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Medicine year 2 semester 2 > Case 24- Pathology 2 > Flashcards

Case 24- Pathology 2 Flashcards

1
Q

Journey of a patient in a major road traffic accident

A
  • Would be brough in by ambulance to a major trauma unit at A&E
  • Trauma team is alerted and they go through the primary survey before the fracture is dealt with
  • Cervical spine immobilisation
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2
Q

Journey of a patient with a minor accident

A
  • Would self present to a minor injuries unit at A&E

* Assessed by a triage nurse then a nurse practitioner or doctor

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3
Q

Management of open fractures

A
  • Intravenous antibiotics to be administered as soon as possible
  • Assessment and documentation of neurovascular status
  • Re align and splint the limb, wound debridement (clean the wound) and stabilisation of the fracture
  • Tetanus toxoid status should be checked and administered if required
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4
Q

Types of fractures

A

Comminuted fracture- when the bone splits into lots of different pieces, there are multiple segments
Simple fracture- when the bone splits into two pieces
Segmental fracture- when its fractured at two different places and becomes completely detatched.
Children fracture- the periosteum is very strong so the bone can fracture and the periosteum keeps it in place

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5
Q

Incomplete and complete fracture

A

A complete fracture is when the two ends of the bone completely break off and an incomplete fracture is when one part off the bone breaks but the other is still intact or the thick periosteum can hold it in. Incomplete fractures are common in children who may get a buckle fracture where the bone buckles but the periosteum is still intact and only part of the bone breaks

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6
Q

Causes of different types of fractures

A

Spinal and oblique fractures- when the break is at an angle, normally because the arm has been twisted.
Transverse fracture- due to direct trauma, normally a knife wound
Segmental fracture- due to multiple breaks often due to a high impact trauma

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7
Q

Intra-articular fracture and pathological fracture

A

An intra-articular fracture involves the joint and is more worrying then an extra-articular fracture. If it affects the joint it can lead to arthritis and stiffness.
Pathological fracture- fracture caused without an injury i.e. in osteoarthritis or bone cancer

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8
Q

Structures in the soft tissue

A 
Skin
Subcutaneous tissue- fat
Muscle
Tendon
Ligaments
Nerve
Blood vessels
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9
Q

Anatomy of the soft tissue

A

Skin- epidermis, dermis
Subcutaneous tissue- fat deep to the skin
Fascia- deep to the fat, overlies the muscles

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10
Q

3 steps of wound healing

A

1) Inflammation
2) Proliferation
3) Remodelling

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11
Q

Wound healing- Proliferative phase

A

Epithelialisation
Formation of granulation tissue
Wound contraction
Angiogenesis

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12
Q

Types of soft tissue injuroes

A

1) Open
2) Penetrating- incised wound, laceration
3) Blunt- Burst laceration, Crush, De-gloving injury, Avulsion, Amputation

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13
Q

Laceration/Incised wound treatment

A

1) Wound debridement
2) Wound washout
3) Repair damaged structures
4) Wound closure

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14
Q

Skin loss

A

Burn, Abrasian, De-gloving injury, Skin necrosis

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15
Q

Effects of skin loss

A

Superficial- Adnexal structures intact, good healing potential
Full-thickness= could heal by secondary intention, may need skin graft or flap
Associated infection/contamination

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16
Q

Complex tissue injury

A

1) Skin and soft tissue loss
2) Exposed structures- muscle/tendon/nerve
3) Exposed bone/fracture
4) Amputation

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17
Q

Management of tissue loss

A

1) Reconstructive ladder/elevator
2) Laceration/incised wound- primary closure
3) Skin loss- secondary intention, skin graft
4) Involvement muscle/tendon/bones- skin graft, flap

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18
Q

Skin grafts and flap

A

Graft- tissue moved from one site to another. Is separated from its blood supply and picks up a new blood supply from the recipient site. Requires a vascularised bed
Fap- tissue moved from one site to another. Brings its blood supply with it. Used to cover non-vascularised tissue i.e. bone, tendon

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18
Q

Skin grafts and flap

A

Graft- tissue moved from one site to another. Is separated from its blood supply and picks up a new blood supply from the recipient site. Requires a vascularised bed
Fap- tissue moved from one site to another. Brings its blood supply with it. Used to cover non-vascularised tissue i.e. bone, tendon

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19
Q

Split thickness skin graft

A

Sheet- laid on as sheet tissue
Meshed- lots of small holes in the graft. Allows graft to be stretched to increase area covered. Allows blood to drain from underneath
Full thickness- full thickness skin taken. Need to stitch up donor site

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20
Q

Classifying flaps

A

Based on:

1) Blood supply- random pattern, axial
2) Constituents- cutaneous, fasciocutaneous, muscle, musculocutenous, osseous, osseocutaneous
3) Method of movement- transposition, advancement, rotation, pedicled, free flap
4) Location to defect- local, regional, distant- free tissue transfer

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21
Q

Compartment syndrome

A

Increased pressure within a muscle compartment
Causes- fractures, crush injury, reperfusion injury
Bleeding
Swelling
Pain- beyond that expected for injury, on stretching muscles
Pulseless, Pallor, Paraesthesia
Treatment- open up leg

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21
Q

Compartment syndrome

A

Increased pressure within a muscle compartment
Causes- fractures, crush injury, reperfusion injury
Bleeding
Swelling
Pain- beyond that expected for injury, on stretching muscles
Pulseless, Pallor, Paraesthesia
Treatment- open up leg

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22
Q

Tendon injury

A

Open- sharp division tendon
Closed- Rupture- tendon snaps mid substance
Closed- Avulsion- tendon avulsed from insertion

23
Q

Tendon injury- Division

A

1) Open injury
2) Sharp object
3) Most commonly knife or glass
4) Most commonly see in the forearm and hand- Falls, DIY, Cooking, Deliberate self harm

24
Q

Terminology- Upper limb

A 
Radial= thumb side (lateral)
Ulnar= little finger side (medial)
Palm= Palmar= Volar= Flexor
Dorsal= extensor
Active movement- movement achieved by the muscle action of the patient
Passive movement- movement achieved
25
Q

Different types of tendons

A

Extensor tendon- dorsal aspect of forearm and hand

Flexor tendons- volar aspect forearm and hand

26
Q

Assessment of tendon injury

A 
Posture of hand
Cascade- normal resting position fingers
Active movement
Pain on movement
Posture of hand
Extensor lag- no active movement, can passively extend
27
Q

Tendon rapair

A

1) Skin marketing
2) Protect other structures
3) Sound repair
4) Post-operative rehabilitation
5) Modified Kessler
6) Adelaide repair
7) Tendon repair- epitendinous suture

28
Q

Post-operative rehabilitation Tendon injury

A

1) Splint
2) Physiotherapy
3) Controlled mobilisation

29
Q

Tendon injury- rupture

A

1) Closed injury
2) Tendon ruptures mid substance
3) Associated with fractures
4) Associated with arthritis

30
Q

EPL rupture

A

1) Extensor pollicis longus
2) 3rd dorsal compartment
3) Distal radius fracture

31
Q

Tendoachilles

A

1) Plantarflexes ankle
2) Sports injury- sudden dorsiflexion of foot when the calf muscles are tensed, direct impact
3) Elderly
4) Treatment- Quinolone antibiotics, steroid injections
5) Sudden pain, difficulty walking, snapping sound
6) Loss of plantarfexion, unable to stand on toes

32
Q

Management of tendoachilles

A

Non-operative management- cast

Surgery- tendon repair, better outcomes. Increased risk of complications

33
Q

Tendon injury- avulsion

A

1) Tendon pulled away from bone due to sudden force
2) Most commonly seen sports injury
3) Commonly seen in the hand at lower limbs

34
Q

Soft- tissue mallet

A

1) Extensor tendon avulsed base distal phalanx
2) Extensor lag- unable to extend DIP joint
3) May be associated with fracture- bony mallet
4) Management- splintage

35
Q

FDP avulsion

A

1) Jersey finger- rugby injury
2) Unable flex DIP joint
3) May be associated with fracture
4) Management- surgical repair

36
Q

Nerve injury

A

Open- incised wound/laceration. Nerve division

Closed- traction, compression

37
Q

Nerve injury- division

A

1) Open injury
2) Incised or penetrating wound
3) Most commonly in the hand and forearm
4) Primary repair

37
Q

Nerve injury- division

A

1) Open injury
2) Incised or penetrating wound
3) Most commonly in the hand and forearm
4) Primary repair

38
Q

Nerve anatomy of the hand

A 
Normal anatomy- median nerve, ulnar nerve, radial nerve
Danger sites (superficial nerves)- Superficial radial nerve, digital nerve (radial and ulnar)
39
Q

Assessment of nerve injury

A

Sensation- radial (extensor pollicis longus), median (abductor pollicis brevis), ulnar (abductor digiti minimi)
Compare with normal- out of 10
Biro= 2-point discrimination

40
Q

Nerve injury- traction injury

A

Nerve stretched- sudden high velocity force. High speed road traffic accidents, associated with fractures or dislocation
Rupture- axons, fascicles, nerve
Nerve avulsed spinal cord

41
Q

Classification of nerve injuries

A

Seddon
Neuropraxia- concussion
Axonotmesis- sheath intact, axons cut
Neurotmesis- sheath and axons cut

42
Q

Nerve injury- compression

A

Soft tissue swelling- compartment syndrome
Fractures or dislocations
Long-lie= Saturday night palsy
Usually neurapraxia
Longer duration or greater compression recovery depends on the extent of nerve damage

43
Q

Management of nerve compression

A 
Watch and wait
Repeated clinical examination
Neurophysiology
Nerve grafts
Nerve transfers
44
Q

Nerve injury and compression= acute/ chronic

A

Acute- Laceration, Penetrating wounds, fracture, haematoma

Chronic- Meralgia paraesthesia, Tarsal tunnel syndrome

45
Q

Injury to the Femoral nerve

A

1) Posterior dislocation hip
2) Hip surgery
3) Laceration- stab wound, penetrating injury

46
Q

Femoral nerve sensation

A

1) Anterior thigh
2) Medial leg via saphenous nerve
3) Motor- knee extension

47
Q

Sciatic nerve injury

A

1) Posterior dislocation hip
2) Hip surgery
3) Laceration- stab wound, penetrating injury

48
Q

Sciatic nerve sensation

A

Sensation- no sensory branches in the thigh
Hip extension/knee flexion (motor)- Semimembranosus, Semitendinosus, Biceps femoralis (long head), Branch to adductor magnus

49
Q

Tibial nerve injury

A 
Fractures
Dislocation knee
Dislocation ankle
Compression
Baker's cyst
Tarsal tunnel
50
Q

Tibial nerve sensation

A

Motor
Ankle plantar flexion
Toe flexion

Sensory- sole of the foot

51
Q

Injury to the common peroneal nerve

A

Fracture of the fibula head
Lacerations
Compression- Casts/braces. Habitual knee flexion ‘Strawberry pickers’ palsy’
Divides into a deep and superficial nerve

52
Q

Superficial peroneal nerve sensory

A

Sensation- two thirds lateral leg, dorsum foot except 1st webspace
Motor- Ankle eversion (Peroneus longus, Peroneus brevis, Peroneus tertius)

53
Q

Deep peroneal nerve sensory

A

Sensation- dorsum foot 1st webspace
Motor- Ankle dorsiflexion (anterior tibialis), Toe extension (Extensor hallucis longus, Extensor digitorum brevis)
Results- stub toe, Footdrop

54
Q

Nerve compression syndromes

A

1) Meralgia parasthesia

2) Tarsal tunnel syndrome

55
Q

Lateral cutaneous nerve thigh

A

Meralgia paraesthesia
Compression- Idiopathic, External i.e. seat belt/tool belt, Pregnancy, Obesity
Injury- Iatrogenic (Hip surgery, Inguinal hernia repair)
Sensation= Anterior-lateral thigh

Medicine year 2 semester 2 (47 decks)

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