Orthopaedics MCQs for NEET PG
922 worked Orthopaedics questions across 112 areas. Each one has its own page with the reasoning for every option.
What this set is
Orthopaedics tests fractures and their complications, nerve injuries, bone tumours and childhood conditions. Radiographs and eponymous fractures appear often.
This page lists the 922 Orthopaedics questions that have a full worked page: 644 application questions that put a fact to use on a patient or a finding, and 278 multi-step questions that combine two or more ideas. Plain one-fact recall items are left out here on purpose. The Orthopaedics practice bank in the app is larger, with 3,781 questions in all, and is where timed tests and daily practice draw from.
How to use it
- Pick an area you are weak in, below.
- Answer first, then read why each wrong option fails.
- Write a three-line note for every miss, and revisit it in a week.
- Move to a timed Orthopaedics test once an area feels steady.
These are original practice items, not recalled exam questions, and they are not yet reviewed by independent faculty. Confirm important facts in a standard textbook.
What Orthopaedics covers in the exam
- Fractures and dislocations
- Peripheral nerve injuries
- Bone and joint infections
- Bone tumours
- Paediatric orthopaedics
- Spine
- Metabolic bone disease
A study map from the standard curriculum; the NBEMS bulletin is the authority. See the Orthopaedics study guide.
Worked questions by area
112 areas, largest first. Open an area to see its questions.
Spine94
- Spine · ApplicationA man with a large lumbar disc prolapse develops bilateral leg weakness, saddle anaesthesia and urinary retention. What is the most appropriate management?
- Spine · ApplicationAn adolescent gymnast has low back pain on extension. An oblique lumbar radiograph shows a break in the neck of the 'Scotty dog'. What does this indicate?
- Spine · ApplicationA 13-year-old girl has a rib hump on forward bending and an asymmetrical waist. Which radiographic measurement is used to quantify the spinal curve?
- Spine: disc prolapse · Multi-stepA 40-year-old man has back pain and weakness of great toe dorsiflexion, with numbness on the dorsum of the foot and lateral leg. The ankle jerk is normal. Which disc pr…
- Spine: Jefferson fracture · ApplicationA man who dived into shallow water has neck pain, and an open-mouth view shows lateral displacement of both lateral masses of C1. What is the injury?
- Spine: Hangman fracture · ApplicationA passenger in a head-on collision has neck pain, and the lateral cervical radiograph shows bilateral fractures through the pars interarticularis of C2 with anterior di…
- Spine: odontoid fracture classification · Multi-stepIn the Anderson and D'Alonzo classification, which type of odontoid fracture has the highest risk of nonunion?
- Spine: Chance fracture · ApplicationA passenger wearing a lap seat belt has an abdominal bruise and back pain after a frontal collision. Radiographs show a horizontal fracture through the L1 vertebral bod…
- Spine: Denis three-column concept · Multi-stepAccording to Denis, which feature makes a thoracolumbar injury mechanically unstable?
- Spine: burst fracture · ApplicationA man falls from a ladder and has severe back pain. CT of L1 shows a vertebral body fracture with retropulsion of fragments into the canal and he has lower limb weaknes…
- Spine: spinal shock · ApplicationWhich finding signals the end of spinal shock after a cord injury?
- Spine: central cord syndrome · ApplicationAn elderly man with cervical spondylosis falls forward and has weakness in both arms, much worse than in the legs, with bladder dysfunction and variable sensory loss. W…
- Spine: Brown-Sequard syndrome · ApplicationAfter a stab wound to the thoracic spine, a patient has right leg weakness with loss of vibration and proprioception on the right, and loss of pain and temperature on t…
- Spine: anterior cord syndrome · Multi-stepA patient with a flexion injury and anterior spinal artery infarction has complete paralysis and loss of pain and temperature below the level, but preserved vibration a…
- Spine: modified Schober test · ApplicationIn the modified Schober test for ankylosing spondylitis, a reduced lumbar flexion is indicated by what finding?
- Spine: spondylolisthesis grading · ApplicationA 15-year-old gymnast has low back pain, and a lateral radiograph shows L5 displaced forward by 40 percent of the width of the S1 body. What is the Meyerding grade?
- Spine: spondylolysis · ApplicationA young fast bowler has chronic low back pain on extension. An oblique lumbar radiograph shows a collar on the Scotty dog. What does this mean?
- Spine: lumbar canal stenosis · ApplicationA 68-year-old man has leg pain and heaviness on walking, relieved by sitting or leaning forward, with normal pedal pulses. What is the likely diagnosis?
- Spine: cervical spondylotic myelopathy · ApplicationA 62-year-old has clumsy hands, difficulty with buttons, a broad-based gait and brisk reflexes with positive Hoffmann sign. What is the diagnosis?
- Spine: idiopathic scoliosis bracing · ApplicationA 12-year-old girl, Risser grade 1, has a Cobb angle of 30 degrees that has progressed from 22 degrees. What is the appropriate management?
- Spine: Risser sign · ApplicationThe Risser sign used in scoliosis assessment denotes what?
- Spine: epidural abscess · ApplicationAn intravenous drug user has back pain, fever, and new leg weakness. Which investigation is the best next step?
- Spine: metastatic cord compression · ApplicationA man with prostate cancer has back pain and bilateral leg weakness, and MRI shows epidural metastatic cord compression at T8. What is the immediate treatment?
- Spine: osteoporotic vertebral fracture · ApplicationAn elderly woman has persistent severe pain from an osteoporotic compression fracture despite 6 weeks of analgesia, and has no neurological deficit. Which procedure may…
- Spine: lumbar root signs · ApplicationA patient with sciatica has weakness of ankle plantar flexion, loss of sensation over the lateral foot and a diminished ankle jerk. Which root is involved?
- Spine: cervical disc prolapse · ApplicationA man has neck pain radiating to the middle finger with weakness of elbow extension and a diminished triceps reflex. Which disc level and root is most likely compressed?
- Spine: cervical spine clearance · ApplicationA conscious, alert patient involved in a road accident has no midline neck tenderness, no focal neurological deficit, no intoxication and no painful distracting injury.…
- Spine: Boston brace · Multi-stepA 12-year-old Risser 1 girl has a 30 degree adolescent idiopathic thoracolumbar curve with the apex at T10. Which brace is appropriate?
- Spine: Waddell signs · ApplicationA man with chronic low back pain has pain on light axial loading of the skull, pain with simulated rotation of the pelvis and shoulders, and widespread non-anatomical t…
- Spine: Mehta rib-vertebra angle difference · Multi-stepA 9-month-old infant has a left thoracic curve of 25 degrees. Which measurement helps predict whether this infantile idiopathic scoliosis will progress?
- Spine: congenital scoliosis · ApplicationA 4-year-old has a progressive curve of 40 degrees from a fully segmented hemivertebra. Which investigation should accompany the spinal work-up?
- Spine: diffuse idiopathic skeletal hyperostosis · ApplicationA 65-year-old obese diabetic man has a stiff thoracic spine. Radiographs show flowing ossification along the anterior right side of at least four contiguous vertebrae,…
- Spine: Modic changes · Multi-stepMRI of a patient with chronic low back pain shows low signal on T1 and high signal on T2 in the vertebral endplate and subchondral marrow adjacent to a degenerate disc.…
- Spine: Steel rule of thirds · Multi-stepOn an axial CT through C1, the Steel rule of thirds divides the space within the ring of the atlas. What are the three parts?
- Spine: conus medullaris versus cauda equina · Multi-stepA patient with a L1 burst fracture has early loss of bladder control, symmetrical saddle anaesthesia, mild bilateral leg weakness and little radicular pain. Which lesio…
- Spine: neuromuscular scoliosis · ApplicationA 12-year-old wheelchair-using child with spastic quadriplegia has a long C-shaped curve of 70 degrees with pelvic obliquity, and is losing sitting balance. What is the…
- Spine: os odontoideum · Multi-stepA young adult with minor trauma has radiographs showing a smooth, corticated ossicle separated from a short dens with a wide gap, and flexion-extension views show 8 mm…
- Spine: TLICS · Multi-stepIn the Thoracolumbar Injury Classification and Severity score (TLICS), which three elements are scored to guide operative or non-operative treatment?
- Spine: Kummell disease · Multi-stepA 75-year-old woman suffered a minor vertebral compression fracture. Three months later she has increasing back pain and kyphosis, and a radiograph shows a gas-filled c…
- Spine: crossed straight leg raising · ApplicationA man with sciatica has pain in his left leg when the examiner raises his right (asymptomatic) leg. What is the significance of this finding?
- Spine: angle range of straight leg raise · ApplicationA straight leg raise reproduces sciatic pain at 20 degrees in one patient and at 50 degrees in another. Which statement about interpreting the test is correct?
- Spine: Bragard sign · Multi-stepIn a patient with leg pain on straight leg raising, the examiner lowers the leg slightly until the pain subsides and then dorsiflexes the foot, which brings the pain ba…
- Spine: femoral stretch test · Multi-stepA prone patient with anterior thigh pain has the knee flexed and the hip extended by the examiner, which reproduces the pain. Which lesion does this test indicate?
- Spine: S1 radiculopathy motor testing · Multi-stepA 40-year-old with sciatica cannot walk on his toes, has an absent ankle jerk and numbness along the lateral border of the foot. Which nerve root is compressed?
- Spine: imaging when MRI is contraindicated · ApplicationA 70-year-old with an old non-MRI-compatible pacemaker has leg pain and suspected lumbar canal stenosis. Which imaging is an appropriate alternative to MRI?
- Spine: degenerative spondylolisthesis · ApplicationA 62-year-old woman has back pain and leg pain on walking relieved by sitting. A radiograph shows forward slip of L4 on L5 with an intact pars interarticularis. What is…
- Spine: inverted supinator sign · Multi-stepA patient has clumsy hands. When the examiner taps the brachioradialis tendon the fingers flex instead of the elbow flexing and the forearm supinating. What does this s…
- Spine: lumbar osteotomy for ankylosing kyphosis · Multi-stepA man with long-standing ankylosing spondylitis has a fixed flexion deformity of the spine and cannot look straight ahead. Which operation corrects the deformity?
- Spine: canal diameter in cervical myelopathy · ApplicationA lateral cervical radiograph shows an anteroposterior diameter of the cervical spinal canal of 11 mm. What is the significance?
- Spine: intramedullary versus extramedullary tumours · Multi-stepA man has a slowly progressive cord syndrome with loss of pain and temperature sensation in a cape-like distribution, preserved sensation in the sacral dermatomes and e…
- Spine: dystrophic scoliosis in neurofibromatosis · Multi-stepA 7-year-old with multiple cafe-au-lait spots has a short, sharply angulated thoracic curve with scalloped vertebral bodies and thin, pencil-like ribs. How is this curv…
- Spine: inflammatory spondyloarthropathy · ApplicationA 22-year-old man has morning back stiffness improving with exercise, and radiographs show bilateral sacroiliitis. Which is the first-line drug treatment?
- Spine: autonomic dysreflexia · Multi-stepA 28-year-old with a complete T4 spinal cord injury has a sudden pounding headache and flushing above the lesion. BP is 200/120 mmHg, pulse 48 per minute, and his urina…
- Spine: Lhermitte sign · ApplicationA 50-year-old has neck pain and an electric-shock sensation passing down the spine and into the limbs on flexing the neck, with brisk reflexes in both legs. The sign po…
- Spine: Gaenslen test · ApplicationA patient lies supine at the edge of the couch. One hip and knee are flexed to the chest while the examiner lets the other thigh hang over the edge and presses it downw…
- Spine: bilateral facet dislocation · Multi-stepA 30-year-old falls from a height and lands on his head with the neck forced forward. He has quadriparesis. A lateral cervical radiograph shows C5 displaced anteriorly…
- Spine: unilateral facet dislocation · Multi-stepAfter a rotational flexion injury in a road accident, a 28-year-old has neck pain, a fixed rotated head posture and radiating pain in one arm, with a normal cord examin…
- Spine: clay-shoveler fracture · ApplicationA labourer lifting a heavy load of wet earth feels a sudden sharp pain at the base of the neck, as if something snapped. There is no neurological deficit. A lateral rad…
- Spine: flexion teardrop fracture · Multi-stepA young man dives into a shallow pool and surfaces unable to move his limbs. He has quadriplegia with loss of pain and temperature sensation but preserved joint positio…
- Spine: neurological level in cervical injury · ApplicationAfter a cervical spine injury, a patient has normal power in the biceps, 4/5 power in the wrist extensors and 1/5 power in the triceps, with a matching sensory level. W…
- Spine: far lateral disc herniation · Multi-stepA 45-year-old has severe anterior thigh pain, quadriceps weakness and a diminished knee jerk. MRI shows a disc fragment lying within the neural foramen at L4-L5, with t…
- Spine: pyogenic spondylodiscitis organism · ApplicationA 62-year-old diabetic man has two weeks of severe back pain and fever. ESR is 95 mm in the first hour, and MRI shows endplate erosion and a T2 bright disc at L3-L4. Wh…
- Spine: ossification of the posterior longitudinal ligament · ApplicationA 58-year-old East Asian man has gradually progressive clumsiness of the hands and spastic gait. A CT of the cervical spine shows a continuous band of calcification lyi…
- Spine: surgery for adolescent idiopathic scoliosis · ApplicationA 13-year-old girl, Risser grade 2, has a right thoracic curve that has progressed to a Cobb angle of 55 degrees despite bracing. What is the most appropriate treatment?
- Spine: atypical scoliosis needing MRI · Multi-stepA 12-year-old boy has a left thoracic curve with a Cobb angle of 25 degrees, headache, and unequal abdominal reflexes on the two sides. Which investigation is the most…
- Spine: high-grade spondylolisthesis in an adolescent · Multi-stepA 13-year-old girl has low back pain, a waddling gait with tight hamstrings and a flat buttock contour. A lateral radiograph shows L5 slipped forward by 60 percent of t…
- Spine: pedicle sign in vertebral metastasis · ApplicationA 60-year-old smoker has persisting back pain. An anteroposterior radiograph of the lumbar spine shows loss of the outline of one pedicle, with the disc spaces preserve…
- Spine: spinal dysraphism with tethered cord · ApplicationA 6-year-old has a tuft of hair over the lumbar spine, a progressive cavovarus deformity of one foot and urinary urgency. What is the most likely diagnosis?
- Spine: scar versus recurrent disc on MRI · Multi-stepA man has recurrent sciatica 6 months after lumbar discectomy. A gadolinium MRI shows soft tissue around the nerve root. Which finding favours epidural scar rather than…
- Spine: biologic therapy in ankylosing spondylitis · ApplicationA 28-year-old man with axial ankylosing spondylitis still has high disease activity after taking two different NSAIDs at full dose for a total of four weeks. Which trea…
- Spine: fracture in ankylosing spondylitis · Multi-stepA 55-year-old man with long-standing ankylosing spondylitis and a fixed kyphosis falls from standing height and has severe neck pain. Plain radiographs look unremarkabl…
- Spine: psoriatic spondylitis · Multi-stepA 45-year-old with scaly plaques and nail pitting has back pain. Radiographs show asymmetric sacroiliitis and bulky, comma-shaped, non-marginal ossification bridging th…
- Spine: SCIWORA · ApplicationA 5-year-old falls from a swing and has transient numbness of both arms, followed by weakness. Plain films and CT show no fracture or malalignment, and MRI shows cord o…
- Spine: pseudosubluxation of C2 · ApplicationA 6-year-old who fell from a bed has no neck tenderness. A lateral cervical radiograph shows 3 mm anterior displacement of C2 on C3, which is thought to be physiologica…
- Spine: pathological fracture and myeloma screen · Multi-stepA 68-year-old develops sudden back pain after a minor strain. A radiograph shows a compression fracture of L2 with generalised osteopenia. Haemoglobin is 8.5 g/dL, ESR…
- Spine: surgery for cervical radiculopathy · ApplicationA 45-year-old has persistent C6 radiculopathy after 12 weeks of conservative treatment. MRI shows a single-level soft disc herniation at C5-C6 with a normal cord and no…
- Spine: spondylolisthesis · ApplicationAnterior displacement of one vertebral body on another is called what?
- Spine: disc prolapse · ApplicationA posterolateral lumbar disc prolapse most commonly compresses what?
- Spine · ApplicationBladder dysfunction and saddle numbness suggest what?
- Spine · ApplicationNight pain with systemic symptoms raises concern for what?
- Spine · ApplicationWhat is a red flag for cauda equina?
- Spine · ApplicationWhat is typical of cervical myelopathy?
- Spine · ApplicationWhat is a red-flag symptom in suspected cauda equina syndrome?
- Spine · ApplicationWhat is a common cause of sciatica?
- Spine · ApplicationWhat symptom is typical of lumbar spinal stenosis?
- Spine · ApplicationWhat is an urgent red flag in back pain assessment?
- Spine · ApplicationWhat symptom combination suggests cauda equina syndrome?
- Spine · ApplicationWhat is a typical feature of lumbar radiculopathy?
- Spine · ApplicationWhat red flag in back pain suggests cauda equina compression?
- Spine · ApplicationWhat condition commonly causes sciatica?
- Spine · ApplicationWhich neurological sign indicates cauda equina syndrome in low-back pain?
- Spine · ApplicationWhat is the usual first-line management of uncomplicated acute mechanical low-back pain?
- Spine: cauda equina syndrome · Multi-stepA patient with low back pain develops bilateral sciatica, saddle anesthesia, and urinary retention. What is the appropriate next investigation?
- Spine: ankylosing spondylitis · ApplicationA young adult has inflammatory back pain that improves with exercise, morning stiffness, and alternating buttock pain. Which diagnosis is most likely?
Bone tumours68
- Bone tumours · ApplicationA teenager has knee pain and a radiograph around the distal femur showing a sunburst periosteal reaction and Codman's triangle. What is the likely diagnosis?
- Bone tumours · ApplicationA sunburst periosteal reaction with Codman's triangle in the metaphysis of a teenager's distal femur suggests:
- Bone tumours · ApplicationA 15-year-old boy has leg pain that is worse at night and relieved promptly by aspirin. A radiograph shows a small lucent nidus in the femoral cortex surrounded by dens…
- Bone tumours · ApplicationA 28-year-old woman has knee pain and swelling. A radiograph shows an eccentric lytic lesion in the epiphysis of the distal femur reaching the subchondral bone, with cl…
- Bone tumours: benign · ApplicationA 15-year-old boy has a hard, painless bony swelling near the knee that grows with him. X-ray shows a pedunculated bony outgrowth from the metaphysis directed away from…
- Bone tumours: genetics of osteosarcoma · Multi-stepWhich genetic abnormality predisposes to osteosarcoma?
- Bone tumours: Ewing sarcoma · ApplicationA 12-year-old has fever, pain and swelling of the femoral diaphysis with onion-peel periosteal reaction. Biopsy shows small round blue cells. Which translocation is cha…
- Bone tumours: chondrosarcoma · ApplicationA 55-year-old man has a slowly enlarging pelvic mass, and radiographs show a lobulated lesion with ring and arc calcifications. Which statement about this tumour is cor…
- Bone tumours: giant cell tumour biology · Multi-stepWhich drug targets the RANKL pathway driving osteoclast-like giant cells in unresectable giant cell tumour of bone?
- Bone tumours: osteoblastoma · Multi-stepA 17-year-old has back pain and scoliosis, and CT shows an expansile lesion with a nidus larger than 2 cm in the posterior elements of a vertebra. The pain is poorly re…
- Bone tumours: osteochondroma · ApplicationWhich feature of an osteochondroma suggests malignant transformation to chondrosarcoma?
- Bone tumours: Ollier and Maffucci disease · ApplicationMultiple enchondromas with soft tissue haemangiomas define which syndrome?
- Bone tumours: chondroblastoma · Multi-stepA 15-year-old has knee pain and a well-defined lytic epiphyseal lesion with chicken-wire calcification on histology. What is the tumour?
- Bone tumours: fibrous dysplasia · ApplicationA girl has café-au-lait spots, precocious puberty and polyostotic bone lesions with a ground-glass appearance and shepherd's crook deformity of the femur. Which syndrom…
- Bone tumours: unicameral bone cyst · ApplicationA child has a pathological fracture through a central lucent lesion of the proximal humerus. A small bone fragment is seen lying in the dependent part of the cyst. What…
- Bone tumours: aneurysmal bone cyst · Multi-stepMRI of a vertebral lesion shows multiple cystic spaces with fluid-fluid levels in a 12-year-old. Which gene rearrangement is commonly present in primary lesions of this…
- Bone tumours: multiple myeloma · ApplicationA 60-year-old has back pain, anaemia and multiple punched-out lytic lesions of the skull. Why is a technetium bone scan often normal in this disease?
- Bone tumours: adamantinoma · Multi-stepA young adult has a slowly growing, multilocular lytic lesion in the anterior cortex of the mid-tibial diaphysis. What is the most likely diagnosis?
- Bone tumours: Mirels score · Multi-stepA Mirels score is used to estimate what in a patient with a metastatic lesion of a long bone?
- Bone tumours: parosteal osteosarcoma · Multi-stepA young woman has a slowly growing hard mass behind the distal femur, and radiographs show a lobulated densely ossified mass attached to the cortex with a thin radioluc…
- Bone tumours: Langerhans cell histiocytosis · ApplicationA 6-year-old has a lytic skull lesion and a single flattened vertebral body (vertebra plana). Biopsy shows cells with Birbeck granules. What is the diagnosis?
- Bone tumours: chordoma · Multi-stepA 60-year-old man has a slowly growing destructive sacral mass with bowel and bladder dysfunction. Biopsy shows physaliferous cells. What is the diagnosis?
- Bone tumours: biopsy principles · ApplicationWhich principle applies when planning a biopsy of a suspected primary bone sarcoma?
- Bone tumours: Enneking staging · Multi-stepIn the Enneking staging of musculoskeletal tumours, which description corresponds to stage IIB?
- Bone tumours: synovial sarcoma · Multi-stepA 25-year-old has a slow-growing soft tissue mass near the knee, with stippled calcification on radiograph. Histology shows a biphasic pattern. Which translocation is t…
- Bone tumours: bone scan in osteoid osteoma · Multi-stepA technetium bone scan of a patient with night pain and a small radiolucent nidus shows intense central uptake surrounded by less intense uptake. What is this sign call…
- Bone tumours: chondromyxoid fibroma · Multi-stepA 20-year-old has a mild ache in the knee. Radiographs show an eccentric, lobulated lytic lesion with a scalloped sclerotic margin in the metaphysis of the proximal tib…
- Bone tumours: hereditary multiple exostoses · ApplicationA boy has multiple bony lumps near the knees and wrists, shortening of the forearm and a father with the same findings. Biopsy of one lump shows a cartilage cap. Which…
- Bone tumours: telangiectatic osteosarcoma · Multi-stepA 15-year-old has a purely lytic, expansile lesion of the distal femur. MRI shows multiple cystic spaces with fluid-fluid levels, and biopsy of the thick septa shows ma…
- Bone tumours: vertebral haemangioma · ApplicationAn incidental MRI of the lumbar spine in a 45-year-old woman shows a vertebral body with vertical, coarse trabeculae resembling corduroy on a lateral radiograph and pol…
- Bone tumours: soft tissue sarcoma · ApplicationA 50-year-old has a deep, painless, enlarging 9 cm mass in the thigh. Biopsy shows a high-grade undifferentiated pleomorphic sarcoma. Which statement about its behaviou…
- Bone tumours: rotationplasty · Multi-stepA 6-year-old girl has an osteosarcoma of the distal femur. The surgeon resects the knee with the tumour and reattaches the tibia to the femur with the foot rotated by 1…
- Bone tumours: response to chemotherapy · Multi-stepAfter neoadjuvant chemotherapy for osteosarcoma, histology of the resected specimen shows more than 90 percent tumour necrosis. What does this signify?
- Bone tumours: hypertrophic osteoarthropathy · ApplicationA 62-year-old smoker has digital clubbing, painful swollen wrists and ankles, and periosteal new bone along the distal tibia and radius on radiographs. Which condition…
- Bone tumours: solitary plasmacytoma · Multi-stepA 58-year-old man has a single lytic lesion in a vertebral body, with plasma cell infiltration on biopsy, a normal bone marrow and a normal skeletal survey elsewhere. W…
- Bone tumours: pathological fracture in enchondroma · Multi-stepA 35-year-old has a painful swollen finger after a minor knock. The radiograph shows a well-defined lytic lesion with stippled calcification in the proximal phalanx and…
- Bone tumours: Campanacci grade of giant cell tumour · ApplicationA giant cell tumour of the distal radius shows cortical thinning and expansion with a breach of the cortex and extension into soft tissue. Which Campanacci grade is this?
- Bone tumours: pulmonary metastases of giant cell tumour · Multi-stepA man treated for a giant cell tumour of the distal radius develops small lung nodules. Biopsy shows histologically benign giant cell tumour tissue. Which statement is…
- Bone tumours: enchondroma versus chondrosarcoma · Multi-stepA 48-year-old with a known enchondroma of the femur develops new persistent pain without any fracture. Imaging shows endosteal scalloping of more than two thirds of the…
- Bone tumours: primary lymphoma of bone · Multi-stepA 55-year-old man has a month of thigh pain. Radiographs show a permeative, moth-eaten lesion of the femoral diaphysis with a soft tissue mass. He looks well. Biopsy sh…
- Bone tumours: osteoid osteoma of the spine · Multi-stepA 14-year-old has a painful scoliosis with pain that is worse at night and relieved by ibuprofen. CT shows a small lucent nidus in the posterior elements at the concavi…
- Bone tumours: malignant · Multi-stepA teenager has a sunburst pattern with a Codman triangle at the distal femoral metaphysis, and biopsy confirms osteosarcoma with no metastases on CT chest. What is the…
- Bone tumours: benign · Multi-stepA 25-year-old woman has knee pain and an eccentric lytic lesion in the distal femoral epiphysis reaching the subchondral bone, with a soap-bubble look and a pathologica…
- Bone tumours: malignant · Multi-stepA 55-year-old has a pelvic lytic lesion with ring-and-arc calcification, and biopsy shows atypical cartilage cells. What is the treatment?
- Bone tumours: malignant · ApplicationA 60-year-old has back pain, anaemia and a high ESR, and radiographs show punched-out skull lesions. A bone scan is cold. Which test is the most useful next?
- Bone tumours: benign · ApplicationA radiograph of the proximal phalanx of a 30-year-old shows a lytic lesion with stippled, popcorn-like calcification, found after a minor fracture. What is the likely t…
- Bone tumours: metastases · Multi-stepA 62-year-old man has a lytic lesion in the femur on a radiograph and no known cancer. Which group of primary sites most commonly gives skeletal metastases?
- Bone tumours: periosteal osteosarcoma · Multi-stepA 17-year-old has a painful swelling over the tibial diaphysis. Radiographs show a sunburst reaction arising from the cortical surface, with a cartilaginous matrix on b…
- Bone tumours: desmoid tumour · ApplicationA 28-year-old with familial adenomatous polyposis develops a firm, infiltrating mass in the abdominal wall after a laparotomy. Biopsy shows bland spindle cells with nuc…
- Bone tumours: Gorham-Stout disease · Multi-stepA 20-year-old has progressive painless disappearance of the humerus and scapula over two years. Radiographs show tapering of bone with no new bone formation and no soft…
- Bone tumours: methotrexate rescue in osteosarcoma · ApplicationAn osteosarcoma regimen includes high-dose methotrexate. Which agent is given afterwards to rescue normal cells from life-threatening toxicity?
- Bone tumours: anthracycline cardiotoxicity · ApplicationA 15-year-old receiving methotrexate, doxorubicin and cisplatin for osteosarcoma develops a fall in ejection fraction on echocardiography. Which drug is responsible?
- Bone tumours: CD99 in small round cell tumours · Multi-stepA 13-year-old has a painful diaphyseal femoral lesion. Biopsy shows sheets of uniform small round blue cells with PAS-positive, diastase-sensitive cytoplasm. Which immu…
- Bone tumours: physaliphorous cells in chordoma · ApplicationA 62-year-old man has a lobulated, destructive midline sacral mass that is bright on T2 weighted MRI. Biopsy shows cords of large cells with abundant vacuolated, bubbly…
- Bone tumours: Bence Jones protein in myeloma · Multi-stepA 62-year-old has back pain, anaemia, renal impairment and punched-out skull lesions. A urine dipstick is negative for protein, but the sulfosalicylic acid test is stro…
- Bone tumours: bone island · ApplicationAn incidental 7 mm round, dense, homogeneous sclerotic focus is seen in the femoral neck of a pain-free 40-year-old. Its margins radiate like thorns into the surroundin…
- Bone tumours: dedifferentiated chondrosarcoma · Multi-stepA 66-year-old man has a long-standing painless pelvic cartilage lesion that suddenly enlarges and becomes painful. Histology shows a low-grade cartilage tumour abruptly…
- Bone tumours: osteofibrous dysplasia · Multi-stepA 4-year-old has painless anterior bowing of the tibia without a fracture. Radiographs show a well-defined, multiloculated lucent lesion within the anterior cortex of t…
- Bone tumours: cement after curettage of giant cell tumour · Multi-stepAfter extended curettage of a giant cell tumour of the distal femur, the surgeon fills the cavity with polymethylmethacrylate rather than bone graft. What is the main a…
- Bone tumours: Mazabraud syndrome · ApplicationA 45-year-old with polyostotic fibrous dysplasia develops painless, slowly growing intramuscular masses in the thigh, which on biopsy are myxomas. What is this associat…
- Bone tumours: skip metastases in osteosarcoma · ApplicationWhen osteosarcoma of the distal femur is staged, MRI is performed along the entire length of the affected bone. What is this mainly done to look for?
- Bone tumours: surgical margins · ApplicationIn musculoskeletal oncology, what does a wide excision margin mean?
- Bone tumours: unplanned excision of a sarcoma · Multi-stepA 55-year-old had excision of a presumed lipoma of the thigh at a district hospital. Histology reports a high-grade sarcoma with positive margins. What is the next step?
- Bone tumours: MDM2 in well-differentiated liposarcoma · Multi-stepA 60-year-old has a large, deep, painless thigh mass that is mostly mature fat with thick septa and nodular non-fatty areas on MRI. To distinguish a well-differentiated…
- Bone tumours: complication of osteochondroma · ApplicationA 14-year-old with a hard, painless lump near the fibular neck develops foot drop and loss of sensation over the dorsum of the foot. What is the most likely mechanism?
- Bone tumours: radiotherapy in Ewing sarcoma · Multi-stepA 14-year-old with Ewing sarcoma of the iliac bone has completed neoadjuvant chemotherapy, and wide resection would leave a major deficit. Which local treatment is an a…
- Bone tumours: Hand-Schuller-Christian disease · ApplicationA 3-year-old has multiple lytic skull lesions, passes large volumes of dilute urine and has bulging eyes. Biopsy of a skull lesion shows Langerhans cells. What is the c…
- Bone tumours: why aspirin relieves osteoid osteoma · ApplicationA teenager with an osteoid osteoma has night pain that is relieved dramatically by aspirin. What explains this response?
Fractures65
- Fractures: Barton fracture · ApplicationA young adult falls on the wrist and radiographs show an oblique intra-articular fracture of the volar rim of the distal radius with the carpus displaced along with the…
- Fractures: scaphoid blood supply · ApplicationAvascular necrosis is most likely after a fracture through which part of the scaphoid, and why?
- Fractures: suspected scaphoid fracture · ApplicationA young man has snuffbox tenderness after a fall on the outstretched hand, but initial wrist radiographs including scaphoid views are normal. What is the most appropria…
- Fractures: Bado classification of Monteggia · Multi-stepIn the Bado classification of Monteggia fracture-dislocations, which type is the most common?
- Fractures: Essex-Lopresti injury · Multi-stepAfter a fall from a height onto the hand, a patient has a comminuted radial head fracture with wrist pain and proximal migration of the radius. Which injury is suspected?
- Fractures: Neer classification · Multi-stepIn the Neer classification of proximal humerus fractures, a segment is considered displaced when it is displaced by more than which of the following?
- Fractures: Holstein-Lewis fracture · Multi-stepA spiral fracture at the junction of the middle and distal thirds of the humeral shaft is associated with which complication?
- Fractures: olecranon fracture · ApplicationA displaced transverse olecranon fracture is best treated by which method?
- Fractures: tardy ulnar nerve palsy · ApplicationA man develops numbness of the ring and little fingers with weak grip 20 years after a childhood elbow fracture with an increased carrying angle. What was the likely or…
- Fractures: Mason classification · Multi-stepWhich radial head fracture is Mason type II?
- Fractures: Bennett fracture · ApplicationWhich muscle pulls the shaft of the first metacarpal proximally and displaces the fragments in a Bennett fracture?
- Fractures: hook of hamate · Multi-stepA golfer has ulnar-sided wrist pain after swinging, with tenderness over the hypothenar eminence and difficulty gripping. Which fracture should be suspected, and which…
- Fractures: pelvic fracture resuscitation · ApplicationA road traffic accident victim with a suspected unstable pelvic ring injury is hypotensive. Which immediate measure best reduces pelvic bleeding?
- Fractures: urethral injury in pelvic fracture · ApplicationA man with a pelvic fracture has blood at the external urethral meatus and a high-riding prostate. What is the next step?
- Fractures: capitellum fracture · Multi-stepA fracture of the capitellum in which a large osseous fragment containing subchondral bone is displaced is named after which pair?
- Fractures: scapular fracture · ApplicationA scapular body fracture after a motor accident should prompt a search for which associated problem?
- Fractures: humeral shaft management · ApplicationA 35-year-old man has a closed, transverse, mid-shaft humerus fracture with minimal displacement and intact nerves. What is the preferred initial treatment?
- Fractures: Pauwels classification · Multi-stepIn the Pauwels classification of femoral neck fractures, which type is the most unstable and carries the highest risk of nonunion?
- Fractures: blood supply of the femoral head · ApplicationA displaced intracapsular femoral neck fracture in a young adult threatens the femoral head mainly by damaging which vessels?
- Fractures: intertrochanteric fracture fixation · ApplicationAn elderly woman has a stable two-part intertrochanteric fracture. Which implant is the standard fixation?
- Fractures: supracondylar femur fracture · Multi-stepIn a displaced supracondylar fracture of the femur, which structure is at risk because of the pull of gastrocnemius on the distal fragment?
- Fractures: Hoffa fracture · Multi-stepA coronal-plane fracture of a femoral condyle, most often the lateral, is known by which eponym?
- Fractures: Schatzker classification · Multi-stepIn the Schatzker classification of tibial plateau fractures, a lateral plateau split with depression of the articular surface is which type?
- Fractures: bumper fracture · ApplicationA pedestrian struck by a car bumper sustains a lateral tibial plateau fracture. Which ligament injury is commonly associated?
- Fractures: Lauge-Hansen classification · Multi-stepIn the Lauge-Hansen classification of ankle fractures, which injury pattern is the most common?
- Fractures: Maisonneuve fracture · Multi-stepA patient with a twisting injury has tenderness at the medial ankle and a proximal fibular fracture on knee films. Which injury should be suspected?
- Fractures: calcaneal fracture · ApplicationA man falls from a ladder and lands on his heels. He has heel pain and swelling, and the Bohler angle on a lateral radiograph is reduced. Which associated injury must b…
- Fractures: Lisfranc injury · Multi-stepA footballer has midfoot pain and swelling after a twisting injury, and radiographs show a small avulsion between the base of the second metatarsal and the medial cunei…
- Fractures: Jones fracture · ApplicationWhich statement best describes a Jones fracture?
- Fractures: talar neck fracture · Multi-stepA talar neck fracture is followed by avascular necrosis of the body. Which radiographic sign at 6 to 8 weeks suggests the talus remains vascularised?
- Fractures: bone grafting · ApplicationWhich property of cancellous autograft makes it the gold standard for bone grafting?
- Fractures: Pipkin classification · Multi-stepWhich injury is classified by the Pipkin system?
- Fractures: Segond fracture · Multi-stepA small elliptical avulsion fracture from the lateral tibial plateau on an AP knee radiograph is strongly associated with which injury?
- Fractures: Delbet classification · Multi-stepWhich Delbet type of paediatric femoral neck fracture is the commonest?
- Fractures: subtrochanteric femur · Multi-stepIn a displaced subtrochanteric fracture, the proximal fragment lies flexed, abducted and externally rotated. Which muscle forces explain this deformity?
- Fractures: ischial apophyseal avulsion · ApplicationA 15-year-old sprinter feels a sudden pop and severe pain in the buttock while starting a race. Radiographs show a fragment pulled off the ischial tuberosity. Which mus…
- Fractures: floating knee · Multi-stepA motorcyclist has an ipsilateral femoral shaft fracture and tibial shaft fracture after a high-speed collision. Which term describes this injury and what is a key conc…
- Fractures: scaphoid proximal pole sclerosis · ApplicationA 24-year-old had an untreated scaphoid waist fracture. Eight months later radiographs show nonunion with the proximal fragment denser than the surrounding carpal bones…
- Fractures: Galeazzi fracture management in adults · Multi-stepA 30-year-old falls on an outstretched hand. Radiographs show a displaced fracture of the distal third of the radius with a prominent ulnar head and a widened distal ra…
- Fractures: Galeazzi radiographic clues · ApplicationIn a radial shaft fracture, which radiographic finding most strongly suggests an accompanying distal radioulnar joint injury?
- Fractures: mechanism of central fracture dislocation · ApplicationA man falls from a height and lands on the side of his hip. Radiographs show a fracture of the medial wall of the acetabulum with the femoral head pushed into the pelvi…
- Fractures: displaced neck of femur in a young adult · Multi-stepA 28-year-old is brought after a road accident with a displaced subcapital fracture of the femoral neck. What is the most appropriate treatment?
- Fractures: limb posture in extracapsular hip fracture · ApplicationAn elderly woman falls and the leg lies in marked external rotation with the lateral border of the foot resting on the bed. There is bruising over the trochanteric regi…
- Fractures: imaging after a calcaneal fracture on plain films · ApplicationAfter a fall from a height, plain films of the heel show a fracture with a reduced Bohler angle that is suspected to be intra-articular. Which investigation best define…
- Fractures: Rolando versus Bennett · ApplicationA boxer has a painful swollen thumb base. The radiograph shows a comminuted Y-shaped intra-articular fracture of the first metacarpal base. How does this differ from a…
- Fractures: medial epicondylitis test · ApplicationA golfer has pain over the medial epicondyle. Which examination finding supports the diagnosis of golfer's elbow?
- Fractures: Charnley three-point moulding · ApplicationWhich condition is necessary for Charnley three-point moulding to keep a reduced fracture stable in a cast?
- Fractures: femoral neck stress fracture · Multi-stepA 22-year-old marathon runner has groin pain on running, and an MRI shows a stress fracture on the superolateral (tension) side of the femoral neck. What is the best ma…
- Fractures: floating shoulder · Multi-stepA motorcyclist has a displaced midshaft clavicle fracture and an ipsilateral fracture of the glenoid neck. Which term describes this injury and why does it matter?
- Fractures: induced membrane technique · Multi-stepA patient has a 6 cm segmental tibial defect after debridement of an infected open fracture. In the Masquelet technique, what is the role of the cement spacer placed in…
- Fractures: lipohaemarthrosis · Multi-stepAfter a fall, a patient has a swollen knee. A cross-table lateral radiograph shows a horizontal fat-fluid level in the suprapatellar pouch. What does this indicate?
- Fractures: snowboarder's fracture · Multi-stepA snowboarder lands from a jump with persistent lateral ankle pain, and the ankle is diagnosed as a sprain. Radiographs are normal and pain persists for weeks. Which fr…
- Fractures: Colles · ApplicationA distal radius fracture has dorsal displacement after a fall on an outstretched hand. What is it called?
- Fractures: Smith · ApplicationA distal radius fracture has volar displacement after a fall on a flexed wrist. What is it called?
- Fractures: Galeazzi · ApplicationA distal radial fracture with distal radioulnar-joint disruption is what injury?
- Fractures: neck of femur · ApplicationAn elderly patient has shortened externally rotated leg after fall. What fracture is likely?
- Fractures · ApplicationPainful deformity after clavicle trauma most often involves what bone?
- Fractures · ApplicationSnuffbox tenderness after fall suggests what fracture?
- Fractures · ApplicationPosterior elbow dislocation commonly follows what mechanism?
- Fractures · ApplicationWhat is the initial priority in an open fracture?
- Fractures · ApplicationWhat imaging study is usually first for suspected limb fracture?
- Fractures · ApplicationWhat should be assessed distal to a fractured limb?
- Fractures · ApplicationWhich finding makes an open fracture an urgent surgical problem?
- Fractures · ApplicationWhich nerve is commonly injured in a mid-shaft humeral fracture?
- Fractures · ApplicationWhat is the preferred initial imaging for suspected scaphoid fracture with snuffbox tenderness?
Fractures and dislocations56
- Fractures and dislocations: upper limb · Multi-stepA child in a cast for a supracondylar fracture develops severe forearm pain, swollen tense fingers and pain on passive finger extension within hours, with a palpable ra…
- Fractures and dislocations: complications · Multi-stepTwo days after a closed femoral shaft fracture, a young man becomes confused and breathless with SpO2 of 88%. There are petechiae over the axillae and conjunctivae, and…
- Fractures and dislocations: complications · Multi-stepA man develops a tense, swollen calf after tibial nailing. He has severe pain on passive toe extension, but distal pulses and capillary refill are normal. What should b…
- Fractures and dislocations: complications · ApplicationA 35-year-old farmer has an open fracture of the tibia with a 10 cm wound, extensive soft tissue loss and exposed bone needing a muscle flap for cover. What is the Gust…
- Fractures and dislocations: pelvis and hip · Multi-stepAfter a dashboard injury, a man's leg is flexed, adducted and internally rotated, with foot drop and numbness over the sole and dorsum. What is the next step?
- Fractures and dislocations: complications · Multi-stepFive weeks after a wrist fracture, a woman has burning pain out of proportion, a shiny swollen hand, pain on light touch and patchy osteopenia on films. What is the bes…
- Fractures and dislocations: upper limb · ApplicationA man falls on his outstretched hand. Radiographs show a fracture of the junction of the middle and distal thirds of the radial shaft with prominence of the ulnar head…
- Fractures and dislocations: pelvis and hip · ApplicationAfter a road accident, a patient has pain over the hip and the radiograph shows a fracture through the floor of the acetabulum with the femoral head protruding into the…
- Fractures and dislocations: Gartland type II supracondylar fracture · ApplicationA 5-year-old falls on an outstretched hand. The lateral elbow radiograph shows an extension-type supracondylar fracture of the humerus with the distal fragment angulate…
- Fractures and dislocations: Vancouver B2 periprosthetic fracture · Multi-stepA 74-year-old woman falls 8 years after a cemented total hip replacement and fractures the femur at the level of the stem. Radiographs show the stem has subsided and is…
- Fractures and dislocations: Seymour fracture of the distal phalanx · Multi-stepA 9-year-old traps a finger in a door. The fingertip is held flexed with the nail plate lying on top of the nail fold, and the radiograph shows a fracture through the p…
- Fractures and dislocations: tip-apex distance after a sliding hip screw · Multi-stepA surgeon fixes an unstable intertrochanteric fracture with a sliding hip screw. Intra-operative films show the lag screw tip lying 35 mm from the apex of the femoral h…
- Fractures and dislocations: cast syndrome · ApplicationA 16-year-old girl is placed in a body cast after scoliosis correction. On the third day she has repeated bilious vomiting and epigastric fullness that gets worse after…
- Fractures and dislocations: ulnar impaction syndrome · Multi-stepA 40-year-old carpenter has ulnar-sided wrist pain that worsens with gripping and forearm rotation. A pronated grip radiograph shows the ulna 3 mm longer than the radiu…
- Fractures and dislocations: Morel-Lavallee lesion · ApplicationAfter a pedestrian is run over by a car wheel, a large fluctuant swelling develops over the greater trochanter. The overlying skin is numb and hypermobile, and aspirati…
- Fractures and dislocations: lag screw technique · ApplicationA surgeon fixes an oblique fracture of the lateral malleolus with an interfragmentary lag screw. What is essential for the screw to compress the fracture?
- Fractures and dislocations: locking plate principle · ApplicationAn osteoporotic 70-year-old has a comminuted distal femur fracture fixed with a locking plate. What is the key advantage of locking screws in such bone?
- Fractures and dislocations: demineralised bone matrix · ApplicationA surgeon packs a bone defect with demineralised bone matrix. Which property does this graft material provide?
- Fractures and dislocations: titanium implants · ApplicationCompared with 316L stainless steel, which property makes titanium alloy attractive for orthopaedic implants?
- Fractures and dislocations: stress shielding · ApplicationYears after insertion of a stiff cementless femoral stem, radiographs show resorption of the proximal medial femur with thickening of the cortex around the distal stem.…
- Fractures and dislocations: ceramic bearing · ApplicationWhich problem is characteristic of a ceramic-on-ceramic hip bearing rather than a metal-on-metal bearing?
- Fractures and dislocations: cross-linked polyethylene · ApplicationHighly cross-linked ultra-high molecular weight polyethylene is used in hip liners. How does cross-linking change its behaviour?
- Fractures and dislocations: total hip replacement dislocation · ApplicationA patient with a total hip replacement done by the posterior approach stands from a low chair, feels a pop and now has a shortened leg held flexed, adducted and interna…
- Fractures and dislocations: skeletal traction pin insertion · ApplicationA Steinmann pin is inserted through the proximal tibia for skeletal traction. In which direction and for what reason is it passed?
- Fractures and dislocations: transport of an amputated part · ApplicationA worker's finger is amputated by a machine. How should the part be transported to the replantation centre?
- Fractures and dislocations: Bunnell test for intrinsic tightness · Multi-stepIn a patient with rheumatoid arthritis, passive flexion of the proximal interphalangeal joint of a finger is limited when the MCP joint is held in extension, but the PI…
- Fractures and dislocations: early mobilisation after flexor tendon repair · ApplicationAfter a flexor tendon repair in the hand, why do surgeons favour early protected mobilisation rather than complete immobilisation?
- Fractures and dislocations: Elson test for central slip injury · Multi-stepAfter a blow to the dorsum of a flexed middle finger, the PIP joint is swollen and tender dorsally. With the PIP joint flexed to 90 degrees over a table edge, the patie…
- Fractures and dislocations: Watson scaphoid shift test · Multi-stepThe examiner presses a thumb on the palmar tubercle of the scaphoid while moving the patient's wrist from ulnar to radial deviation. A painful dorsal clunk is produced.…
- Fractures and dislocations: haemochromatosis arthropathy · ApplicationA 52-year-old man with bronzed skin, diabetes and hepatomegaly has pain and stiffness in his hands. Radiographs show hook-like osteophytes and cystic change. Which join…
- Fractures and dislocations: lift-off test · ApplicationA patient with an injured shoulder holds the back of the hand against the lumbar spine with the arm internally rotated but cannot lift the hand away from the back. Whic…
- Fractures and dislocations: Hornblower sign · ApplicationWith the arm abducted to 90 degrees and the elbow flexed, a patient with a massive posterosuperior rotator cuff tear cannot hold external rotation and the hand falls to…
- Fractures and dislocations: Ely test · ApplicationA patient lies prone and the examiner passively flexes the knee. The hip on that side lifts off the couch into flexion. Which tight structure does this test reveal?
- Fractures and dislocations: anterior inferior iliac spine avulsion · ApplicationA 15-year-old sprinter feels a pop in the groin at the start of a sprint. The pelvis radiograph shows an avulsed fragment from the anterior inferior iliac spine. Which…
- Fractures and dislocations: dial test for posterolateral corner injury · Multi-stepA patient with a knee injury is examined prone. External rotation of the tibia is more than 10 degrees greater than on the other side at 30 degrees of knee flexion, but…
- Fractures and dislocations: os trigonum syndrome · ApplicationA ballet dancer has deep pain at the back of the ankle when she goes fully on point. A lateral radiograph shows a small accessory ossicle behind the talus. What is the…
- Fractures and dislocations: Baxter nerve entrapment · Multi-stepA runner has chronic medial heel pain that has not improved with treatment for plantar fasciitis. Tenderness is maximal at the medial heel and there is wasting of abduc…
- Fractures and dislocations: pilon fracture staging · Multi-stepA man falls from a ladder and lands on his heels. The ankle is grossly swollen with blisters, and CT shows a comminuted fracture of the distal tibial articular surface.…
- Fractures and dislocations: elbow fat pad sign · ApplicationA 5-year-old falls on an outstretched hand and has a swollen, tender elbow. The lateral radiograph shows no visible fracture line, but there is an elevated anterior fat…
- Fractures and dislocations: Baumann angle · ApplicationAfter closed reduction of a displaced supracondylar fracture in a child, the surgeon measures the angle between the long axis of the humerus and a line along the capite…
- Fractures and dislocations: physeal bar · Multi-stepA boy had a displaced fracture through the epiphysis, physis and metaphysis of the distal femur into the knee joint. Two years later he has a progressive varus angulati…
- Fractures and dislocations: femoral shaft nailing · ApplicationA 30-year-old man has a closed, displaced, transverse fracture of the mid-shaft of the femur after a motorcycle crash. Which is the standard definitive fixation?
- Fractures and dislocations: thromboprophylaxis after hip fracture · ApplicationAn 80-year-old woman is admitted with a displaced neck of femur fracture and will have surgery the next day. Which measure is recommended to reduce the risk of venous t…
- Fractures and dislocations: femoral fracture in a non-walking infant · Multi-stepA 7-month-old infant who cannot yet crawl is brought with a swollen, painful thigh. Radiographs show a spiral fracture of the femoral shaft. The parents say he rolled o…
- Fractures and dislocations: isolated lesser trochanter fracture in an adult · Multi-stepA 68-year-old man with prostate cancer has thigh pain after a minor stumble. Radiographs show an isolated avulsion of the lesser trochanter. What should be suspected?
- Fractures and dislocations: distal tibial fracture union · ApplicationA tibial shaft fracture in the distal third often heals more slowly than one in the proximal third. Which feature of the anatomy mainly explains this?
- Fractures and dislocations: bladder injury in pelvic fracture · Multi-stepA man with a pelvic ring fracture has gross haematuria and suprapubic pain. There is no blood at the meatus, and the prostate is normally placed. A urinary catheter dra…
- Fractures and dislocations: rotator cuff tear with shoulder dislocation · Multi-stepA 62-year-old woman has a first anterior dislocation of the shoulder, reduced in the emergency department. Three weeks later she still cannot lift the arm and has a dro…
- Fractures and dislocations: CT after hip dislocation reduction · ApplicationA young man's posterior hip dislocation is reduced under sedation. The post-reduction radiograph looks concentric. What is the next step?
- Fractures and dislocations: simple elbow dislocation rehabilitation · ApplicationA 25-year-old has a simple posterior elbow dislocation without fracture. The joint is reduced and stable through the range of movement. Which approach reduces long-term…
- Fractures and dislocations: indication to fix a midshaft clavicle fracture · ApplicationMost midshaft clavicle fractures are treated in a sling. Which finding is an indication for urgent surgery?
- Fractures and dislocations: proximal humerus fracture treatment · ApplicationA 75-year-old woman falls and has a minimally displaced fracture of the proximal humerus with a single part involved. What is the usual treatment?
- Fractures and dislocations: window in a plaster cast · ApplicationTwo days after a below-knee cast for a tibial fracture, a patient has a constant burning pain over the heel that is not relieved by elevation. The pain is localised to…
- Fractures and dislocations: anterior hip dislocation · Multi-stepA man in a road accident has his hip dislocated so that the leg is held extended, abducted and externally rotated, with a prominent mass in the groin. Which structure i…
- Fractures and dislocations: ankle fracture reduction principle · Multi-stepA patient has a displaced bimalleolar ankle fracture with the talus subluxed laterally. Why is anatomical reduction and stable fixation of the lateral malleolus emphasi…
- Fractures and dislocations: skin traction contraindication · ApplicationSkin traction is applied to the leg of a patient before surgery for a femoral fracture. In which condition is skin traction contraindicated?
Paediatric orthopaedics49
- Paediatric orthopaedics · ApplicationAn obese 13-year-old boy has limp and knee pain with limited internal rotation of the hip. What is the diagnosis?
- Paediatric orthopaedics · ApplicationWhich tests are used to screen newborns for developmental dysplasia of the hip?
- Paediatric orthopaedics · ApplicationA newborn has a rigid foot with the heel in equinus and varus, forefoot adduction and a high arch. What is the recommended first-line treatment?
- Paediatric orthopaedics · ApplicationA 6-year-old boy has a limp and vague knee pain for several weeks without fever. Hip abduction and internal rotation are limited, and the radiograph shows a small, dens…
- Paediatric orthopaedics: lower limb alignment · ApplicationAn 18-month-old walking toddler has symmetrical bowing of both legs and is otherwise well, with normal height and no family history of rickets. What is the appropriate…
- Paediatric orthopaedics: arthrogryposis multiplex congenita · ApplicationA newborn has rigid, extended knees, internally rotated shoulders, clubbed feet and wrist flexion contractures, with thin muscles and normal intelligence. The deformiti…
- Paediatric orthopaedics: Perkin line · ApplicationOn an infant pelvis radiograph, Hilgenreiner's line is drawn through the triradiate cartilages and Perkin's line is drawn vertically from the lateral edge of the acetab…
- Paediatric orthopaedics: Waldenstrom stages · ApplicationIn the radiographic course of Legg-Calve-Perthes disease, which sequence of Waldenstrom stages is correct?
- Paediatric orthopaedics: chondrolysis after SCFE · Multi-stepA 13-year-old boy underwent in situ pinning for a slipped capital femoral epiphysis. Three months later he has increasing hip pain and stiffness, with radiographs showi…
- Paediatric orthopaedics: Madelung deformity · ApplicationA 12-year-old girl has a prominent dorsal ulnar head, a bayonet-like deviation of the wrist and limited wrist extension. Radiographs show a premature closure of the vol…
- Paediatric orthopaedics: epiphysiodesis · ApplicationA 10-year-old boy has a projected leg length discrepancy of 3.5 cm at skeletal maturity from a previous femoral growth disturbance. Which procedure is an appropriate wa…
- Paediatric orthopaedics: radial club hand · ApplicationA newborn has a radial club hand with absent radius. Which associated screening is most important before any surgery is planned?
- Paediatric orthopaedics: femoral anteversion · ApplicationA 5-year-old girl who sits in a W position walks with her feet turned in. Hip examination shows internal rotation of 90 degrees and limited external rotation. What is t…
- Paediatric orthopaedics: Langenskiold classification · Multi-stepA 3-year-old bow-legged child who walked early has a unilateral tibia vara with a medial metaphyseal beak on radiographs. Which classification stages infantile Blount d…
- Paediatric orthopaedics: bilateral Perthes-like disease · Multi-stepA 6-year-old has bilateral hip pain and symmetrical flattened femoral epiphyses on radiographs. He is also short for his age. What is the most appropriate next step?
- Paediatric orthopaedics: atypical age in SCFE · Multi-stepA 9-year-old thin boy presents with slipped capital femoral epiphysis. What further assessment is recommended?
- Paediatric orthopaedics: Salter-Harris type V injury · Multi-stepA child falls and lands on the leg with an axial crush force. Early radiographs of the knee look normal. Eight months later there is leg shortening and angulation. Whic…
- Paediatric orthopaedics: rickets deformity management · Multi-stepA 3-year-old with biochemical and radiological nutritional rickets has moderate genu varum. What is the best initial management?
- Paediatric orthopaedics: proximal femoral focal deficiency · ApplicationA newborn has a markedly short right thigh held flexed, abducted and externally rotated. A radiograph shows absence of the proximal femoral segment with a normal acetab…
- Paediatric orthopaedics: tibial versus fibular hemimelia · Multi-stepA newborn has absence of the tibia with a hindfoot held in marked varus and the fibula prominent at the knee. How does this differ from fibular hemimelia?
- Paediatric orthopaedics: Perthes disease · ApplicationA 6-year-old boy has a painless limp, and a radiograph shows a small, dense capital femoral epiphysis. What is the main principle of treatment?
- Paediatric orthopaedics: osteogenesis imperfecta · ApplicationA child with blue sclerae, dentinogenesis imperfecta and recurrent fractures has severe disease. Which drug reduces the fracture rate?
- Paediatric orthopaedics: osteogenesis imperfecta type II · ApplicationA newborn has a deformed chest, markedly short and crumpled long bones with continuously beaded ribs on radiograph, and dark blue sclerae. The baby dies of respiratory…
- Paediatric orthopaedics: pseudoachondroplasia · Multi-stepA 5-year-old has short-limbed dwarfism and a waddling gait, with irregular, fragmented epiphyses and flared metaphyses on radiographs. Her skull, head size and facial f…
- Paediatric orthopaedics: diastrophic dysplasia · ApplicationA newborn has short limbs, a thumb that sticks out sideways like a hitchhiker's, cystic swelling of the pinna, bilateral clubfeet and a cleft palate. Which skeletal dys…
- Paediatric orthopaedics: Ellis-van Creveld syndrome · ApplicationA child has short limbs, postaxial polydactyly, dysplastic nails and teeth, and an atrial septal defect. Which syndrome is this?
- Paediatric orthopaedics: amniotic band syndrome · ApplicationA newborn has circumferential constriction rings around the forearm with distal lymphoedema, and fusion of the fingertips with proximal clefts. The rest of the skeleton…
- Paediatric orthopaedics: Iselin disease · ApplicationA 12-year-old athlete has lateral midfoot pain at the base of the fifth metatarsal that worsens with running. Radiographs show a fragmented, enlarged secondary ossifica…
- Paediatric orthopaedics: Little leaguer's elbow · ApplicationA 13-year-old baseball pitcher has medial elbow pain with throwing and tenderness over the medial epicondyle. Radiographs show widening and fragmentation of the medial…
- Paediatric orthopaedics: Grisel syndrome · Multi-stepA 7-year-old develops a painful, fixed head tilt to one side with rotation to the opposite side a week after a throat infection. Movement of the neck is limited and CT…
- Paediatric orthopaedics: Craig test for femoral anteversion · ApplicationA child lies prone with the knee flexed to 90 degrees. The examiner rotates the hip until the greater trochanter is most prominent laterally and then measures the angle…
- Paediatric orthopaedics: Graf alpha angle · ApplicationIn Graf's ultrasonography of the infant hip, what does the alpha angle assess?
- Paediatric orthopaedics: Klein line in SCFE · ApplicationA 12-year-old obese boy has groin and knee pain. On an AP pelvis radiograph, a line drawn along the superior border of the femoral neck normally cuts across part of the…
- Paediatric orthopaedics: Herring lateral pillar group B · ApplicationIn the Herring lateral pillar classification of Perthes disease, which description corresponds to group B?
- Paediatric orthopaedics: developmental coxa vara · Multi-stepA 3-year-old walks with a painless Trendelenburg limp. The leg is slightly short and abduction is limited. The radiograph shows a reduced neck-shaft angle, a vertical p…
- Paediatric orthopaedics: posteromedial bowing of the tibia · ApplicationA newborn has posteromedial bowing of the lower leg with the foot held dorsiflexed in valgus against the tibia. The bowing is smooth and there is no fracture. What is t…
- Paediatric orthopaedics: relapsed clubfoot with dynamic supination · Multi-stepA 4-year-old whose clubfoot was corrected by the Ponseti method now shows dynamic supination of the forefoot during gait, with a strongly firing tibialis anterior and a…
- Paediatric orthopaedics: idiopathic toe walking · ApplicationA 3-year-old has walked on tiptoe since starting to walk. Neurological examination and development are normal, she can stand flat-footed on request, and ankle dorsiflex…
- Paediatric orthopaedics: crouch gait after Achilles lengthening · Multi-stepA 14-year-old with spastic diplegia had Achilles tendon lengthening at age 8. He now walks with excessive ankle dorsiflexion and excessive knee and hip flexion in stanc…
- Paediatric orthopaedics: hemihypertrophy and tumour screening · Multi-stepA 4-year-old has isolated hemihypertrophy of the right leg with a limb-length discrepancy. Which surveillance is recommended in this child?
- Paediatric orthopaedics: Pavlik harness complication · ApplicationA 2-month-old in a Pavlik harness for hip dislocation has lost active knee extension on the treated side, with a flaccid quadriceps. What is the complication, and what…
- Paediatric orthopaedics: Pemberton osteotomy · Multi-stepA 2-year-old with residual acetabular dysplasia needs a redirection procedure that is an incomplete cut through the ilium just above the acetabulum, hinging on the trir…
- Paediatric orthopaedics: congenital pseudarthrosis of the clavicle · ApplicationA newborn has a painless firm lump over the mid-right clavicle noted at birth after an uncomplicated delivery. A radiograph shows rounded, sclerotic bone ends separated…
- Paediatric orthopaedics: congenital radioulnar synostosis · ApplicationA 6-year-old boy has difficulty turning door handles. His right forearm is fixed in pronation, painless, with no history of injury, and a radiograph shows fusion of the…
- Paediatric orthopaedics: Tillaux fracture · Multi-stepA 14-year-old girl twists her ankle. CT shows a vertical split through the anterolateral distal tibial epiphysis, with the medial physis already closed and the metaphys…
- Paediatric orthopaedics: childhood discitis · ApplicationA 3-year-old refuses to walk or sit and has low-grade fever. She stands with a rigid, flexed lumbar spine, and ESR is raised. Initial radiographs are normal, but a repe…
- Paediatric orthopaedics: negative Ortolani in a late-presenting hip · Multi-stepA 7-month-old girl has asymmetrical thigh creases, a short left thigh with knees flexed and limited left hip abduction. Ortolani and Barlow tests are negative on the le…
- Paediatric orthopaedics · ApplicationWhich condition presents with a painless limp and limited hip abduction in a young child?
- Paediatric orthopaedics · ApplicationWhat is the typical age group for slipped capital femoral epiphysis?
Paediatric42
- Paediatric: Barlow test · ApplicationIn a Barlow test, the examiner adducts the flexed hip while applying posteriorly directed pressure. A positive test means what?
- Paediatric: imaging for DDH · ApplicationA 3-month-old girl with a breech birth history has a suspicious hip examination. Which is the preferred imaging method?
- Paediatric: Pavlik harness · ApplicationA 6-week-old infant has a reducible dislocated hip. What is the initial treatment?
- Paediatric: DDH at 8 months · ApplicationAn 8-month-old infant is diagnosed with a dislocated hip. Which is the usual treatment?
- Paediatric: crescent sign in Perthes disease · Multi-stepA radiograph in a child with Legg-Calve-Perthes disease shows a subchondral radiolucent line in the femoral head. What does this crescent sign indicate?
- Paediatric: prognosis of Perthes disease · Multi-stepWhich factor indicates a poor prognosis in Legg-Calve-Perthes disease?
- Paediatric: slipped capital femoral epiphysis · ApplicationAn obese 13-year-old boy has knee pain and limp. On flexing the hip, the thigh rotates externally and cannot be flexed straight. Which sign is this?
- Paediatric: SCFE treatment · ApplicationWhat is the standard treatment for a stable slipped capital femoral epiphysis?
- Paediatric: Ponseti method · ApplicationIn the Ponseti method for clubfoot, which component is corrected last?
- Paediatric: Pirani score · Multi-stepThe Pirani scoring system assesses which condition?
- Paediatric: congenital vertical talus · ApplicationA newborn has a rigid rocker-bottom foot, and a lateral radiograph in maximum plantar flexion shows the talus still pointing vertically with the navicular dislocated do…
- Paediatric: congenital pseudarthrosis of the tibia · Multi-stepA 1-year-old child has anterolateral bowing of the tibia, which later fractures and fails to heal. Which condition is most commonly associated?
- Paediatric: Sinding-Larsen-Johansson disease · ApplicationWhich site is affected in Sinding-Larsen-Johansson disease?
- Paediatric: Kohler disease · ApplicationA 5-year-old boy limps with pain over the medial midfoot, and radiographs show a sclerotic, flattened tarsal navicular. What is the diagnosis?
- Paediatric: Freiberg infraction · ApplicationAn adolescent girl has pain at the ball of the foot with flattening and sclerosis of the second metatarsal head. What is the diagnosis?
- Paediatric: Scheuermann disease · ApplicationA 15-year-old has a rigid thoracic kyphosis. A lateral radiograph shows anterior wedging of at least 5 degrees in three or more consecutive vertebrae with endplate irre…
- Paediatric: Panner disease · Multi-stepA 8-year-old boy has lateral elbow pain with fragmentation of the capitellum on radiographs. How does this differ from osteochondritis dissecans of the capitellum?
- Paediatric: osteochondritis dissecans of the knee · ApplicationIn osteochondritis dissecans of the knee, which is the typical site of the lesion?
- Paediatric: Salter-Harris type IV · ApplicationA fracture of the distal humerus in a child runs through the metaphysis, physis and epiphysis, entering the joint. Which Salter-Harris type is it?
- Paediatric: lateral condyle fracture · Multi-stepWhy do displaced lateral condyle fractures of the humerus in children usually need open reduction and fixation?
- Paediatric: cubitus varus · ApplicationA 10-year-old who had a childhood supracondylar fracture has a gunstock deformity of the elbow. What is the primary cause?
- Paediatric: non-accidental injury · ApplicationA 7-month-old infant has multiple fractures of different ages with posterior rib fractures and a metaphyseal corner fracture. What is the most likely cause?
- Paediatric: toddler's fracture · ApplicationA 2-year-old suddenly refuses to bear weight after a minor twist. Radiographs show a spiral undisplaced fracture of the distal tibia. What is this fracture called?
- Paediatric: Sprengel deformity · ApplicationA child has an elevated, small scapula on one side with limited shoulder abduction. An omovertebral bar is found. What is the diagnosis?
- Paediatric: cerebral palsy · ApplicationA child with spastic diplegia has a scissoring gait and tiptoe walking. Which hip complication is most likely?
- Paediatric: Duchenne muscular dystrophy · ApplicationA 5-year-old boy uses his hands to climb up his thighs when rising from the floor and has enlarged calves. Which gene is affected?
- Paediatric: sequelae of poliomyelitis · ApplicationWhich describes the characteristic paralysis in poliomyelitis?
- Paediatric: Ilizarov method · ApplicationIn distraction osteogenesis by the Ilizarov method, which rate and rhythm of lengthening is generally used?
- Paediatric: osteopetrosis · ApplicationA child has recurrent fractures despite very dense bones, anaemia and cranial nerve palsies. Radiographs show a bone-within-bone appearance and Erlenmeyer flask deformi…
- Paediatric: pes cavus · ApplicationAn adolescent has high-arched feet, clawing of toes, frequent ankle sprains and distal wasting of the legs with a positive family history. Which disorder should be susp…
- Paediatric: Gross Motor Function Classification System · ApplicationA paediatrician records that a child with cerebral palsy can walk indoors and outdoors and climb stairs but has limited speed, balance and coordination. Which scale is…
- Paediatric: Silfverskiold test · Multi-stepA child with spastic diplegia has equinus. Ankle dorsiflexion is limited with the knee straight but improves markedly when the knee is flexed. Which structure is tight,…
- Paediatric: migration percentage in cerebral palsy · ApplicationA child with spastic quadriplegia has regular hip surveillance radiographs. What does the Reimers migration percentage measure?
- Paediatric: Beighton score · ApplicationA teenager with recurrent joint sprains is assessed for generalised joint hypermobility. Which manoeuvre forms part of the Beighton score?
- Paediatric: fibular hemimelia · Multi-stepA newborn has a short leg, an absent fibula, a valgus ankle with a ball-and-socket configuration and absent lateral rays of the foot. Which associated finding is most c…
- Paediatric: congenital trigger thumb · ApplicationA 2-year-old has a thumb held in flexion at the interphalangeal joint, with a palpable nodule at the base of the thumb on the palmar side. The thumb cannot be actively…
- Paediatric: congenital dislocation of the knee · Multi-stepA newborn has a knee that rests in hyperextension, with the tibia displaced anteriorly on the femur and a flexion arc limited by a tight quadriceps. Which statement abo…
- Paediatric: latex allergy in spina bifida · ApplicationA child with myelomeningocele has hives and wheeze during a routine operation after a latex catheter is used. Which statement about this problem is correct?
- Paediatric: Apert syndrome · ApplicationA newborn has a tall, broad skull from craniosynostosis, midface hypoplasia and complex fusion of the fingers and toes into a mitten-like hand. Which mutation is typical?
- Paediatric: hinge abduction in Perthes disease · Multi-stepA 9-year-old with Perthes disease and a deformed, enlarged femoral head has pain on abduction. Radiographs on abduction show the lateral margin of the head impinging on…
- Paediatric: stable and unstable slipped epiphysis · Multi-stepA 12-year-old obese boy with a slipped capital femoral epiphysis cannot bear weight even with crutches because of severe pain. How is this slip classified, and what is…
- Paediatric: Salter innominate osteotomy · ApplicationA 3-year-old with untreated developmental dysplasia of the hip has a well-formed femoral head and a shallow acetabulum with an open triradiate cartilage. Which procedur…
Bone infection36
- Bone infection · Multi-stepA man has a chronically discharging sinus over the tibia after an old open fracture. A radiograph shows a dense bone fragment lying in a lucent cavity with surrounding…
- Bone infection: osteomyelitis · ApplicationAn 8-year-old with sickle cell disease has fever and pain over the tibia with MRI features of osteomyelitis. Which organism is more common in these patients than in the…
- Bone infection: Brodie abscess · ApplicationA 14-year-old boy has long-standing mild pain in the proximal tibia, worse at night, with a well-defined lucent lesion in the metaphysis with a sclerotic margin on radi…
- Bone infection: Garre osteomyelitis · Multi-stepA child has a swollen painful mandible or tibia with thick sclerotic new bone and no pus, no sequestrum. Which condition is this?
- Bone infection: osteomyelitis in sickle cell disease · ApplicationBesides Staphylococcus aureus, which organism is characteristically associated with osteomyelitis in sickle cell disease?
- Bone infection: imaging in early osteomyelitis · ApplicationA child has fever and bone pain for 3 days. Plain radiographs show only soft tissue swelling. Which investigation best confirms early osteomyelitis?
- Bone infection: Marjolin ulcer · ApplicationA man with a chronic discharging sinus from osteomyelitis of the tibia for 25 years develops a non-healing ulcer with everted edges. Which complication is suspected?
- Bone infection: Phemister triad · Multi-stepEarly radiographic changes of tuberculosis of a large joint are described by the Phemister triad. Which is part of it?
- Bone infection: caries sicca · Multi-stepTuberculosis of the shoulder in which there is marked bone loss, little effusion and no abscess formation is known as which entity?
- Bone infection: cold abscess of the psoas · ApplicationA young man with tuberculosis of the lumbar spine develops a swelling in the groin below the inguinal ligament and a flexed hip. How does the abscess reach the groin?
- Bone infection: surgery in spinal tuberculosis · ApplicationWhich situation is an accepted indication for surgery in spinal tuberculosis?
- Bone infection: tuberculous dactylitis · ApplicationA 4-year-old child has a painless fusiform swelling of the proximal phalanx of the index finger. Radiographs show an expanded bone with a cystic lesion. What is the lik…
- Bone infection: injection drug users · ApplicationA man who injects drugs has fever and pain at the sternoclavicular joint. Which organism is particularly associated with bone and joint infection at unusual sites in th…
- Bone infection: chronic osteomyelitis treatment · ApplicationA patient with chronic osteomyelitis of the femur shows a sequestrum on radiograph. What is the key surgical step?
- Bone infection: Cierny-Mader classification · Multi-stepIn the Cierny-Mader anatomic classification of adult osteomyelitis, what characterises type IV disease?
- Bone infection: empirical antibiotic in children · ApplicationA 7-year-old with fever and a painful warm distal femur has a diagnosis of acute haematogenous osteomyelitis. After blood cultures, which empirical antibiotic choice ta…
- Bone infection: probe-to-bone test · ApplicationA diabetic man has a deep plantar ulcer under the first metatarsal head. A sterile metal probe passed into the ulcer touches hard bone. What does a positive probe-to-bo…
- Bone infection: CBNAAT in skeletal tuberculosis · ApplicationPus aspirated from a cold abscess in a patient with suspected spinal tuberculosis is sent for CBNAAT. What additional information does this test give besides detecting…
- Bone infection: prognosis of Pott paraplegia · Multi-stepIn a patient with spinal tuberculosis, paraplegia develops during the active phase of the disease, from abscess, granulation tissue and inflammatory oedema. What is the…
- Bone infection: brucellar spondylitis · Multi-stepA dairy farmer who drinks unpasteurised milk has fever, sweats and low back pain. MRI shows L4-L5 spondylodiscitis with erosion of the anterior vertebral corner and a b…
- Bone infection: antibiotic cement beads · ApplicationA surgeon fills a debrided cavity of chronic osteomyelitis with polymethylmethacrylate beads containing gentamicin. What is the main advantage of this approach?
- Bone infection: cervical spine tuberculosis · ApplicationA child with tuberculosis of the cervical spine develops difficulty swallowing, a nasal voice and neck stiffness. Which complication should be suspected?
- Bone infection: chronic recurrent multifocal osteomyelitis · Multi-stepA 10-year-old girl has recurrent bone pain at several metaphyseal sites, including the clavicle, with raised ESR. Repeated biopsies and cultures show chronic inflammati…
- Bone infection: central type spinal tuberculosis · ApplicationA 6-year-old has back pain and a flattened, collapsed single vertebral body on radiograph with a relatively preserved disc space. Which pattern of spinal tuberculosis d…
- Bone infection: early tuberculosis of the hip posture · ApplicationA 7-year-old has had a limp and night cries for three months. The right hip lies flexed, abducted and externally rotated. What is the apparent limb length finding?
- Bone infection: advanced tuberculous arthritis of the hip · ApplicationA 10-year-old with long-standing tuberculosis of the hip holds the hip flexed, adducted and internally rotated. How does the limb appear compared with the opposite side?
- Bone infection: triple deformity of the knee · Multi-stepA young adult has long-standing tuberculous arthritis of the knee with a painful stiff joint. Which combination of deformities is typical of advanced disease?
- Bone infection: septic arthritis · ApplicationWhat is the joint-saving priority in suspected septic arthritis?
- Bone infection · ApplicationWhat is key early imaging for osteomyelitis?
- Bone infection · ApplicationWhat is urgent in septic arthritis?
- Bone infection · ApplicationWhat is a typical systemic feature of acute osteomyelitis?
- Bone infection · ApplicationWhat imaging modality is sensitive for early osteomyelitis?
- Bone infection · ApplicationWhat laboratory marker often rises with acute osteomyelitis?
- Bone infection · ApplicationWhat systemic feature can occur in acute osteomyelitis?
- Bone infection · ApplicationWhich investigation is most useful for identifying the causative organism in suspected osteomyelitis when feasible?
- Bone infection: osteomyelitis · ApplicationA child has fever, localized bone pain, refusal to use a limb, and elevated inflammatory markers. Which diagnosis should be considered urgently?
Metabolic bone disease35
- Metabolic bone disease: Paget disease · ApplicationA 70-year-old man notes that his hat size has increased and he has hearing loss and bowing of the tibia. Serum alkaline phosphatase is markedly raised, while calcium an…
- Metabolic bone disease: fluorosis · ApplicationA man from an area with high groundwater fluoride has stiff back, osteosclerosis and calcified spinal ligaments with a normal calcium. Which pathology explains the bone…
- Metabolic bone disease: hungry bone syndrome · Multi-stepA 45-year-old with severe primary hyperparathyroidism and brown tumours has a parathyroidectomy. Three days later he has perioral tingling and carpopedal spasm. Serum c…
- Metabolic bone disease: bone turnover markers · ApplicationIn monitoring a patient on an antiresorptive drug, which pair correctly identifies a marker of bone resorption and a marker of bone formation?
- Metabolic bone disease: bisphosphonate mechanism · ApplicationAlendronate lowers fracture risk in postmenopausal osteoporosis. What is its action in osteoclasts?
- Metabolic bone disease: zoledronic acid acute-phase reaction · ApplicationA woman has fever, myalgia and bone pain the day after her first intravenous infusion of zoledronic acid for osteoporosis. What is the best explanation and management?
- Metabolic bone disease: raloxifene · ApplicationWhich drug reduces the risk of vertebral fractures and invasive breast cancer in postmenopausal women but increases the risk of venous thromboembolism?
- Metabolic bone disease: romosozumab · ApplicationA monoclonal antibody that increases bone formation by neutralising an osteocyte-derived inhibitor of Wnt signalling is used for severe postmenopausal osteoporosis. Whi…
- Metabolic bone disease: contraindication to teriparatide · Multi-stepTeriparatide is being considered for patients with severe osteoporosis. In which patient is it contraindicated?
- Metabolic bone disease: Z-score · ApplicationA DXA scan is reported for a 30-year-old woman who has had amenorrhoea for several years. Which score should be used to interpret her bone density?
- Metabolic bone disease: DXA site in the elderly · Multi-stepA 78-year-old woman with severe kyphosis and extensive aortic calcification has a lumbar spine T-score of -0.5 on DXA, yet she has had a hip fracture. Which site should…
- Metabolic bone disease: postmenopausal osteoporosis fracture pattern · ApplicationIn the first decade after the menopause, accelerated loss of trabecular bone leads mostly to which fractures?
- Metabolic bone disease: osteoprotegerin · ApplicationOsteoblasts and stromal cells release a soluble protein that acts as a decoy receptor for RANKL, so that osteoclast formation is limited. What is it?
- Metabolic bone disease: PTH action on bone · ApplicationParathyroid hormone increases bone resorption even though osteoclasts do not have PTH receptors in significant numbers. How does it act?
- Metabolic bone disease: vitamin D-dependent rickets type II · Multi-stepAn infant with total alopecia has rickets that does not respond to usual doses of vitamin D. Serum calcium and phosphate are low, PTH is high, and calcitriol levels are…
- Metabolic bone disease: vitamin D-dependent rickets type I · Multi-stepA 10-month-old has rickets with low calcium, raised PTH and a normal 25-hydroxyvitamin D, while calcitriol is low. Which defect is present and how is it treated?
- Metabolic bone disease: renal tubular acidosis rickets · Multi-stepA 4-year-old with rickets has hypokalaemia and hyperchloraemic metabolic acidosis with a normal anion gap. The urine pH stays above 5.5 despite acidaemia. What is the u…
- Metabolic bone disease: oncogenic osteomalacia · Multi-stepA 50-year-old man has progressive bone pain, proximal muscle weakness and pseudofractures. Serum phosphate is low with excessive urinary phosphate loss, calcitriol is l…
- Metabolic bone disease: first sign of rickets healing · ApplicationA child with active rickets starts treatment with vitamin D and calcium. Which is the earliest radiographic sign of healing?
- Metabolic bone disease: Paget disease and sarcoma · ApplicationA 72-year-old man with known Paget disease of the pelvis develops a rapid increase in pain and a soft tissue swelling over the affected bone. Which complication is most…
- Metabolic bone disease: lytic phase of Paget disease · ApplicationIn the early lytic phase of Paget disease, a long bone radiograph shows an advancing front of radiolucency along the shaft. How is this described?
- Metabolic bone disease: carbonic anhydrase II deficiency · Multi-stepA child with dense bones and recurrent fractures also has renal tubular acidosis and intracranial calcification. Which enzyme deficiency explains this combination?
- Metabolic bone disease: treatment of infantile osteopetrosis · ApplicationAn infant with severe autosomal recessive osteopetrosis has anaemia, hepatosplenomegaly and optic nerve compression. Which treatment can correct the underlying defect?
- Metabolic bone disease: Gaucher disease · ApplicationA 12-year-old has splenomegaly, anaemia, bone pain with episodes of fever, and an Erlenmeyer flask deformity of the distal femur. Which enzyme is deficient?
- Metabolic bone disease: transient osteoporosis of the hip · Multi-stepA woman in the third trimester of pregnancy develops sudden hip pain and a limp. A radiograph shows osteopenia of the femoral head. MRI shows diffuse marrow oedema of t…
- Metabolic bone disease: salt-and-pepper skull · ApplicationA 45-year-old woman has renal stones and bone pain. A skull radiograph shows fine granular mottling. Serum calcium is high, phosphate is low and PTH is raised. What is…
- Metabolic bone disease: aluminium bone disease · Multi-stepA dialysis patient taking aluminium hydroxide as a phosphate binder for many years has bone pain and fractures. PTH is low and a bone biopsy shows osteomalacia with alu…
- Metabolic bone disease: dialysis-related amyloidosis · ApplicationA man on haemodialysis for 12 years has carpal tunnel syndrome, shoulder pain and cystic lesions in the carpal bones. Which protein forms the deposits?
- Metabolic bone disease: bone biopsy in osteomalacia · Multi-stepA transiliac bone biopsy after double tetracycline labelling is performed to confirm osteomalacia. Which finding is expected?
- Metabolic bone disease: atypical femoral fracture management · Multi-stepA 70-year-old woman who has taken alendronate for eight years has two weeks of dull thigh pain. A radiograph shows thickening and beaking of the lateral cortex of the s…
- Metabolic bone disease: medical therapy for X-linked hypophosphataemic rickets · ApplicationA 3-year-old boy has been diagnosed with X-linked hypophosphataemic rickets. Which conventional medical therapy is used?
- Metabolic bone disease: pathogenesis of renal osteodystrophy · ApplicationIn chronic kidney disease, which two changes are the main drivers of secondary hyperparathyroidism and renal bone disease?
- Metabolic bone disease · ApplicationWhich vitamin is essential for efficient intestinal calcium absorption and bone mineralization?
- Metabolic bone disease: osteoporosis · ApplicationWhich fracture after a fall from standing height is considered a fragility fracture suggesting osteoporosis?
- Metabolic bone disease: osteomalacia · ApplicationA patient has diffuse bone pain, proximal muscle weakness, low phosphate, and elevated alkaline phosphatase due to vitamin D deficiency. What is the diagnosis?
Nerve injuries25
- Nerve injuries: Wallerian degeneration · ApplicationWallerian degeneration after axonotmesis occurs in which part of the nerve?
- Nerve injuries: sciatic nerve in hip dislocation · ApplicationAfter a posterior hip dislocation, a patient has foot drop. Which part of the sciatic nerve is more susceptible to injury?
- Nerve injuries: tibial nerve · ApplicationWhich finding is expected in a complete tibial nerve injury at the popliteal fossa?
- Nerve injuries: Klumpke palsy · ApplicationA patient who grabbed a branch while falling presents with a claw hand and ipsilateral ptosis and miosis. Which lesion is this?
- Nerve injuries: radial nerve at the axilla · ApplicationA man who slept with his arm over a chair back wakes with wrist drop. Elbow extension is also weak. Where is the lesion?
- Nerve injuries: ulnar paradox · Multi-stepIn the ulnar paradox, a lesion at which site produces less claw deformity than a distal lesion?
- Nerve injuries: median nerve at the elbow · ApplicationA patient asked to make a fist can flex only the ring and little fingers, and the index finger remains straight (pointing finger). Where is the median nerve injured?
- Nerve injuries: anterior interosseous nerve · ApplicationAfter a supracondylar fracture, a child cannot make the OK sign, with the index tip and thumb tip failing to flex, but sensation is normal. Which nerve is injured?
- Nerve injuries: posterior interosseous nerve · ApplicationA man with a Monteggia fracture-dislocation has finger drop but can extend the wrist, with radial deviation, and has no sensory loss. Which nerve is injured?
- Nerve injuries: suprascapular nerve entrapment · Multi-stepA volleyball player has posterior shoulder pain and wasting of infraspinatus only, with normal supraspinatus bulk. Where is the nerve entrapped?
- Nerve injuries: timing of repair · ApplicationA forearm laceration from clean glass has completely divided the median nerve with no wound contamination. What is the best management?
- Nerve injuries: tendon transfer for radial palsy · Multi-stepIn a radial nerve palsy that does not recover, which tendon transfer is commonly used to restore wrist extension?
- Nerve injuries: Sunderland grade IV · Multi-stepAfter a traction injury to the median nerve, there is loss of axons, endoneurium and perineurium, but the epineurium is intact, and a neuroma in continuity forms. Which…
- Nerve injuries: Ochsner clasping test · ApplicationA patient is asked to clasp the hands together with fingers interlocked. The index finger of the right hand stays straight and cannot flex. Which lesion does this sugge…
- Nerve injuries: Wartenberg sign · ApplicationA patient with long-standing ulnar neuropathy at the elbow cannot adduct the little finger when the fingers are held together. What is this called and why does it occur?
- Nerve injuries: card test · ApplicationA patient is asked to hold a card between two extended adjacent fingers while the examiner pulls it away. The card slips out easily. Which muscles and nerve are weak?
- Nerve injuries: Camitz opponensplasty · ApplicationA patient with severe long-standing carpal tunnel syndrome has thenar wasting and cannot oppose the thumb. Which transfer can restore opposition?
- Nerve injuries: EMG timing · ApplicationA patient has foot drop after a knee dislocation. A nerve conduction study done on day 3 is normal below the injury. When do fibrillation potentials typically appear on…
- Nerve injuries: tendon transfer prerequisites · ApplicationBefore planning a tendon transfer for an irreparable nerve palsy, which condition must be met?
- Nerve injuries: two-point discrimination · ApplicationA carpenter has a lacerated digital nerve repaired. At follow-up, sensory recovery is assessed with static two-point discrimination. Which value is regarded as normal a…
- Nerve injuries: preganglionic brachial plexus lesion · Multi-stepA motorcyclist has a flail, anaesthetic arm after a high-speed crash, with Horner syndrome and winging of the scapula. Sensory nerve action potentials in the anaestheti…
- Nerve injuries: superficial peroneal nerve · Multi-stepAfter a fibular shaft fracture, a patient can dorsiflex the ankle but cannot evert the foot and has numbness over the dorsum of the foot, sparing the first web space. W…
- Nerve injuries: leprosy neuropathy · ApplicationIn India, a farmer with a hypoaesthetic skin patch develops a thickened, tender nerve at the elbow with clawing of the ring and little fingers. Which nerve is most comm…
- Nerve injuries: sural nerve graft · ApplicationA 25-year-old has a clean laceration of the median nerve at the wrist, treated at 1 week. After debridement, a gap remains that cannot be closed without tension. What i…
- Nerve injuries: Bouvier test · Multi-stepIn an ulnar claw hand, the examiner blocks hyperextension of the metacarpophalangeal joints with a finger and the patient can then extend the interphalangeal joints. Wh…
Peripheral nerve injuries24
- Peripheral nerve injuries · ApplicationAfter a supracondylar fracture, a patient with cubital tunnel compression has a hand with hyperextension of the ring and little finger metacarpophalangeal joints and fl…
- Peripheral nerve injuries: ape hand thumb posture · ApplicationA man has a deep laceration at the wrist with thenar flattening, and the thumb lies adducted and extended in the plane of the palm. Which explains the thumb posture?
- Peripheral nerve injuries: accessory nerve versus long thoracic nerve · Multi-stepAfter a lymph node biopsy in the posterior triangle of the neck, a woman has a drooping shoulder and cannot shrug. The scapula sits lower and is displaced laterally, wi…
- Peripheral nerve injuries: musculocutaneous nerve · Multi-stepAfter an anterior shoulder injury, a man has weak elbow flexion with the forearm supinated, a reduced biceps reflex and numbness over the lateral forearm. Elbow flexion…
- Peripheral nerve injuries: radial nerve · Multi-stepA man with a closed fracture of the humeral shaft at the junction of the middle and distal thirds has wrist drop and loss of sensation over the first dorsal web space.…
- Peripheral nerve injuries: entrapment · Multi-stepA 50-year-old woman with long-standing carpal tunnel syndrome now has constant numbness, thenar wasting and a markedly prolonged distal motor latency on nerve conductio…
- Peripheral nerve injuries: entrapment · ApplicationA seamstress has night-time tingling of the thumb, index and middle fingers relieved by shaking the hand, and the symptoms reproduce on holding both wrists flexed for o…
- Peripheral nerve injuries: Parsonage-Turner syndrome · ApplicationA 30-year-old man develops sudden severe shoulder pain without injury. The pain eases over two weeks and is followed by weakness and wasting of the shoulder girdle musc…
- Peripheral nerve injuries: Vaughan-Jackson syndrome · Multi-stepA woman with long-standing rheumatoid arthritis suddenly cannot extend her little finger at the metacarpophalangeal joint, and over the next weeks the ring finger follo…
- Peripheral nerve injuries: anterior tarsal tunnel syndrome · ApplicationA runner who laces her shoes tightly has burning pain and numbness restricted to the first web space on the dorsum of the foot. The symptoms are reproduced by tapping o…
- Peripheral nerve injuries: regimental badge area · ApplicationAfter an anterior shoulder dislocation, a patient has numbness over a small patch on the lateral upper arm, over the deltoid. Which additional finding is expected?
- Peripheral nerve injuries: ankle-foot orthosis in foot drop · ApplicationA patient has a persistent foot drop after a common peroneal nerve injury at the fibular neck, with no signs of recovery yet. What is the most useful measure while wait…
- Peripheral nerve injuries: obturator nerve · ApplicationAfter pelvic surgery for a gynaecological malignancy, a woman has difficulty crossing her legs because she cannot adduct the thigh. She has numbness over the medial thi…
- Peripheral nerve injuries: gluteal injection injury · ApplicationA child develops foot drop and loss of sensation over the sole after an intramuscular injection in the buttock. Which injection site avoids this injury?
- Peripheral nerve injuries: carpal compression test · ApplicationIn a patient with suspected carpal tunnel syndrome, the examiner presses firmly with the thumbs over the carpal tunnel for 30 seconds and the symptoms are reproduced. W…
- Peripheral nerve injuries: carpal tunnel in pregnancy · ApplicationA woman in her third trimester has night-time tingling in the median nerve distribution of both hands with no wasting. What is the best initial management?
- Peripheral nerve injuries: nerve conduction in carpal tunnel · ApplicationWhich finding on nerve conduction studies supports the diagnosis of carpal tunnel syndrome?
- Peripheral nerve injuries: cheiralgia paraesthetica · Multi-stepA woman who wears a tight wristwatch strap has numbness and tingling over the dorsum of the thumb and first web space. Motor power is normal, and Tinel sign is positive…
- Peripheral nerve injuries: radial tunnel syndrome · Multi-stepA 45-year-old has deep aching pain in the proximal forearm just distal to the lateral epicondyle, worse with repeated forearm rotation. There is no weakness or sensory…
- Peripheral nerve injuries: radial palsy in humeral fracture · Multi-stepA 40-year-old has a closed mid-shaft humeral fracture and a radial nerve palsy noted at presentation. The skin is intact and the fracture is acceptably aligned. What is…
- Peripheral nerve injuries: peroneal palsy from cast pressure · ApplicationA man in a long-leg cast for a tibial fracture complains of numbness over the dorsum of the foot and cannot lift his toes. The cast fits tightly below the knee. What is…
- Peripheral nerve injuries: conduction block in neurapraxia · ApplicationA patient has a drop of the wrist after prolonged pressure on the arm. Electrical stimulation of the radial nerve proximal to the compression site produces no muscle re…
- Peripheral nerve injuries: cubital tunnel provocative test · ApplicationA patient with tingling in the ring and little fingers is asked to hold the elbow fully flexed with the wrist extended for one minute, which reproduces the symptoms. Wh…
- Peripheral nerve injuries: deep peroneal nerve · Multi-stepAfter an injury to the anterior compartment of the leg, a patient cannot dorsiflex the ankle or extend the toes. Sensation is lost only in the skin between the first an…
Hip21
- Hip · ApplicationA positive Trendelenburg sign is due to weakness of the gluteus medius and minimus. Which nerve supplies them?
- Hip · ApplicationAvascular necrosis of the femoral head after an intracapsular femoral neck fracture is due to injury of which vessel?
- Hip: complication of total hip replacement · ApplicationWhich is the commonest early complication after total hip arthroplasty by the posterior approach?
- Hip: Girdlestone arthroplasty · ApplicationA frail patient has a chronically infected total hip replacement that is removed along with the femoral head and neck, leaving no prosthesis. Which operation is this?
- Hip: MRI double line sign in AVN · ApplicationMRI of the hip in a young man on long-term steroids shows a serpiginous margin of the necrotic segment, with a bright inner line and a dark outer line on T2 images. Wha…
- Hip: Caisson disease · ApplicationA deep-sea diver who ascended rapidly in the past develops chronic hip and shoulder pain. Radiographs show a mottled sclerotic head of the femur and humerus. What is th…
- Hip: greater trochanteric pain syndrome · ApplicationA 55-year-old woman has lateral hip pain on lying on the affected side and climbing stairs, with sharp tenderness over the greater trochanter. The hip joint moves painl…
- Hip: femoroacetabular impingement · Multi-stepA 26-year-old athlete has groin pain on deep hip flexion with internal rotation, and a positive impingement test. Radiographs show loss of the normal femoral head-neck…
- Hip: surgical approaches and nerve risk · Multi-stepAfter a total hip replacement through a direct lateral approach, a patient has a Trendelenburg gait. Which nerve was most likely injured by splitting the gluteus medius…
- Hip: piriformis syndrome · ApplicationA cyclist has deep buttock pain radiating down the back of the thigh, worse on prolonged sitting and with resisted external rotation of the flexed hip. The lumbar MRI i…
- Hip: core decompression · Multi-stepA 32-year-old man on long-term corticosteroids has groin pain. MRI shows necrosis of the femoral head with an intact articular surface and no collapse. Which joint-pres…
- Hip: centre-edge angle · ApplicationA 25-year-old woman has groin pain. On an AP pelvis radiograph the lateral centre-edge angle of Wiberg is 12 degrees. What does this indicate?
- Hip: antalgic gait · ApplicationA patient with a painful hip walks with a shortened stance phase on the affected side. How is this gait described?
- Hip: FABER test · ApplicationA patient lies supine while the examiner places the foot of the painful leg on the opposite knee and presses the knee down into flexion, abduction and external rotation…
- Hip: DDH · ApplicationWhich newborn test reduces a dislocated hip during abduction?
- Hip: Perthes · ApplicationA child with painless limp and limited hip abduction may have what disease?
- Hip · ApplicationWhat test detects hip abductor weakness?
- Hip · ApplicationAdolescent with limp and external rotation suggests what?
- Hip · ApplicationWhat maneuver tests hip dislocatability in newborn?
- Hip · ApplicationWhich investigation is most useful to confirm suspected septic arthritis of the hip?
- Hip · ApplicationWhich condition is a risk factor for avascular necrosis of the femoral head?
Bone and joint infections19
- Bone and joint infections: skeletal tuberculosis · Multi-stepA 30-year-old has weight loss, a dorsal spine tuberculous lesion with a paravertebral abscess and early paraparesis, and the spine is stable. What is the initial treatm…
- Bone and joint infections: osteomyelitis · ApplicationA 9-year-old with fever and a painful distal femur for four days has an essentially normal radiograph apart from swelling. When does a periosteal reaction typically bec…
- Bone and joint infections: late-onset paraplegia of healed spinal tuberculosis · Multi-stepA 45-year-old man was treated for dorsal spine tuberculosis 20 years ago and healed with a severe kyphosis. He now has slowly progressive spastic paraparesis, and the E…
- Bone and joint infections: suspected necrotising fasciitis · Multi-stepA diabetic man has a swollen, tense leg with skin pain out of proportion to the findings, dusky blisters, tachycardia and a falling blood pressure. What is the most app…
- Bone and joint infections: Kingella kingae septic arthritis · ApplicationA 2-year-old attending day care has had low-grade fever and a limp for three days. The knee is mildly swollen, the leucocyte count is near normal, and routine culture o…
- Bone and joint infections: Batson plexus in vertebral osteomyelitis · Multi-stepA 66-year-old man with a recent urinary tract infection and catheterisation has fever and low back pain. MRI shows destruction of the L3-L4 disc and adjacent endplates.…
- Bone and joint infections: tuberculous versus pyogenic spondylodiscitis · Multi-stepMRI of the thoracic spine in a young adult with months of back pain and weight loss shows involvement of three contiguous vertebrae and a large paravertebral collection…
- Bone and joint infections: posture in tuberculosis of the hip · ApplicationIn tuberculosis of the hip, the early stage of synovitis places the limb in flexion, abduction and external rotation with apparent lengthening. Which posture characteri…
- Bone and joint infections: tuberculous flexor tenosynovitis · ApplicationA 38-year-old farmer has had a painless swelling across the volar wrist and palm for eight months. Fluctuation can be elicited between the palm and the forearm componen…
- Bone and joint infections: amyloidosis in chronic osteomyelitis · ApplicationA 50-year-old man has had a discharging sinus from tibial osteomyelitis for 30 years. He now has heavy proteinuria and oedema, and a renal biopsy shows Congo red positi…
- Bone and joint infections: monitoring treatment response · ApplicationA child is on intravenous antibiotics for acute haematogenous osteomyelitis. Which blood test normalises fastest and is most useful for early monitoring of response?
- Bone and joint infections: pyomyositis · ApplicationA 14-year-old boy in rural India develops four days of fever and a firm, tender, woody swelling of the thigh after minor muscle trauma. Joint movement is painless, the…
- Bone and joint infections: tabetic Charcot knee · Multi-stepA 58-year-old man has a grossly swollen, unstable right knee with a large painless effusion, crepitus and multiple loose bodies. He has small irregular pupils that acco…
- Bone and joint infections: surgery for tuberculous paraparesis · Multi-stepA 30-year-old with dorsal spine tuberculosis has had four weeks of antituberculous drugs, but his paraparesis is worsening. MRI shows an anterior abscess and caseous de…
- Bone and joint infections: cause of early-onset Pott paraplegia · Multi-stepA 24-year-old with active dorsal spine tuberculosis develops paraparesis over three weeks. MRI shows a large paravertebral abscess and no healed bony ridge. What is the…
- Bone and joint infections: osteomyelitis after a shoe puncture · ApplicationA 10-year-old steps on a nail that passes through a rubber-soled sports shoe. Two weeks later she has persistent forefoot pain, swelling and low-grade fever, and an MRI…
- Bone and joint infections: intracapsular metaphysis · Multi-stepIn an infant with metaphyseal osteomyelitis, pus can rupture directly into the neighbouring joint only when the metaphysis lies inside the joint capsule. In which of th…
- Bone and joint infections: spine-at-risk signs in children · Multi-stepA 5-year-old has dorsal spine tuberculosis with 25 degrees of kyphosis at presentation. Which radiographic sign indicates a spine at risk of severe progressive kyphosis…
- Bone and joint infections: rifampicin in implant infection · Multi-stepA 70-year-old has an acute haematogenous infection of a stable total knee replacement with methicillin-sensitive Staphylococcus aureus. Debridement with implant retenti…
Dislocations19
- Dislocations · ApplicationAfter a car dashboard injury, a young man lies with the left hip flexed, adducted and internally rotated, and the leg appears shortened. Which nerve is most at risk?
- Dislocations: Hill-Sachs lesion · ApplicationAfter recurrent anterior shoulder dislocations, CT shows a defect on the posterolateral humeral head. What is this lesion called?
- Dislocations: Bankart lesion · ApplicationWhich structure is avulsed in the Bankart lesion, the essential lesion in recurrent anterior shoulder dislocation?
- Dislocations: posterior shoulder dislocation · ApplicationA man has a shoulder locked in internal rotation after an epileptic seizure, and an AP radiograph shows the light-bulb sign. What is the diagnosis?
- Dislocations: luxatio erecta · ApplicationAfter a hyperabduction injury a patient holds the arm fully abducted above the head and cannot lower it. Which dislocation is this?
- Dislocations: terrible triad of the elbow · Multi-stepWhich combination constitutes the terrible triad of the elbow?
- Dislocations: lunate dislocation · Multi-stepA lateral wrist radiograph shows the spilled teacup sign with a triangular lunate on the AP view. Which nerve is most at risk?
- Dislocations: scapholunate dissociation · ApplicationA wrist radiograph after a fall shows a widened gap of more than 3 mm between the scaphoid and lunate. What is this sign called?
- Dislocations: posterior sternoclavicular dislocation · Multi-stepA man in a rugby scrum has pain over the sternoclavicular joint, difficulty swallowing and a hoarse voice after a blow to the shoulder. What is the likely injury and it…
- Dislocations: acromioclavicular joint injury · Multi-stepIn the Rockwood classification of acromioclavicular joint injuries, which feature defines type III?
- Dislocations: Hippocratic method · ApplicationIn reducing an anterior shoulder dislocation by the Hippocratic method, what is applied?
- Dislocations: knee dislocation · ApplicationA man with a dislocated knee that has been reduced has normal-appearing foot pulses. Which step is most important?
- Dislocations: patellar dislocation · ApplicationA teenage girl twists her knee and the patella dislocates laterally. Which structure is characteristically torn?
- Dislocations: hip reduction timing · ApplicationHow soon should a traumatic posterior dislocation of the hip be reduced to reduce the risk of avascular necrosis?
- Dislocations: anterior hip dislocation · ApplicationAfter a fall from a height with the hip forced into abduction and external rotation, the limb is held flexed, abducted and externally rotated, and the femoral head is p…
- Dislocations: Bigelow manoeuvre · Multi-stepAn emergency physician reduces a posterior hip dislocation by applying traction in the line of the deformity, then adducting and internally rotating the flexed hip and…
- Dislocations: Rockwood type IV · Multi-stepAfter a fall onto the point of the shoulder, a cyclist has a prominent distal clavicle. An axillary radiograph shows the clavicle displaced posteriorly into the trapezi…
- Dislocations: greater arc carpal injury · Multi-stepA motorcyclist has a perilunate dislocation with a fracture through the scaphoid waist. What is the term for this injury and how is it classified?
- Dislocations: posterolateral rotatory instability of the elbow · Multi-stepMonths after an elbow dislocation, a man feels the elbow give way and click when pushing up from a chair with the forearm supinated. Which ligament is deficient?
Knee18
- Knee: posterior cruciate ligament injury · ApplicationA footballer falls on a flexed knee with the foot plantar flexed. On examination the tibia sags backward at 90 degrees of flexion. Which ligament is injured?
- Knee: unhappy triad · ApplicationA footballer is tackled from the lateral side with a valgus and external rotation force on a planted foot. Which combination constitutes O'Donoghue's unhappy triad?
- Knee: discoid meniscus · Multi-stepA child has a snapping knee with a clunk on extension and no trauma. MRI shows a thick, disc-shaped meniscus. Which meniscus is typically affected?
- Knee: Baker cyst · ApplicationA patient with knee osteoarthritis has a swelling in the popliteal fossa that becomes tense in extension. Where does this cyst lie?
- Knee: patellofemoral pain · ApplicationA teenage girl has anterior knee pain on climbing stairs and after prolonged sitting, with a positive patellar compression test. What is the likely diagnosis?
- Knee: iliotibial band syndrome · ApplicationA marathon runner has lateral knee pain that begins after a fixed distance, with tenderness over the lateral femoral epicondyle. What is the diagnosis?
- Knee: Apley grinding test · ApplicationA footballer lies prone with the knee flexed to 90 degrees. The examiner presses the heel downward while rotating the tibia and the patient has joint line pain, which e…
- Knee: meniscal vascular zones · Multi-stepA 22-year-old has a 1.5 cm longitudinal tear in the peripheral third of the medial meniscus, near the capsule. Why is meniscal repair rather than excision preferred?
- Knee: Q angle · ApplicationA teenage girl has anterior knee pain and lateral patellar tracking. Which statement about the Q angle is correct?
- Knee: J sign · Multi-stepAs a patient with recurrent patellar instability actively extends the knee from a flexed position, the patella shifts laterally in a J-shaped path at terminal extension…
- Knee: jumper knee · ApplicationA volleyball player has pain at the inferior pole of the patella that is worse after jumping, with local tenderness and no instability. Ultrasound shows thickening of t…
- Knee: spontaneous osteonecrosis · Multi-stepA 65-year-old woman has sudden severe medial knee pain at night and tenderness over the medial femoral condyle. Radiographs are normal and MRI shows marrow oedema with…
- Knee · ApplicationWhat structure is tested by posterior drawer?
- Knee · ApplicationLocked knee after twisting injury suggests what?
- Knee · ApplicationWhat ligament is tested by Lachman?
- Knee · ApplicationWhat mechanism classically injures PCL?
- Knee · ApplicationWhich finding is most typical of a meniscal tear?
- Knee · ApplicationWhat does a positive posterior drawer test assess?
Shoulder18
- Shoulder · ApplicationA 55-year-old diabetic woman has a painful stiff shoulder, with both active and passive movement restricted, especially external rotation. The radiograph is normal. Wha…
- Shoulder: subacromial impingement · ApplicationA painter has shoulder pain on abduction between 60 and 120 degrees, which settles when the arm is raised higher. What is this finding called?
- Shoulder: calcific tendinitis · ApplicationA 45-year-old woman has sudden severe shoulder pain, and a radiograph shows a dense calcific deposit above the greater tuberosity. Which tendon is most often involved?
- Shoulder: rotator cuff tear · ApplicationAfter a fall, a 60-year-old man cannot hold his arm abducted at 90 degrees and the arm drops when lowering it. Which injury is suggested?
- Shoulder: Latarjet procedure · Multi-stepA rugby player has recurrent anterior shoulder dislocations with a glenoid bone loss of over 20 percent. Which operation provides a bony block plus a sling effect from…
- Shoulder: pectoralis major rupture · Multi-stepA 30-year-old weightlifter feels a tearing sensation in the shoulder during a bench press. He has bruising of the arm and chest, and the anterior axillary fold has lost…
- Shoulder: O'Brien active compression test · Multi-stepIn the O'Brien test the arm is flexed to 90 degrees, adducted 15 degrees and internally rotated with the thumb down; resisted elevation causes deep pain that is relieve…
- Shoulder: os acromiale · ApplicationAn axillary view of the shoulder in a 35-year-old with impingement pain shows a separate bone fragment at the front of the acromion that is mobile on dynamic examinatio…
- Shoulder: reverse shoulder arthroplasty · Multi-stepA 74-year-old woman has pseudoparalysis of active elevation from an irreparable massive rotator cuff tear with glenohumeral arthritis. Her deltoid function is good. Whi…
- Shoulder: dislocation · ApplicationWhat is the commonest direction of shoulder dislocation?
- Shoulder · ApplicationWhat nerve is at risk in anterior shoulder dislocation?
- Shoulder · ApplicationPainful arc may indicate what pathology?
- Shoulder · ApplicationWhat is the commonest shoulder dislocation?
- Shoulder · ApplicationWhat nerve may be injured in anterior dislocation?
- Shoulder · ApplicationWhat tendon group stabilizes the glenohumeral joint?
- Shoulder · ApplicationWhat test is commonly used to assess rotator cuff impingement?
- Shoulder · ApplicationWhich test is commonly used to assess supraspinatus weakness?
- Shoulder · ApplicationWhat clinical feature is typical of adhesive capsulitis?
Metabolic bone16
- Metabolic bone: bisphosphonates · ApplicationA rare complication of long-term bisphosphonate therapy is what?
- Metabolic bone: teriparatide · ApplicationWhich agent used for severe osteoporosis has an anabolic action on bone when given as a daily subcutaneous injection?
- Metabolic bone: denosumab · Multi-stepA patient stops denosumab after 3 years of treatment for osteoporosis. What is the recognised risk?
- Metabolic bone: biochemistry of nutritional rickets · ApplicationWhich pattern of laboratory results is expected in nutritional vitamin D deficiency rickets?
- Metabolic bone: X-linked hypophosphataemic rickets · Multi-stepA boy has bow legs, short stature and rickets that fails to respond to standard doses of vitamin D. Serum phosphate is low, calcium is normal and PTH is normal. Which d…
- Metabolic bone: osteomalacia · ApplicationA woman with chronic malabsorption has diffuse bone pain, proximal weakness and waddling gait. Radiographs show bilateral symmetrical linear lucencies perpendicular to…
- Metabolic bone: renal osteodystrophy · ApplicationA patient on long-term dialysis has a lateral spine radiograph showing dense sclerotic bands at the vertebral endplates alternating with a lucent central zone. What is…
- Metabolic bone: hyperparathyroidism · ApplicationWhich radiographic finding of the hand is the most characteristic early sign of hyperparathyroidism?
- Metabolic bone: scurvy · Multi-stepAn infant fed only boiled milk has pain on handling, swollen legs and subperiosteal haemorrhages. Radiographs show a dense sclerotic ring around a lucent epiphysis, wit…
- Metabolic bone: skeletal fluorosis · ApplicationAn adult from an area with high groundwater fluoride has stiffness of the spine, dense bones and ligament ossification, with genu valgum in children. What is the diagno…
- Metabolic bone: hypophosphatasia · Multi-stepA child has premature loss of deciduous teeth, rickets-like bone changes and low serum alkaline phosphatase. Which condition is this?
- Metabolic bone: heterotopic ossification · ApplicationWhich measure is used to prevent heterotopic ossification after total hip arthroplasty in high-risk patients?
- Metabolic bone: FRAX · ApplicationA clinician estimates the 10-year probability of a major osteoporotic fracture in a 65-year-old woman who smokes and has taken steroids. Which tool is designed for this?
- Metabolic bone: pseudohypoparathyroidism · Multi-stepA 12-year-old with a round face, short stature and short fourth and fifth metacarpals has low calcium, high phosphate and a raised parathyroid hormone. What is the diag…
- Metabolic bone · ApplicationLow-trauma fracture in older adult suggests what?
- Metabolic bone · ApplicationWhat does low-energy fracture suggest?
Foot14
- Foot: Morton neuroma · ApplicationA woman who wears narrow shoes has burning pain between the third and fourth toes, relieved by removing the shoe. A palpable click is felt on squeezing the forefoot. Wh…
- Foot: hallux rigidus · ApplicationA middle-aged man has pain and limited dorsiflexion of the great toe at the first MTP joint with a dorsal osteophyte. What is the diagnosis?
- Foot: Wagner classification of diabetic foot · Multi-stepIn the Wagner classification of diabetic foot ulcers, which grade denotes a deep ulcer with abscess or osteomyelitis?
- Foot: tarsal tunnel syndrome · ApplicationA runner has burning pain and numbness of the sole of the foot, worse at night, with Tinel sign positive behind the medial malleolus. Which nerve is compressed?
- Foot: Haglund deformity · ApplicationA young woman who wears stiff-backed shoes has pain and a firm bump at the back of the heel, with swelling of the retrocalcaneal bursa. Radiographs show a prominent pos…
- Foot: talocalcaneal coalition · Multi-stepA 13-year-old has recurrent ankle sprains and a rigid, painful flatfoot with spasm of the peroneal muscles. A lateral radiograph shows a continuous curved line along th…
- Foot: Coleman block test · Multi-stepA teenager has cavovarus feet with a plantarflexed first ray and hindfoot varus. When a block is placed under the lateral heel and lateral border, with the first metata…
- Foot: accessory navicular · ApplicationA 12-year-old girl has pain and a bony prominence on the medial border of the midfoot that is aggravated by tight shoes. Radiographs show a separate ossicle attached to…
- Foot: Jack test in flatfoot · ApplicationA 9-year-old has a flat arch when standing. When the examiner passively dorsiflexes the great toe, a medial arch appears and the heel inverts. What does this indicate?
- Foot: peroneal tendon dislocation · Multi-stepA skier falls with forced dorsiflexion of the ankle and feels a snap behind the lateral malleolus. A radiograph shows a small fleck of bone off the posterolateral dista…
- Foot: plantar fasciitis · ApplicationHeel pain worst with first steps after rest suggests what?
- Foot: hallux valgus · ApplicationLateral deviation of great toe at first MTP joint is called what?
- Foot · ApplicationSudden posterior ankle pain and positive Thompson test suggests what?
- Foot · ApplicationWhat causes pain under heel on first steps?
Hand injuries12
- Hand injuries: jersey finger · ApplicationA rugby player grips an opponent's shirt and the finger is pulled away. He cannot flex the distal interphalangeal joint of the ring finger. Which structure is injured?
- Hand injuries: gamekeeper thumb · ApplicationA skier falls with the thumb forced into abduction and is unable to pinch firmly. There is pain and laxity on radial stress of the thumb metacarpophalangeal joint. Whic…
- Hand injuries: Stener lesion · Multi-stepExamination of a thumb after a ski-pole injury shows complete ulnar collateral ligament rupture with a tender palpable lump proximal to the MCP joint. Ultrasound shows…
- Hand injuries: flexor tendon zone II · ApplicationA laceration across the proximal phalanx of the index finger divides both flexor tendons within the digital sheath. Why is repair in this zone traditionally called a no…
- Hand injuries: high-pressure injection injury · Multi-stepA mechanic accidentally injects grease from a high-pressure gun into his index fingertip. The finger looks only slightly swollen and is painless. What is the correct ma…
- Hand injuries: buddy strapping · ApplicationA carpenter has an undisplaced, stable, non-rotated fracture of the proximal phalanx of the ring finger. What is the simplest effective treatment?
- Hand injuries · ApplicationWhat nerve is commonly compressed in carpal tunnel syndrome?
- Hand injuries · ApplicationWhat deformity can result from ulnar nerve palsy?
- Hand injuries · ApplicationWhat nerve is affected in carpal tunnel syndrome?
- Hand injuries · ApplicationWhy is snuffbox tenderness after a fall on an outstretched hand clinically important?
- Hand injuries · ApplicationWhich tendon injury causes inability to actively extend the distal interphalangeal joint after a forced finger flexion?
- Hand injuries · ApplicationWhich injury prevents active flexion of the distal interphalangeal joint after forced extension?
Pediatric orthopaedics12
- Pediatric orthopaedics · ApplicationWhat is a common presentation of developmental dysplasia of the hip?
- Pediatric orthopaedics · ApplicationWhat is the usual problem in clubfoot?
- Pediatric orthopaedics · ApplicationWhat gait may be seen in a child with hip abductor weakness?
- Pediatric orthopaedics · ApplicationWhat symptom is characteristic of slipped capital femoral epiphysis?
- Pediatric orthopaedics · ApplicationDuring infant screening, asymmetry and reduced abduction when the hips are flexed raise concern for which developmental condition?
- Pediatric orthopaedics · ApplicationWhat condition presents with hip or knee pain and a limp in an overweight adolescent?
- Pediatric orthopaedics · ApplicationWhat finding can indicate developmental dysplasia of the hip?
- Pediatric orthopaedics · ApplicationWhat gait may occur with hip abductor weakness?
- Pediatric orthopaedics · ApplicationWhat is the preferred imaging test to screen infants at risk of developmental dysplasia of the hip before femoral head ossification?
- Pediatric orthopaedics · ApplicationA child with a limp and hip pain has fever and refuses to bear weight. What diagnosis must be excluded urgently?
- Pediatric orthopaedics: SCFE · Multi-stepAn obese adolescent has hip pain referred to the knee and an externally rotated leg. Which condition must be excluded urgently?
- Pediatric orthopaedics: developmental dysplasia · ApplicationWhich examination maneuver is used in newborns to attempt reduction of a dislocated but reducible hip?
Trauma12
- Trauma: crush syndrome · Multi-stepA man is rescued after 8 hours under a collapsed wall with a crushed thigh. Shortly after release he becomes hypotensive, passes dark brown urine and his ECG shows tall…
- Trauma: damage control orthopaedics · Multi-stepA polytrauma patient with a femoral fracture is in shock, is hypothermic and has coagulopathy. What is the preferred initial orthopaedic strategy?
- Trauma: Mangled Extremity Severity Score · Multi-stepA surgeon uses the Mangled Extremity Severity Score (MESS) to decide between salvage and amputation of a severely injured leg. Which set of factors does the score inclu…
- Trauma: open fracture · ApplicationWhat is a key immediate treatment for an open fracture?
- Trauma · ApplicationWhat is an immediate concern in open fracture?
- Trauma · ApplicationWhich sign supports compartment syndrome?
- Trauma · ApplicationWhat is key in a suspected scaphoid fracture with normal initial xray?
- Trauma · ApplicationWhat fracture risk follows neck-of-femur injury?
- Trauma · ApplicationWhat signs suggest compartment syndrome?
- Trauma · ApplicationWhy are repeated limb examinations important after trauma?
- Trauma: open fracture · Multi-stepA patient has a tibial fracture with bone visible through a contaminated wound. What is the most appropriate initial principle?
- Trauma: compartment syndrome · Multi-stepAfter a forearm fracture, a patient has escalating pain despite analgesia and marked pain when the fingers are passively extended. Pulses are present. What is the key d…
Fracture complications11
- Fracture complications · Multi-stepOn day 2 after a closed femoral shaft fracture, a young man becomes breathless and confused, has low oxygen saturation and a petechial rash over the chest and axillae.…
- Fracture complications: fat embolism · ApplicationA young man with a femoral shaft fracture develops breathlessness, confusion and petechiae over the chest and axillae 36 hours after injury. What is the most likely dia…
- Fracture complications: complex regional pain syndrome · ApplicationSix weeks after a distal radius fracture a woman has burning pain, swelling, shiny skin and stiff fingers disproportionate to the injury. What is the diagnosis?
- Fracture complications: myositis ossificans · ApplicationAfter a severe elbow dislocation treated with vigorous passive stretching, a young man develops increasing stiffness and a hard mass in front of the elbow. Radiographs…
- Fracture complications: late tendon rupture after distal radius fracture · Multi-stepThree weeks after a minimally displaced Colles fracture treated in a cast, a patient cannot extend the thumb interphalangeal joint. Which tendon has ruptured?
- Fracture complications: Volkmann contracture pathology · Multi-stepA 6-year-old is treated in a tight cast for a displaced supracondylar fracture. He had severe forearm pain worsened by passive finger extension, but the cast was not lo…
- Fracture complications: pulseless pink hand · Multi-stepA 5-year-old with a displaced extension-type supracondylar fracture has an absent radial pulse, but the hand is warm, pink and has brisk capillary refill. What is the m…
- Fracture complications: Sudeck atrophy on imaging · ApplicationSix weeks after a wrist fracture treated in plaster, a woman has burning pain, a swollen shiny hand and stiff fingers. Which radiographic finding is expected in this co…
- Fracture complications: bone scan in CRPS · Multi-stepA man has persistent pain, allodynia and skin colour change in the foot three months after an ankle fracture. Plain films are equivocal and a three-phase bone scan is r…
- Fracture complications: surgery for Volkmann contracture · Multi-stepA 12-year-old has a moderate established Volkmann contracture of the forearm flexors with fixed finger flexion and intact sensation. Which operation addresses the short…
- Fracture complications · ApplicationWhat is delayed union?
Hip fractures11
- Hip fractures · ApplicationA 78-year-old woman who walked independently falls and has a displaced intracapsular fracture of the femoral neck (Garden type IV). Which is the most appropriate treatm…
- Hip fractures: timing of surgery · ApplicationAn 82-year-old with a displaced intracapsular hip fracture is medically stable apart from stable chronic conditions. What is the best approach to the timing of surgery?
- Hip fractures: fascia iliaca block · ApplicationAn 85-year-old with a hip fracture is waiting for surgery and has severe pain, and opioids have caused confusion. Which analgesic technique is most suitable?
- Hip fractures · ApplicationAn older adult with a fall, groin pain, and shortened externally rotated leg likely has what?
- Hip fractures · ApplicationWhat complication is especially associated with intracapsular femoral neck fracture?
- Hip fractures · ApplicationWhat leg posture commonly accompanies a displaced femoral neck fracture?
- Hip fractures · ApplicationWhat injury is likely after a low-energy fall in an older adult with groin pain?
- Hip fractures · ApplicationAn older adult falls and has a shortened, externally rotated leg. Which diagnosis is most likely?
- Hip fractures · ApplicationWhy do displaced intracapsular femoral neck fractures carry a risk of avascular necrosis?
- Hip fractures · ApplicationAn older adult falls and has a shortened externally rotated leg with groin pain. Which injury is most likely?
- Hip fractures: avascular necrosis · ApplicationWhich complication is particularly associated with an intracapsular fracture of the femoral neck?
Hand9
- Hand: Guyon canal syndrome · ApplicationA long-distance cyclist has numbness of the little finger and weakness of finger abduction with sensation over the dorsum of the hand preserved. Where is the ulnar nerv…
- Hand: glomus tumour · Multi-stepA woman has years of severe pain under the fingernail triggered by cold and light touch, with a small bluish spot under the nail. Which diagnosis and treatment are appr…
- Hand: carpometacarpal arthritis of the thumb · ApplicationA 60-year-old woman has pain at the base of the thumb on opening jars. Axial compression of the thumb metacarpal with rotation against the trapezium reproduces the pain…
- Hand: carpal tunnel · ApplicationWhich symptom is typical of carpal tunnel syndrome?
- Hand: Dupuytren · ApplicationProgressive flexion contracture of ring finger from palmar fascia suggests what?
- Hand · ApplicationTriggering of a finger due to tendon catching is what?
- Hand · ApplicationInability to extend DIP after ball injury suggests what?
- Hand · ApplicationWhat causes nighttime median-nerve tingling?
- Hand · ApplicationWhat causes fixed flexed ring finger from palmar fascia?
Fracture healing8
- Fracture healing · Multi-stepA tibial shaft fracture treated in a cast shows no union at nine months. The radiograph shows flaring, sclerotic bone ends with abundant callus (elephant foot) and a pe…
- Fracture healing: types of nonunion · Multi-stepRadiographs of an ununited tibial fracture show hypertrophic callus with a persistent fracture line and flared bone ends, often called an elephant foot. What is the mai…
- Fracture healing: primary bone healing · Multi-stepPrimary (direct) bone healing is seen when a fracture is fixed with which conditions?
- Fracture healing · ApplicationUnion in poor alignment is what?
- Fracture healing · ApplicationFailure of fracture healing without progression is what?
- Fracture healing · ApplicationWhat tissue forms early in normal fracture healing?
- Fracture healing · ApplicationWhat term describes failure of a fracture to unite over an expected period?
- Fracture healing · ApplicationWhat term describes healing of a fracture in poor alignment?
Joints8
- Joints: Kellgren-Lawrence grading · Multi-stepIn the Kellgren-Lawrence classification of osteoarthritis, which radiographic finding defines grade 3?
- Joints: rheumatoid hand deformities · ApplicationA patient with rheumatoid arthritis has hyperextension at the PIP joint with flexion at the DIP joint. What is the deformity?
- Joints: atlantoaxial subluxation in rheumatoid arthritis · ApplicationIn a patient with long-standing rheumatoid arthritis, a lateral flexion cervical radiograph shows an atlanto-dens interval above 3 mm. Which issue should be anticipated?
- Joints: psoriatic arthritis · ApplicationWhich radiographic feature is characteristic of psoriatic arthritis?
- Joints: haemophilic arthropathy · ApplicationWhich joints are most frequently involved by haemarthrosis in haemophilia?
- Joints: Charcot arthropathy · ApplicationA man with syringomyelia develops a painless swollen disorganised shoulder joint. Which type of arthropathy is this?
- Joints: pigmented villonodular synovitis · Multi-stepA 30-year-old has a chronic swollen knee with recurrent blood-stained aspirate. MRI shows low signal blooming areas of synovium. What is the diagnosis?
- Joints: synovial chondromatosis · Multi-stepA man has a locking painful knee with multiple small calcified loose bodies of uniform size on radiograph. What is the likely diagnosis?
Knee injuries8
- Knee injuries · ApplicationWhich structure is commonly injured with a twisting knee injury and hemarthrosis?
- Knee injuries · ApplicationWhat examination maneuver assesses anterior cruciate ligament integrity?
- Knee injuries · ApplicationWhat structure can be injured by a blow to the lateral knee causing valgus stress?
- Knee injuries · ApplicationWhat clinical test is commonly used to assess anterior cruciate ligament integrity?
- Knee injuries · ApplicationWhat symptom pattern is typical of meniscal injury?
- Knee injuries · ApplicationWhat structure is commonly torn in a twisting knee injury with hemarthrosis?
- Knee injuries · ApplicationWhat test assesses anterior cruciate ligament laxity?
- Knee injuries · ApplicationWhich bedside test is commonly used to assess an anterior cruciate ligament injury?
Compartment syndrome7
- Compartment syndrome · Multi-stepA 25-year-old with a tibial shaft fracture in a below-knee cast has increasing pain 10 hours later that is unrelieved by analgesics. The calf is tense, passive toe exte…
- Compartment syndrome: delta pressure · Multi-stepA patient with a tibial fracture has pain on passive stretch and a tense calf. His diastolic pressure is 70 mmHg and the measured anterior compartment pressure is 48 mm…
- Compartment syndrome · ApplicationWhich early sign is most concerning for compartment syndrome?
- Compartment syndrome · ApplicationWhat is an early concerning feature of compartment syndrome?
- Compartment syndrome · ApplicationWhat is definitive urgent treatment for acute compartment syndrome?
- Compartment syndrome · ApplicationWhat is definitive treatment for acute compartment syndrome?
- Compartment syndrome · ApplicationWhat is the definitive treatment for acute compartment syndrome?
Hand disorders7
- Hand disorders · ApplicationA woman who is breastfeeding has pain at the radial side of her wrist. Her pain is reproduced when she makes a fist over her thumb and the wrist is deviated to the ulna…
- Hand disorders · ApplicationA 58-year-old man with chronic alcoholic liver disease has painless nodules in his right palm and a progressive inability to extend the ring and little fingers fully at…
- Hand disorders: palmar cutaneous branch in carpal tunnel · Multi-stepA woman with carpal tunnel syndrome has numbness of the thumb, index and middle fingers but normal sensation over the thenar eminence. What explains this?
- Hand disorders: Poland syndrome · ApplicationA boy has absence of the sternocostal head of pectoralis major on the right with short, webbed fingers of the right hand. What is the diagnosis?
- Hand disorders: intersection syndrome · Multi-stepA rower has pain, swelling and crepitus on the dorsoradial forearm about 5 cm proximal to the wrist, where tendons cross. Finkelstein test is negative. What is the diag…
- Hand disorders: carpal tunnel syndrome · ApplicationA patient has nocturnal tingling in the thumb, index, middle, and radial half of the ring finger. Which nerve is compressed?
- Hand disorders: Dupuytren disease · ApplicationA patient has painless nodules and cords in the palm causing progressive flexion contracture of the ring finger. What is the diagnosis?
Joint disorders7
- Joint disorders · ApplicationA 60-year-old man with long-standing diabetic neuropathy has a swollen, warm, but painless midfoot with joint destruction, fragmentation and subluxation on radiographs.…
- Joint disorders: reactive arthritis · ApplicationA 24-year-old man has an asymmetric painful swelling of the knee and ankle 3 weeks after an episode of urethritis, with conjunctivitis and a painless circinate balaniti…
- Joint disorders: alkaptonuric ochronosis · ApplicationA 45-year-old has low back stiffness, early large joint arthritis and dark pigmentation of the ear cartilage. His urine turns black on standing. Radiographs show calcif…
- Joint disorders: Outerbridge classification · ApplicationAt knee arthroscopy, the surgeon finds full-thickness cartilage loss on the medial femoral condyle with exposed subchondral bone. What Outerbridge grade is this?
- Joint disorders: microfracture · ApplicationA 28-year-old has a 1.5 cm full-thickness cartilage defect of the femoral condyle with a stable knee and normal alignment. Which technique stimulates repair by releasin…
- Joint disorders: Jaccoud arthropathy · Multi-stepA young woman with systemic lupus erythematosus has reducible ulnar deviation of the fingers and swan-neck deformities, with no erosions on radiographs. What is this ca…
- Joint disorders: Clutton joints · ApplicationA 12-year-old with Hutchinson teeth and interstitial keratitis has painless symmetrical swelling of both knees with sterile effusions. What is the likely joint disorder?
Skeletal dysplasias7
- Skeletal dysplasias: pycnodysostosis · Multi-stepA short-statured child has dense bones that fracture easily, persistently open anterior fontanelle, an obtuse mandibular angle and terminal phalangeal acro-osteolysis.…
- Skeletal dysplasias: Camurati-Engelmann disease · Multi-stepA 10-year-old child has leg pain, a waddling gait, muscle weakness and symmetrical thickening of the diaphyses of the long bones on radiographs, with sparing of the epi…
- Skeletal dysplasias: Morquio syndrome · Multi-stepA 6-year-old with normal intelligence has short trunk dwarfism, platyspondyly, corneal clouding and a hypoplastic odontoid process. Which accumulation is responsible, a…
- Skeletal dysplasias: Hurler syndrome · ApplicationA 2-year-old has coarse facies, corneal clouding, hepatosplenomegaly, a thoracolumbar gibbus and radiographs showing oar-shaped ribs and beaked vertebrae. Which diagnos…
- Skeletal dysplasias: cleidocranial dysplasia · Multi-stepA boy can bring both shoulders together in front of his chest. He has a large open anterior fontanelle, frontal bossing and delayed eruption of teeth. What is the diagn…
- Skeletal dysplasias: ossification in cleidocranial dysplasia · ApplicationWhich bones are mainly affected in cleidocranial dysplasia, and by what ossification process do they form?
- Skeletal dysplasias: fibrodysplasia ossificans progressiva · Multi-stepA 4-year-old has short, valgus-deviated great toes and painful neck swellings that later become hard. A surgeon plans a biopsy of a lump. What is the correct advice?
Arthritis6
- Arthritis · ApplicationA 62-year-old has activity-related knee pain with brief morning stiffness. Which radiograph pattern best fits osteoarthritis?
- Arthritis: pseudogout · ApplicationRhomboid positively birefringent crystals indicate what?
- Arthritis · ApplicationSymmetric small-joint inflammatory arthritis suggests what?
- Arthritis · ApplicationMorning stiffness under 30 minutes with bony enlargement suggests what?
- Arthritis · ApplicationWhat crystal is negatively birefringent?
- Arthritis · ApplicationWhat crystal is positively birefringent?
Fracture care6
- Fracture care · ApplicationWhat is the purpose of splinting a suspected fracture before transfer?
- Fracture care · ApplicationWhat fracture feature requires urgent neurovascular reassessment?
- Fracture care · ApplicationWhat is the primary purpose of reducing a displaced fracture?
- Fracture care · ApplicationWhich fracture is classically associated with radial nerve palsy?
- Fracture care · ApplicationWhat should be assessed distal to an injured limb?
- Fracture care · ApplicationWhat does immobilization achieve after fracture reduction?
Fractures in children6
- Fractures in children · ApplicationA child with a displaced supracondylar fracture of the humerus develops a painful, pale forearm with pain on passive finger extension. If untreated, which complication…
- Fractures in children: supracondylar · ApplicationA 6-year-old falls on an outstretched hand and has a displaced supracondylar fracture of the humerus. After the injury he cannot form an 'OK' sign with the thumb and in…
- Fractures in children: triplane fracture · Multi-stepA 14-year-old girl twists her ankle in netball. Radiographs show a physeal fracture of the distal tibia with a vertical epiphyseal split and a posterior metaphyseal fra…
- Fractures in children: newborn clavicle fracture · ApplicationA newborn delivered after shoulder dystocia does not move the right arm. There is crepitus over the clavicle and the grasp reflex is intact. What is the best management?
- Fractures in children: tibial spine avulsion · Multi-stepA 10-year-old falls off a bicycle and has a haemarthrosis with a positive Lachman test. A radiograph shows an avulsed fragment from the intercondylar eminence of the ti…
- Fractures in children: femoral shaft fracture at 8 years · Multi-stepAn 8-year-old boy has a closed transverse midshaft femoral fracture after a fall from a tree. He weighs 28 kg. Which treatment is most appropriate?
Joint infection6
- Joint infection: Kocher criteria · ApplicationA child with a painful hip is assessed for septic arthritis. Which is one of the Kocher criteria?
- Joint infection: prosthetic joint infection · Multi-stepLate infection of a total knee prosthesis by coagulase-negative staphylococci is difficult to eradicate mainly because of what?
- Joint infection: synovial fluid analysis · ApplicationWhich synovial fluid finding best supports septic arthritis?
- Joint infection: neonatal septic hip · ApplicationA 10-day-old premature baby, who had a central line, lies with the right leg flexed, abducted and externally rotated and does not move it. There is little fever. What i…
- Joint infection: gonococcal arthritis · ApplicationA sexually active 22-year-old woman has 3 days of migratory joint pains, tenosynovitis of the wrist and a few pustular lesions on the hands, with a single swollen knee.…
- Joint infection: Tom Smith arthritis · Multi-stepAn infant who survived septicaemia has an unstable hip with shortening and a proximally migrated head, resulting from destruction of the femoral head and neck by earlie…
Shoulder injuries6
- Shoulder injuries · ApplicationWhat is the most common direction of shoulder dislocation?
- Shoulder injuries · ApplicationWhich nerve is vulnerable in anterior shoulder dislocation?
- Shoulder injuries · ApplicationWhich injury commonly follows a fall directly onto the shoulder tip?
- Shoulder injuries · ApplicationWhat nerve should be checked after an anterior shoulder dislocation?
- Shoulder injuries · ApplicationAfter a direct fall onto the point of the shoulder, a patient has a visible step deformity above the lateral clavicle. Which injury is most likely?
- Shoulder injuries · ApplicationWhat tendon group stabilizes the shoulder joint dynamically?
Techniques6
- Techniques: skin traction · ApplicationWhat is the maximum weight usually applied through skin traction for an adult?
- Techniques: high tibial osteotomy · ApplicationA 45-year-old active man has isolated medial compartment knee osteoarthritis with varus alignment. Which procedure may delay arthroplasty?
- Techniques: thoracic outlet syndrome · ApplicationA woman has paraesthesia along the medial forearm and hand, and the radial pulse disappears when she turns her head to the affected side and takes a deep breath. A cerv…
- Techniques: pin tract infection · ApplicationOn day 5 after application of an external fixator, a patient has mild erythema and serous drainage around one pin without systemic signs. What is the best initial manag…
- Techniques: position of arthrodesis · ApplicationWhen the knee is fused for a destroyed joint, which position is generally chosen for the arthrodesis?
- Techniques: distal femoral osteotomy · ApplicationA 35-year-old active woman has valgus alignment of the knee with isolated lateral compartment osteoarthritis. Which osteotomy is used to offload the lateral compartment?
Arthroplasty5
- Arthroplasty: metal-on-metal bearing · Multi-stepFive years after a metal-on-metal hip resurfacing, a woman has groin pain and a cystic mass near the hip. Serum cobalt and chromium are markedly raised and MRI shows a…
- Arthroplasty: cemented stem for hemiarthroplasty · ApplicationAn 82-year-old woman with osteoporosis has a displaced intracapsular femoral neck fracture and is to receive a hemiarthroplasty. Which choice of stem fixation is genera…
- Arthroplasty: Charnley low friction principle · ApplicationSir John Charnley's low friction arthroplasty improved the longevity of hip replacement. Which design feature was central to it?
- Arthroplasty: wear particle osteolysis · ApplicationTen years after a total hip replacement, a patient has thigh pain and radiographs show progressive radiolucency around the acetabular cup, with no features of infection…
- Arthroplasty: prosthetic joint infection · Multi-stepA patient with a knee replacement develops new pain, warmth, effusion, fever, and raised CRP. Which complication must be urgently considered?
Rehabilitation5
- Rehabilitation · ApplicationWhat is a main goal of early rehabilitation after stable injury?
- Rehabilitation · ApplicationWhat is an important goal of physiotherapy after joint surgery?
- Rehabilitation · ApplicationWhat is a principal goal of postoperative physiotherapy?
- Rehabilitation · ApplicationFor a patient using crutches with a non-weight-bearing lower limb, which safety instruction is most important on stairs?
- Rehabilitation · ApplicationWhat is the main goal of postoperative thromboprophylaxis after major lower-limb surgery?
Septic arthritis5
- Septic arthritis · Multi-stepA 4-year-old has a three-day fever, refuses to bear weight and holds her right hip flexed, abducted and externally rotated, crying on any movement. Temperature is 39 C,…
- Septic arthritis · ApplicationWhat is an important management step for suspected septic arthritis?
- Septic arthritis · ApplicationWhat is the priority when septic arthritis is suspected?
- Septic arthritis · ApplicationWhat is an essential step in suspected septic arthritis?
- Septic arthritis · ApplicationWhat is the most appropriate next step for a hot, swollen joint with fever and suspected septic arthritis?
Sports injuries5
- Sports injuries: chronic exertional compartment syndrome · ApplicationA 24-year-old long-distance runner has tight, aching pain in both lower legs after 15 minutes of running that settles within 20 minutes of rest. Examination at rest is…
- Sports injuries: anterior tibial stress fracture · Multi-stepA basketball player has anterior shin pain on jumping. A lateral radiograph shows a thin horizontal lucent line in the anterior tibial cortex. What is the concern with…
- Sports injuries: female athlete triad · ApplicationA 19-year-old distance runner has amenorrhoea, a low body weight and a second metatarsal stress fracture. Which combination describes the underlying syndrome?
- Sports injuries · ApplicationWhich feature suggests a stress fracture rather than acute complete fracture?
- Sports injuries · ApplicationWhat is the usual mechanism of anterior talofibular ligament injury?
Ankle injuries4
- Ankle injuries · ApplicationA man twists his ankle and the radiograph shows a fibular fracture proximal to the syndesmosis with widening of the medial clear space and a positive stress view. What…
- Ankle injuries: Ottawa ankle rules · ApplicationA 25-year-old has a twisted ankle. She has swelling but no bony tenderness at the posterior edge or tip of either malleolus and can take four steps both at the scene an…
- Ankle injuries: Weber C fibular fracture · Multi-stepA man twists his ankle and radiographs show a fibular fracture 8 cm above the joint line with widening of the medial clear space. What is the implication?
- Ankle injuries · ApplicationWhich ligament is most often injured in an inversion ankle sprain?
Foot and ankle4
- Foot and ankle · ApplicationWhich feature is concerning for a Lisfranc injury after midfoot trauma?
- Foot and ankle · ApplicationWhat is the key concern in a diabetic patient with a hot swollen minimally painful foot?
- Foot and ankle: Achilles rupture · ApplicationA middle-aged person feels as if kicked in the calf while pushing off to run and cannot stand on tiptoe. Which test supports Achilles tendon rupture?
- Foot and ankle: ankle fracture · ApplicationAccording to the Ottawa ankle rules, which finding supports ankle radiography after an ankle injury?
Genetic bone disorders4
- Genetic bone disorders: osteopoikilosis · ApplicationRadiographs of a 30-year-old taken for knee pain after a fall show multiple small, round, uniform sclerotic foci clustered around the knee and hip epiphyses. He has no…
- Genetic bone disorders: melorheostosis · ApplicationA teenager has pain and joint contracture in one lower limb. Radiographs show dense cortical hyperostosis that flows along the bone like melted candle wax, in a single…
- Genetic bone disorders: Fassier-Duval rod · Multi-stepA 4-year-old with osteogenesis imperfecta type III has recurrent femoral fractures and progressive bowing despite bisphosphonate therapy. Which surgical approach is com…
- Genetic bone disorders: nail-patella syndrome · Multi-stepA young man has dysplastic fingernails, hypoplastic patellae with recurrent dislocation and bilateral posterior iliac horns on pelvic radiograph. Which organ should be…
Inflammatory arthritis4
- Inflammatory arthritis · ApplicationA 22-year-old man has chronic low back pain with morning stiffness that improves with exercise and not with rest. Which radiographic finding is usually the earliest?
- Inflammatory arthritis · ApplicationWhat joint pattern is common in rheumatoid arthritis?
- Inflammatory arthritis · ApplicationWhat pattern favors rheumatoid arthritis over osteoarthritis?
- Inflammatory arthritis · ApplicationWhich laboratory marker may support monitoring inflammation in rheumatoid arthritis but is not diagnostic alone?
Knee ligament injuries4
- Knee ligament injuries · ApplicationA footballer twists his knee while pivoting, feels a pop and develops a large swelling within hours. The Lachman test shows increased anterior translation with a soft e…
- Knee ligament injuries: pivot shift test · Multi-stepAn examiner extends the knee, applies a valgus force with internal rotation of the tibia and then flexes the knee. At about 30 degrees the patient feels a sudden clunk…
- Knee ligament injuries: Lachman versus anterior drawer · ApplicationWhy is the Lachman test usually more sensitive than the anterior drawer test in an acutely injured knee?
- Knee ligament injuries: Pellegrini-Stieda lesion · ApplicationA footballer had a valgus knee injury several months ago and has persistent medial knee pain. Radiographs show an ossific shadow adjacent to the medial femoral condyle.…
Osteoarthritis4
Osteoporosis4
- Osteoporosis · ApplicationWhat test measures bone mineral density?
- Osteoporosis · ApplicationWhat is a major preventable consequence of osteoporosis?
- Osteoporosis · ApplicationWhich imaging study uses dual-energy X-ray absorptiometry to quantify hip and spine bone density in osteoporosis assessment?
- Osteoporosis · ApplicationWhich fracture pattern is particularly typical of osteoporotic vertebral bone?
Pelvis4
- Pelvis: Young-Burgess lateral compression · Multi-stepA pedestrian is struck from the side by a car. Pelvic radiographs show horizontal rami fractures with an impacted sacral fracture on the same side. Which Young-Burgess…
- Pelvis: Young-Burgess APC III · Multi-stepA driver crushed in a head-on collision has symphysis diastasis and the posterior sacroiliac ligaments are completely disrupted. He is hypotensive. Which pattern is thi…
- Pelvis: vertical shear injury · Multi-stepA construction worker falls from a scaffold and lands on his right leg. The right leg appears shortened and the pelvic radiograph shows upward displacement of the right…
- Pelvis: sacral insufficiency fracture · Multi-stepA 78-year-old osteoporotic woman has severe buttock and low back pain after minimal activity, with a normal pelvic radiograph. A bone scan shows an H-shaped pattern of…
Spinal cord injury4
- Spinal cord injury · Multi-stepA man is stabbed on the right side of his back at the T10 level. On examination, he has right leg weakness with loss of vibration and position sense on the right, and l…
- Spinal cord injury: methylprednisolone · ApplicationA 30-year-old has a cervical spinal cord injury after a diving accident. Which statement about high-dose methylprednisolone in acute spinal cord injury reflects current…
- Spinal cord injury: neurogenic shock · ApplicationA man with a T4 complete spinal cord injury has a blood pressure of 80/50 mmHg, a heart rate of 50 per minute and warm, dry peripheries. What is the diagnosis?
- Spinal cord injury: ASIA grade B · Multi-stepAfter a fall, a man has no voluntary movement below the level of injury but retains light touch and pinprick sensation in the perianal region and below the level. Which…
Foot disorders3
- Foot disorders: ingrown toenail · ApplicationA 17-year-old has recurrent painful infection of the lateral edge of the great toenail with granulation tissue despite conservative care. Which procedure gives the lowe…
- Foot disorders · ApplicationWhat tissue is inflamed in plantar fasciitis?
- Foot disorders · ApplicationWhat joint is commonly affected in an acute gout attack?
Hand infections3
- Hand infections: Kanavel signs · Multi-stepA carpenter has a swollen, flexed index finger after a puncture wound 3 days ago. Which Kanavel sign is considered the most important in diagnosing pyogenic flexor teno…
- Hand infections: felon · ApplicationA gardener has a throbbing, very tense swelling of the index fingertip pulp after a thorn prick. What is the main reason this infection can lead to osteomyelitis of the…
- Hand infections: clenched fist injury · ApplicationA man presents the day after punching someone in the mouth with a small wound over the third metacarpophalangeal joint. Which organism needs to be covered, and what is…
Open fractures3
- Open fractures · Multi-stepA farmer's tibia is fractured by a tractor wheel. A 14 cm wound is contaminated with soil, with extensive periosteal stripping and exposed bone that cannot be covered w…
- Open fractures: antibiotic for type III injury · ApplicationA farmer has an open tibial fracture with a 14 cm contaminated wound and extensive soft tissue loss. Which antibiotic regimen is conventionally given in addition to tet…
- Open fractures: wound irrigation · ApplicationDuring debridement of an open tibial fracture, which type of irrigation is preferred?
Sports3
- Sports: tennis elbow · ApplicationPain at lateral epicondyle with wrist extension suggests what?
- Sports: Achilles tendon · ApplicationA patient cannot actively plantarflex after a sudden painful snap behind the ankle. Which bedside test supports Achilles tendon rupture?
- Sports · ApplicationWhat causes lateral elbow pain with wrist extension?
Upper-limb injuries3
Acetabular fractures2
- Acetabular fractures: Judet views · ApplicationAfter a road traffic crash, anteroposterior pelvic radiographs suggest an acetabular fracture. Which additional radiographs are used to define the columns and walls?
- Acetabular fractures: posterior wall · Multi-stepIn Letournel's classification, which elementary acetabular fracture pattern is commonest, and which nerve is most at risk with it?
Bone disease2
Bone tumor2
Bone tumors2
Crystal arthritis2
Crystal arthropathy2
- Crystal arthropathy · ApplicationWhat do the crystals in synovial fluid of gout look like under polarised light?
- Crystal arthropathy: associations of CPPD · Multi-stepA 44-year-old has knee chondrocalcinosis on radiographs and mild diabetes with skin pigmentation. Which underlying disease should be sought?
Elbow2
Elbow injuries2
Fracture2
Fracture assessment2
Hip disorders2
Infection2
Knee trauma2
- Knee trauma: ACL injury · ApplicationA footballer twists the knee, hears a pop, develops rapid swelling, and later reports instability when changing direction. Which ligament is most likely injured?
- Knee trauma: septic arthritis · Multi-stepA child has fever, refuses to bear weight, and has a hot painful swollen knee with restricted passive motion. What is the priority?
Lower-limb injuries2
Shoulder trauma2
- Shoulder trauma: anterior dislocation · ApplicationAfter a fall onto an outstretched arm, a patient has a squared-off shoulder contour and holds the arm slightly abducted and externally rotated. What is most likely?
- Shoulder trauma: axillary nerve · ApplicationAfter reduction of an anterior shoulder dislocation, which deficit suggests axillary nerve injury?
Tendon2
Tendon injuries2
Upper-limb trauma2
Wrist2
- Wrist: triangular fibrocartilage complex injury · Multi-stepA gymnast has ulnar-sided wrist pain with a painful click on rotation after a fall on the pronated hand. Plain films are normal. Which structure is most likely injured?
- Wrist: scaphoid nonunion advanced collapse · Multi-stepA manual worker has chronic wrist pain years after an untreated scaphoid nonunion. Radiographs show arthritis between the radial styloid and the scaphoid, later involvi…
Bone and joint infection1
Humeral shaft fractures1
Low back pain1
Orthopedic emergencies1
Orthopedic infection1
Orthopedic oncology1
Pediatric trauma1
Perioperative orthopaedics1
Peripheral nerve entrapment1
Rheumatology1
Shoulder disorders1
Spine trauma1
Trauma care1
Upper limb fractures1
Wrist injuries1
Common questions
How many Orthopaedics questions are there?
922 original questions across 753 topics, and the bank grows over time.
Which Orthopaedics topics are covered?
Upper limb fractures, Fractures in children, Bone tumours, Hip, Peripheral nerve entrapment, Paediatric orthopaedics, Infections, Crystal arthropathy, Spine infection, Compartment syndrome, Fracture complications, Spine, and more.
How difficult are these Orthopaedics questions?
0 are recall, 644 are application and 278 are multi-step. The tags are our own editorial judgement, not an official difficulty rating.
Are these Orthopaedics questions from past papers?
No. They are original practice items. NBEMS does not publish its paper or an official key, and we do not use recalled or leaked questions.
Can I practise Orthopaedics for free?
Yes. The free plan includes 20 practice questions a day across all subjects, and the free 20-question assessment covers every subject. A paid term removes the daily limit.
Is there a timed Orthopaedics test?
Yes. The Orthopaedics subject test is included with a paid term, with a countdown and a question palette.
How should I use these Orthopaedics questions?
Answer before you look, read the reason for every option, and write a three-line note for each mistake. A few questions you fully review are worth more than many you skim.
Have these Orthopaedics questions been reviewed by faculty?
Not yet. They are original and drafted with AI assistance, then edited by our team. Independent faculty review is planned, and each item shows its status. Confirm important facts in a standard textbook.