Clinical Quiz

1. Clinical Quiz Bones, bones the magical fruit!

2. Which is not a cause of bony lumps: Developmental Injury Inflammation Hyperaldosteronism Avulsion Tumour

3. Which is not a cause of bony lumps: Developmental Injury Inflammation Hyperaldosteronism Avulsion Tumour

4. Osteomyelitis implies inflammation by its name, but does it also correlate closely with infection?

5. Osteomyelitis implies inflammation by its name, but does it also correlate closely with infection? Yes

6. Where is the most common location that osteomyelitis effects in children (not a specific bone)?

7. Where is the most common location that osteomyelitis effects in children (not a specific bone)? metaphyseal area of long bones (particularly the tibia and femur)

8. What are the two most typical bacteria causing osteomyelitis in the neonate?

9. What are the two most typical bacteria causing osteomyelitis in the neonate? S. aureus and streptococci

10. What is the most common primary cancer of bone?

11. What is the most common primary cancer of bone? Osteosarcoma

12. You’re quite agitated after just having had an extended consultation with a man who has had multiple throat cancers removed but believes it wasn’t due to his 2 pack a day habit, so continues to smoke. Mr Matheson comes in complaining of muscle pain and you think to yourself, “maybe I can rush this along”. What are 4 possible DDx and give one reason for each which would suggest such a diagnosis.

13. 1 – Strenous exercise response -unaccustomed exercise 1-2d previous - spontaneous recovery

14. 2 – Polymyalgia rheumatica -abrupt onset of Sx - severe morning stiffness and limb girdle pain - fatigue, night sweats and fever in elderly

15. 3 – Rheumatoid arthritis -early morning stiffness - swan neck deformity, Z deformity in thumb - ulnar deviation

16. 4 – Ankylosing Spondylitis -onset over months or years - spinal pain and stiffness with progressive loss of spinal movement - kyphosis and spinal extension

17. What is the name of tumour that usually stops growing at time of growth plate closure?

18. What is the name of tumour that usually stops growing at time of growth plate closure? Osteochondroma

19. Johnny is a 45 y.o. male who is referred to your orthopaedic practice after presenting with dull pain for months around his ribs. Johnny mutters something about his GP seeming too rushed to ask any questions and says he had looked up on the internet about what he could have. After shaking your head at the minimal history taken by the GP you question Johnny. He suspects that he has Chondrosarcoma. As you’re about to ask further questions he blurts out, “I don’t want any surgery! Chemo should kill it!”. What should you tell Johnny regarding his treatment options for chondosarcoma?

20. The most typical treatment is wide surgical excision • Most chondorsarcomas are resistant to chemotherapy

21. After hearing that chemo may not have any effect on a possible chondrosarcoma diagnosis, Johnny seems concerned. “What the hell is a wide excision Doc?”, he asks. • In 1 sentence describe the procedure of a wide excision in terms of tissue removal • What grade of tumourwould this excision be best for?

22. Dissection is carried out well clear of the tumour, through normal tissue • Low-grade intracompartmental lesion

23. Johnny accepts that this might be the only option but then looks concerned. “Does this mean I’m going to lose my ribs?”

24. Johnny accepts that this might be the only option but then looks concerned. “Does this mean I’m going to lose my ribs?” No, limb sparing surgery is the preferred treatment for intracompartmental lesions

25. Johnny seems relieved that bone may be spared. If amputation was required, and a leg rather than ribs where in question, what are the names of the 3 types of amputation?

26. Johnny seems relieved that bone may be spared. If amputation was required, and a leg rather than ribs where in question, what are the names of the 3 types of amputation? - provisional - definitive end-bearing - definitive non-end-bearing

28. What are the intrinsic muscles of the hand?

29. What are the intrinsic muscles of the hand? - dorsal interossei - lumbricals - palmar interossei

30. What are the three muscles that make up the Thenar eminence?

31. What are the three muscles that make up the Thenar eminence? - Abductor pollicisbrevis - flexor pollicisbrevis - opponenspollicis

32. When injury (such as a sprain) is caused to the ankle, is the foot normally dorsiflexed or plantar flexed?

33. When injury (such as a sprain) is caused to the ankle, is the foot normally dorsiflexed or plantar flexed? - Plantar flexed

34. When injury (such as a sprain) is caused to the ankle, is the foot normally dorsiflexed or plantar flexed? - Plantar flexed

35. What other structure is most likely to be damaged if the medial collateral ligament of the knee is ruptured? Why?

36. What other structure is most likely to be damaged if the medial collateral ligament of the knee is ruptured? Why? - Medial meniscus - the medial collateral and meniscus adhere to each other (joined)

37. If an eversion fracture of the ankle takes place, while the foot is dorsiflexed and force travel through the medial malleolus, what is a common finding?

38. If an eversion fracture of the ankle takes place, while the foot is dorsiflexed and force travel through the medial malleolus, what is a common finding? • Fibula fracture distally

39. Is compartment syndrome considered a medical emergency? What would be a way (mnemonic) to assess whether this process is taking place?

40. Is compartment syndrome considered a medical emergency? What would be a way (mnemonic) to assess whether this process is taking place? • YES • Pain • Pressure • Paraesthesia • Paresis • Pallor • Pulselessness

41. What is the first vessel type to be occluded in compartment syndrome and why?

42. What is the first vessel type to be occluded in compartment syndrome and why? • Lymphatics • Lowest pressure (followed by veins and arteries)

43. An 22 y.o. man comes into the ED hobbling and with multiple grazes on his arms. He says that he’s just come from a social touch game where he stepped in a hole. You notice that his right foot is quite everted. What would be your provisional Dx from general inpection?

44. An 22 y.o. man comes into the ED hobbling and with multiple grazes on his arms. He says that he’s just come from a social touch game where he stepped in a hole. You notice that his right foot is quite twisted medially. What would be your provisional Dx from general inpection? • A rupture of a cruciate ligament of the knee