - Pain ↓ on lying down and ↑ on sitting or walking; - Numbness; - Paraesthesia; - Weakness; - +/- loss of tendon reflexes.
44
What is the `cause` of **sciatica**?
➜ Disk prolapse: - L4 - L5 - S1 ➜ Large herniation can cause cauda equina syndrome
45
What is the `management` of **sciatica**?
- NSAIDs - Amitriptyline ➜ **Avoid gabapentinoids.**
46
Describe the **unhappy triad** of `knee injuries`.
**Injury to:** - Anterior cruciate ligament; - Medial collateral ligament; - Medial meniscus.
47
What is **`investigation`** done in **unhappy triad** of `knee injuries`?
**Gold standard:** MRI.
48
What is **`management / treatment`** done in **unhappy triad** of `knee injuries`?
- Protect - Rest - Ice - Compression - Elevation - Rehabilitation ➔ **Complete ligament tear:** Arthroplasty.
49
Describe the **mechanism of knee injury** in `medial collateral ligament`.
- Direct blow / twisting injury to lateral side of knee. - Associated to meniscal tears.
50
Describe the **mechanism of knee injury** in `lateral collateral ligament`.
- Direct blow / twisting injury to medial side of knee with the foot planted.
51
Describe the **mechanism of knee injury** in `anterior cruciate ligament`.
- Foot is fixed + rotational force + POP sound. - Deceleration movement.
52
Describe the **mechanism of knee injury** in `posterior cruciate ligament`.
- Direct impact on the shin (proximal tibia) with bent knee.
53
What are the tests done **for knee injury**?
**Medial collateral ligament:** - `Valgus stress test`. **Lateral collateral ligament:** - `Varus stress test`. **Anterior cruciate ligament:** - Anterior drawer test, Lachman test. **Posterior cruciate ligament:** - Posterior drawer test.
54
What are the tests done **for meniscal tears**?
- McMurray test; - Apley test.
55
Describe the **mechanism of injury** in `meniscal tears`.
- Twisting / pivoting + POP sound; - Associated with ACL injury.
56
Describe the `types and symptoms` of **knee bursitis**. | `Housemaid's knee`.
**Prepatellar bursitis** - Localized swelling `anterior` to patella; - Fluctuant / movable and compressible. **Infrapatellar bursitis** - Localized swelling `inferior` to patella; - Fluctuant / movable and compressible.
57
Which `nerve injury` is associated to **Traction injury at birth**?
Brachial plexus.
58
Which `nerve injury` is associated to: **- Fracture of humeral neck** **- Shoulder dislocation**?
Axilliary nerve.
59
Which `nerve injury` is associated to **fracture of humeral neck (Spiral groove)**?
Radial nerve.
60
Which `nerve injury` is associated to **elbow dislocation**?
- Ulnar nerve OR - Median nerve.
61
Which `nerve injury` is associated to **Monteggia fracture**? | Fracture of proximal 1/3 of the ulna.
Radial nerve (wrist drop).
62
Which `nerve injury` is associated to **fibular neck fracture**?
Common peroneal nerve (foot drop).
63
Which `nerve injury` is associated to: **- Femoral neck / acetabular fracture**; **- Hip dislocation**?
Sciatic nerve.
64
**DDx between:** - Radial nerve palsy; - C7 nerve root injury.
**Radial nerve palsy** `Numbness/tingling:` - Dorsolateral aspect of the hand; - Thumb; - Index finger; - Dorsal aspect of the middle finger; `Wrist:` - Weakness - Wrist drop **C7 nerve root injury** `Numbness:` - Middle finger
65
**DDx between:** - High ulnar nerve palsy; - Low ulnar nerve palsy.
**High ulnar nerve palsy** - Weakness in flexion of 4th and 5th finger; - `Ulnar claw hand`; - Sensory loss on the medial one and half finger anterior and posterior. **High ulnar nerve palsy** - Pins and needles in the medial one and half finger anterior and posterior - Seen in cyclists.
66
What are the `symptoms` of **carpal tunnel syndrome**?
- Tingling & numbness (median nerve area); - Weakness on hand grip and opposition of the thumb.
67
What are the `causes` of **carpal tunnel syndrome**?
- Pregnancy; - Wrist trauma; - Obesity; - Hypothyroidism; - Renal failure.
68
What are the `tests` to diagnose **carpal tunnel syndrome**?
**Gold standard:** electroneurography **Others** - Tine's sign; - Carpal tunnel compression test; - Phalen's test.
69
What is the `Rx` of **carpal tunnel syndrome**?
- Activity modification; - Local steroid injection; - Release of flexor retinaculum.
70
What is the `risk factor` of **developmental dysplasia of the hip**?
- Vaginal birth of a breeched baby. - Female infant.
71
What are the `symptoms` of **developmental dysplasia of the hip**?
- Asymetrical gluteal or thigh skin folds; - Limb lenghts discrepancies; - Limitation of hip abduction;
72
What are the `tests` done in **developmental dysplasia of the hip**?
◆ **Barlow test** - Attempts to dislocate the femoral head; ◆ **Ortolani test** - Attempts to relocate a dislocated femoral head; ◆ **Ultrasound scan of the hip** - In `infants < 4.5 months old`. ◆ **X-ray** - Older than 4.5 months.
73
What is the `Rx` of **developmental dysplasia of the hip**?
◆ **< 6 months** - Pavlik harness; ◆ **> 6 months** - Surgery.
74
Describe what is `Legg-Calve-Perthes' disease`.
Avascular necrosis of the femoral head.
75
What are the `symptoms` of **Legg-Calve-Perthes' disease**? | Avascular necrosis of the femoral head.
- Limping; - Pain on the hip or knee; - Limited internal rotation; - Common in: 4-8 YO boys.
76
What is the `investigation` done in **Legg-Calve-Perthes' disease**?
- **X- ray**: joint space widening - **MRI** of the hip
77
What is the `Rx` of **Legg-Calve-Perthes' disease**?
- Conservative; - Crutches; - Plasters; - Physiotheraphy.
78
Describe what is **Paget's disease (BONE)**.
Bone turnover (bone makig process) becomes faster and out of control with disorganised new bone formation.
79
What are the `symptoms` of **Paget's disease (BONE)**?
- Bone pain; - Pathological fractures; - Deafness & Tinittus (compression of CN VIII).
80
What are the `investigations` done in **Paget's disease (BONE)**?
**Labs** - ⬆︎ alkaline phosphatase. - Normal: Ca²⁺, PTH, phosphate. **X-ray** - `Skull: Cotton wool sclerotic pattern;` - Osteolytic lesions; - Thickened cortices.
81
What is the `Rx` of **Paget's disease (BONE)**?
- Biphosphonates (zolendrainc acid) ➝ to ↓ bone resortion. - Paracetamol & NSAIDs ➝ pain.
82
**DDx between:** - Paget's disease (BONE); - Osteomyelitis.
**Paget's disease** - Bowing of long bones due to remodelling deformities; - ⬆︎ ALP; - Warm skin; **Osteomyelitis** - Localised bone pain; - Swelling over the affected area; - Systemic infection: fever, malaise. - Mild raised ALP. - Warm skin.
83
What are `symptoms/presentation` of **fracture neck of femur**?
- H/o of fall in elderly patient - H/o of osteoporotic bone - Pain in the upper thigh or bone - Inability to bear weight - High risk of avascular necrosis of femoral head.
84
What are the `investigations` of **fracture neck of femur**?
1. **X-ray** - Broken shento's line 2. **MRI** - If x-ray is normal
85
What is the `Pain Rx` of **fracture neck of femur**? | **High yield**
➜ `Most initial` - IV Morphine (5 mg in elderly patient to start) ➜ `Most aproppriate` - Fascia iliaca compartment block.
86
What is `definitive management` of **fracture neck of femur**?
- Internal fixation of the femoral head; - Total hip replacement if AVN.
87
What are the `symptoms` of **osteoarthritis**?
- ⬆︎ Joint pain during activity that ⬇︎ at rest. - Commonly affects hip and knees; - Joint crepitus and tenderness; ◆ **Bone swelling:** `HD: BP` - `H`eberdern's nodes ➝ `D`istal interphalangeal joints - `B`ouchard's nodes ➝ `P`roximal IP joints
88
What is the `investigation` done in **osteoarthritis**?
**X-ray** `➜ LOSS` - `L`oss of joint space; - `O`steophytes; - `S`ubchondral cysts; - `S`ubchondral sclerosis.
89
What is the `treatment` of **osteoarthritis**?
- Weight reduction & physiotherapy; - Joint replacement surgery (last resort) **Pain management:** `➔ Newly diagnosed + Pain` - Paracetamol - Topical NSAID's `➔ Already on paracetamol + topical NSAIDs` - Codeine *(before tramadol)* - Oral NSAIDs *(if no risk of GI bleeding)*
90
**DDx between:** - Osteoarthritis - Rheumatoid arthritis
**Osteoarthritis** - > 50 YO - `Unilateral` monoarthritis; - Hip and knee joints - `DIP joint can be affected` - Pain gets worse with movement `(worse at the end of the day)` **Rheumatoid arthritis** - 30-50 YO - Symetrical polyarthritis - DIP sparred - Pain and stiffness early in the morning and after a period of inactivity; | DIP: Distal interphalangeal joint
91
What is the `cause` of **Mallet finger**?
Rupture of extensor tendon of finger.
92
What are the `symptoms` of **Mallet finger**?
- Fixed flexion deformity at DIP joint; - Swelling and ecchymosis; - H/O of trauma.
93
What is the `management` of **Mallet finger**?
- **Partial tear:** splint; - **Complete tear:** Surgical fixation.
94
Describe **Gamekeeper's / skier's thumb**?
- Rupture of ulnar collateral ligament; - Thumb is hyperextended and deviated laterally.
95
Describe the bone mineral density of **Osteoporosis**.
Bone mineral density ⩽ -2.5 from mean.
96
What are the `risk factors` for **Osteoporosis**?
- ⬆︎ age; - Female sex *(postmenopausal)* - Corticosteroid use - Cushing's syndrome - Primary hyperparathyroidism
97
What are the `symptoms ` of **Osteoporosis**?
Fracture with even low trauma.
98
What are the `investigations` done in **Osteoporosis**?
- Dexa scan; - Normal calcium; - Normal PTH.
99
What is the `management` of **Osteoporosis**?
- **Biphosphonates:** alendronate - Vit D - Calcium - Denosumab
100
In **osteoporosis**, what is the step by step management for `assessment and prevention`?
**Risk of osteoporosis** 1. Fracture risk assessment; 2. If risk ≥10% of osteoporotic; fracture than step 3; 3. Dexa scan; 4. T-score <-2.5 ➝ offer Rx. **≥ 50 years & has a fragility fracture** - Dexa scan; - T-score <-2.5 ➝ offer Rx.
101
What is the `management` when **DEXA scan's reading** `< -2.5`: - Spine - Hip - Neck of femur?
Biphosphonates.
102
What are the `symptoms` of **tennis elbow / lateral epicondylitis**?
- Pain and tenderness at the lateral epicondyle of the humerus; - Positive cozen's test (pain on resisted extension of the wrist).
103
What is the `Rx` for **tennis elbow / lateral epicondylitis**?
- `Physiotherapy` - Activity modification; - NSAIDs - Local steroid injection - Surgery (last resort)
104
What are the `symptoms` of **golfer's elbow / medial epicondylitis**?
- Pain and tenderness at the medial epicondyle of the humerus; - Pain ⬆︎ on wrist flexion and pronation.
105
What is the `Rx` for **golfer's elbow / medial epicondylitis**?
- Physiotherapy - Activity modification; - NSAIDs - Local steroid injection - Surgery (last resort)
106
What are the **common organisms** that `cause` **`septic arthritis`**?
- **General:** S. Aureus - **Sexually active adults:** N. gonorrhoea
107
What are the `symptoms` of **`septic arthritis`**?
- Common swollen and red joint; - Pain on active and passive movement; - Fever and rigors; - Common joint: knee.
108
What is the **investigation** done in **septic arthritis**?
- Synovial fluid aspiration - Blood culture
109
What is the **Rx** done in **septic arthritis**?
- Flucloxacillin for 4-6 weeks - Gonococcal arthritis: cefotaxime or ceftriaxone.
110
DDx between: - Septic arthritis - Reactive arthritis
**Septic arthritis** - *Organism*: S. aureus or N. Gonorrhoeae - *Arthritis*: Monoarthritis (knee) - *Synovial fluid aspiration*: growth of causative organism **Reactive arthritis** - *Organism*: C. Trachomatis, C. pneumoniae - *Arthritis*: Migratory oligoarthritis - *Synovial fluid aspiration*: raised WBC
111
What is the **causative organism** for **osteomyelitis**?
S. Aureus.
112
What are the **risk factors** for **osteomyelitis**?
- Recent trauma - Recent surgery - Open fractures - Immunocompromised state - DM
113
What are the **symptoms** for **osteomyelitis**?
- Acute onset of pain in the affected bone; - Swelling - Warmth - Fever
114
What are the **investigations** done for **osteomyelitis**?
**Gold standard**: MRI **Other**: Blood cultures
115
What is the **management** of **osteomyelitis**?
IV flucloxacillin.
116
What are the **symptoms** of **slipped capital femoral epiphysis**?
- Pain/discomfort in the groin or knee - Limp on the affected side - Common in obese teens
117
What is the **investigation** done in **slipped capital femoral epiphysis**?
**X-ray**: widening of the epiphyseal line or displacement of the femoral head.
118
What is the **Rx** of **slipped capital femoral epiphysis**?
Surgery.
119
Describe what is **Toddler’s fracture**.
Mid-tibial spiral fracture on toddlers 1-3 years old.
120
What are the **features** of **Toddler’s fracture**?
- Not walking after a fall - Mid-tibial tenderness - Suspect even if X-ray is normal.
121
Management of **Toddler’s fracture**?
- Analgesia - Review in outpatient fracture clinic after 1-2 weeks.
122
Describe the **limps rule** in **children**.
**< 3 years** - Developmental dysplasia of the hip - Septic arthritis - Toddler’s fracture **3 - 9 years** - *Acute:* transient synovitis - *Chronic:* Perthes disease **> 9 years** - Slipped upper femoral epiphysis
123
Describe **foot fractures** and the bones affected.
**Vertical fall on feet:** Calcaneus. **Stress fracture:** Metatarsals
124
When to apply a **below elbow back slab**?
- Colles fracture - Distal radius and ulnar fractures.
125
What are the **Symptoms** of **lumbar stenosis**?
- Neurogenic claudication (improves on sitting and bending forward and cycling). - Pain on dermatome distribution - Unilateral or bilateral - With or without back pain
126
What are the **investigations** for **lumbar spinal stenosis**?
**Initial:** X-ray (degenerative changes) **Gold-standard:** MRI
127
What is the **treatment** of **lower back pain**?
**1st line:** NSAIDs **2nd line:** Paracetamol.
128
What are the **symptoms** of **reactive arthritis**?
Reiter’s triad: - **Can’t see**: conjunctivitis - **Can’t pee**: urethritis - **Can’t climb a tree**: arthritis
129
What is the **cause** of **reactive arthritis**?
One of the following: - Urogenital infection - Gastrointestinal infection
PLAB 1 August 2024
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