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3rd Year > MDEMO > Flashcards

MDEMO Flashcards

1
Q

chemical burns - neutralise?

A

No, it worsens thermal damage

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2
Q

age of wound
<6hrs
>6hrs
on face and <24hrs

A

close
delayed primary closure (leave and close after 48 hours
close

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3
Q

tetanus prone injuries

A 
anything within 6 hours of surgery
puncture wound
significant devitalised tissue
evidence of sepsis 
contamination with soil
burns/frostbite
high velocity missile injuries
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4
Q

moderate risk tetanus

high risk tetanus

A

tetanus diphtheria vaccine or tetanus toxoid vaccine

tetanus immunoglobulin

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5
Q

nutrient artery

A

supplies diaphysis

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6
Q

fracture healing process

A 
haematoma
granulation tissue
osteoid
soft callus
hard callus/woven bone
remodelling
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7
Q

Perren’s law

A

the degree of strain at the fracture site determines the type of tissue that forms between the fracture fragments

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8
Q

composition of a Haversian system

A

3 concentric rings of collagen fibres in opposite directions

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9
Q

types of non-union

A

hypertrophic (Perren’s law)

atrophic (host factors means it doesn’t heal - heavy drinker, smoker, diabetic, NSAID user)

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10
Q

Wolff’s law

A

bone will be deposited along lines of stress due to piezoelectric forces

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11
Q

Heuter-Volkman law

A

overload causes too much negative charge in early walkers or overweight children so the medial part of the physis shuts down causing severe genu varum

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12
Q

rugby jersey stripe on vertebrae on xray

A

osteopetrosis

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13
Q

most common form of rickets in developed world

A

familial hypophosphataemic rickets

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14
Q

deformities in rickets

A

erlenmeyer flask deformity in femur

tibial bowing

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15
Q

genu varu, or valgum in children

A 
<1yo = genu varum
1-2 = 3-5degrees of genu valgum
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16
Q

McMurrays test

A

internally rotate for lateral meniscus

Externally rotate for medial meniscus

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17
Q

blood supply in ligamentum teres

A

obturator artery –> foveal artery –> small medial part of epiphysis

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18
Q

treatment of perthes

A

self limiting. the younger the patient the better the result (Expect in a 2-4 year old)

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19
Q

what affects 50% of eskimos

A

spondylithesis (affects 5% of general population)

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20
Q

spondylosis

A

stress fracture in the pars interarticularis of the vertebral arch. can lead to spondylolithesis when the whole thing slips on the sacrum

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21
Q

congenial spinal stenosis

A

dwarves

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22
Q

shopping trolley sign

A

spinal stenosis (like how cycling is good for it)

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23
Q

bones that form the floor of the carpal tunnel

A

hamate capitate

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24
Q

contents of the carpal tunnel

A

4 flexor digitorum superficialis
4 flexor digitorum profundum
1 flexor hallucis longus
median nerve

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25
Q

steroid injections in carpal tunnel

A

cure 80% of symptoms but 100% recur within 12 months

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26
Q

ulnar paradox

A

closer to the paw the worse the claw

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27
Q

treatment of ganglions

A

conservative

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28
Q

treatment of tenosynovitis (e.g. trigger finger)

A

immobilise + NSAIDs

steroids

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29
Q

collagen type in Dupuytrens contracture

A

3 (instead of 1)

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30
Q

indications for surgery in Dupuytrens contracture

A

progressive symptoms
greater than 30 degrees contracture
functional loss

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31
Q

mechanism of:
transverse fracture
spiral fracture
oblique fracture

A

direct blow
rotation/torsion
anchored limb

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32
Q

gold standard for joint replacemrnt

A

cemented bone and uncemented cup

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33
Q

DMARDs and biologics in surgery

A

DMARDs increase risk of infection but are not stopped

biologics are stopped

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34
Q

Dorr A B C

A

narrow, medium, wide marrow in long bones

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35
Q

fromen’s test

A

tests adductor pollucis, suppled by the deep branch of the ulnar nerve

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36
Q

Colles

A

dorsal angulation radius fracture

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37
Q

Smith

A

volar angulation radial fracture

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38
Q

Barton

A

intra-articular radial head fracture (dorsal or ventral)

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39
Q

Galleazi

A

radius broken, ulna dislocated

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40
Q

Montegia

A

ulna broken, radius dislocated

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41
Q

Bennet

A

base of the first metacarpal bone with associated CMC joint disruption

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42
Q

Mallet finger

A

extensor tendon broken so DIP is flexed
splint for 6-8 weeks in extension
mechanism = ball hitting outstretched finger and forcing DIP to over flex, breaking extensor tendon

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43
Q

Jersey finger

A

Flexor tendon is broken so can’t curl that finger
surgery and rehab
grabbing onto jersey and forcing extension when trying to flex

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44
Q

felon

A

infected anterior facial compartment of fingertip

45
Q

paronychia

A

infection of nail bed

46
Q

causes of dupuytrens

A

manual labour
phenytoin
alcoholic liver disease
trauma

47
Q

contraindication to uncememented joint replacement

A

osteoporosis

48
Q

LMWH after hip replacement

A

6 hours after

49
Q

most common cause of THR revision

A

aseptic loosening

50
Q

Bankart lesion

Hill-Sachs lesion

A

from glenohumeral dislocation
bankart is of the labrum on the glenoid fossa
hill-sacks is on the humerus

51
Q

sulcus sign

A

shoulder instability

52
Q

apprehension test/Fowler test/Jobe relocation test/crank test

A

supine and external rotation of elbow for shoulder instability and anterior dislocation

53
Q

pressures in compartment syndrome

A

> 40 is diagnostic

>20 is high

54
Q

Kanavel’s signs

A 
4 signs for flexor tendon sheath infection:
fixed flexion
fusiform swelling
tenderness
pain on passive extension

surgical emergency.

55
Q

when to not use FRAX and go straight to DEXA scan

A

<40yo with a risk factor:
history of fragility fracture
use of high-dose steroids for >3months

56
Q

Pott’s fracture

A

bimalleolar fracture
torn deltoid ligament but in tact syndesmosis
lateral talar subluxation
occurs in forced foot eversion

57
Q

leriche syndrome

A

Atherosclerotic occlusive disease of the aorta and/or both iliac arteries

claudication of buttocks and thigh
atrophy of leg muscles
impotence (paralysis of L1 nerve)

58
Q 
rotator cuff actions
supraspinatus
infraspinatus
teres minor
subscalpularis
A

abduction first 20 degrees
external rotation
external rotation
internal rotation

59
Q 
rotator cuff innervations
supraspinatus
infraspinatus
teres minor
subscalpularis
A

supra scapular nerve
suprascapular nerve
axillary
subscapular nerve

60
Q

signs for posterior dislocation

A

Rim’s sign

lightbulb sign

61
Q

when to use the FRAX tool

A

Any woman >65 or any man >75 unless:

basically any risk factor is present (family history, smoking, alcohol, falls, low BMI,)

62
Q

Abx causing awhiles tendon rupture

A

CIPROFLOXACIN

63
Q

what side is congenital hip dislocation more common

A

left

also more common in:
girls
breech
family history
firstborn
oligohydraminos
64
Q

rotator cuff tear vs impingmenet

A

both have painful arcs
cuff tear –> weakness compared to other side and pain on palpation over anterior acromion
impingement –> no weakness or pain on palpation

65
Q

positive scarf test

A

acromioclavicular degenration

66
Q

Lloyd-Davies position nerve damage risk

A

peroneal nerve

67
Q

Hip replacement nerve damage risk

A

sciatic (posterior approach)

68
Q

groin pain following inguinal hernia repair

A

Ilioinguinal nerve may have been entrapped in the mesh causing a neuroma

69
Q

management of osteomyelitis

A

Flucloxacillin for 6 weeks

Clindamycin if penicillin allergic

70
Q

features of osteopetrosis

A

recurrent infections and lethargy

brittle bones with no differentiation between cortex and medulla (marble bone)

71
Q

features of osteogenesis imperfecta

A

hypermobility
multiple fractures of long bones with irregular patches of ossification (wormian bones)
trefoil pelvis

72
Q

supracondylar fracture worry

A

brachial artery and median nerve

73
Q

types of osteogenesis imperfecta

A 
quality + quantity
1 + -
2 - -
3 - +
4 - +
74
Q

Anti-Jo antibodies in polymyositis meaning

A

found in 20%
worse prognosis
more likely to get interstitial lung disease, Raynaud’s and fever

75
Q

treatment for first venous/arterial thromboembolic event in anti-phospholipid syndrome

A

6 months of warfarin INR 2.5

If arterial, lifelong warfarin INR 2.5

76
Q

treatment for second venous thromboembolic event in anti-phospholipid syndrome

A

lifelong warfarin INR 2.5

77
Q

treatment for any thromboembolic event whilst on warfarin with a target fo 2.5 in anti-phospholipid syndrome

A

increase warfarin with INR 3.5

78
Q

score for hypermobility

A

Beighton score. positive if 5/9 in adults and 6/9 in children

79
Q

% of patients with polymyositis with Anti-Jo

A

20%

80
Q

Complications of Paget’s

A 
deafness
bone sarcoma (1% >10 years)
fractures
skull thickenning
high output cardiac failure
81
Q

stills disease and treatment

A

Triad of:
spiking fevers before bed
salmon coloured rash
polyarthalgia

NSAIDs

82
Q

acute attack of gout

A

high dose NSAID (Aspirin or coxib)

if NSAID CI, colchicine.

83
Q

If allopurinol is CI or not tolerated

A

Febuxostat (also a XOi)

84
Q

CIs of using NSAIDs in acute flare of gout

A

Peptic ulcer

Elderly and taking warfarin

85
Q

SLE is what type of hypersensitivity

A

3 (antigen/antibody complexes)

86
Q

Aspirin and gout

A

Fine at prophylactic doses 75-150mg

Interferes with uric acid excretion in analgesic doses (600-2400mg)

87
Q

Causes of drug induced lupus

A

Procainamide
Hydralazine

Less common:
Isoniazid
Minocycline
Phenytoin

88
Q

inheritance of Marfan’s

A

AD of fibrillin gene

89
Q

Luflunomide SEs

A

liver impariemnt
lung disease
hypertension

90
Q

when to offer allopurinol

A

4 weeks after the first attack of gout has settled.

start at 100mg OD and titrate for a serum uric acid of <300umol/l

91
Q

Lifestyle modifications for gout

A

reduce alcohol
lose weight if obese
avoid food high in purines (liver, kidney, seafood, oily fish)

92
Q

serotypes A-C of chhlamydia

A

Trachoma

93
Q

Serotypes D-K chylamydia

A

adult inclusion conjunctivitis

94
Q

Mx of inclusion conjunctivitis

A

topical erythromycin

95
Q

Mx of allergic conjunctivitis

A

Levocabastine (topical antihistamine)
Sodium cromoglycate (topical mast cell stabiliser)
Olopatadine (combination of above)

96
Q

Mx episcleritis

A

Observation + lubricants

topical steroids only used in persistent cases

97
Q

Mx of scleritis

A

Oral prednisolone

Immunosuppression (mycophenolate/azathioprine)

98
Q

Mx bacterial keratitis

A

Broad spectrum topical ofloxacin (every hour)

99
Q

Mx viral keratitis

A

dendritic ulcer HSV one

Topical acyclovir

100
Q

Mx adenospots

A

Adenoviral conjunctivitis is self limiting but topical steroids can be used to speed up resolution

101
Q

Mx fungal keratitis

A

Topical anti-fungals
Natamcin
Amphotericin
Corneal graft in unresponsive cases

102
Q

Disproportionate pain compared to ocular signs (red eye, dendritiform epithelial lesions) in someone who has been swimming with contact lenses

A

Acanthamoeba keratitis

103
Q

Mx Anterior uveitis

A

Topical prednisolone

Dilating cyclopentolate

104
Q

Mx AACG

A

Medical
Acetazolamide
Beta blockers (topical)
Pilocarpine constrictor

Surgical
Iridotomy
Trabeculectomy

105
Q

Mx Orbital cellulitis

A

CT scan and IV Abx

106
Q

Mx Preseptal cellulitis

A

Borad spectrum oral antibiotics

107
Q

Mx of rentinal vein occlusion

A
  1. reverse underlying cause (smoking, pill, tumours, hypertension etc)
  2. laser treatment for macular oedema or neovascularisation
108
Q

Mx of rental artery occlusion

A

Low dose aspirin
Send for carotid ultrasound

?drop intraocular pressure to restore vision using ocular massage, paracentesis or acetazolamide

3rd Year (9 decks)

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