Cortex Flashcards
risk factors for type 1/post menopausal osteoporosis
early menopause white caucasians smoking alcohol low exercise poor diet
risk factors for type 2/ old age osteoporosis
vit D / sunshine
inactivity
emergency Rx of very high serum Ca2+
IV fluids
biphosphonates
calcitonin
PTH increases bone ___ and renal ___ of Ca2+
resorption
reabsorption
CKD => decreased ___ excretion and inactive activation of ___ => _____ => __+__+__
phosphate vitamin D 2ndry hyperparathyroidism sclerosis of bone osteomalacia calcification of soft tissues
seronegative arthitises
ank spond
psoriatic
reactive
enteropathic
seropositive arthritises
RA lupus scleroderma vasculitis Sjogrens
limited type systemic sclerosis is ass with which auto Ig
anti centromere
diffuse type systemic sclerosis is ass with which auto Ig
anti-Scl-70
myositis is ass with which auto Ig
anti Jo 1
typical xray of OA (LOSS)
loss of joint space
osteophytes
sclerosis
subchondral cysts
sacroiliitis, uveitis, dactylitis and enthesopathies are common features of ___
seronegative arthritis
v aggressive and destructive form of psoriatic arthritis
arthritis mutilans
enteropathic arthritis tends to be a __ joint _____ ___arthiritis
large
asymmetrical
oligo
Reiter’s syndrome =
urethritis
uveitis/conjunctivitis
reactive arthritis
___ is low in active SLE and especially in ___
C3/4
renal disease
used to monitor the activity level of SLE
C3/4
anti dsDNA Ig
auto Igs in Sjogrens
anti Ro + La
For Sjogrens: ___ can stimulate saliva production but may cause facial flushing
pilocarpine
3 stages in cutaneous systemic sclerosis
oedematous -> indurative > atrophic
beaking of the nose skin is a sign of
systemic sclerosis
MCTD is ass with which auto Ig
anti-RNP Ig
usual sites of pseudogout
knee
wrist
ankle
chondrocalcinosis =
calcium pyrophashate deposition in cartilage/other soft tissues without acute inflammation
antigens specific to myositis
anti-Jo-1
anti SRP
Rx for dermato+polymyositis
prednisolone (initially 40mg)
IS eg. methotrexate
early features of Takayasu arteritis
low grade fever night sweats wt loss arthralgia fatigue
Takayasu arteritis population?
East Asian 100x the risk
young F 10-30yo
later signs of Takayasu arteritis
claudication in upper and lower limbs
if untreated = vascular stenosis and aneurysms
ass with cANCA and PR3
GPA
brittle bone disease =
defect of __+__
osteogenesis imperfecta
maturation and organisation of Type 1 collagen
commonest skeletal dysplasia
Achondroplasia
IQ in achondroplasia is ___
normal
double jointed - ness inheritance pattern =
dominant inheritance
Ehlers Danlos - abnormal __+__ formation
inheritance =
elastin and collagen
autosomal dominant
DMD = ___ gene defect involved in __ transport
dystrophin
Ca2+
Diagnosis of DMD is by __+__
increased serum creatinine phosphokinase
muscle biopsy
similar to DMD but able to walk in teens and live til 30-40yo
Beckers muscular dystrophy
upper motor system = __+__
brain and spinal cord
lower motor system = ++_
anterior horn cells
nerve roots
peripheral nerves
spastic CP is caused by injury to __/__/___
motor cortex
upper motor neurons
corticospinal tract
ataxic CP is caused by injury to __
cerebellum
athetoid CP is caused by injury to __+__+__
extrapyramidal motor system, pyramidal tract and basal ganglia
spina bifida is caused by __ not fusing
two halves of posterior vertebral arch
polio is an infection of the ____ cells in ____ = L/UMN deficit
motor anterior horn cells
spinal cord/brainstem
LMN
2 digits fused together congenitally =
syndactyly
fibular hemimelia =
features =
partial/complete abscence of fibula often with abscence of lateral foot rays
shortened limb, tibia bowing + ankle deformity
Erb’s palsy is caused by __+__ damage
loss of motor innervation to __+__+__+__+__
classic sign =
C5 +6
deltoid, supraspinatus, infraspinatus, biceps and brachialis
Waiters tip posture
watiers tip sign of __
Erbs palsy
Klumpkes palsy = __+__ injury due to forceful ___ => paralysis of ___ +/- finger and wrist ___
possible ___ syndrome
fingers are in ___ position
C8 T1 adduction intrinsic hand muscles flexors Horners flexed
Blount’s disease =
growth disorder of medial proximal tibial physis => genu varum - also called tibia vara
DDH: __/___ of femoral head in perinatal that affects development of the hip
subluxation/dislocation
Pavlik harness for ___ keeps in __+__
DDH (dislocated/unstable) - keeps in flexion and abduction
most common cause of hip pain in childhood
usually preceded by ___
age:
M:F
Transient synovitis of the hip
URTI (viral)
2-10yo
M>F
presentation of transient synovitis of the hip
limp/no wt bearing
motion restriction
low grade fever
Ix for transient synovitis of the hip
radiographs (exclude Perthes)
normal CRP (exclude septic arth)
MRI (exclude osteomyelitis)
Rx for transient synovitis of the hip
NSAIDs and rest - resolves in a few weeks
idiopathic osteochondritis of the femoral head =
Perthes
presentation of Perthes
pain and limp
loss of internal rotation
+ve trendelenburg test (loss of abduction + gluteal weakness)
Rx for Perthes
regular xray + decrease physical activity
mainly affects overweight prepubertal boys
hypothyroid and renal might predispose
SUFE
in SUFE get loss of ___ (movement)
internal rotation
Rx for SUFE =
urgent Sx pinning
replacement
osteotomyif chronic
jumpers knee =
Rx:
patellar tendonitis
rest +/- physio
Sinding-Larsen-Johansen =
inferior pole of patella apophysitis of patellar tendon
patellofemoral dysfunction =
anterior knee pain in adolescents
adolescent with poorly localised knee pain, effusion and locking =
Osteochondritis Dissecans
___ technique for splinting talipes equinovarus =
Ponseti
tarsal coalition is between ___ or ___
calcaneus-navicular
talus-calcaneus
management of cauda equina syndrome =
urgent PR -> MRI > discectomy
cervical disc prolapse is usually __/___ nerve roots that are affected
C7/8
Downs and Rheum arth are at risk of _/__ spine subluxation
C1/2
rotator cuff muscle that initiates abduction
attaches to ___
supraspinatus
greater tuberosity
rotator cuff muscle that is external rotator
attaches to ___
infraspinatus and
greater tuberosity
rotator cuff muscle that is internal rotator
attaches to ___
subscapularis
lesser tuberosity
in frozen shoulder: initial ___ (subsides in ___ months) as ___ increases (for __ months)
pain
2-9months
stiffness
4-12 months
Ca2+ deposition in supraspinatus tendon seen on xray just proximal to greater tuberosity
=> ___
Acute calcific tendonitis
acute severe shoulder pain
Rx of acute calcific tendonitis =
self limiting as Ca2+ resorbs
injection of subacromial steroid and local anaesthetic
carpal tunnel contains -
median nerve
9 flexor tendons ( 4x FDS + FDP and 1 FPL) with synovial covering
carpal tunnel syndrome => paraesthesia of ____
worse at ___
loss of ___ and ___ of thumb or __ of hand
thumb and radial 2 1/2 fingers
night
sensation and weakness
clumsiness
Osborne’s fascia
tight band over cubital tunnel roof
cubital tunnel syndrome => paraesthesia in ___
ulnar 1 1/2 fingers
__+__ supinate forearm
biceps and supinators
__+__ pronate forearm
pronator teres and pronator quadratus
hyperplasia of myofibroblast cells and production of type 3 not 1 collagen in palmar fascia =
Dupuytrens contracture
__+__ contractures occur in Dupuytrens
MCP and PIP
deformities of hand and wrist in RA
volar MCPJ subluxation ulnar deviation swan neck boutonniere z-shaped thumb
hanging rope sign =
AVN of femoral head
pain and tender at greater trochanter and pain on ____
troachanteric bursitis
resisted abduction
menisci are made from ___
fibrocartilagenous
degenerative meniscal tears are Steinmann’s ___
-ve
usually extensor mech part that ruptures in < and > 40yos
<40yo = patellar > = quadriceps
avoid ___ in tendonitis in extensor mechanism as increases rupture risk
steroid injection
___ (Abx) that can cause tendonitis
quinolones
patellofemoral dysfunction encompasses (3)
chondromalacia patellae
adolescent ant knee pain
lateral patellar compression syndrome
quad muscle tends to pull patella medially/laterally
this is greater in F/M due to ___
laterally
F - wider hips
patella almost always dislocates ___
and is reduced when __
laterally
leg is straightened
OA of foot and ankle common in __ due to repeated dorsiflexion => osteophytes and impingement
___ Rx is more reliable and has fewer re-op rates
___Rx has a better functional outcome, usually only in elderly
footballers
Arthrodesis
replacements
hallux valgus is due to ___ of 1st MT and ___ of toe
medial deviation
lateral deviation
gold standard for hallux rigidis (1st MTPJ OA)
means F can no longer___
arthrodesis
wear heels
plantar interdigital nerves (from medial and lateral plantar nerves) overlying intermetatarsal ligaments can be subjected to repeated trauma. Become swollen and inflamed =
Morton’s neuroma
Morton neuroma => ___ pain and ___ into toes
burning
tingling
most common site of Morton’s neuroma
3rd interspace nerve > 2nd
Med-laterally compressing MT heads reproduces burning pain and toe tingling and produces a click =
test for
Mulder’s click test
Mortons neuroma
Rx of Mortons neuroma
US
may => MT pad/offloading insole
Steroid and LA injections
can be excised
MT stress # is usually in ___ then ___ next most common
Rx =
2nd > 3rd
xray might not show til 3rd wk and bone scan may be useful
6-12wk in rigid soled boot
tibialis posterior distal insertion is predominantly \_\_\_ function =
medial navicular
support medial arch (+ plantarflexion + invertor of foot)
hyperextension at MTPJ and hyperflex at PIP+DIPJ =
claw toe
hyperextension at MTPJ + DIPJ and hyperflex at PIPJ =
hammer toe
metal particles in arthroplasty can => ___ => ___
inflammatory granuloma (pseudotumour) bone and muscle necrosis
polyethylene particles in arthroplasty can => ___ => __+__
inflammation in bone
osteolysis and loosens joint replacement
___ used in arthroplasty can shatter due to being brittle
ceramics
arthrodesis = remove __+___ and stabilise bone with __
hyaline cartilage and subchondral bone
fusion
arthrodesis is an option for __++
ankle arthritis
wrist arthritis
hallux rigidis
osteotomy =
remove a wedge of bone to redistribute weight, realign and correct deformity
osteotomy can be used for __+__
early hip and knee arthritis
___ may infect osteocytes intracellularly
S. aureus
in neonates some metaphyses are ___ and so osteomyelitis can cause
intra articular
septic arthritis
Brodies abscess =
children’s subacute osteomyelitis where abscess is walled by thin sclerotic bone
most common site in spine for osteomyelitis
lumbar
neonatal organisms of osteomyelitis
S aureus
enterobacter spp
Strep A + B
4m -4yo organisms of osteomyelitis
S. aureus
Strep A
H. infu
enterobacter spp
4yo - adult orgs of osteomyelitis
S aureus 80%
Strep A
H influ
enterobacter spp
adult orgs of osteomyelitis
S aureus
occasionally Strep/enterobacter spp
sickle cell anaemic org.s of osteomyelitis
S. aureus
salmonella - unique to this group
salmonella osteomyelitis is unique to which pop group
Sickle cell anaemics
late onset haemotologically spread causative org.s of infection post ortho Sx =
S. aureus
beta strep
enterobacter
in primary healing gap fills with
new bone from osteoblasts
hypertrophic non-union occurs if ____ => abundant ___ but no bridging
excessive movement
hard callus
cause of transverse # = __ force
bending
oblique fractures are caused by a ___ force
shearing (fall/deceleration)
transverse #s may ___ and don’t ___ unless completely displaced
angulate
shorten
oblique fractures tend to ___ and may ___
fix with ____
shorten
angulate
interfragmentary screws
spiral #s are due to ___ forces
torsional
most spiral fractures are unstable to ___ and can ___. Fix with ___
rotation
angulate
interfragmentary screws
bone fracture with >=3 parts =
usually high E / poor bone quality
comminuted
2 separate fractures =
need ___ Rx
segmental
need stabilisation with rod / plates
direct translation of distal fragment =
displacement
direction the distal fragment to the degree of deformity
angulation
Ix for #s =
1st line = AP and lateral xray perhaps later: tomography (mandibular) CT complex/Sx plan) MRI (occult #) technetium bone scan (stress #)
compartment syndrome:
__+__ increase pressure in fascial compartment => compress ___ => ____ as ___ cant supply
blood inflammation veins secondary ischaemia arteries
if untreated compartment can => necrosis => ____
Volkmann’s ischaemic contracture
increased pain on passive stretching and more severe pain than expected
compartment syndrome
contusion =
bruising
blisters are caused by:
inflammatory exudates lift epidermis
of tibia take ___ to unite
16wk-1yrs
of the femoral shaft take ___ to unite
3-4 months
___ heal faster that cortical #
metaphyseal
fracture disease symptoms = __+__ usually Rx =
stiffness
weakness
resolve with time
sites prone to non-union =
scaphoid waist
distal clavicle
subtrochanteric femoral
Jones # of 5th MT
heightened chronic pain response after injury =
CRPS - chronic regional pain syndrome
type 1+2 CRPS =
1 - due to peripheral nerve injury
2 - no cause
Rx for CRPS
analgesia amitriptylline gabapentin + steroids TENS lidocaine patches symp nerve block injections
Gustilo classifaction describes the degree of __+__+__ in assessing ____
contamination, wound size, if can be closed, if vascular injury
open #s
Rx of open #s =
IV broad spectrum Abx (fluclox, gent + metro if soil contaminants) + sterile dressing =>
debride + int/ext fixation => close wound
skin grafts don’t take to +++
bare tendon, bone, metal or fat
most disclocations Rx =
closed manipulation and anaesthesia
__+__ tendon tears need repair to restore function
quad and patellar
+++ tendon tears can be treated conservatively unless reduced function
achilles
rotator cuff
long head of biceps brachii
distal biceps
suspect ___ if septic arthritis in multiple joints
endocarditis
Organisms of Septic arthritis
S aureus (most common) strep H influ (kids) Neisseria gonorrhoea E coli (IS, elderly, IVDUs)
Rx in septic arthritis
aspirate
Abx ( after confirmed diagnosis and organism)
Sx washout
criteria for a clinically clear (collar can be removed) C spine =
no Hx of loss of consciousness GCS 15 without intoxication no other sig distracting injuries no neuro no midline tenderness no pain on neck movement
if C spine not clinically cleared must ___ clear
radiologically
CT/xray
Rx for C spine #
immobilise in halo vest or stabilise
flexion distraction # with failure of posterior ligaments of thoracolumbar spine
Chance #
spinal shock = physiological response to ___ with complete loss of ++_
resolves in __
____ return signals its end
injury
sensory, motor and reflexes
24hrs
Bulbocavernous reflex
Bulbocavernous reflex =
signals end of ___
anal sphincter contracts with squeeze of glans penis/ tap mons pubis / pull urethral catheter
neurogenic shock is 2ndry to ____ of ___
temporary shutdown of sympathetic outflow from T1-L2
in men neurogenic shock may => ___ due to unopposed
priapism
parasympathetics
neurogenic shock => __+__ resolves in ___
hypotension
bradycardia
24-48hrs
corticospinal tract is responsible for __
motor
spinothalmic tract is responsible for __+__+_
coarse touch
pain and temp
central cord syndrome more commonly affects __ >___ as corticospinal tracts lie more ___ than __ ones
arms > legs
central
leg
anterior cord syndrome = loss of __+__ with __+__+__ preserved
corticospinal tract (motor) + lateral spinothalmic tract (coarse touch, pain temp) proprioception, vibration sense and light touch (dorsal collumns)
Brown Sequard syndrome:
due to ___ of cord => loss of ___ sensation (proprioception, vibration sense and light touch) and ___ ipsilaterally
an contralateral loss of ++_ sensation as ___ nerves cross 1/2 levels above entry into cord + others cross in ___
hemisection dorsal paralysis pain, temp and coarse touch medulla
lateral compression # of pelvis:
__ impact
1 hemipelvis is displaced ___
#s through __/___ + ___ #/____ disruption
side
medially
pubic rami/ischium
sacral compression #/ SIJ disruption
Vertical shear # of the pelvis:
__ force on one hemipelvis where its displaced ___
may cause __+___ injury and major haemorrhage
leg on affected side will look ___
axial
superiorly
sacral nerve root + lumbosacral plexus
shorter
anteroposterior compression injury to pelvis => ___ of ___ (“____” #) = substantial bleeding
wide disruption
pubic symphysis
open book #
low E pelvic #s in elderly:
usually __ displaced __ compression injuries with __/___ posteriorly
minimally
lateral
sacral#/ SIJ disruption
___ needed for Sx planning of acetabulum #s
CT
most common humeral neck # =
surgical neck with medial displacement of humeral shaft due to pull of pectoralis major muscle
Rx of humeral neck Rx =
sling
if repeatedly displaced # = internal fixation
Bankart lesion =
anterior glenoid labrum and capsule detach
post humeral head impact on ant glenoid causing an impaction # of posterior head =
Hill-Sachs lesion
light bulb sign is seen in __ xrays = sign of
AP
posterior GHJ dislocation
__ union rate ; ___ angulation is acceptable in humeral shaft #s as __+__ are mobile
90%
<=30 degrees
elbow and shoulder
radial nerve injury => ___ + ___ sensation loss
wrist drop
first dorsal web space sensation loss
humeral shaft # Rx =
functional humeral brace
internal fixation may => quicker recovery
olecranon # is caused by fall onto __ with ___ contraction
Rx =
elbow point
triceps
ORIF
radial head + neck # Rx =
sling and physio
may need ORIF
Rx of Galeazzi and Montegggia # dislocations
ORIF
volarly displaced/angulated extra-art # of distal radius usually due to fall on back of flexed wrist =
Smith’s #
intra art # of distal radius involving dorsal/volar rim and carpal bones sublux with displaced rim # fragment
Barton’s #
intra-art Smith’s # =
volar Barton’s #
intra-art Colles # =
dorsal Barton’s #
anatomical snuff box is between __/__ + __ tendons
APB/EPB
EPL
spilt cup sign on xray =
lunate dislocation
lateral ankle ligs affected in a sprain=
ant and posterior talofibular and calcaneofibular
stable ankle # = ___ without __/___
isolated distal fibular #
medial#/ deltoid lig rupture
suspect deltoid lig rupture if ___
medial tenderness
if talar shift then ___ msut be ruptured
deltoid lig
Rx of talar # =
reduce and screw fixation
prox diaphyseal # of 5th MT
Jones #
in paeds ___ angulation is corrected with every year of growth remaining
10 degrees
treat #s in kids that are ___ as adults as remodelling potential is less
12-14yo
Salter harris I classification of physeal #s
purely physeal separation
least likely to result in growth arrest
Salter harris II classification of physeal #s
most common
physeal separation + small metaphyseal fragment attached to physis and epiphysis
Salter harris III + IV classification of physeal #s
intraarticular + # splits physis
must reduce and stabilise
Salter harris V classification of physeal #s
compression injury to physis => growth arrest
only detected when angular deformity shows
if displaced forearm # in paeds Rx=
flexible IM nail
__ are more common than ___ as causes for supracondylar # of elbow in paeds
FOOSH
flexion #
median nerve branch predominantly damaged in supracondylar #s?
=> no __ sign as lose __+__ to index
anterior interosseous
OK
FPL + FDP
Rx of femoral shaft # in <2yo
Gallows traction and early hip spica cast
Rx of femoral shaft # in 2-6yo
Thomas splint/ hip spica cast
Rx of femoral shaft # in 6-12yo
flexible IM nail
Rx of femoral shaft# in >12yo
adult IM nail
undisplaced spiral tibial shaft # is common in (age groups)
Rx =
toddlers
cast
