Orthopaedics & Rheumatology Comprehensive Review

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This flashcard set covers key principles, definitions, complications, investigations, and treatments across orthopaedic trauma, pediatric fractures, rehabilitation, rheumatology, bone tumors, metabolic bone disease, spine, gait, and emergency care as presented in the lecture notes.

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227 Terms

1
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What term describes anterior inclination of the femoral neck relative to the distal femoral condyles?

Anteversion

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Which joint classification best describes the hip joint?

Synovial (ball-and-socket)

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What is the hallmark pain finding in compartment syndrome?

Severe pain on passive stretching of muscles within the compartment

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What surgical procedure treats established compartment syndrome?

Fasciotomy (surgical decompression)

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What is the earliest objective physical sign of compartment syndrome?

Tense, swollen compartment

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What pediatric fracture location remodels best?

Fractures close to the physis

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Which structure is responsible for longitudinal bone growth in children?

Epiphyseal (growth) plate

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Most common elbow fracture in children?

Supracondylar fracture of the humerus

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Most common complication (late) of supracondylar humerus fracture in children?

Cubital varus (mal-union, ‘gun-stock’ deformity)

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Most serious acute complication of supracondylar humerus fracture?

Compartment syndrome

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Supracondylar fracture with ‘pointing index’ indicates injury to which nerve?

Anterior interosseous nerve

12
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Usual direction of traumatic elbow dislocation?

Posterior

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Commonest nerve injured in posterior elbow dislocation?

Ulnar nerve

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First step in Advanced Trauma Life Support (ATLS) primary survey?

Airway management with cervical-spine protection

15
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A high-energy open tibial fracture needing muscle flap but intact vessels is Gustilo-Anderson grade?

Grade III-B

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Primary goal of passive exercises in rehabilitation?

Maintain joint range of motion and prevent disuse atrophy

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Who performs passive therapeutic exercise?

Therapist moves the limb for the patient

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Deep-heat modalities exclude which of the following: microwave, short wave, ultrasound, ultraviolet?

Ultraviolet (it is NOT a deep-heat modality)

19
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Best modality to correct distal extremity contractures (e.g., wrist, ankle)?

Paraffin wax bath therapy

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Which effect is NOT produced by cold therapy?

Vasodilation (cold causes vasoconstriction)

21
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Electrotherapy modality used specifically for pain control?

TENS (Transcutaneous Electrical Nerve Stimulation)

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Faradic current is primarily used to stimulate which type of muscle?

Innervated (normally supplied) muscle

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Massage technique producing pain/tension relief via micro-circulation improvement?

General therapeutic massage (compression, stroking, friction, etc.)

24
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Primary purpose of splints in rheumatology?

Maintain joints in functional position and prevent/correct deformity

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Example of a superficial heat source used in physiotherapy?

Infra-red heat lamp

26
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Ultrasound therapy exerts a to-and-fro ‘micromassage’ effect on tissue to soften adhesions. True or False?

True

27
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Most common fracture of proximal humerus in adults?

Surgical neck fracture

28
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Nerve most often injured in anterior shoulder dislocation?

Axillary nerve

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Mid-shaft humeral fracture commonly injures which nerve causing wrist drop?

Radial nerve

30
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Best standard treatment for closed mid-shaft femur fracture in adults?

Locked intramedullary nail

31
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Post-immobilization limitation of abduction & external rotation with preserved flexion in elderly shoulder injury suggests what lesion?

Rotator cuff tear

32
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Treatment of middle-third both-bone forearm fracture in an 8-year-old?

Above-elbow cast with neutral rotation

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Commonest functional loss after childhood both-bone forearm fracture?

Partial loss of pronation/supination

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Definition of a Galeazzi fracture?

Fracture of distal radius with dislocation of distal radio-ulnar joint (DRUJ)

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Definition of a Smith’s fracture?

Fracture of distal radius with volar (palmar) displacement of distal fragment

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Most common complication of distal radius fractures?

Mal-union

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Carpal bone fractured most frequently?

Scaphoid

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Proximal scaphoid fractures risk what serious complication?

Avascular necrosis

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Monteggia fracture consists of?

Proximal ulnar fracture with radial-head dislocation

40
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Radiographic disruption of Shenton’s line indicates what around the hip?

Dislocation or fracture of the hip (commonly posterior dislocation)

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Limb attitude of posterior hip dislocation?

Flexion, adduction, internal rotation, and shortening

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Nerve commonly injured in posterior hip dislocation producing foot drop?

Sciatic nerve

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Ideal time to reduce traumatic hip dislocation?

Immediately (within 6 hours)

44
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Most common organ injured with pelvic fractures?

Urethra (especially posterior urethra)

45
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Definitive treatment for a stable intertrochanteric femur fracture in elderly?

Dynamic hip screw or intramedullary device (mal-union most common, but here question? flashcards referencing earlier note) – Main complication: Malunion

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Gold-standard imaging for initial evaluation of developmental dysplasia of hip in neonates?

Ultrasound

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Shenton line on pelvic radiograph runs from which anatomical landmarks?

Inferior border of superior pubic ramus to medial aspect of femoral neck

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Name the vertical line through the lateral edge of the acetabulum used in DDH assessment.

Perkin’s line

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Garden type III subcapital femoral-neck fracture in a 75-year-old – best treatment?

Total hip arthroplasty (replacement)

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First priority in management of multiple-injury (polytrauma) patient?

Maintenance of airway

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Which ankle ligament is most commonly sprained during inversion injury?

Anterior talofibular ligament

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Ligament injured in high (syndesmotic) ankle sprain?

Anterior & posterior tibiofibular ligaments

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Danis-Weber type C ankle fracture occurs at what level?

Above the syndesmosis (supra-syndesmotic)

54
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Nerve compressed in carpal tunnel syndrome?

Median nerve

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Clinical sign used to elicit carpal tunnel syndrome by tapping the volar wrist?

Tinel sign

56
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Steppage gait is due to weakness of which muscle group?

Ankle dorsiflexors (common peroneal nerve lesion)

57
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Hypothenar atrophy points to lesion of which nerve?

Ulnar nerve

58
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Acute mono-arthritis with red, hot joint is most characteristic of which crystal disease?

Gout

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Gout most commonly affects which joint first?

First metatarsophalangeal (big-toe) joint

60
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Drug used for acute gouty arthritis pain when NSAIDs contraindicated (renal impairment)?

Colchicine (with cautious dosing)

61
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Diuretic commonly precipitating hyperuricemia and gout?

Furosemide

62
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Biologic agent reserved for RA refractory to conventional DMARDs?

Anti-TNF agents (e.g., adalimumab)

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First-line DMARD for rheumatoid arthritis?

Methotrexate

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Most specific serologic test for rheumatoid arthritis?

Anti-CCP (anti–cyclic citrullinated peptide) antibodies

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Earliest radiographic change in RA?

Peri-articular soft-tissue swelling

66
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Pattern of joint involvement typical for RA?

Bilateral, symmetrical small-joint polyarthritis (PIP, MCP)

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Osteoarthritis most commonly affects which large synovial joint?

Knee

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Heberden’s nodes occur at which joints?

Distal interphalangeal (DIP) joints

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Radiographic hallmarks of osteoarthritis include joint-space narrowing, osteophytes, subchondral sclerosis, and cysts. Which of these is usually asymmetrical?

Joint-space narrowing

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Bisphosphonate mechanism in osteoporosis therapy?

Inhibits osteoclast-mediated bone resorption

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Gold-standard test for diagnosing osteoporosis?

DEXA (dual-energy X-ray absorptiometry) scan

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Anabolic agent (recombinant PTH 1-34) used in severe osteoporosis?

Teriparatide (Forteo)

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Paget disease pathophysiology involves first increased activity of which bone cell?

Osteoclasts (followed by compensatory osteoblast activity)

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Characteristic radiographic ‘picture-frame vertebra’ or ‘mixed lytic-sclerotic spine’ sign is associated with which bone disease?

Paget’s disease of bone

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Most sensitive study for detecting early bone metastases?

Technetium-99m bone scan

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Commonest malignant bone lesion in adults overall?

Metastatic bone disease

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Osteosclerotic bone metastases in elderly males usually originate from which primary?

Prostate carcinoma

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Multiple myeloma originates from proliferation of which cells?

Plasma cells

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Classic lab hallmark of multiple myeloma?

Monoclonal (M-protein) spike in serum/urine

80
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Most common benign bone tumor?

Osteochondroma

81
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Osteoid osteoma pain is typically relieved by which medication class?

Salicylates/NSAIDs

82
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Radiographic ‘nidus’ is characteristic of which benign tumor?

Osteoid osteoma

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Most common epiphyseal tumor in skeletally immature patients?

Chondroblastoma

84
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Sun-ray (sun-burst) periosteal reaction on X-ray of a teenager’s knee region suggests which tumor?

Osteosarcoma

85
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‘Onion-skin’ (laminated) periosteal reaction in a child’s diaphyseal bone lesion indicates what tumor?

Ewing sarcoma

86
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Triple arthrodesis fuses which three hind-foot joints?

Talocalcaneal, talonavicular, and calcaneocuboid joints

87
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Classic four deformities of congenital talipes equinovarus (clubfoot)?

Forefoot adduction, midfoot cavus, hind-foot varus, ankle equinus

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Order of correction in Ponseti method for clubfoot?

Cavus → adduction → varus → equinus

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Best maintenance device after serial casting for clubfoot?

Abduction brace (Denis-Browne)

90
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Best initial imaging for suspected neonatal hip dysplasia with family history?

Ultrasound of hips

91
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Initial pathologic change in primary osteoarthritis?

Fibrillation (surface cracking) of articular cartilage

92
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Tri-compartmental knee osteoarthritis definitive surgical option?

Total knee arthroplasty (replacement)

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Most common metabolic bone disease worldwide?

Osteoporosis

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Risk factor for male osteoporosis involving sex hormones?

Hypogonadism

95
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Commonest site for osteoporotic vertebral compression fracture?

Thoracolumbar junction

96
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Schober test assesses lumbar flexion; ≤ 5 cm increase indicates which disease?

Ankylosing spondylitis

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HLA-B27–positive spondyloarthropathy presenting with urethritis, conjunctivitis & arthritis?

Reactive arthritis (Reiter syndrome)

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Skin lesion balanitis circinata is associated with which arthropathy?

Reactive arthritis

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Extra-articular condition strongly linked to ankylosing spondylitis?

Anterior uveitis

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Trendelenburg gait pelvic drop on right indicates weakness of which side gluteus medius?

Left gluteus medius/minimus