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Archive for the ‘self assessment’ Category

Topic: Complications of Fractures

1 B – compartment syndrome
2 A – ulnar nerve injury
3 G – osteomyelitis
4 E – avascular necrosis
5 D – deep venous thrombosis
6 I – pneumothorax

Topic: Treatment options in Fracture Management

1 D – dynamic hip screw
2 K – hemiarthoplasty
3 A – collar & cuff
4 B – open reduction & internal fixation
5 G – tension band wiring
6 E – intramedullar nailing
7 J – below elbow cast

Topic: Common Disorders of the Hand

1 F – trigger finger
2 B – dupuytren’s contracture
3 C – ganglion
4 A – carpal tunnel syndrome
5 E – pulp space infection

Topic: The Painful Knee

1 C – anterior cruciate injury
2 F – pre-patellar bursitis
3 H – rheumatoid arthritis
4 E – medial meniscal tear

Topic: Childhood Disorders

1 A – SUFE
2 G – perthe’s disease
3 F – transient synovitis
4 B – septic arthritis
5 D – developmental dysplasia of the hip

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From feedback, most of you wanted to see more SAQs so here are some single best answer questions to help with your revision. Answers will be given in a separate post.

Topic: Complications of Fractures

A Associated Nerve injury
B Compartment Syndrome
C Non-Union
D Deep Venous Thrombosis
E Avascular Necrosis
F Delayed Union
G Osteomyelitis
H Fat Embolism
I Pneumothorax
J Pulmonary Embolism

1. An 18 year old footballer sustained a closed spiral fracture to his right tibia. He was placed in an above knee backslab. Overnight, he asks for more and more analgesia and complains of increasing pain with numbness in the first web space. His toes are well perfused and pedal pulses are present

2. A 29 year old gymnast with a fracture dislocation of her left elbow has the dislocation reduced under sedation. Afterwards, she complains of numbness and tingling in her little and ring fingers.

3. A 60 year old diabetic with an open fracture dislocation of the ankle has a post-operative wound binfection, treated with antibiotics. 6 months post-op X-rays show lucency around the screws and periosteal reaction. CRP is mildly elevated.

4. A 40 year old lady who fell onto an outstretched hand is treated in a scaphoid cast for 6 weeks. at 6 months, she continues to have pain in her wrist and her X-rays show increased density at the proximal pole of the scaphoid.

5. A 30 year old lady with anti-phospholipid syndrome is treated conservatively in a below knee cast for a distal fibular fracture. 2 weeks later she complains of a painful, tender calf.

6. A 45 year old man who came off a motorbike, sustaining a clavicle fracture and 2 rib fractures, complains of shortness of breath in A&E. Saturations are 85% and his respiratory rate is 38.

Treatment Options in Fracture Management

A Collar and Cuff
B Open reduction & internal fixation
C External Fixator
D Dynamic hip Screw
E Intramedullary Nailing
F Screw fixation
G Tension Band Wiring
H Traction
I Above elbow cast
J Below below cast
K Hemiarthroplasty

1. An intertrochanteric 2 part fractured neck of femur in a 95 year old lady which is minimally displaced.

2. A displaced intra-capsular fractured neck of femur in an 85 year old man who is house bound.

3. A 2 part fractured neck of humerus with minimal displacement in a 75 year old lady on her dominant side

4. A fracture dislocation of an ankle in a 21 year old rugby player

5. A displaced 2 part fracture of the patella which is displaced in an active 40 year old man

6. An isolated transverse femoral shaft fracture in an 18 year old

7. A minimally displaced, extra-articular fractured distal radius in a 70 year old lady on her non-dominant side.

Topic: Common Disorders of the Hand

A Carpal Tunnel Syndrome
B Dupuytren’s Contracture
C Ganglion
D Mallet Finger
E Pulp Space Infection
F Trigger Finger
G Paronychia
H Rheumatoid arthritis
I Game Keeper’s thumb
J Heberden’s nodes

1. A 46 year old man complaining of his finger sticking in a flexed position and then clicking upon straightening it.

2. A 60 year old alcoholic with progressive flexion of his MCP and PIP joints. His father had a similar problem.

3. A 30 year old man with a cystic swelling over the dorsum of the wrist, limiting wrist extenison.

4. A 20 year old pregnant woman with numbness and tingling of her thumb, index and middle fingers.

5. A 30 year old worker with a minor abrason over his left index finger. 1 week later, he presents with erythema and swelling affecting the palmar surface of the distal aspect of his left index finger.

Topic: The Painful Knee

A. Medial Collateral Ligament Sprain
B. Postero-lateral corner injury
C. Anterior Cruciate Injury
D. Posterior Cruciate Injury
E. Medial Meniscal Tear
F. Pre-patellar Bursitis
G. Osteoarthritis
H. Rheumatoid Arthritis
I. Septic arthritis

1. An 18 year old with a twisting injury and audible pop whilst skiing. Immediately afterwards, a large haemarthrosis developed.

2. A 30 year old joiner who sustained a minor cut to the front of his knee. 7 days later he develped erythema, pain and swelling.

3. A 40 year old lady with a chronic history of pain and swelling of her knee. Examination revealed decreased flexion and extension along with a valgus deformity, most marked on weight bearing.

4. A 22 year old footballer with a twisting injury to his knee. He presented to the A&E department being unable to fully straighten his knee.

Topic: Childhood Disorders

A SUFE
B Septic Arthritis
C Still’s disease
D Developmental dysplasia of the hip
E Osgood-Schlatter’s disease
F Transient Synovitis
G Perthe’s disease
H Tuberculous synovitis

1. An overweight 14 year old boy who presents with a 6 month history of a painful knee. He fell 3 days ago and limps now. Examinaton reveals that his leg is shorter and he has reduced rotations.

2. A 6 year old boy with groin pain and a limp presents to paediatrics. Initially, his symptoms were severe but subsequently resolved with bed rest. He has limited abduction and internal rotation of his hip.

3. A 3 year old toddler is admitted with a limp and temperature of 37.9 after an upper respiratory tract infection. He has mild tenderness of his hip joint, but a good range of movement.

4. A 4 year old girl with fever for 3 days presents with inability to weight bear and a grossly decreased range of movement of her hip. Her peripheries are cool to touch.

5. A young girl is brought to her GP by her mother who is concerned that her left leg is shorter than the other. She seems to limp slightly. Her mother had a “clicky” hip at birth.

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EMI on the back (part2)

Another 3 problems to  go with the Pathology / diagnosis theme EMI in the previous post.

I’m hoping it will be possible  to get all this self-assessment material into the Test Yersel page soon but at the moment there’s not a quick way in.

Enjoy the EMIs, answers at the end of the week, (the photo of the spine model has nothing to do with the questions, Ed)

Theme : pathology

A S1 nerve root entrapment

B  spondylolisthesis

C  central  cord compression

D T1 root entrapment

E  C5/6 root entrapment

F  L3 root compression on the  left

G  infection in the L4/5 disc

H  spinal  tumour

I  cauda equina lesion

J  L3 root compression  on the right side

Match the clinical presentations below to the most appropriate pathology listed above:

4.   Back pain without radiation in a 60 year-old woman associated with pyrexia, high white cell count and a “hot spot”    on bone scan.

5.  Bilateral  leg pain with back pain and urinary retention.

6.  Loss of ankle jerk on examination.

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Here’s an example of a EMI question for spinal problems which goes with last week’s core clinical focus

Theme : pathology

A S1 nerve root entrapment

B  spondylolisthesis

C  central  cord compression

D T1 root entrapment

E  C5/6 root entrapment

F  L3 root compression on the  left

G  infection in the L4/5 disc

H  spinal  tumour

I  cauda equina lesion

J  L3 root compression  on the right side

Match the clinical presentations below to the most appropriate pathology listed above:

1  Neck pain and wasting of the interossei muscles in the hand

2  Depressed right knee jerk and weakness on knee extension

3  Pain shooting from the back down the side of the leg to the lateral  side of the foot

More later but that’s all for now (don’t let me forget to post the answers by Friday, Ed)

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Self Assessment

More sample questions to test yourself

Carpal tunnel syndrome is due to which nerve being compressed?

A. Radial

B. Musculocutaneous

C. Ulnar

D. Median

Carpal tunnel syndrome is typically due to entrapment at the:

A. Flexor retinaculum

B. Spiral groove in the humerus

C. 1st cervical rib

D. Ligament of Struthers

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The child with  a limp

A.  malignant primary bone tumour

B.  Perthe’s disease

C.  Septic arthritis

D. Developmental dysplasia of the hip

E.  Osgood -Schlatter’s  disease

F.  Slipped upper femoral  epiphysis

Match the following presentations with the most  likely diagnosis above:

1.  an overweight 13 year old boy with  a limp for 3 weeks

2.  a 14 year old boy with a warm hard mass above the knee

3.  a two year old with  painfree limp since starting to walk

4  a 6 year old boy with knee pain and a limp for  2 months

5  a 3 year old girl with a swollen knee and a fever with pain on weight bearing.

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