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Phase 2- MSK > Emergency MSK > Flashcards

Emergency MSK Flashcards

1
Q

What is an open fracture?

A

Fracture with communication with the outside world

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2
Q

What system is used to classify open fractures?

A

Gustilo classification

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3
Q

What is a type I Gustilo fracture?

A

Wound <1cm, low energy, no contamination, simple fracture

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4
Q

What is a type II Gustilo fracture?

A

wound is 1-10cm, moderate energy, mild contamination, mild comminution

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5
Q

What is a type IIIa Gustilo fracture?

A

Wound >10cm, high energy, enough tissue for coverage, contamination
PLUS any wounds with comminuted fractures and ALL farm injuries

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6
Q

What is a type IIIb Gustilo fracture?

A

Extensive peritoneal stripping and requires a free tissue transfer

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7
Q

What is a type IIIc Gustilo fracture?

A

Vascular injury requiring vascular repair

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8
Q

What antibiotics are recommended for a Gustilo I or II open fracture?

A

Cephalosporin (eg. Cefazolin)

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9
Q

What antibiotics are recommended for a Gustilo III open fracture?

A

Cephalosporin and an Aminoglycoside

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10
Q

What antibiotics are given additionally in an open wound contaminated with bowel contents or occuring on a farm?

A

Penicillin (for C.diff coverage)

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11
Q

In tetanus prophylaxis, what toxoid dose should be given in open fractures regardless of age?

A

0.5mL

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12
Q

How is an open fracture managed in A&E?

A

Antibiotics
Tetanus prophylaxis
Control bleeding
Assess soft tissue damage and neurovascular supply
Remove debris from wound
Splint the fracture to decrease pain and reduce risk of further damage

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13
Q

How are open fractures managed surgically?

A

Debridement and irrigation with saline
Fracture stabilisation
Early soft tissue coverage or wound closure
Bone gap reconstruction

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14
Q

How much saline is needed to debride a:

a. Type I Gustilo open fracture
b. Type II Gustilo open fracture
c. Type III Gustilo open fracture

A

a. 3L
b. 6L
c. 9L

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15
Q

What is compartment syndrome?

A

A condition where an osteofascial compartment pressure rises to a level that restricts blood flow to the distal limb.

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16
Q

Give 5 causes of compartment syndrome

A 
BEST BAE
Burns 
Extravasation of IV infusion 
Swelling (post-ischaemia) 
Trauma- fractures/crush injury/gunshot wound/contusions 
Bleeding disorders
Arterial injury 
External casts/dressings/wrappings
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17
Q

What are the symptoms of compartment syndrome?

A

5Ps: pulselessness, pain, pallor, paresthesia, paralysis

Pain will be out of proportion to injury, pain will occur on passive stretching, the leg will swell

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18
Q

How is compartment syndrome treated?

A

Observation
Remove/loosen cast or dressing
Hyperbaric oxygen therapy
Emergency fasciotomy

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19
Q

What is the major complication of compartment syndrome?

A

Permanent injury to muscle and nerves due to ischaemia

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20
Q

What is cauda equina syndrome?

A

Terminal spinal nerve root compression in the lumbosacral region. It is a medical emergency.

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21
Q

Give 4 symptoms of cauda equina syndrome

A 
Bilateral leg pain 
Urinary retention 
Urinary overflow incontinence 
Saddle anaesthesia
Sensorimotor changes 
Impotence
Bowel dysfunction 
Decreased rectal tone
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22
Q

Give 3 potential causes of cauda equina

A 
Disc herniation 
Spinal stenosis
Tumour 
Trauma 
Spinal epidural haematoma 
Epidural abscess
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23
Q

How is cauda equina treated?

A

Urgent surgical decompression within 48hrs

Discectomy or laminectomy

24
Q

Give 3 potential complications of cauda equina

A

Sexual dysfunction
Urinary dysfunction
Chronic pain
Persistent leg weakness

25
Q

What is septic arthritis?

A

Infection of the joint space which can lead to profound, extensive cartilage damage within hours

26
Q

Where is the most common place affected by septic arthritis?

A

Knee (50% of cases)

27
Q

Give 4 risk factors of septic arthritis

A 
>80 years old
Diabetes 
RA
Cirrhosis 
HIV 
Endocarditis
IV drug user
Recent joint surgery
28
Q

Give the 3 potential ways a joint can become infected

A

Bacteraemia –> spread of infection through the blood
Direct inoculation –> from trauma or surgery
Contiguous spread –> from adjacent osteomyelitis

29
Q

What is the most common bacteria responsible for septic arthritis?

A

Staphylococcus aureus

30
Q

Give 2 symptoms of septic arthritis

A 
Pain in joint
Fever 
Erythematous joint 
Swollen joint 
Warm and tender to touch 
Inability to bear weight on joint
31
Q

What can be seen on an x-ray of septic arthritis?

A

Joint space widening
Effusion
Periarticular osteopenia

32
Q

What is the gold standard diagnostic test for septic arthritis?

A

Joint fluid aspirate analysis

33
Q

How is septic arthritis managed?

A

IV antibiotics

Drainage of the joint

34
Q

What is necrotising fasciitis?

A

Life-threatening infection which spreads along soft tissue planes

35
Q

Give 4 risk factors for necrotising fasciitis

A 
Diabetes 
AIDS
Cancer 
IV drug use
Skin abrasions 
Obesity 
Abdominal surgery
36
Q

What is Type I necrotising fasciitis?

A

Most common (80-90%)
Polymicrobial cause
Seen in immunosuppressed and post-op patients

37
Q

What is Type II necrotising fasciitis?

A

Monomicrobial- usually group A beta-haemolytic streptococci

38
Q

What is Type IV necrotising fasciitis?

A

Caused by MRSA

39
Q

What are the early signs of necrotising fasciitis?

A 
Localised abscess 
Rapid progression 
Mild swelling 
No trauma 
No discolouration
40
Q

What are the late signs of necrotising fasciitis?

A 
Severe pain 
High fever
Chills 
Rigor 
Tachycardia
41
Q

What is found on examination of necrotising fasciitis?

A

Skin bullae, cutaneous gangrene, ischaemic patches, swelling, oedema, erythema, subcutaneous emphysema

42
Q

What score can be used to assess diagnosis of necrotising fasciitis?

A

LRINEC score

Looks at CRP, leukocytes, haemoglobin, sodium, creatinine and glucose

43
Q

How is necrotising fasciitis treated?

A

Emergency radical debridement

Broad spectrum IV antibiotics

44
Q

During the operation to fix necrotising fasciitis, what may be found?

A

Liquified subcutaneous fat
Dishwater pus
Muscle necrosis
Venous thrombosis

45
Q

Which empirical antibiotics are given in necrotising fasciitis?

A

Penicillin
Clindamycin
Metronidazole
Aminoglycoside

46
Q

If MRSA is confirmed in necrotising fasciitis, what antibiotics should be given?

A

Vancomycin

47
Q

What is osteomyelitis?

A

Infection of the bone characterised by progressive inflammatory destruction and apposition of new bone

48
Q

Give 4 risk factors for osteomyelitis

A 
Recent trauma
Recent surgery 
Immunocompromised
IV drug use
Poor vascular supply 
Diabetes 
Sickle cell disease
Peripheral neuropathy
49
Q

Why are antibiotics less efficient at treating osteomyelitis

A

Bacteria produce a biofilm layer which covers necrotic bone and stops antibiotics from penetrating the bone

50
Q

What is the most common infecting organism in adults with osteomyelitis?

A

Staphylococcus aureus

51
Q

What can be seen on an x-ray of osteomyelitis?

A

Lytic region surrounded by sclerosis
May look like neoplastic changes
Sequestrum
New bone around bone necrosis

52
Q

How is osteomyelitis treated?

A 
IV antibiotics
Hyperbaric oxygen therapy 
Surgical irrigation and debridement
Vascularised bone grafts
Stabilisation of bone
53
Q

What is gas gangrene?

A

Rapidly spreading gangrene which affects injured tissue infected by clostridium bacteria.

54
Q

What are the pathological effects of gas gangrene?

A 
Muscle necrosis
Vessel thrombosis
Haemolysis 
Shock 
Foul-smelling odour (glucose breakdown)
55
Q

Give 4 risk factors for gas gangrene

A 
Car accidents
Crush injuries
Gunshot wounds
Burns
Frostbite
IV drug abuse
Bowel resection 
Biliary surgery 
Colon cancer
Neutropenia
56
Q

Give 2 symptoms which precede evidence of gas gangrene

A

Feeling of impending doom
Sudden progressive pain out of proportion of what is expected
Tachycardia

57
Q

How is gas gangrene managed?

A

IV antibiotics
Hyperbaric oxygen therapy
Radical surgical debridement with fasciotomy

Phase 2- MSK (7 decks)

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