INI CET Orthopaedics Flashcards

24 sample cards from the Orthopaedics deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. Which special tests assess anterior cruciate ligament integrity?

   The Lachman test (most sensitive - tibia drawn forward at ~30 degrees flexion), the anterior drawer test (at 90 degrees flexion), and the pivot-shift test (assesses rotational instability). Increased anterior tibial translation with a soft endpoint indicates ACL deficiency.

2. What is the McMurray test used for?

   It assesses meniscal tears: the knee is flexed and the tibia rotated while extending the knee; a painful click/clunk suggests a meniscal tear (external rotation tests the medial meniscus, internal rotation the lateral meniscus).

3. Differentiate the most common ankle ligament injured in an inversion sprain.

   The anterior talofibular ligament (ATFL) of the lateral ligament complex is the most commonly injured in an inversion (supination) ankle sprain. The Ottawa ankle rules help decide the need for radiographs.

4. What is developmental dysplasia of the hip (DDH)?

   A spectrum of abnormal development of the hip joint in which the femoral head and acetabulum are improperly aligned, ranging from acetabular dysplasia to subluxation and frank dislocation. It is more common in firstborn girls, breech presentation, and with a positive family history.

5. Which two clinical tests screen newborns for DDH, and what does each detect?

   The Ortolani test reduces a dislocated hip (a palpable 'clunk' as the femoral head relocates into the acetabulum on abduction). The Barlow test dislocates a dislocatable hip (posterior pressure with adduction). Ultrasound is the imaging of choice under 6 months.

6. What is the first-line treatment for DDH in an infant under 6 months of age?

   A Pavlik harness, which holds the hips in flexion and abduction to maintain reduction and promote normal acetabular development. Older or failed cases may need closed/open reduction and a hip spica cast.

7. Describe the components of the deformity in congenital talipes equinovarus (clubfoot) using CAVE.

   CAVE: Cavus (high medial arch), Adductus (forefoot adduction), Varus (hindfoot inversion), and Equinus (plantarflexion of the ankle). The foot is turned inward and downward and cannot be passively corrected to neutral.

8. What is the standard first-line treatment for clubfoot?

   The Ponseti method: serial manipulation and casting (correcting in the CAVE order), usually with a percutaneous Achilles tenotomy to correct residual equinus, followed by a foot-abduction (boots-and-bar) bracing programme to prevent relapse.

9. Differentiate scoliosis, kyphosis, and lordosis.

   Scoliosis is an abnormal lateral curvature of the spine (with rotation), measured by the Cobb angle. Kyphosis is excessive posterior (outward) curvature of the thoracic spine. Lordosis is excessive anterior (inward) curvature, typically lumbar. Adolescent idiopathic scoliosis is the most common type of scoliosis.

10. What are the most common primary malignant and benign bone tumours, and the typical age groups?

    Osteosarcoma is the most common primary malignant bone tumour, typically in adolescents/young adults around the knee (distal femur/proximal tibia). Osteochondroma is the most common benign bone tumour. Ewing sarcoma and chondrosarcoma are other important malignancies.

11. Which radiographic signs suggest an aggressive/malignant bone lesion?

    A wide zone of transition (ill-defined margins), permeative/moth-eaten bone destruction, aggressive periosteal reaction (Codman triangle, 'sunburst'/'onion-skin' patterns), cortical breach, and an associated soft-tissue mass. Sunburst suggests osteosarcoma; onion-skin suggests Ewing sarcoma.

12. Which primary cancers most commonly metastasise to bone, and what is the typical lesion type?

    Breast, prostate, lung, kidney (renal), and thyroid (mnemonic 'BLT with Kosher Pickle'). Most are osteolytic; prostate metastases are characteristically osteoblastic (sclerotic). The axial skeleton (spine, pelvis) is most commonly involved, and metastases are far more common than primary bone tumours.

13. What is the most common soft-tissue sarcoma in adults, and a key clinical warning sign of a soft-tissue mass?

    Undifferentiated pleomorphic sarcoma (formerly malignant fibrous histiocytoma) and liposarcoma are among the most common adult soft-tissue sarcomas. Warning ('red flag') features of a soft-tissue mass: size >5 cm, deep to fascia, rapidly enlarging, and painful - these warrant urgent MRI and referral before biopsy.

14. What is the immediate management of an acute soft-tissue sports injury?

    The RICE protocol: Rest, Ice, Compression, Elevation (often expanded to PRICE with Protection, or POLICE with Optimal Loading). The aim is to limit swelling and bleeding in the first 48-72 hours; NSAIDs may aid analgesia.

15. What distinguishes an overuse injury from an acute injury, and give common examples.

    An overuse injury results from repetitive submaximal loading without adequate recovery (microtrauma exceeding repair), rather than a single traumatic event. Examples: stress fractures, tendinopathies (Achilles, patellar 'jumper's knee'), shin splints (medial tibial stress syndrome), and apophysitis (e.g., Osgood-Schlatter disease).

16. What general criteria must be met before an athlete is cleared for return to play after injury?

    Full pain-free range of motion, restored strength (typically >=90% of the contralateral side), normal sport-specific function and proprioception/neuromuscular control, psychological readiness, and being symptom-free under sport-specific loading. Return is graded and progressive to minimise re-injury.

17. State the core principles of orthopaedic rehabilitation.

    Control pain and inflammation, protect healing tissue while avoiding harmful loading, restore range of motion, then progressively rebuild strength, endurance, proprioception, and finally sport/activity-specific function. Rehabilitation should be early, graded, patient-specific, and respect tissue-healing timelines.

18. Name common physical modalities used in orthopaedic physiotherapy and a key indication for each.

    Cryotherapy (acute injury - reduces swelling/pain), heat/thermotherapy (chronic stiffness - increases blood flow), ultrasound (deep tissue heating/healing), TENS (pain relief via gate control), electrical muscle stimulation (muscle re-education/atrophy prevention), and therapeutic exercise/hydrotherapy (mobility and strengthening).

19. What are the general goals of postoperative orthopaedic rehabilitation?

    Protect the surgical repair, control pain and swelling, prevent complications (DVT, stiffness, muscle atrophy), restore range of motion and strength progressively within surgeon-specified weight-bearing and motion restrictions, and return the patient to functional independence following protocol-driven phased progression.

20. What is arthroscopy and what are its main advantages?

    Arthroscopy is minimally invasive joint surgery using a fibre-optic camera (arthroscope) and instruments through small portals. Advantages: smaller incisions, less soft-tissue damage, reduced pain, faster recovery, and the ability to both diagnose and treat (e.g., meniscectomy, ACL reconstruction, rotator cuff repair). The knee and shoulder are the most commonly scoped joints.

21. What are the leading indications for total joint replacement (arthroplasty)?

    Severe symptomatic osteoarthritis (most common), rheumatoid arthritis, avascular necrosis, and selected fractures. The aim is to relieve pain and restore function. The hip and knee are the most commonly replaced joints; aseptic loosening and periprosthetic infection are major long-term complications.

22. Differentiate spinal decompression from spinal fusion surgery.

    Decompression (e.g., discectomy, laminectomy) removes tissue (disc/bone) compressing neural structures to relieve nerve-root or cord symptoms. Fusion permanently joins vertebrae (with grafts/instrumentation) to eliminate motion at an unstable or painful segment. The two are often combined for instability with stenosis.

23. What is the hierarchy (levels) of evidence in evidence-based orthopaedics?

    Level I: high-quality randomised controlled trials/systematic reviews of RCTs. Level II: lesser-quality RCTs and prospective cohort studies. Level III: case-control and retrospective comparative studies. Level IV: case series. Level V: expert opinion. Higher levels carry stronger evidence and lower bias.

24. What is a Patient-Reported Outcome Measure (PROM) and give an orthopaedic example?

    A PROM is a validated questionnaire capturing the patient's own assessment of health/function and quality of life, used to evaluate treatment effectiveness in research and practice. Examples: Oxford Hip/Knee Scores, WOMAC (osteoarthritis), DASH (upper limb), and the Harris Hip Score.

What this deck covers

Orthopaedics flashcards FAQ