1
Q
vitamin D normal serum value
A
75-250 nanomole/L
2
Q
Normal BMD T-score
A
> -1
3
Q
osteopenic BMD T-score
A
-1 to -2.5
4
Q
Osteoporotic BMD T-score
A
< -2.5
5
Q
NEXUS Criteria
A
6
Q
Finkelstein’s test
A
De Quervain tenosynovitis
7
Q
Tinel sign
A
Carpal tunnel syndrome
8
Q
Fromenr’s sign
A
Ulnar nerve injury
9
Q
Thompsons test
A
Achilles tendon lesion/rupture
10
Q
Lachmans test
A
ACL
11
Q
Drawers test
A
anterior: ACL
posterior: PCL
12
Q
Bulb sign
A
Posterior dislocation of shoulder
13
Q
most useful test for evaluation of osteoporosis
A
- DEXA
- 25-hydroxy vitamin D
14
Q
corticosteroid use in osteoporosis
A
at least 3 months
15
Q
Back pain without neurological symptoms
A
pulled muscle/muscle spasm
- analgesia + normal activity
16
Q
Back pain classification
A
1- Acute low back pain lasts less than 6 weeks.
2- Sub-acute low back pain lasts between 6 and 12 weeks.
3- Chronic low back pain persists for more than 12 weeks.
17
Q
Back pain diagnosis
A
chronic back pain persisting longer than 3 months, have to exclude:
- central canal stenosis
- nerve root compression
18
Q
Signs of cauda equina compression
A
- loss of bladder
- loss of bowel control
- paraparesis/paraplegia
19
Q
bilateral leg pain + worse on erect posture + responds to exercise
A
Spinal stenosis
20
Q
Back pain around the anus, scrotum or vagin*
A
saddle anaesthesia
- investigate by MRI
21
Q
Acute herniation of an intervertebral disk that will require emergency surgery
A
crushed cauda equina
22
Q
shooting radiating pain through the posterior thigh and posterior leg to little toe + anterior + posterior motor symptoms
A
Sciatica
23
Q
pain radiating to the hip + anterior thigh + medial aspect of knee + calf + diminished knee jerk
A
L4 radiculopathy
24
Q
posterolateral buttock + posterior thigh + lateral leg +
A
L5 radiculopathy
25
Q
posterolateral buttock + posterior thigh + lateral leg posterior calf + lateral foot + diminished Ankle jerk
A
L5-S1 radiculopathy
26
Q
pain radiates through posterior buttock + posterior calf +
lateral foot + diminished Ankle jerk
A
S1 radiculopathy
27
Q
weakness of eversion and dorsiflexion + sensory loss of dorsum of foot + hc of colon cancer surgery
A
Common peroneal nerve damage
28
Q
weakness of foot plantar flexion + inversion
A
Tibial nerve
29
Q
Hip pain management
A
- walking stick on the contralateral hand
30
Q
hip joint degeneration affected movement
A
Internal rotation
31
Q
osteoporosis most common site fracture
A
Vertebrae
32
Q
Osteoporosis risk factors
A
– Menopause
– Age over 70
– Corticosteroid use longer than three months
– Rheumatoid arthritis
– Alcoholism
– Smoking
– Anorexia nervosa.
– Inflammatory Bowel Disease
33
Q
pain in the distal interphalangeal joints + carpometacarpal joints + hard/bony swelling + evening stiffness
A
Osteoarthritis (OA)
34
Q
Osteoarthritis treatment
A
symptomatic pain treatment
35
Q
Osteoarthritis not responding to pain
A
Severe
- orthopaedic consult for knee replacement
36
Q
Osteoporosis treatment
A
- Alendronate, risedronate and zoledronic acid: first-line therapy in **postmenopausal osteoporosis **
and prevent vertebral, Non-vertebral and hip fractures. - bisphosphonates: primary prevention of fractures in px who never had minimal trauma fracture, secondary prevention of fractures
- Strontium ranelate: primary prevention of osteoporosis in women
- bisphosphonates and raloxifene: secondary prevention of fractures in women who have had minimal trauma fractures
37
Q
Osteoporosis treatment not going to plan, what to do
A
- BMD T-score of =<-3
- > 1 symptomatic new
fracture after at least 12-months of
continuous therapy - > 2 minimal trauma fractures despite being on sufficient doses of bisphosphonates.
switch to teriparatide for 18 months
38
Q
Most common pelvic bone tumour in young adult
A
Metastatic tumor
39
Q
non-healing diabetic foot ulcer concern
A
osteomyelitis
- Do MRI
40
Q
child + fever + limp + raised ESR
A
Acute osteomyelitis
41
Q
osteomyelitis in children
A
- S aureus
- secondary to deep cellulitis
-MRI investigation
42
Q
pain in the proximal interphalangeal joints + carpometacarpal joints + soft/tender swelling + morning stiffness > 30 minutes
A
Rheumatoid arthritis (RA)
43
Q
Diagnosis of rheumatoid arthritis (RA)
A
-Persistent joint pain and swelling affecting at least three joint areas
2-Symmetrical involvement of the MCP or MTP joints
3-Morning stiffness lasting more than 30 minutes.
(if there’s a rash: Psoriatic arthritis)
44
Q
Rheumatic arthritis treatment
A
NSAIDs + DMARDS
45
Q
asymmetrical large joint monoarthritis/oligoarthritis + rash + uveitis + enthesitis
A
Reactive arthritis
46
Q
Distal interphalangeal joints are most commonly seen in
A
Psoriatic arthritis
47
Q
A
septic arthritis
48
Q
septic arthritis management
A
- IV antibiotics (flucloxacillin) for 2 weeks
- Oral antibiotics after 6 weeks
49
Q
positive rhomboid-shaped birefringent crystals
A
Pseudogout
50
Q
Negative needle shaped birefringent crystals
A
Gout
51
Q
Gout causes
A
- Alcohol (increase urate)
52
Q
Gout investigation
A
Diagnostic: joint aspiration
53
Q
sclerosis of sacroiliac joint
A
sacroiliitis
54
Q
sacroiliitis ddx
A
– Psoriasis.
– Reactive arthritis.
– Ankylosing spondyloarthropathy.
– Arthritis related to inflammatory bowel disease
55
Q
sacroiliitis causes
A
1-HLA-B27
2-Chlamydia and Gonorrhoea serology
3-RA factor, anti-ccp to rule out Rheumatoid arthritis
4-Inflammatory markers such as ESR and C-reactive protein
56
Q
Ankylosing spondylitis features
A
- Sacroilitis is the earliest manifestation
- In only 5% cases, onset is after the age of 40 years
- Median age of onset is 23 years of age
- More than 40% patients present with unilateral ocular pain, lacrimation and
photophobia - Limited chest expansion
- Limitation of movement of lumbar spine in both sagital and frontal planes
- inflammatory back pain
57
Q
Ankylosing spondylitis management
A
1st line: NSAIDs
2nd: TnF alpha inhibitors
- Infliximab
- Adalimumab
- rituximab
58
Q
Bisphosphonates prerequisites
A
Vitamin D level (symptomatic hypocalcaemia)
renal function test (creatinine > 35mL)
59
Q
Bisphosphonates side-effects
A
- oesophagitis
- jaw osteonecrosis
60
Q
Scaphoid fracture
A
- proximal pole fracture 20%
- Distal pole fractures are 10%
- Most common site of fracture is waist of the bone 70%
61
Q
Most common type of scaphoid fracture
A
proximal pole fracture 20%
62
Q
blood supply to the scaphoid
A
distal to proximal
63
Q
Scaphoid fracture complication
A
– Non-union.
– Avascular necrosis.
– Carpal instability.
– Osteoarthritis.
64
Q
Scaphoid fracture investigation
A
CT scan
65
Q
Scaphoid fracture prognosis
A
distal pole fractures is better than proximal pole because of low risk of vascular compromise
- may take up to 1-2 weeks to become visible radiologically
66
Q
age 3-8 + viral illness + acute hip/thigh Pain + limp + hip decreased range decreased range of motion
A
transient synovitis transient synovitis (TS),
67
Q
transient synovitis transient synovitis (TS) management
A
ibuprofen
68
Q
medial deviation of the forefoot with a normal neutral position of the hindfoot
A
Metatarsus adductus (MA)
- corrects spontaneously;
69
Q
rigid positioning + medial/upward deviation of forefoot & hindfoot + hyperplantar flexion of foot
A
congenital clubfoot
70
Q
congenital clubfoot management
A
serial manipulation and casting
-surgery if dire
71
Q
knee X-ray is required when a child presents after an injury
A
– Isolated patellar tenderness.
– Tenderness at the head of the fibula.
– Inability to flex at 90 degrees.
– Inability to bear weight immediately after trauma and in an emergency.
72
Q
subluxed, dislocated femoral heads + knees are at unequal heights when hips and knees are flexed + asymmetric skin folds + limited abduction
A
Developmental dysplasia of the hip
73
Q
Developmental dysplasia of the hip risk factors
A
- female
- breech presentation
- positive family history of hip dysplasia
74
Q
Developmental dysplasia of the hip screening
A
- < 6 months: Hip examination (Ortolani), US
- > 6 months: X-ray
75
Q
athlete + overuse apophysitis of the tibial tubercle + pain upon quadriceps contraction
A
Osgood-Schlatter disease
76
Q
4-10 years + avascular necrosis of the femoral head
A
Legg-Calve-Perthes Disease
77
Q
Overweight adolescent + limping + hip stiffness + hip pain radiating to antero-medial thigh and knee
A
Slipped capital femoral epiphysis
78
Q
Slipped capital femoral epiphysis management
A
Percutaneous pin fixation
79
Q
injuries warranting knee X-ray in children
A
– Isolated patellar tenderness.
– Tenderness at the head of the fibula.
– Inability to flex at 90 degrees.
– Inability to bear weight immediately after trauma and in an emergency
80
Q
by trauma, as a result of a fall, or by the direct pressure and friction of repetitive kneeling
A
Acute prepatellar bursitis (housemaid’s knree)
81
Q
Acute prepatellar bursitis management
A
- NSAIDs
- glucocorticoid injection
82
Q
Absolute contraindication to total knee
replacement
A
Septic knee
83
Q
‘pop’ at time of knee injury + severe pain + effusion (hemarthrosis) + instability of the knee changing direction
A
anterior cruciate ligament (ACL) injury
84
Q
‘twinge’ or sudden pain + Medial Joint line tenderness + able to continue activity with some discomfort
A
Medial meniscus tear
85
Q
Medial meniscus tear investigation
A
- barefooted with the knee flexed to 20 degrees and rotates the body
and knee three times internally and externally (Thessaly test) most useful
Flexion/rotation test (McMurray test) for screening
86
Q
hx of type 2 DM + severe global passive movement restriction affecting all planes of movement + bilateral pain
A
Adhesive capsulitis (Frozen shoulder)
87
Q
adhesive capsulitis movement restriction
A
all planes of movement but especially internal rotation
88
Q
Adhesive capsulitis features
A
- bilateral 20%
- Diabetic 80%
- painful freezing phase, adhesive phase and a recovery phase 6months-2years
89
Q
Adhesive capsulitis management
A
– 1st line: NSAIDS.
– 2nd line: - Intra-articular steroids
- Physiotherapy /Occupational Therapy
– Oral steroids (prednisolone) if NSAIDs not working
90
Q
Winging of the scapula nerve impingmeent
A
Long thoracic nerve
91
Q
shoulder pain + shoulder abduction weakness + external roation weakness
A
suprascapular nerve entrapment (SNE)
- shoulder abduction (supraspinatus)
- external rotation (infraspinatus)
92
Q
Muishaft humeral fracture will cause what nerve injruy
A
radial nerve
93
Q
prominent acromion + loss of deltoid contour + slightly abducted and externally rotated
A
anterior shoulder dislocation
94
Q
anterior shoulder dislocation nerve injury
A
Axillary nerve
95
Q
Adhesive capsulitis management
A
prednisolone 30 mg daily for 3 weeks
- wean after 6 weeks
96
Q
most common complication of Colles
fracture
A
Malunion
97
Q
earliest complication of Colles fracture
A
Ischemic Volkmann contracture
98
Q
Most common elbow fracture in children
A
supracondylar fracture
99
Q
most serious complication of supracondylar fractures
A
Volkmann ischemic contracture
- permanent damage to nerves and muscles of the forearm leading to contractures
100
Q
Radial nerve injury
A
wrist drop
- decreased or absent thumb extension and abduction
- Decreased sensation over dorsum of the hand (thumb, index, middle and half of the ring fingers)
101
Q
Median nerve injury
A
- Colles fracture
- acute carpal tunnel syndrome
- impaired thumb abduction
- paraesthesia
102
Q
Colles fracture nerve injury
A
median nerve
103
Q
Colles fracture cast management
A
the wrist should be in 10° flexion and 10° ulnar deviation 4-6 weeks
104
Q
lower limbs trauma or surgery + 24 to 72 hours after injury + altered mental state + dyspnoea + petechiae + eye/torso haemorrhage
A
fat embolism
105
Q
sudden onset of severe calf pain + limping + absent plantar reflex
A
Achilles tendon rupture
106
Q
Achilles tendon rupture investigation
A
Thompson Test
- absent plantar reflex
107
Q
Calcaneal fracture can give rise to what injury
A
spinal injury
- do Spinal x-ray series
108
Q
serious complication after cast application
A
compartment syndrome
109
Q
compartment syndrome diagnostic symptom
A
throbbing pain increasing after wiggling fingers/toes
110
Q
compartment syndrome complications
A
permanent nerve damage or loss of limb due to decreased circulation and oxygen to the tissue
111
Q
bone pain + tibia bowing + enlarged skull with frontal bossing
A
Paget’s disease
112
Q
Paget’s disease features
A
-Elevated alkaline phosphatase (early finding)
- bone pain (most common symptom)
113
Q
Paget’s most common location
A
Pelvis 70%
114
Q
Paget’s disease management
A
IV Zoledronic acid
Bisphosphonate, Alendronate
- paracetamol, NSAIDs
- vitamin D and calcium supplementation (prevent hypocalcaemia and secondary hyperparathyroidism)
115
Q
wrist movements is most likely to reproduce the pain in a patient with lateral epicondylitis
A
Resisted extension
116
Q
lateral epicondylitis management
A
Band support below the elbow
117
Q
pain worsens on thumb and wrist + grasping + tenderness on proximal to radial styloid
A
De Quervain tenosynovitis
118
Q
thickened fascia of 4th digit + joint stiffness + a loss of full extension
A
Dupuytren’s contracture
119
Q
Dupuytren’s contracture cause
A
- Alcohol
- DM
- epilepsy
- male
120
Q
Dupuytren’s contracture management
A
depends on severity
low/moderate: Steroid injection
severe: Open fasciectomy
121
Q
pain and numbness in the fingers + HIV + multiple loose bodies in the ulnar bursal fluid
A
Mycobacterial tenosynovitis due to Mycobacterium avium complex
122
Q
volleyball and baseball injury + flexion deformity + inability to actively extend finger
A
Mallet finger
123
Q
Mallet finger management
A
Maintain hyper-extension of the distal interphalangeal joint for 6-8 weeks
124
Q
most common joint affected in diabetic neuropathy
A
tarsus and tarsometatarsal joints(midfoot)
125
Q
severe burning pain between the third and fourth toe + gets better walking barefoot + gets worse on weight bearing + localised tenderness
A
Morton Neuroma
126
Q
Heel pain + medial tuberosity tenderness + worse getting out of bed + relieved by walking
A
Plantar Fasciitis
127
Q
treatment for plantar fasciitis
A
- stretching exercises for the plantar fascia and calf muscles
- Avoid flat shoes and barefoot walking
- arch supports
and/or heel cups - Decreasing causative or aggravating exercise
- NSAIDs
- glucocorticoids and a local anesthetic
128
Q
Major Branches of Brachial Plexus
A
- MUSCULOCUTANEOUS NERVE ( C5,C6,C7) - REMEMBER IT SUPPLIES- BICEPS
BRACHII, BRACHIALIS - AXILLARY NERVE ( C5,C6)- it wraps around the neck of humerus. REMEMBER DELTOID AND REGIMENTAL BADGE SIGN
- MEDIAN NERVE ( C5-T1)- REMEMBER - ALL FLEXORS OF FOREARM EXCEPT 1.5
- RADIAL NERVE (C5-T1) - REMEMBER ALL THE EXTENSORS
- ULNAR NERVE (C8-T1)- 1.5 FLEXORS + ALL THE INTRICATE MUSCLES OF THE Hand
129
Q
Anatomy of the orbit
A
130
Q
Orbital Fractures
floor
zygomatic fracture
naso
roof
A
131
Q
Orbital fractures
Common signs and symptoms
imaging
A
132
Q
Depressed fracture of the zygoma
A
After a blow to the cheek or side of the face, double vision of binocular type is very suggestive of a depressed fracture of the zygoma/zygomatic arch .Inspection and palpation of the orbital margins may reveal a step deformity ofthe orbital margin or a depressed contour of the cheek, and there may also be anaesthesia in the distribution of the infraorbital nerve. Operative elevation is usually required.
Rupture of the globe will cause gross loss of vision rather than diplopia.
Hyphaema(bleeding into the anterior chamber) will cause monocular visualblurring, and is diagnosed by inspection revealing evidence of blood in the anteriorchamber, often with a fluid level.
**Fracture of the mandibular ramus **can cause difficulty opening the mouth, but notdiplopia.
Maxillary antrum rupture would be secondary to a comminutedmaxillary fracture.or blowout fracture of the orbit, and usually follows a direct blow to the eye ratherthan to the lateral face or cheek.
133
Q
Orbital Fractures
A
134
Q
A
135
Q
A
