Orthopaedics & Rheumatology Comprehensive Review

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.

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

Anteversion

Which joint classification best describes the hip joint?

Synovial (ball-and-socket)

What is the hallmark pain finding in compartment syndrome?

Severe pain on passive stretching of muscles within the compartment

What surgical procedure treats established compartment syndrome?

Fasciotomy (surgical decompression)

What is the earliest objective physical sign of compartment syndrome?

Tense, swollen compartment

What pediatric fracture location remodels best?

Fractures close to the physis

Which structure is responsible for longitudinal bone growth in children?

Epiphyseal (growth) plate

Most common elbow fracture in children?

Supracondylar fracture of the humerus

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

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

Most serious acute complication of supracondylar humerus fracture?

Compartment syndrome

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

Anterior interosseous nerve

Usual direction of traumatic elbow dislocation?

Posterior

Commonest nerve injured in posterior elbow dislocation?

Ulnar nerve

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

Airway management with cervical-spine protection

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

Grade III-B

Primary goal of passive exercises in rehabilitation?

Maintain joint range of motion and prevent disuse atrophy

Who performs passive therapeutic exercise?

Therapist moves the limb for the patient

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

Ultraviolet (it is NOT a deep-heat modality)

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

Paraffin wax bath therapy

Which effect is NOT produced by cold therapy?

Vasodilation (cold causes vasoconstriction)

Electrotherapy modality used specifically for pain control?

TENS (Transcutaneous Electrical Nerve Stimulation)

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

Innervated (normally supplied) muscle

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

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

Primary purpose of splints in rheumatology?

Maintain joints in functional position and prevent/correct deformity

Example of a superficial heat source used in physiotherapy?

Infra-red heat lamp

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

True

Most common fracture of proximal humerus in adults?

Surgical neck fracture

Nerve most often injured in anterior shoulder dislocation?

Axillary nerve

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

Radial nerve

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

Locked intramedullary nail

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

Rotator cuff tear

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

Above-elbow cast with neutral rotation

Commonest functional loss after childhood both-bone forearm fracture?

Partial loss of pronation/supination

Definition of a Galeazzi fracture?

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

Definition of a Smith’s fracture?

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

Most common complication of distal radius fractures?

Mal-union

Carpal bone fractured most frequently?

Scaphoid

Proximal scaphoid fractures risk what serious complication?

Avascular necrosis

Monteggia fracture consists of?

Proximal ulnar fracture with radial-head dislocation

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

Dislocation or fracture of the hip (commonly posterior dislocation)

Limb attitude of posterior hip dislocation?

Flexion, adduction, internal rotation, and shortening

Nerve commonly injured in posterior hip dislocation producing foot drop?

Sciatic nerve

Ideal time to reduce traumatic hip dislocation?

Immediately (within 6 hours)

Most common organ injured with pelvic fractures?

Urethra (especially posterior urethra)

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

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

Ultrasound

Shenton line on pelvic radiograph runs from which anatomical landmarks?

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

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

Perkin’s line

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

Total hip arthroplasty (replacement)

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

Maintenance of airway

Which ankle ligament is most commonly sprained during inversion injury?

Anterior talofibular ligament

Ligament injured in high (syndesmotic) ankle sprain?

Anterior & posterior tibiofibular ligaments

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

Above the syndesmosis (supra-syndesmotic)

Nerve compressed in carpal tunnel syndrome?

Median nerve

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

Tinel sign

Steppage gait is due to weakness of which muscle group?

Ankle dorsiflexors (common peroneal nerve lesion)

Hypothenar atrophy points to lesion of which nerve?

Ulnar nerve

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

Gout

Gout most commonly affects which joint first?

First metatarsophalangeal (big-toe) joint

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

Colchicine (with cautious dosing)

Diuretic commonly precipitating hyperuricemia and gout?

Furosemide

Biologic agent reserved for RA refractory to conventional DMARDs?

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

First-line DMARD for rheumatoid arthritis?

Methotrexate

Most specific serologic test for rheumatoid arthritis?

Anti-CCP (anti–cyclic citrullinated peptide) antibodies

Earliest radiographic change in RA?

Peri-articular soft-tissue swelling

Pattern of joint involvement typical for RA?

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

Osteoarthritis most commonly affects which large synovial joint?

Knee

Heberden’s nodes occur at which joints?

Distal interphalangeal (DIP) joints

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

Joint-space narrowing

Bisphosphonate mechanism in osteoporosis therapy?

Inhibits osteoclast-mediated bone resorption

Gold-standard test for diagnosing osteoporosis?

DEXA (dual-energy X-ray absorptiometry) scan

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

Teriparatide (Forteo)

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

Osteoclasts (followed by compensatory osteoblast activity)

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

Paget’s disease of bone

Most sensitive study for detecting early bone metastases?

Technetium-99m bone scan

Commonest malignant bone lesion in adults overall?

Metastatic bone disease

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

Prostate carcinoma

Multiple myeloma originates from proliferation of which cells?

Plasma cells

Classic lab hallmark of multiple myeloma?

Monoclonal (M-protein) spike in serum/urine

Most common benign bone tumor?

Osteochondroma

Osteoid osteoma pain is typically relieved by which medication class?

Salicylates/NSAIDs

Radiographic ‘nidus’ is characteristic of which benign tumor?

Osteoid osteoma

Most common epiphyseal tumor in skeletally immature patients?

Chondroblastoma

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

Osteosarcoma

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

Ewing sarcoma

Triple arthrodesis fuses which three hind-foot joints?

Talocalcaneal, talonavicular, and calcaneocuboid joints

Classic four deformities of congenital talipes equinovarus (clubfoot)?

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

Order of correction in Ponseti method for clubfoot?

Cavus → adduction → varus → equinus

Best maintenance device after serial casting for clubfoot?

Abduction brace (Denis-Browne)

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

Ultrasound of hips

Initial pathologic change in primary osteoarthritis?

Fibrillation (surface cracking) of articular cartilage

Tri-compartmental knee osteoarthritis definitive surgical option?

Total knee arthroplasty (replacement)

Most common metabolic bone disease worldwide?

Osteoporosis

Risk factor for male osteoporosis involving sex hormones?

Hypogonadism

Commonest site for osteoporotic vertebral compression fracture?

Thoracolumbar junction

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

Ankylosing spondylitis

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

Reactive arthritis (Reiter syndrome)

Skin lesion balanitis circinata is associated with which arthropathy?

Reactive arthritis

Extra-articular condition strongly linked to ankylosing spondylitis?

Anterior uveitis

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

Left gluteus medius/minimus