MBBS 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. What is the most common type of elbow dislocation, and the most commonly fractured elbow bone in adults?

   Posterior elbow dislocation is most common. In adults the radial head is the most commonly fractured elbow bone; in children the supracondylar humerus.

2. What are lateral epicondylitis and medial epicondylitis commonly called, and which tendons are involved?

   Lateral epicondylitis = 'tennis elbow' (common extensor origin, especially extensor carpi radialis brevis). Medial epicondylitis = 'golfer's elbow' (common flexor-pronator origin).

3. Why is a supracondylar humeral fracture in a child an emergency?

   Because of the risk of neurovascular injury — the brachial artery and median nerve (especially the anterior interosseous branch) may be damaged, risking Volkmann's ischaemic contracture.

4. What are the clinical features and at-risk structure of a scaphoid fracture?

   Tenderness in the anatomical snuffbox, pain on telescoping the thumb. The proximal pole has a retrograde blood supply, so fractures risk avascular necrosis and nonunion. Initial X-rays may be normal — treat clinically and re-image.

5. What is carpal tunnel syndrome, which nerve is compressed, and what is the distribution of symptoms?

   Compression of the median nerve at the wrist beneath the flexor retinaculum. Causes paraesthesia/pain in the thumb, index, middle, and radial half of the ring finger, with thenar wasting in advanced cases.

6. What is Dupuytren's contracture?

   Progressive fibrosis and contracture of the palmar fascia causing fixed flexion deformity, most commonly of the ring and little fingers; associated with diabetes, alcohol, and a positive family history.

7. What is the most common direction of hip dislocation and the resulting limb position?

   Posterior dislocation is most common (~90%); the limb lies shortened, adducted, and internally rotated. The sciatic nerve is at risk.

8. What is the typical presentation of an osteoporotic intertrochanteric/femoral neck fracture in an elderly patient?

   After a low-energy fall, the affected leg is shortened and externally rotated with pain on weight-bearing and movement at the hip.

9. What is avascular necrosis (osteonecrosis) of the femoral head and what are its main risk factors?

   Death of bone due to interrupted blood supply, leading to collapse of the femoral head. Risk factors: corticosteroids, alcohol, sickle cell disease, trauma (femoral neck fracture/dislocation), and caisson disease.

10. What are the special tests for anterior cruciate ligament (ACL) integrity in the knee?

    The anterior drawer test and the Lachman test (knee at 20–30° flexion, more sensitive); a pivot-shift test indicates rotational instability.

11. What is the McMurray test used to assess in the knee?

    A meniscal tear — the examiner flexes and rotates the knee while extending it; a painful click or pop indicates a meniscal injury (medial meniscus with external rotation, lateral with internal rotation).

12. What is the 'unhappy triad' of the knee?

    Injury to the ACL, the medial collateral ligament (MCL), and the medial meniscus, classically from a lateral blow to a planted, flexed knee.

13. What is the Ottawa Ankle Rules' purpose and a key criterion?

    To decide which ankle injuries need X-rays. X-ray is required if there is bone tenderness at the posterior edge/tip of either malleolus, tenderness at the navicular or base of the 5th metatarsal, or inability to bear weight for 4 steps both immediately and in the ED.

14. What does the Weber classification describe for ankle fractures?

    Lateral malleolus (fibular) fractures relative to the syndesmosis: Weber A (below syndesmosis, stable), Weber B (at the level of syndesmosis), Weber C (above syndesmosis, unstable, syndesmosis usually disrupted).

15. What is hallux valgus and the typical radiographic angle that defines it?

    Lateral deviation of the great toe at the first MTP joint with a medial bony prominence (bunion). It is defined by a hallux valgus angle greater than $15^{\circ}$ and an intermetatarsal angle greater than $9^{\circ}$.

16. What are the classic clinical tests for screening developmental dysplasia of the hip (DDH) in neonates?

    The Ortolani test (relocates a dislocated hip — a palpable 'clunk' of reduction on abduction) and the Barlow test (dislocates an unstable hip on adduction and posterior pressure).

17. What is the imaging investigation of choice for DDH under and over 4–6 months of age?

    Ultrasound is used under ~4–6 months (femoral head not yet ossified); plain radiograph is used after ~6 months once the femoral head ossific nucleus appears.

18. What are the components of the deformity in congenital talipes equinovarus (clubfoot)?

    CAVE: Cavus (high medial arch), Adductus (forefoot), Varus (hindfoot inversion), and Equinus (plantarflexion/ankle pointing down).

19. What is the first-line treatment for idiopathic clubfoot?

    The Ponseti method — serial manipulation and casting to correct the deformity in sequence, usually followed by a percutaneous Achilles tenotomy and a foot abduction (boots-and-bar) bracing programme.

20. How are spinal curvatures defined, and what Cobb angle defines scoliosis?

    Scoliosis is a lateral curvature with rotation, defined by a Cobb angle greater than $10^{\circ}$. Kyphosis is excessive posterior (thoracic) convexity; lordosis is excessive anterior (lumbar/cervical) concavity.

21. What is spondylolisthesis, and what is spondylolysis?

    Spondylolysis is a defect/stress fracture of the pars interarticularis. Spondylolisthesis is the forward slippage of one vertebra on the one below (commonly L5 on S1), graded by Meyerding I–IV by percentage of slip.

22. What is the most common primary malignant bone tumour, and its typical age and site?

    Osteosarcoma — typically in adolescents/young adults (10–20 years), arising at the metaphysis of long bones around the knee (distal femur, proximal tibia). Radiographs may show a 'sunburst' appearance and Codman's triangle.

23. Compare the typical radiographic 'onion-skin' tumour and its demographic with osteosarcoma.

    Ewing sarcoma shows a lamellated 'onion-skin' periosteal reaction, affects younger children (5–15 years), arises in the diaphysis of long bones/pelvis, and is associated with the t(11;22) translocation (EWS-FLI1).

24. Which five primary cancers most commonly metastasise to bone, and what is the most common type of bone metastasis (lytic vs blastic)?

    Breast, prostate, lung, kidney (renal), and thyroid (mnemonic: 'BLT with a Kosher Pickle'). Most metastases are osteolytic; prostate cancer classically produces osteoblastic (sclerotic) lesions.

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