Hip Fractures

Question 1

major risk in hip fractures?

Answer 1

avascular necrosis

Question 2

blood supply to femoral head?

Answer 2

medial femoral circumflex artery

Question 3

classical signs of hip fracture?

Answer 3

shortened and externally rotated leg

some people can weight bear some cant depending on severity and displacement etc

Question 4

classification of hip fracture?

Answer 4

intracapsular = between edge of femoral head to insertion of capsule of hip joint (basically within narrow neck bit)
extracapsular = can be trochanteric or sub-trochanteric (basically within chunky bit below narrow neck bit)

Question 5

how else can hip fractures be classified?

Answer 5

garden system

Question 6

how is an un-displaced intracapsular hip fracture managed?

Answer 6

internal fixation

hemiarthroplasty if unfit

Question 7

how is a displaced intra-capsular hip fracture managed?

Answer 7

fit and active with no cognitive impairment = total hip replacement
less active/mobile = hemiarthroplasty

Question 8

how is a stable intertrochanteric extracapsular hip fracture managed?

Answer 8

dynamic hip screw

Question 9

how is an unstable/subtrochanteric extracapsular hip fracture managed?

Answer 9

intra-medullary device/nail

Question 10

first line management of stable COPD?

Answer 10

SABA/SAMA

Question 11

step 2 management in stable COPD if patient still breathless taking SABA/SAMA?

Answer 11

if no asthmatic features = LABA + LAMA (swap to SABA if taking SAMA)
if asthmatic features present = LABA + ICS

Question 12

what counts as asthmatic features in COPD?

Answer 12

previous diagnosis of asthma
higher blood eosinophil count
substantial variation in FEV1 or peak flow

Question 13

step 3 management of stable COPD if still breathless on LABA + LAMA or LABA + ICS?

Answer 13

LABA + LAMA + ICS (as well as SABA reliever)

Question 14

when is oral theophylline used in COPD?

Answer 14

if trials of short and long acting bronchodilators fail

if cant take inhaled medication