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323 Cards in this Set
- Front
- Back
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What are the 3 types of Rheumatoid Cervical Spondolysis ? |
Subaxial subluxation Atlantoaxial subluxation Basilar invagination |
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True or false: A male patient presents with a history of back pain. Does this statement describe an inflammatory spondyloarthropathy as a cause for his symptoms. A 30 y.o male with a sudden onset of well localised pain and associated radiation down the back of his left leg. |
False This type of pain is a typical picture of a pain which is more likely to be mechanical due to the fact that it is very acute in onset |
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True or false: A male patient presents with a history of back pain. Does this statement describe an inflammatory spondyloarthropathy as a cause for his symptoms. A 60 y.o male with gradual onset of mid-thoracic pain with associated weight loss |
False The patient is not under 40 years of age at the time of onset, this it is not highly suggestive of an inflammatory spondyloarthropathy |
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True or false: A male patient presents with a history of back pain. Does this statement describe an inflammatory spondyloarthropathy as a cause for his symptoms. A 30 y.o male with gradual onset of lower back pain and associated pain in the right buttock |
True It is a young patient, with an insidious onset of typical pain of a spondyloarthropathy |
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True or false: A male patient presents with a history of back pain. Does this statement describe an inflammatory spondyloarthropathy as a cause for his symptoms. A 60 year old male with sudden onset of lower back pain that improves with activity |
False |
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True or false: Immediate wound closure is a principle of compound fracture treatment |
False If the wound were to be closed immediately the field could not be irrigated to help prevent secondary infection and tissues that are dead could not be debrided |
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True or false: Wound debridement is a principle of compound fracture treatment. |
True Thorough debridemnt is critical in preventing deep infection of the involved tissues |
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True or false: Aggressive antibiotic cover is a principle of compound fracture treatment |
True It should be initiated immediately |
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True or false: Informed consent is a principle of compound fracture treatment |
True ? Treatment involves surgical intervention |
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True or false: No tendon repair is a principle of open fracture treatment |
? True |
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True or false: An aneurysmal bone cyst is an expansile lesion |
True It is defined as a cystic expansile bone tumour seen in the first and second decade |
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True or false: An osteoid osteoma is an expansile lesion |
False An osteoid osteoma is a benign lesion with sclerotic and lytic changes which causes pain that is worse at night and is relieved by asprin |
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True or false: A simple bone cyst is an expansile lesion |
? False It is described as a mildly expansile lesion but not to the extent of an anuerysmal bone cyst |
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True or false: An osteoblastoma is an expansile bone lesion |
False |
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True or false: The following radioisotope scan would be the most suitable for helping diagnose a septic total hip replacement prosthesis- white cell scan |
False ? |
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True or false: The following radioisotope scan would be the most suitable for helping diagnose a septic total hip replacement prosthesis- sulphur colloid scan |
False |
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True or false: The following radioisotope scan would be the most suitable for helping diagnose a septic total hip replacement prosthesis- Technetium scan |
False Although it gives you information about the activity of remodeling, it is not necessarily useful to identify a spot of infection in a patient who has recently had a THR as some bone changes are to be expected |
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True or false: The following radioisotope scan would be the most suitable for helping diagnose a septic total hip replacement prosthesis- blood pool scan |
? False |
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True or false: The following radioisotope scan would be the most suitable for helping diagnose a septic total hip replacement prosthesis- Gallium scan |
True ? |
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A patient's lumbar x-ray show's a missing pedicle on a single side. What is this sign called, and what is it suggestive of ? |
This is called a winking owl sign, as in the missing pedicle is the eye of the owl that is closed. It is highly suggestive of bony metastases (malignant). |
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In a 58 year old male patient presents with a 3 month history of backache which is especially worse at night. You recognize this as a red flag and consequently as an indication for referral and a lumbar x-ray. You see the lumbar x-ray of the patient at it show's a missing pedicle of the L3 vertebra (winking owl sign). Which 2 further blood investigation would you perform and why ? |
Night pain may be due to either metastases or infection. Furthermore the patient is 58 years of age, in this age group the most likely malignant growth for this patient is either metastatic disease or myeloma. We can look at the pt's ESR (an inflammatory marker) and do a serum electrophoresis (to look at possible myeloma). A very high ESR might be suggestive of TB or Myeloma. |
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A 58 year old male patient presents with a 3 month history of backpain, especially night pain. A lumbar x-ray shows loss of one of the L3 pedicles. Further investigation shows a very high ESR. What is the most likely diagnosis ? |
The most likely diagnosis is TB. But an electrophoresis can be done to look at possible multiple myeloma. Skeletal metastases is not considered as it does not form part of the differential of a very high ESR |
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True or false: Regarding a Colles (distal radius) fracture- it is characterized as being intra-articular |
False According to the classification of distal radius fractures, an intra-articular fracture of the distal radius is called a Barton's fracture |
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True or false: Regarding a Colles (distal radius) fracture- it is associated with an ulnar styloid fracture |
? True |
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True or false: Regarding a Colles (distal radius) fracture-it is a fracture that is dorsally displaced |
True This is characterized by the dinner fork deformity |
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True or false: Regarding a Colles (distal radius) fracture- there is radial shortening or impaction |
True |
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True or false: Regarding a Colles (distal radius) fracture- there is an angulation with the apex of the lesion volarly (i.e. to the palmar side) |
True The fracture is displaced dorsally and in doing so the apex of the lesion points towards the palmar or volar side |
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Define a Galeazzi fracture
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Distal radial shaft fracture with distal radio-ulnar joint dislocation |
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Define a Monteggia fracture |
A proximal ulna shaft fracture with radial head dislocation |
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True or false: Regarding Pavlik harness treatment for DDH - It may require up to 4 weeks to reduce or stabilize |
True |
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True or false: Regarding Pavlik harness treatment for DDH - 90% of successful cases are reduced by 2 weeks |
True |
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True or false: Regarding Pavlik harness treatment for DDH - May attempt Pavlik for subluxated hips between 6-12 months |
? Flase This modality of treatment is indicated in children with DDH who are <6 months old. other modalities such as closed reduction and spica casting would be indicated in this case |
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True or false: Regarding Pavlik harness treatment for DDH - Full time wear with hip ultrasound in harness every 7-14 days |
True |
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True or false: Regarding Pavlik harness treatment for DDH - abandon harness if hip not reduced by 12 weeks in child <6 months old |
False The harness treatment should be abandoned by 3-4 weeks if the child is <6 months old and his hip has not been reduced |
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True or false: Torticollis in an infant is a risk factor for DDH |
True |
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True or false: Anus imperforatum is a risk factor for DDH |
False |
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True or false: Assisted delivery via suction is a risk factor for DDH |
False |
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True or false: Cardiac abnormalities is a risk factor for DDH |
False |
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True or false: Pes planus is a risk factor for DDH |
False |
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True or false: Regarding applying a pavlik harness, the leg should be supported up to the ankle crease |
False http://hipdysplasia.org/developmental-dysplasia-of-the-hip/child-treatment-methods/pavlik-harness/ |
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True or false: Regarding applying a pavlik harness, the chest halter should be position at the axillary line |
False http://hipdysplasia.org/developmental-dysplasia-of-the-hip/child-treatment-methods/pavlik-harness/ |
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True or false: Regarding applying a pavlik harness, posterior straps are attached over the buttock |
False The posterior straps attach to the boots http://hipdysplasia.org/developmental-dysplasia-of-the-hip/child-treatment-methods/pavlik-harness/ |
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True or false: Regarding applying a pavlik harness, adjust the posterior straps to allow the hips to adduct to within 15 cm between the knees |
False about 3-5 cm between the knees should be allowed for during adduction http://hipdysplasia.org/developmental-dysplasia-of-the-hip/child-treatment-methods/pavlik-harness/ |
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True or false: Regarding applying a pavlik harness, anterior straps should be adjusted so hips are flexed at 100 to 110 degrees |
True http://hipdysplasia.org/developmental-dysplasia-of-the-hip/child-treatment-methods/pavlik-harness/ |
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Of the following list, which factor is the most important in fracture healing ? Immobilization Good alignment Adequate calcium intake Accurate reduction and 100% apposition of fractured fragments Organization of blood clot |
Immobilization or organization of blood clot ? |
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Which of the following drugs is effective against mycobacteria only ? Streptomycin Rigampacin Kanamycin Isoniazid |
Isoniazid, Not rifampacin because it is used in the treatment of coagulase negative Staph infections as well as in mycobacterial infections |
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A unilateral decrease in the triceps reflex is most likely evidence of what clinical syndrome ? |
? C7 radiculopathy |
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Which blood vessel provides the main blood supply to the femoral head ? |
Medial femoral circumflex artery |
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The ulnar nerve supplies which muscles ? |
In the forearm: FCU; Half of the FDP In the hand: Adductor Pollicis Interossei Medial 2 lumbricals Hypothenar group |
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The median nerve supplies which muscles ? |
In the forearm: All the forearm muscles of the anterior compartment except- FCU and the medial half of the FDP In the hand: Thenar compartment Lateral 2 lumbricals |
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What are the indications for internal fixation ? |
Intra-articular fractures Neurovascular repair - Surgery is required Multiple injuries - Decreases traumatic 'insult' Head injury Elderly patients - To allow early mobilization Unstable fractures - Cannot reduce Pathological fractures |
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Define Bioavailability |
The fraction of a substance that is unchanged that reaches the systemic circulation following any route of administration |
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What is this condition called ? |
Paronechium, it can be distinguished from Felon which is an abscess formation on the tip of the finger |
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What type of gate pattern would you expect to see in an 18 month old child with unilateral DDH ? |
A trendelenburg gate due to the weakness of their abductor mucles |
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True or false: Prolonged labour is a risk factor for DDH |
True |
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True or false: Oligohydramnios is a risk factor for DDH |
True |
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Of the following differential, which condition is most unlikely to cause a limp in a child of 16 years ? Idiopathic disorder Taral coalition Malignant disease Osteochondritis dissecans Muscular dystrophy |
Muscular dystrophy as the age of presentation is usually between 2-5 years ? |
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True or false: Ewing's sarcoma is sclerotic because it contains many osteoblasts which form osteoid |
False Ewing's is a cancer which has a lytic radiographical feature |
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True or false: Ewing's sarcoma is only seen in the metaphysis of a bone because this is a rapidly growing area |
False It is not only seen in the metaphysis, but also in the diaphysis (50%) |
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True or false: Ewing's sarcoma can sometimes be mistaken for osteomyelitis because the x-ray picture is similar and too may have a high ESR and white cell count |
True |
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True or false: Ewing's sarcoma is never seen in children because it cannot cross the growth plate |
False It presents mostly in ages 10-25 |
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True or false: Ewing's sarcoma is characterized by perostial reaction known as Codman's triangle, because the fast growing tumour lifts off the periosteum in this manner |
False It is characterized by a onion skin periosteal reaction |
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Which benign bone lesions cause pathological fractures in children ? |
SAFe Simple bone cyst Anuerysmal Bone cyst Non Ossifying Fibroma |
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What is the characteristic of pain in patients presenting with compartment syndrome ? |
Crescendo pain |
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Which of the following is an unlikely cause for acute compartment syndrome ? Crush Injurt Achillies Tendon Rupture Snake Bite Comminuted Tibial Fracture Circumferential Burns |
? Snake Bite |
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What is the value of normal compartmental pressure in the leg ? |
< 15 mm Hg |
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True or false: Non-orthopaedic injuries can result in compartment syndrome |
True |
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True or false: A circular cast cannot cause compartment syndrome |
False |
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True or false: Compartment syndrome can not occur in open fractures |
False |
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True or false: Normal intercompartmental pressure is > 30 Hg mm |
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Which structure does the straight leg raise and bowstring tests clinically evaluate ? |
The sciatic nerve A patients leg is passively raised until pain is felt, the patient then flexes his knee slightly, thereafter pressure is applied to the popliteal fossa. If there is tenderness it is indicative of sciatic nerve pain |
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Which structures in the knee are clinically evaluated by the McMurray test ? |
The medial and lateral menisci (McMurray and Meniscus both start with M) The patients knee is flexed and a hand is placed on the medial side of the knee, the leg is then externally rotated and the knee is brought into extension. A palpable pop or click is a positive test and can correlate with a medial meniscus tear |
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An 80 year old female presents with thoracic back ache, and a markedly positive sagittal balance. Her pain is worse when standing erect and resloved by supine position. She does not have any weight loss or night pain. She has a sideroom ESR within normal limits for age. The most probable diagnosis is: True or false: Multiple myeloma |
False The patient has no history indicative of metastatic disease and she has a normal ESR, therefore Myeloma is not considered a cause |
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An 80 year old female presents with thoracic back ache, and a markedly positive sagittal balance. Her pain is worse when standing erect and resloved by supine position. She does not have any weight loss or night pain. She has a sideroom ESR within normal limits for age. The most probable diagnosis is: True or false: A pathological fracture secondary to osteoporosis |
True This is the most likely cause as the pain is worsened with axial loading, and better when there is no axial load. Furthermore the patient is an elderly female which makes her very likely to have osteoporosis |
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An 80 year old female presents with thoracic back ache, and a markedly positive sagittal balance. Her pain is worse when standing erect and resloved by supine position. She does not have any weight loss or night pain. She has a sideroom ESR within normal limits for age. The most probable diagnosis is: True or false: Tuberculosis infection of the spinal column |
False The patient has no history indicative of some sort of infective process. Her ESR is also normal |
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An 80 year old female presents with thoracic back ache, and a markedly positive sagittal balance. Her pain is worse when standing erect and resloved by supine position. She does not have any weight loss or night pain. She has a sideroom ESR within normal limits for age. The most probable diagnosis is: True or false: Metastases from cervical cancer |
False Cervical cancer is not a well known origin of skeletal metastases and the patient has no history suggestive of malignancy which is currently underway |
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An 80 year old female presents with thoracic back ache, and a markedly positive sagittal balance. Her pain is worse when standing erect and resloved by supine position. She does not have any weight loss or night pain. She has a sideroom ESR within normal limits for age. The most probable diagnosis is: Dysplastic spondylolisthesis |
False ? |
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Tinell's and Phalen's tests clinically evaluates pressure on which nerve ? |
The median nerve Tinels Sign- Gnetle tapping over the median nerve at the wrist in a neutral position. Positive if this produces parasthesia or dysaethesia in the distribution of the median nerve. Phalen's Sign- Elbows on the table allowing the wrists to passively flex. If symptoms provoked within 60 secs then positive |
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A gunshot wound of the spine results in destruction of the entire vertebral body of C4 with only the posterior bony elements intact. This is described as: True or false: An unstable spinal-column injiry due to loss of bearing capacity under physiological load |
True When we look at the 3 column theory of stability, if 2 columns are destroyed it is an unstable spine, i.e. it won't be able to handle physiological load. Although the posterior bony elements are intact, the 2 other columns (which both form part of the vertebral body) are destroyed and therefore this is an unstable spinal fracture |
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An 80 year old female presents with thoracic back ache, and a markedly positive sagittal balance. Her pain is worse when standing erect and resloved by supine position. She does not have any weight loss or night pain. She has a sideroom ESR within normal limits for age. The most probable diagnosis is: True or false: A C4 motor-sensory incomplete lesion |
False From the clinical information given, we cannot ascertain whether this is a superimposed neurological injury |
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An 80 year old female presents with thoracic back ache, and a markedly positive sagittal balance. Her pain is worse when standing erect and resloved by supine position. She does not have any weight loss or night pain. She has a sideroom ESR within normal limits for age. The most probable diagnosis is: True or false: A Brown-Sequard lesion |
False From the clinical information given, we cannot ascertain whether this is a superimposed neurological injury |
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An 80 year old female presents with thoracic back ache, and a markedly positive sagittal balance. Her pain is worse when standing erect and resloved by supine position. She does not have any weight loss or night pain. She has a sideroom ESR within normal limits for age. The most probable diagnosis is: True or false: A chance fracture |
False A chance fracture is defined as a pure bony injury extending from posterior to anterior through the spinous processes, pedicles and vertebral bodies respectively. By definition the posterior elements are not intact, thus this is not a chance fracture. |
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After a fall from a height with a patient landing on his feet, one should exclude a spinal injury of the: Pars inter-articularis Ponticulus Posticus Tibial spine Thoracolumbar spine Conus medularis |
Thoracolumbar spine ? Due to the relative mobility at the junction of the thoracic spine to the lumbar spine, it is very prone to injury |
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Despite being made out of soft material a cloth corset can be rigid enough to provide support to alleviate backache because ? |
The cloth has a low Young's modulus but the moment of inertia is high because of the relatively large diameter of the corset |
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True or false: Lever systems in the body are usually used to increase the force of muscle action because muscle is usually to weak to do its job |
False Lever systems in the body act at a mechanical disadvantage and decrease the original effort force spreading its action out over a longer distance to increase it's speed. |
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True or false: Most lever systems increase the speed of the distal part of the bone at the cost of force transferred to the distal end |
True |
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True or false: The elbow joint is an example of a type 4 lever system because the fulcrum is in the middle |
False The fulcrum of the elbow joint is in the middle, but this is a class 3 lever system. There is no such thing as a class 4 lever system |
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List the 3 most desirable characteristics of orthopaedic implant materials |
Must not corrode Be non-toxic Be durable |
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True or false: Orthopaedic implant materials have a high resistance to corrosion because they form a passive oxide film on the outside of the metal |
True |
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True or false: Orthopaedic implant materials have a high resistance to corrosion because they are anions |
False |
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True or false: Orthopaedic implant materials corrode rapidly because of body acids |
False They have a protective passive oxide layer on the outside to fight corrosion |
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True or false: Orthopaedic implant materials corrode moderately, except in the depth of crevices where oxygen levels are lower |
False |
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True or false: Orthopaedic implant materials have a high resistance to corrosion because there is little oxygen in the surrounding tissues |
False |
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Regarding initial conservative management of a stable midshaft tibial fracture. Is the following statement true or false ? Application of an above knee plaster cast with milld flexion of the knee and neutral position at the ankle |
True The mild flexion is to relax the cruciate ligaments and the neutral position of the ankle is to prevent equines |
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Regarding initial conservative management of a stable midshaft tibial fracture. Is the following statement true or false ? Application of an above knee plaster cast with full extension of the knee and neutral position at the ankle |
False If the knee is in full extension it places stress on the cruciate ligaments |
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Regarding initial conservative management of a stable midshaft tibial fracture. Is the following statement true or false ? Patella tendon bearing cast as your initial cast |
False |
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Regarding initial conservative management of a stable midshaft tibial fracture. Is the following statement true or false ? Application of a below knee plaster cast with neutral position at the ankle and ending at the mp joints of the foot |
False |
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Regarding initial conservative management of a stable midshaft tibial fracture. Is the following statement true or false ? Balanced skeletal traction with Denham pin through the calcaneus |
False |
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A 30 year old male suffers a traumatic amputation through the tibia from a train accident. Is the following statement true or false about your management ? Debridement and the wound closed with interrupted sutures |
False |
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A 30 year old male suffers a traumatic amputation through the tibia from a train accident. Is the following statement true or false about your management ? Debridement to viable tissue and the wound left open for secondary suture later |
True |
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A 30 year old male suffers a traumatic amputation through the tibia from a train accident. Is the following statement true or false about your management ? The patient and the mangled limb should be referred immediately to an orthopaedic facility because re-implantation is indicated |
False |
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A 30 year old male suffers a traumatic amputation through the tibia from a train accident. Is the following statement true or false about your management ? Debridement is not necessary because the wound is already open |
False |
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A 30 year old male suffers a traumatic amputation through the tibia from a train accident. Is the following statement true or false about your management ? After debridement, the fresh stump is sutured then covered immediately after surgery with a minimal wound dressing and wrapped by a rigid plaster cast socket |
False |
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A patient visits your outpatient clinic 9 months post injury for follow up of the fractured distal third of her right tibia. She had been treated in an above knee cast. The leg remains tender and X-rays show callus that does not bridge the fracture gap. What type of non-union is described ? |
This is definitely a non-union as we would have expected the fracture to have healed within 9 months. Furthermore, it sounds like a hypertrophic non-union is described. There is bone callus formation on either side of the fractured but incomplete bridging of the fracture gap. |
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A 40 year old male patient presents with lumbar backache after jumping from 2m height at work. He has had intermittent pain in the same area previously. The patient has no previous medical history, but admits to intermittent IV drug use and disciplinary problems at his current workplace. Observations - A temperature of 37.9 A PR of 98/min On examination he has central lower back pain with tenderness over L3 and L4 area Neurological examination normal. What would be acceptable standard of practise for this patient ? |
The next line of investigations are special investigations. This patient presents with signs of infection and is an IV drug abuser. These are red-flags when dealing with backache and must prompt further investigation via a lumbar X-ray to identify the cause. Further special investigations include ESR. |
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What are the Ottawa ankle rules ? |
An ANKLE X-ray is only required if there is any pain in malleolar zone and any of these findings: 1. Bone tenderness on the posterior edge or tip of lateral malleolus 2. Bone tenderness on the posterior edge or tip of medial malleolus 3. inability to bear weight both immediately and in the emergency room A FOOT X-ray is indicated if there is any pain in the midfoot zone and any of these findings: 1. Tenderness over the base of the 5th metatarsal 2. Tenderness over the navicular bone 3. Inability to bear weight both immediately and in the emergency room |
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True or false: Quadriceps tendon rupture are more common than patellar tendon avulsions in children |
False Quadricep tendon rupture are more common in older patietns where patellar tendon avulsions are more common in children |
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True or false: A child presents with pain and instability after a twisting injury to the right knee, septic arthritis is not a possibility because there is a history of trauma |
False Septic arthritis can have an atypical presentation and a high index of suspicion should always be kept |
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True or false: Mid substance rupture of ligaments are common in children |
False An injured knee in a child seldom involves ligaments. The growth plates are weaker than the ligaments |
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True or false: A child presents with pain and instability after a twisting injury to the right knee, a tibial eminence avulsion is a common cause of clinical anterior cruciate laxity in this age group |
True |
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A 30 year old female experiences acute knee pain and falls to the ground, what is the most likely diagnosis ? |
Patella dislocation Patients experience pain in the knee and fall as a result because of disruption of the quadriceps mechanism. The patella can then be felt laterally |
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True or false: Drop foot from peroneal nerve injury is a very rare complication in knee dislocations |
False |
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True or false: The lateral collateral ligamnet will be ruptured in all cases of knee dislocation |
False Sometimes the cruciate ligaments are damaged |
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True or false: A segond lesion is pathognomonic of an anterior knee dislocation |
False A segond lesion is an avulsion fracture on the lateral side of the tibial plateau and is indicative of an ACL injury |
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True or false: Arterial damage is common in knee dislocations |
True There is vascular compromise in up to 30% of cases |
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True or false: Lipohaemarthrosis will always be present in an anterior knee dislocation |
False Note it is indicative of a fracture |
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True or false: Femoral artery injuries form part of complications of posterior hip dislocations |
False The femoral neurovascular bundle runs in close proximity anterior to the capsule and is a common complication in anterior hip dislocation |
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True or false: Femoral nerve injuries form part of complications of posterior hip dislocations |
False The femoral neurovascular bundle runs in close proximity anterior to the capsule and is a common complication in anterior hip dislocation |
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True or false: Miositis ossificans is a known complications of posterior hip dislocation |
True This is not however true for posterior hip dislocations exclusively, but also occurs in anterior hip dislocations |
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True or false: Secondary osteoarthritis is a known complication of posterior hip dislocations |
True This is not however true for posterior hip dislocations exclusively, but also occurs in anterior hip dislocations |
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True or false: Avascular necrosis of the femoral head is a known complication of posterior hip dislocations |
True This is not however true for posterior hip dislocations exclusively, but also occurs in anterior hip dislocations |
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What is the typical appearance of a posterior dislocated hip (with regards to the position of the hip joint) ? |
Posterior dislocation- Internally rotated Adducted Markedly flexed |
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What is the typical apperance of an anterior dislocated hip (with regards to the position of the hip joint) ? |
Anterior dislocation- Externally rotated Abducted Not flexed and might be extended |
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What is the most common cause of death in a pelvic fracture ? |
Haemorrhage and hypovolaemic shock |
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True or false: An antalgic gate is a typical sign of DDH |
False You would expect to see a trendelenburg gate due to weak abductors on the affected side |
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Which bacteria are most commonly associated with neonatal septic arthritis ? |
Staph Aureus and group B streptococci |
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A patient presents with a C5-C6 bifacet dislocation has no anal tone or bulbocavernosus reflex on clinical examination. He has no sensation or voluntary motor function caudal to his shoulders. True or false: His prognosis cannot yet be determined, his bulbo-cavernosus reflex needs to return prior to prognostication |
True This reflex arc is the first to return after an incident of spinal shock, if it is present the true extent of neurological deficit is evident |
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A motorcyclist presents in the emergency department following a high energy accident. He is unable to move his lower limbs. In addition to this he presents with bradycardia and priapism. What is the most likely cause for his bradycardia ? |
The patient is in neurogenic shock secondary to spinal cord dysfunction (spinal shock). Sympathetic outflow is disrupted during spinal shock, then unopposed vagal persists. There is a loss in TPR and consequently bradycardia and hypotension. This is called neurogenic shock. The priapism is explained by the spinal shock. Neurons become hyperpolarized and unresponsive to stimuli from the brain which results in priapism. |
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True or false: You would expect to see severe out-toeing in an 8 year old child with metatarsus adductus |
False You would expect to see sever in-toeing |
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True or false: You would expect to see severe out-toeing in an 8 year old child with external tibial torsion |
True |
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True or false: You would expect to see severe out-toeing in an 8 year old child with tibial malunion after a tibial fraction |
True |
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True or false: You would expect to see severe out-toeing in an 8 year old child with pes planus |
True Pes planus is also known as flat feet |
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True or false: You would expect to see severe out-toeing in an 8 year old child with femoral retroversion |
True |
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Which of the following is the most likely diagnosis in a child of 3 presenting with a limp ? Osteochonditis dessecans Perth's Disease Idiopathic disorder Developmental Dysplasia of the Hip SUFE |
DDH All the other condition do cause a limp, but not in a child of the age of 3 years. OCD typically in adolescents Perthe's Disease typically 4-8 years SUFE typically 12-13 years |
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Which ligament is the most commonly injured in a low ankle sprain ? |
The Anterior Talo Fibular Ligament (tenderness anterior to lateral maleolus) |
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Define a Torus fracture |
A compression fold of the junction between metaphysis and diaphysis in children |
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What is the best treatment option for a ruptured calcaneal tendon ? |
Surgical debridement and repair |
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True or false: Acute clacaneal tendon rupture usually occurs due to direct injury |
False It occurs due to either Sudden forced plantar flexion Violent dorsiflexion in a plantar flexed foot |
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True or false: Acute calcaneal tendon rupture is diagnosed on an X-ray |
False An X-ray is used to rule out other pathology |
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True or false: Acute calcaneal tendon rupture, if you compress the calf muscles it will produce plantar flexion of the foot |
False There is disruption of the plantar flexion mechanism, this it will not produce plantar flexion. This test is known as the Thomson test |
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True or false: Acute calcaneal tendon rupture is common in middle aged persons |
True Usually 30-40 |
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True or false: Surgical repair is unecessary in acute calcaneal tendon rupture |
False |
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Which degree of flexion is the most comfortable for a knee joint effusion ? |
30 degrees of flexion |
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Define Young's Modulus |
Young's Modulus is a constant of a material that describes its elasticity, it can be calculated as Stress/Strain |
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Which complication of hip dislocation will early reduction have the greatest benifit ? |
AVN |
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List 4 Systemic factors that impair wound healing |
Diabetes Mellitus Malnutrition Vitamin Deficiency Chemotherapy Smoking Age Steroid use HIV |
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What is the difference between a tissue flap and a graft ? |
A skin flap brings its own blood supply and a graft needs to pick up blood supply from the recipient area |
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True or false: Acute compartment syndrome is exclusively seen in open tibia fractures and is seldom seen in closed fractures |
False |
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True or false: Pulselessness is a reliable early sign of acute compartment syndrome |
False It is a late sign |
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True or false: The diagnosis of acute compartment syndrome must always be confirmed with intracompartmental pressure measurements before a fasciotomy is done |
False |
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True or false: A Valuable sign of acute compartment syndrome is pain on passive stretching of involved muscles |
True |
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True or false: Release of a plaster cast and dressings can decrease intracompartmental pressure greatly and prevent the development of compartment syndrome |
True |
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Which is the most common nerve damaged in the followign injuries ? a) Shoulder dislocation b) Humerus fracture c) Lunate fracture d) Radial head dislocation |
a) Axillary nerve b) Radial nerve c) Median nerve d) Posterior interosseous nerve |
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Describe lunate and peri-lunate dislocation |
Carpal injury where dislocation of the lunate happens volarly, and in peri-lunate injury the dislocation of carpal bones happens around the lunate, but the lunate stays in the radial fossa |
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Describe a Bennet fracture |
Fracture dislocation at the base of thumb metacarpal |
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Define Arthrodesis |
A surgical fixation of a joint by a procedure designed to acomplish fusion of the joint surfaces by promoting the proliferation of bone cells |
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Define Osteophyte |
Osseous outgrowth in response to micro instability of a joint, it is a stabilizing response |
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A 13 year old obese boy complains of anterior knee pain and the inability to walk after minor trauma at school. What is the most likely diagnosis ? |
Slipped Upper Femoral Epiphysis |
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In a patient with a knee dislocation, which structures must you evaluate during your examination ? |
Vascularity by feeling distal pulses and nerve supply, more specifically the peroneal nerve |
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Why is Ewing's sarcoma sometimes confused with chronic osteomyelitis ? Discuss the reasons for possible miss diagnosis |
Often have similar X-ray pictures In both the ESR and WCC may be raised |
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Which organism most commonly is the reason for prosthetic joint infection ? |
Coagulase negative staphylococci |
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Which antibiotic is used to treat Staphylococcus aureus septic arthritis ? |
Cloxacillin |
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What is the current empiric drug of choice for the treatment of gonococcal arthritis in South Africa ? |
Ceftriaxone |
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True or false: Physiotherapy is a treatment modality for frozen shoulder |
False |
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True or false: Impingement syndrome is caused by arthritis of the acromio-clavicular joint |
False It is caused by damage to the rotator cuff tissues |
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True or false: Ganglions of the wrist originate from the scapho-lunate joint |
True This is the most common spot |
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True or false: Extensor pollicus longus is involved in De Quervain's syndrome |
False This is a disease of the 1st dorsal compartment of the hand, it contains 2 tendons- Abductor pollicis longus and extensor pollicis brevis NOT extensor pollicis longus |
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True or false: Froment's test is used for the diagnosis of carpal tunnel syndrome |
False It is a test used to diagnose ulnar nerve palsy. It is a test specifically designed to test the function of the adductor pollicis muscle. If there is an ulnar palsy present the patient will compensate by flexing the thumb IP joint by using the flexor pollicis longus mucle |
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Define Morton's neuroma |
Interdigital neuroma usually between the 3rd and 4th metatarsal heads which presents with pain in the webspace |
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Define ilio-tibial band syndrome |
Pain due to friction of the ITB over the lateral femoral condyle. Usually in atheletes and sportive patients |
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Define Shin Splints |
Pyn, usually postero-medial or antero-medial over the tibia. It is due to periostitis due to the surrounding muscles causing traction on the periosteum |
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Define Perthe's Disease |
AVN of the capital femoral epiphysis in children, usually between the age of 4-8 Remember Perthe's starts with PER, which you can use to remember- Proximal Epiphysis Rotting |
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Which type of radio isotope would you choose to make a diagnosis of a) Bony metastasis in osteosarcoma b) Chronic sepsis in a total hip replacement |
a) Tc - Shows bone formation b) Gallium - Shows glucose uptake |
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A 21 year old male is brought to your casualty after a motor accident. His left lower limb is aDducted and internally rotated. X-rays show a dislocation of the left hip. What type of dislocation is this ? |
A posterior dislocation because the limb is aDducted and internally rotated |
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A 21 year old male is brought to your casualty after a motor accident. His left lower limb is aDducted and internally rotated. X-rays show a dislocation of the left hip. Which possible associated fractures should you look for in this case ? |
Acetabular fracture Femoral Neck Fracture Femoral Shaft Fracture |
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A 5 year old boy presents with a short history of painful knee and fever. He is unable to bear weight on the leg and clinically the knee is warm, tender to touch and swollen. What is the most likely diagnosis ? |
Septic Arthritis |
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Which criteria would you use to confirm a diagnosis of septic arthritis ? |
Kocher Criteria Increased WCC Increased CRP Increased ESR Unable to bear weight on affected leg Fever |
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Describe the typical appearance of TB in the thoracic spine on an X-ray |
A lytic lesion, adjacent vertebra affected with endplate erosion. There is disc space narrowing and para-vertebral soft tissue mass. Furthermore, this can result in anterior wedge formation, collapse and kyphosis |
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What are the 4 pathological stages of Perthe's disease ? |
Firstly there is ischaemia and necrosis. Then follows fragmentation/resorption. Thereafter there is re-ossification and then remodeling |
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A twenty year old patient presents with an infected tenosynovitis of his left little finger. What are the group of signs called which are pathognomonic for this condition ? |
Kanavel's signs |
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Which modality do you use to evaluate the growth potential of a child during your evaluation for scoliosis ? |
Risser's Sign |
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A 40 year old housewife presents with right hip pain. X-rays revel a 3cm lytic, destructive lesion of the subtrochanteric region of her right femur. She had a mastectomy 3 years previously but is otherwise healthy. What is the most likely diagnosis ? |
Breast Cancer metastases |
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According to ATLS principles- If a patient presents to you, what is the first think you should assess ? |
Airway and stabilize the C-spine |
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This patient complains of neck pain after a MVA. Interpret this cervical X-ray |
We look at adequacy of the X-ray first. We want to see from C1 - T1, we cannot do so for this x-ray so we would have requested a flying angel view to look at the cervico-thoracic junction. Now we look at the soft tissue line. It should be half a vertebral body width up until the level of the hyoid bone, and a full vertebral body width from there onward. It is increased at the top. We now look at the anterior vertebral body line. It is also disrupted at the level of C1 and C2. We then look at the posterior body line and the spinolaminar line. Both are disrupted at the same level as C1 and C2. We then look at the ADI. In this patient it is increased, but a dynamic X-ray was taken to confirm the diagnosis of a transverse ligament injury. The dynamic X-ray clearly shows an unstable C-spine due to a transverse ligament disruption. |
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Young patient presents with pain over his thigh after trauma. Interpret this x-ray. |
We are looking at an X-ray of the right femur. Applying rule of 2's- We are not happy with the views. Since it is a diaphyseal fracture, we want to see an AP and a lateral X-ray (as is done) but with the joint above and joint below in both. Only the joint below is visible on the lateral. We then look at the soft tissues. Particularly for foreign bodies, swelling or air. Fracture pattern- Mid dyaphiseal spiral fracture Deformity- Length- about 4cm shortening Angulation- not really Rotation - assessed clinically Apposition- 5% about in contact on the lateral |
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Which terms do we use to describe deformities in the a) Anterior and Posterior plane b) lateral and medial plane |
A) Procurvatum and rearcurvatum B) Varus and Valgus |
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What is Perkin's rule ? |
It is a rule used to estimate the time it would take for a fracture to heal: 3 weeks for a upper limb fracture in a child x2 if it is an adult x2 if it is transverse in nature x2 if it is a lower limb fracture |
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A premature neonate born at 30 weeks spent 3 weeks in NICU. Paeds concerned about failure to gain weight and swollen knee. What is your diagnosis ? |
Spetic arthritis. Apart from a clincal picture suggesting septic arthritis, the neonate is also at risk for spending time in the NICU and being premature. |
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A 6 year old girl fell of her bicycle three days ago. She complains about feeling pain around her knee. Her father says that she had two episodes of fever in the last 12 hours, what is the diagnosis ? |
Either acute osteomyelitis or septic arthritis |
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A 30 year old male complains about a one week history of pain in his ankle. He has a history of a urtehtral discharge. What is the most likely organism causing his ankle pain ? |
Neiseria Gonorrhoea |
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This patient was in a MVA as the driver. What is the diagnosis ? |
A posterior hip dislocation of the left hip. Hip is adducted, flexed and shorter which suggest posterior dislocation. Furthermore the left femoral head has a smaller shadow than that of the right, suggesting it lies more posterior. |
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This is an X-ray of an elderly woman after a fall. What is the diagnosis ? |
Bilateral Neck Of femur fractures. Note they are displaced and intracapsular. Treatment consists of bilateral replacement. |
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41 year old Mr Dave presents to you. He had an ankle fracture 18 month ago which he received an ORIF for. He now complains of progressive pain and stiffness. On examination there is decreased ROM of the ankle and pain with movement. What is your diagnosis ? |
This is mechanical pain associated with previous trauma to the ankle. The diagnosis is post traumatic osteoarthritis. |
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41 year old Mr Tim presents to you. He had spontaneous onset ankle pain and swelling with loss of function and constitutional symptoms.On examination he had decreased ROM with pain upon movement. A boggy swelling of the ankle was noted. His ESR is 103. What is your diagnosis ? |
There is complete destruction of his ankle joint. Due to the fact that it sounds like an infective condition, and the fact that he has a very high ESR, the most likely diagnosis is TB arthritis. |
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41 year old Mrs. Purdy present to you. She is a so called 'weekend warrior'. She complains of inferior heel pain which is worse at the end of the day after prolonged standing. Examination reveals inferior medial heel tenderness and a short achilles tendon. What is the most likely diagnosis ? |
Plantar Fasciitis |
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52 year old Mrs. Haglund presents to you. She has posterior heel pain, swelling, burning and stiffness. She complains of pain when she wears her shoes and also of an increasing size of swelling. On examination there is tenderness and fullness on the achilles tendon insertion. What is the diagnosis ? |
Degeneration is present on the MRI and the clinical picture strongly suggests insertional Achilles tendonosis. Treatment is surgical debridement and tendon transfer |
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41 year old Mr Worsie presents to you. He reports a popping sound and a sensation of being kicked on the calf afterwards. On examination you note increased resting ankle dorsiflexion, weakness to ankle plantar flexion and a negative Thompson test. What is your diagnosis ? |
Acute Achilles tendon rupture. Treatment is surgical repair |
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56 year old Mrs Tamy presents to you. She has pain with prolonged standing or walking. It is sharp, burning and often occurs at night. She also complains of numbness and intermittent parasthesia in the plantar part of the foot. On physical examination you note tenderness of the tibial nerve. Sensory examination of the foot is normal. What is your diagnosis ? |
Tarsal tunnel syndrome |
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60 Year old Mrs. Penny presents to you. She has medial ankle/foot pain and has a history of a progressive loss of arch. What is your diagnosis ? |
PTT insufficiency. |
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33 Year old Mr. Holic presents to you. He has a history of falling of a roof 2 years ago. His foot has never fully recovered since then and now has a deformity and pain. Examination shows Pes Planus, a midfoot deformity and pain with stress. What is your diagnosis ? |
This patient's pain character is typical of mechanical pain. The X-ray shows a Lisfranc injury. |
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58 year old Mr Dave presents to you. He has a vague history of trauma to the foot with a progressive pes planus. He is a type 2 diabetic for 7 years. |
Diabetic arthropathy |
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List the different Salter Harris fractures |
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What is this sign called and what is it suggestive of ? |
Crescent Sign. It is a subchondral fracture likely due to AVN of the femoral head. |
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A child presents to you with anterior knee pain after minor trauma. What is your diagnosis ? |
SUFE |
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A child presents at your room with an unstable SUFE. What do you do to prevent further slippage that may yet again cause AVN of the epuphysis ? |
The child must be strictly non weightbearing = on a bed or trolley. Urgently refer and place the child in light skin traction if there is a delay in referral. |
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A 11 year old adipose genital child presents to your hospital with an unstable SUFE. The medical officer asks you to perform an endocrine workup. Why does he ask this ? |
Since the child fits the classical phenotype for a SUFE no endocrine workup is indicated, so it should not be done. |
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What are the 5 questions that should be asked when assessing limb alignment in a child ? |
1. Is the alignment normal for his age
2. If abnormal, describe the plane of deformity 3. Is it unilateral, bilateral, or symmetrical ? 4. Where is the deformity situated ? 5. Are there any other associated abnormalities present that will explain the eitiology ? |
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Describe the characteristic deformity of a club foot. |
The mnemonic CAVE is used - Cavus of midfoot Adduction of forefoot Varus of hindfoot Equinus of hindfoot |
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For which foot deformity is a neurological workup mandatory ? |
Pes Cavus |
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What is Gower's Sign ? |
A child t`hat rises by walking hands up legs to compensate for gluteus maximus and quadriceps weakness. It is seen in Duchenne muscular dystrophy. |
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We are looking at the left shoulder. There seems to be a lot of soft tissue swelling, which resulted in a subluxed shoulder joint. Furthermore there is an ill-defined sclerotic lesion present in the metaphysis of the long bone. The most likely diagnosis for this presentation and a young patient is - Osteosarcoma. |
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18 year old male complains of gradual onset of pain in the left knee. What is your diagnosis ? |
We are loooking at a left knee. There is an ill-defined sclerotic region in the metaphysis of the distal femur. A perisoteal reaction is also visible - the formation of a Codman's triangle Given the age and the presentation, the most likely diagnosis is - Osteosarcoma |
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A 79 year old female presents with shoulder pain. What is your diagnosis ? |
We are looking at an X-ray of the right shoulder. There seems to be an ill-defined sclerotic lesion in the metaphysis of the proximal humerus. Given the age of the patient and the clinical presentation, the most likely diagnosis is- Chondrosarcoma. ALthough it might also be an enchondroma, which is the benign equivalent of a chondrosarcoma. |
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We are looking at a pelvic X-ray. There is a very ill-define slightly sclerotic lesion of the left ileum/pelvis. Thus we can say that it is most likely a malignant tumour. The 2 types of malignant bone tumours in children are- Ewing's and Osteosarcoma. |
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A 20 year old patient complains of pain in the proximal knee. What is your diagnosis ? |
We are looking at an X-ray of the left knee. There seems to be an ill-defined sclerotic lesion in the metaphysis of the proximal tibia. Furthermore a sun-burst appearance around that area is noted. Most likely diagnosis is Osteosarcoma. |
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What is most likely the diagnosis ? |
Osteochondroma |
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9 Year old patient with pain in the distal femur. What is your diagnosis ? |
We are looking at a lateral x-ray of the right femur. There seems to be a relatively ill-defined sclerotic lesion in the mataphysis that extends up to the growth plate. A sun-burst appearance is noted, along with a Codman's trianlge. The most likely diagnosis is osteosarcoma. |
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A 25 year old patient complains of an enlarging mass in the groin. What is your most likely diagnosis ? |
We are looking at an X-ray of the right side of the pelvis. The X-ray picture is very suggestive of an osteochondroma. |
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52 year old patient presents with a recently enlarging mass over her right hip. Her ESR was not high. What is your most likely diagnosis ? |
In a patient of this age we consider 2 types of primary malignant tumours - Chondrosarcoma or myeloma. Due to the fact that she had a low ESR the most likely diagnosis points to chondrosarcoma. |
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A 24 year old patient presents with a mass over his scapula for the last few years. What is your most likely diagnosis ? |
We are looking at a large benign mass over the right scapula. It has a cystic appearance. The most likely diagnosis is an aneurysmal bone cyst. |
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What is the most likely diagnosis ? |
Due to the fact that the tumour is well defined and extends into the joint, the most likely diagnosis is a giant cell tumour. |
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A child complains of pain over the right humerus. What is the most likely diagnosis ? |
A simple bone cyst. |
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True or false: Regarding internal tibial torsion- in 90% of cases, it gradually resolves on its own by the time the child reaches 8 years of age |
True |
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True or false: Regarding internal tibial torsion- avoiding prone sleeping and sitting on feet enhance resolution |
True |
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True or false: Regarding internal tibial torsion- treatment with night splints, shoe wedges and orthotics are unnecassary and ineffective |
True |
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True or false: Regarding internal tibial torsion- osteotomy of the tibia has been associated with high complication rate because of compartment syndrome or peroneal nerve injury |
True |
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True or false: Regarding internal tibial torsion- internal tibial torsion can be effectively treated with guided growth of the physis |
False You cannot block part of the growth plate for a rotational abnormality, it is more for angulated abormalities. Furthermore, the natural progression of internal tibial torsion is self-resolution |
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A patient known with a previous recent epileptic fit is unable to externally rotate their shoulder. What is the most likely diagnosis ? |
The mechanism of injury (forced internal rotation during a fit) and failure of external rotation strongly suggests a posterior shoulder dislocation. |
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Mr. Neuro presents with pain that radiates into his toe distally. It is often elicited by pushing off of his foot. He complains of a sensation of a stone under the ball of his foot when walking without shoes. He has parasthesia in his lessertoes. Physical examn reveals plantar tenderness distal to the metatarsal heads along with decreased sensation and a bursal click (when squeezing the metatarsal heads. What is the most likely diagnosis ? |
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A 60 year old female presents with forefoot pain under the 2nd MTP joint. She has a vlagus deformity of the first MTP joint and also a deformity of the 2nd lesser toe. The pain she experiences is associated with shoe wear. What is your most likely diagnosis ?
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This patient has mehanical pain over her forefoot area. The diagnosis is hallux valgus. |
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56 year old female presents with forefoot pain. She has a hallux valgus and claw deformity of all lesser toes. She also complains of morning stiffness in both her hands and report her aunt having the same problem. What is your diagnosis ? |
The patient complains of an inflammatory type of pain over the forefoot. Furthermore, there is a hallux valgus along with a claw deformity of the lesser toes. The most likely diagnosis is rheumatoid arhtritis of the fore foot. |
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37 year old female complains of metatarsalgia when walking. She recently ran her first comrades. She has severe tenderness over her second metatarsal ray. Special investigations were done. What is the most likely diagnosis ? |
The patient has mechanical pain over her forefoot. No deformities are of note. Given her her history of a recent marathon and very localized pain, along with the X-ray and scan - the most likely diagnosis is a stress fracture. This is treated with rest. |
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A young female presents with alopecia and this rash. She also complains of her hands turning white, blue and red on emersion in cold water. Which special investigations would you perform to help confirm your diagnosis ? |
This is most likely SLE We can test serologically for dsDNA or ANF |
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A male with an acute monoarthritis, presents with the above features on general examination. What are these lesions called ? |
Tophi |
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This is the hand of a 58 year old lady with painful hands and early morning stiffness lasting 20 minutes. What special investigation will confirm your diagnosis ? |
The clinical picture is strongly suggestive of OA. An X-ray to confirm the diagnosis of OA. |
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a 40 year old female presents to the rheumatology clinic with recent onset Raynauds, polyarthralgia and severe heratburn. Examination reveals sclerodactyly and clinical evidence of pulmonary hypertension. How would you treat her Raynauds ? |
Raynuds is treated with- Keeping the extremities warm Stopping smoking Avoiding B-blockers TNT topical Calcium Channel Antagonists |
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True or false: Fybromyalgia with onset above the age of 60 will make you doubt the true diagnosis |
True Above this age you must look for a more organic cause |
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True or false: HIV positive patients with psoriatic arhtritis typically have less severe skin involvement |
False Skin involvement in HIV positive patients may be very extensive, especially in those not on HAART |
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True or false: The painful articular syndrome is the most common rheumatic manifestation in HIV positive individuals |
False It is very uncommon |
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True or false: AVN of bone may occur as a treatment-related complication of HIV positive patients using protease inhibitors |
True |
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True or false: Antibody testing (for rheumatological diseases) usually yields false-negative results in HIV positive patients, especially those with advanced disease |
False It yields false positives |
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A 40 year old female presents with painful hands. The following feature is most supportive of a diagnosis of rheumatoid arthritis as an underlying cause for her pain- True or false: associated nail pitting |
False |
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A 40 year old female presents with painful hands. The following feature is most supportive of a diagnosis of rheumatoid arthritis as an underlying cause for her pain-True or false: Morning stiffness of 20 mins |
False Morning stiffness lasting longer would be suggestive of RA |
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A 40 year old female presents with painful hands. The following feature is most supportive of a diagnosis of rheumatoid arthritis as an underlying cause for her pain-True or false: Bilateral metacarpo-phalangeal joint involvement |
True These joints are 'loved' by RA and RA usually has a symmetrical picture |
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A 40 year old female presents with painful hands. The following feature is most supportive of a diagnosis of rheumatoid arthritis as an underlying cause for her pain-True or false: Bilateral 1st carpo-metacarpal joint involvement |
False |
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A 27 year old male patient presents with a 3 week history of a swollen left knee. He also complains of pain over the back of his left heel and a painful, red eye. He admits to have had a burning urethral discharge 2 weeks prior to the onset of his symptoms. What would be the most appropriate blood test to do in this patient ? |
The clinical picture is strongly suggestive of Reiter's Syndrome, but for that diagnosis to be made you must exclude HIV - thus an HIV test is indicated |
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True or false: A fracture through a simple bone cyst in the femur neck of a 5 year old child requires ORIF because the proximal femur is a high stress area |
True Other pathological fractures cause by SBC's in children can be treated appropriately via conservative treatment |
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True or false: Scleroderma with limited skin involvement rarely causes GERD |
False One of the variants of limited skin involvement is often associated with GERD |
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True or false: The heliotrope rash is a non-specific finding of dermatomyositis |
False It is highly specific |
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True or false: A DLE rash can sometimes occur in dermatomyositis |
False This type of rash is seen in SLE |
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True or false: Gottrons lesions are diagnostic of dermatomyositis |
True |
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True or false: Nail bed capilloroscopy is unhelpful in diagnosis dermatomyositis |
False It is very helpful |
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Discuss the clinical presentation of polymyalgia rheumatica |
You can remember the presentation with the useful mnemonic SECRET Stiffness Elderly Constitutional Symptoms Rheumatism Eleveated ESR Temporal arteritis |
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True or false: GCA is a medium-vessel type vasculitis |
False It is a large vessel type vasculitis |
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True or false: Regarding Takayasus, it mostly occurs in older individuals |
False It occurs in young women |
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True or false: Regarding Takayasus, it occurs mainly in males |
False It occurs in young women |
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True or false: Regarding Takayasus, is mainly an aortic arch disease |
True |
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True or false: Regarding Takayasus, typically presents with a rash |
False |
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True or false: Regarding scaphoid fractures, non-union often develops |
True This is due to the reverse blood supply to the bone |
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A patient is scheduled for a total hip replacement the next day. On work-up he tests positive for being a nasal MRSA carrier. What would be the best course of action with regards to antibiotic prophylaxis ? |
The patient should be put on prophylactic vancomycin pre-operatively. In the case that it was MSSA intravenous cloxacillin would have been indicated. |
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True or false: A simple bone cyst is a tumour which is commonly a cause of pathological fractures in children |
True |
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What is the most common limb length and rotational profile found as a sequaele to a SUFE ? |
Limb shortening, with loss of hip internal rotation, abduction and flexion |
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True or false: Ulnar nerve damage will result in loss of thum abduction |
False This is an action responsible by median nerve innervation |
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True or false: Ulnar nerve damage will result in loss of thumb adduction |
True |
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What are the characteristic x-ray changes of a patient with osteoarthritis ? |
Osteosclerosis with cysts and osteophyte formation ( which is secondary to joint subluxation). |
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Which muscle is largely addressed when you do the Thomas test ? |
Iliopsoas |
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True or false: Knees that are able to hyperextend to 30 degrees form part of the criteria for hyper-laxity |
False If they can hyperextend beyond 0 degrees they do |
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True or false: Ankle dorsiflexion >45 degrees forms part of the criteria for hyper-laxity |
True |
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True or false: Increased femoral anterversion is a cause for in-toeing |
True |
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True or false: Metatarsus adductus is a cause for in-toeing |
True |
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True or false: In-toeing is a normal physiological rotational variation |
True |
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True or false: Internal tibial torsion is a cause for in-toing |
True |
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True or false: Pes planus is a cause for in-toeing |
False It is a cause for out-toeing |
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What is the most likely diagnosis of plantar medial heel pain ? |
Plantar fascitis |
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Which part of the bone is usually the site of onset of AOM ? |
The metaphysis Possibly due to the sluggish blood flow in this area giving the bacteria time to adhere to surrounding tissues |
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True or false: Trendelenburg's sign is used in the diagnosis of congenital hip dislocation |
True |
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Which tests are used to diagnose DDH ? |
Barlow Ortelani Galeazi |
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The word talipes equinovarus refers to what condition ? |
Club foot |
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A Milwaukee brace is used in the treatment of which condition ? |
Scoliosis |
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True or false: Legg-Calve-Perthe's disease is osteochondritis of the proximal femoral epiphysis |
True |
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True or false: Charcot is the name associated with joint neuropathy |
True |
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True or false: Closed fracture complications include infection |
False |
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From which emrbyonic tissue does bone originate ? |
Mesoderm |
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What is the most common site for myositis ossificans ? |
Shoulder |
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True or false: Cubitus valgus commonlu follows a fracture of the medial condyle |
False This will give rise to a varus deformity |
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True or false: Cubitus valgus commonly follows a fracture of the lateral condyle |
True |
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Describe the mallet finger deformity |
It is flexion of the distal IP joint due to disruption of the extensor tendon at the DIP joint |
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True or false: Sudeck's atrophy of the hand is associated with a painful and swollen hand |
True
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Which nerve is compressed in carpal tunnel syndrome ? |
The median nerve
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True or false: Regarding femoral neck fractures, a total hip replacement is the optimal treatment for a stable fracture |
False All stable fractures are treated by internal fixation |
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True or false: Regarding femoral neck fractures, in very old patients these fractures are always treated by open reduction and internal fixation |
False They might also be treated with hemiathroplasty in the case that they are unstable |
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True or false: Regarding femoral neck fractures, AVN is a common complication thereof |
True |
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True or false: Regarding femoral neck fractures, young patients (less than 60) are best treated by hemiarthroplasty |
False In young patients they are treated with ORIF |
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Define Fracture malunion |
A fracture which unites in a position of deformity |
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What is the conidtio nTennis Elbow ? |
Non-articular rheumatism of the extensor muscles of the forearm which are attached to lateral epicondule of the humerus |
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True or false: A trigger finger is an inflamed index finger |
False |
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True or false: A trigger finger is an atrophic index finger in a median nerve palsy |
False |
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True or false: A trigger finger is due to stenosing tensovaginits affection one of the flexor tendons in the palm |
True |
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True or false: A trigger finger is an essential feature of the carpal tunnel syndrome |
False |
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True or false: A triger finger is a component of syndactyly |
False Syndactyly is a condition where digits are fused together |
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In which direction does the humeral head of the shoulder dislocate ? |
Anteriorly |
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True or false: Monteggia fracture-dislocation always requires surgical treatment in adults |
False Most of these in adults are treated surgically |
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A 44 year old obese male patient presents with a history of episodic joint pain and swelling which resolves after approximately 10 days. He is a known smoker with hypertension for which he takes Enalapril and Amlodipine and has mild renal impairment. On examination he has a tender 1st Metatarsophalangeal joint, but no obvious synovitis. What is the most likely diagnosis ? In the mentioned case, what is the a risk factor for his specific condition ? |
A middle aged man who is obese, has recurrent transient joint pain, especially in the 1st metatarsophalangeal joint is highly suggestive of gout. The risk factor in the mentioned case is his mild renal impairment. This will affect the kidney's function in excreting uric acid, leading to accumulation thereof in the joint = gout. |
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True or false: In a patient with systemic sclerosis, the following drug will most likely be of benefit in preventing scleroderma renal crisis - ARB |
False Ace-inhibitors however do |
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True or false: In a patient with systemic sclerosis, the following drug will most likely be of benefit in preventing scleroderma renal crisis - Beta Blockers |
False Ace-inhibitors do however |
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True or false: In a patient with systemic sclerosis, the following drug will most likely be of benefit in preventing scleroderma renal crisis - Steroids |
False This is actually a risk factor for the complication |
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True or false: In a patient with systemic sclerosis, the following drug will most likely be of benefit in preventing scleroderma renal crisis - Ace Inhibitors |
True |
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The mother of a 3 year old boy has noticed him limping on his right leg. He has been having pain at night especially in his right knee for the past 4 weeks. The knee is swollen around the joint and it is painful in the adjoining soft tissues of the upper and lower leg. The pain persists with resting. The boy has recently become tired more easily and appears pale also. What is your differential ? |
A differential of a 0-4 year old child limping includes the following: Trauma SA Reactive Arthritis Juvenile Idiopathic Arthritis Malignancy (of joint or bone) DDH Transient Synovitis Non-accidental injury However, in the case of this child the most likely diagnosis would be a malignancy or SA. The duration of less than 6 weeks is against the diagnosis of JIA. |
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A 31 year old hypertensive female presents with a 6 month history of pain and swelling in her hands. She complains of difficulty making a fist in the morning, with grip strength improving after about 1 hour. The only medication she uses is an ACE inhibitor. The following physical findings is indicative of what condition: |
Rheumatoid Arthritis |
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A 56 year old hypertensive woman is known with primary inflammatory, osteoarthritis. She is on Choloroquine, Enalapril, hydrocholorthiazide and paracetomol. She presents with a week of painful, red swollen L 3rd DIP joint and R 4th PIP joint. Her ESR is 46 and her serum RF is 32 (N 0-21). What is the most likely diagnosis ? |
The most likely diagnosis is Rheumatoid Arthritis superimposed on her current OA. Due to the PIP joint involvement, a raised ESR and a raised RF. |
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True or false: Takayasus Arteritis is a small vessel vasculitis |
False
It is a large vessel vasculitis |
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True or false: Polyarteritis Nodosa is assocaited with a positive ANF |
False False by exclusion |
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True or false: Wegener's is associated with a positive ANCA |
True |
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True or false: Steroids are seldom required in the treatment of vasculitis due to its toxicity |
False It forms part of the management of all the vasculitis |
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True or false: A painless lesion is noted in the mouth of a patient with joint pain. Gout is associated with this physical finding. |
False Gout is associated with Tophi |
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True or false: A painless lesion is noted in the mouth of a patient with joint pain. Lupus is associated with this physical finding. |
True It is associated with painless mouth ulcers |
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True or false: A painless lesion is noted in the mouth of a patient with joint pain. Rheumatoid arthritis. |
False |
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True or false: A painless lesion is noted in the mouth of a patient with joint pain. Ankylosing spondylitis |
False |
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A young female presents with the following rash. She also complains of joint pain, tiredness and recurrent painless mouth ulcers. Which laboratory investigations would best aid you in making a diagnosis in this specific patient ? |
ANA - This is elevated in 95-98% of patients. A positive ANA in isolation however does not make a specific diagnosis. More specifically: Anti-Double-Stranded DNA antibodies and Anti-Smith Antibodies are more specific for the condition. The diagnosis is most likely SLE. |
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Mr Smith is a 32 old gentlemen that comes and sees you with back pain which has been there for 4 months. It wakes him at night and is especially bad in the mornings. Which is the most appropriate treatment to start him on as part of your initial management ? |
Apart from non-pharmacological therapy, the most appropriate first drug to give him is NSAIDs to relieve his pain. |
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True or false: The rotator cuff asists with abduction, internal rotation and external rotation. |
True |
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True or false: Bilateral 1st CMC joint involvement is suggestive of RA |
True |
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Ms Solomons is a 24 year old lady that comes and sees you with some arthralgia and alopecia. She has an ANA of 1:640 and a negative anti-dsDNA. Which DMARD would you prescribe for her joint complaints ? |
Anti-malarial drugs are regarded as DMARD, such as Cholorquine |
