EMQs in Clinical Medicine.pdf - Peshawar Medical College

140 Orthopaedics and rheumatology
continued
• Winged scapula Long thoracic nerve injury [32]
‘Dinner fork’ deformity Colles’ fracture [49]
• Forced adduction and flexion thumb De Quervain’s syndrome
elicits pain on radial side wrist
• Thickening, fibrosis palmar fascia Dupuytren’s contracture
• Pain, paraesthesia median nerve Carpal tunnel syndrome
distribution
Box 6 summarizes some typical presenting symptoms/signs that you may find in
an EMQ that is describing a particular problem in the lower limb.
Box 6 Orthopaedic presentations: lower limb
Presentation
Problem
Flexed, adducted and externally rotated Femoral shaft fracture
leg
Locked knee, positive McMurray’s test Meniscal tear [51]
Drop foot after hip replacement Sciatic nerve injury [36]
Drop foot after knee injury Common peroneal nerve injury [32]
Excessive anterior glide tibia on femur Anterior cruciate ligament injury [51]
Excessive posterior glide tibia on femur Posterior cruciate ligament injury
Prominent tender tibial tubercle Osgood–Schlatter disease [51]
Radiological findings can often prove to be the best clue to the correct answer in
an EMQ.
Box 7 summarizes some radiological findings that are typical of particular
conditions.
Box 7 Radiological findings
Findings
Condition
• Loss of joint space Osteoarthritis [42]
Subchondral sclerosis
Subchondral cysts
Osteophytes
• Loss of joint space Rheumatoid arthritis [42, 53]
Juxta-articular osteoporosis
Erosions, subluxation joints
• Localized enlargement of bone with Paget’s disease
deformity (e.g. enlarged skull, bowed tibia)
• Syndesmophytes Ankylosing spondylitis [45, 52]
‘Bamboo-spine’ appearance
• ‘Sunray’ spiculation
Osteosarcoma
• ‘Onion-peel sign’
Ewing’s sarcoma