LOCO5 Flashcards
Define crush injury [1] and crush syndrome [1]
Crush injury:
* Injury caused as a result of direct physical crushing of the muscles due to something heavy.
Crush syndrome:
* Also termed rhabdomyolysis, involves a series of metabolic changes produced due to an injury of the skeletal muscles of such a severity as to cause a disruption of cellular integrity and release of its contents into the circulation.
Healing time
Define what clinical union is [1]
Define what radiological union [1]
Clinical union:
* the bones move as one and can be tender when stressed
Radiological union:
* Bridging callus formation
* Fracture line is often still present
* Remodelling
What is are early [4] and late [3] complication to soft tissue from trauma?
Early:
* Plaster sores
* Infection
* Neurovascular injury
* Compartment syndrome
Late:
* Tendon rupture
* Nerve compression
* Volkmann contracture
Define volkman contracture [1]
Volkmann contracture is a deformity of the hand, fingers, and wrist caused by injury to the muscles of the forearm.
The condition is also called Volkmann ischemic contracture.
What triad of things are you looking for with a fat embolism? [3]
Lung involement: causes hypoxaemia
Brain involvement: fat droplets get lodged in white matter in brain
Petachie: droplets get stuck in vessels and cause haemorrhage
What are the 6Ps of compartment syndrome? [6]
Which one is early? [1] and which is late? [1]
Pale
Pulseless
Parenthesis: first stage
Pain
Paralysis: late stage
Polar
How would a S. aureus infection appear in culture? [1]
Appears as grape like clusters, on trypticase soy agar plate produces yellow pigment: staphlyoxanthin
Why does acute blood born osteomyelitis affect children? [2]
Have a very rich blood supply to the bones, especially the metaphyseal ends of the long bones as this is where the growth plate is
The capillary loops near the metaphysis have slow flow/sluggish flow due to a rich blood supply here, meaning they are more at risk for bacterial invasion of the bone from the blood here
Describe how osteomyelitis causes abscesses to grow
- Bacteria enters the bone, it commonly lodges just below the epiphyseal growth plate
- Bone produces new bone around the bacterial infection to try and wall off and contain the bacteria in one location, however it walls it off yet this cannot be accessed by antibiotics as it is walled off.
- Can cause bone to die
Common consequences of osetomeylitis? [2]
Rare consequences of osetomeylitis? [2]
Common:
* Local bone loss
* Persistent drainage through sinuses
Rare
* Squamous cell carcinoma
* Amyloidosis
Risk factors for osteomyelitis? [6]
Age
Malnutrition
Impairment of local vascular blood supply:
* Diabetes mellitus
* Venous stasis
* Radiation fibrosis (radiation therapy damaging blood vessels)
* Sickle cell disease (due to crisis)
Describe how you diagnose osteomyelitis [4]
How does it appear on ultrasound? [2]
(same as SA)
Local non-specific pain
Elevated neutrophil count (< 50% of cases)
Elevated ESR
Ultrasound:
* Cortical thinning
* Inflamation
* Periosteal lifiting: abscess lifting it off
How do you treat chronic osteomyelitis? [5]
Puncture drainage if abscessed
Surgical debridement
Reconstruct bone (allograft/ autograft)
Antibiotics (4-6wks, at least 2 IV):
* Vancomyocin cement beads
* Flucoxallin (gram +ve)
* Clindamycin
* Piperacillin
* Ciprofloxacilin
How do you investigate for chronic osteomyelitis? [3]
MRI:
* Bone scintigraphy if MRI not available or suspicion of multifocal osteomyelitis - radiation that shows reactive bone
- Bone biopsy
- Blood samples
- Radiography
Why does joint infection occur when giving prosthetic bone / joint replacements occur? [2]
Where does it occur? [2]
Occurs in osseous tissue adjacent to prosthesis:
* bone cement interface
* bone contiguous with prosthesis (cementless devices)
Results from:
* local inoculation at surgery or post-op spread from wound sepsis
* haematogenous spread
Name an organism that cause septic arthritis for each organism type of bacteria
Gram positive cocci [1]
Gram positive bacilli [1]
Gram negative cocci: [1]
Gram negative bacilli [1]
Gram positive cocci: staphylococcus aureus
Gram positive bacilli: clostridium sp
Gram negative cocci: Neisseria gonorrhoea
Gram negative bacilli: Escherichia coli, pseudomonas aeruginosa, haemophilus influenza
What is sequestrum in chronic osteomyelitis? [1]
What is Involucrum in chronic osteomyelitis? [1]
Sequestrum: fragment of necrosed bone that has become separated from surrounding tissue
Involucrum: covering or sheath that contains a sequestrum of bone
Which of the following is a fibrous ligament
achilles ligament
deltoid ligament
spring ligament
patella ligament
spring ligament
Which of the following is associated with enthesitis
RA
OA
Ankylosing sponditlitis
Gout
Which of the following is associated with enthesitis
RA
OA
Ankylosing sponditlitis
Gout
Unloading by temporary paralysis is most beneficial for which type of tendons?
Long tendons that undergo tendon-bone healing
Short tendons that undergo tendon-bone healing
Long tendons that undergo flexor tendon healing
Short tendons that undergo flexor tendon healing
Short tendons that undergo tendon-bone healing
Name the condition for pain at the tendon at the arrow [1]
De Quervain’s tenosynovitis
Jaccoud arthropathy is a deforming non-erosive arthropathy characterized by ulnar deviation of the 2nd to 5th fingers with metacarpophalangeal joint subluxation.
Which of the following is it associated with
Which pathogen causes hot tub folliculitis? [1]
Pseudomonas aeruginosa
What is cellulitis in the face called? [1]
How does it differ to cellulitis in location? [1]
Most common pathogen? [1]
Erysipelas (cellulitis of the face) but just in the dermis and not in subcutaneous fat
Streptococcus pyogenes
What is this skin infection? [1]
Which pathogen causes this? [1]
Scalded skin syndrome:
Staphylococcus aureus
Describe the pathophysiology of scalded skin syndrome [2]
Exotoxins are proteases that destroy desmosomes holding keratinocytes in granulosum and spinosum layers together:
Causes widespread fluid filled blisters that easily break
Therapy for Necrotising fascitis? [3]
Treatment:
* Surgical debridement
* Empiric antibiotics
* Hyperbaric oxygen (Add on therapy)
Treatment for HPV: viral warts and veruccas? [5]
Topical salicylic acid
**Fluorouracil cream **
Cryosurgery
Surgical curettage
Laser treatment (CO2 laser 582nm)
Describe the pathophysiology of Pityriasis versicolour [1]
Which populations does it impact more? [1]
Overgrowth of commensal yeast Pityrosporum orbiculare; young adults, brown/pink scaly patches, hypopigmented if suntanned
Affects young adults and slightly more men than women:
It is not contagious infection is not due to poor hygiene usually occurs in warmer months white, salmon or light brown patches chest,back, arms and legs
More common in hot humid climates and only affects people that sweat heavily
Often clears during the winter months and reappears each summer
Describe what Postherpetic neuralgia (PHN) is [2]
Unpredictable complication of varicella zoster virus- (VZV-) induced herpes zoster (HZ) which often occurs in elderly and immunocompromised persons
The main symptom of post-herpetic neuralgia is intermittent or continuous nerve pain in an area of your skin previously affected by shingles.
Treatment for leprosy? [3]
Rifampicin, dapsone and clofazimine
Which imaging technique is preferred in diagnosing DDH in young patients?
MRI
Ultrasound
X-ray
CT
Ultrasound
State what the acetabular angle should be for each of the following ages?
0 - 1 year old < []
1 > 4 year old < []
> 4 year old < []
The acetabular angle should decrease with age:
0 - 1 year old < 34
1 > 4 year old < 28
> 4 year old < 25
DDH:
What acetabular angles would correct with splintage [1] and would require surgery [1]
An angle of < 45 deg will spontaneously correct with splintage, whereas angle of > 60 deg will usually require surgery.
Describe how you would manage CDH in a
Newborn [1]
6-18 months [2]
Newborn
* Splintage in abduction (Pavlik harness, Von Rosen splint)
6 - 18 months
* Closed reduction – Traction, Splintage
* Open reduction and Splintage
Ankle arthrodesis is the fusion of the [] most commonly performed for end-stage arthritis of the joint.
Ankle arthrodesis is the fusion of the tibiotalar joint most commonly performed for end-stage arthritis of the joint.
State the effect of:
Barlow test [1]
Ortalini test [1]
What are positive results for each test? [2]
Barlow test:
* dislocates / subluxes the hip
* Positive if the hip can be popped out of the socket with this maneuver.
Ortalini test:
* if the hip was dislocated, a distinctive clunk will be heard as the hip relocates.
Name this apparatus being used [1]
What pathology is it treating? [1]
What ages would this be used for? [1]
Pavlik harness: treats CDH for newborns - 6 months
Name this apparatus being used [1]
What pathology is it treating? [1]
What ages would this be used for? [1]
Von Rosen splint: CDH between newborn - 6 months
