MDEMO Flashcards
chemical burns - neutralise?
No, it worsens thermal damage
age of wound
<6hrs
>6hrs
on face and <24hrs
close
delayed primary closure (leave and close after 48 hours
close
tetanus prone injuries
anything within 6 hours of surgery puncture wound significant devitalised tissue evidence of sepsis contamination with soil burns/frostbite high velocity missile injuries
moderate risk tetanus
high risk tetanus
tetanus diphtheria vaccine or tetanus toxoid vaccine
tetanus immunoglobulin
nutrient artery
supplies diaphysis
fracture healing process
haematoma granulation tissue osteoid soft callus hard callus/woven bone remodelling
Perren’s law
the degree of strain at the fracture site determines the type of tissue that forms between the fracture fragments
composition of a Haversian system
3 concentric rings of collagen fibres in opposite directions
types of non-union
hypertrophic (Perren’s law)
atrophic (host factors means it doesn’t heal - heavy drinker, smoker, diabetic, NSAID user)
Wolff’s law
bone will be deposited along lines of stress due to piezoelectric forces
Heuter-Volkman law
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
rugby jersey stripe on vertebrae on xray
osteopetrosis
most common form of rickets in developed world
familial hypophosphataemic rickets
deformities in rickets
erlenmeyer flask deformity in femur
tibial bowing
genu varu, or valgum in children
<1yo = genu varum 1-2 = 3-5degrees of genu valgum
McMurrays test
internally rotate for lateral meniscus
Externally rotate for medial meniscus
blood supply in ligamentum teres
obturator artery –> foveal artery –> small medial part of epiphysis
treatment of perthes
self limiting. the younger the patient the better the result (Expect in a 2-4 year old)
what affects 50% of eskimos
spondylithesis (affects 5% of general population)
spondylosis
stress fracture in the pars interarticularis of the vertebral arch. can lead to spondylolithesis when the whole thing slips on the sacrum
congenial spinal stenosis
dwarves
shopping trolley sign
spinal stenosis (like how cycling is good for it)
bones that form the floor of the carpal tunnel
hamate capitate
contents of the carpal tunnel
4 flexor digitorum superficialis
4 flexor digitorum profundum
1 flexor hallucis longus
median nerve
steroid injections in carpal tunnel
cure 80% of symptoms but 100% recur within 12 months
ulnar paradox
closer to the paw the worse the claw
treatment of ganglions
conservative
treatment of tenosynovitis (e.g. trigger finger)
immobilise + NSAIDs
steroids
collagen type in Dupuytrens contracture
3 (instead of 1)
indications for surgery in Dupuytrens contracture
progressive symptoms
greater than 30 degrees contracture
functional loss
mechanism of:
transverse fracture
spiral fracture
oblique fracture
direct blow
rotation/torsion
anchored limb
gold standard for joint replacemrnt
cemented bone and uncemented cup
DMARDs and biologics in surgery
DMARDs increase risk of infection but are not stopped
biologics are stopped
Dorr A B C
narrow, medium, wide marrow in long bones
fromen’s test
tests adductor pollucis, suppled by the deep branch of the ulnar nerve
Colles
dorsal angulation radius fracture
Smith
volar angulation radial fracture
Barton
intra-articular radial head fracture (dorsal or ventral)
Galleazi
radius broken, ulna dislocated
Montegia
ulna broken, radius dislocated
Bennet
base of the first metacarpal bone with associated CMC joint disruption
Mallet finger
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
Jersey finger
Flexor tendon is broken so can’t curl that finger
surgery and rehab
grabbing onto jersey and forcing extension when trying to flex
felon
infected anterior facial compartment of fingertip
paronychia
infection of nail bed
causes of dupuytrens
manual labour
phenytoin
alcoholic liver disease
trauma
contraindication to uncememented joint replacement
osteoporosis
LMWH after hip replacement
6 hours after
most common cause of THR revision
aseptic loosening
Bankart lesion
Hill-Sachs lesion
from glenohumeral dislocation
bankart is of the labrum on the glenoid fossa
hill-sacks is on the humerus
sulcus sign
shoulder instability
apprehension test/Fowler test/Jobe relocation test/crank test
supine and external rotation of elbow for shoulder instability and anterior dislocation
pressures in compartment syndrome
> 40 is diagnostic
>20 is high
Kanavel’s signs
4 signs for flexor tendon sheath infection: fixed flexion fusiform swelling tenderness pain on passive extension
surgical emergency.
when to not use FRAX and go straight to DEXA scan
<40yo with a risk factor:
history of fragility fracture
use of high-dose steroids for >3months
Pott’s fracture
bimalleolar fracture
torn deltoid ligament but in tact syndesmosis
lateral talar subluxation
occurs in forced foot eversion
leriche syndrome
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)
rotator cuff actions supraspinatus infraspinatus teres minor subscalpularis
abduction first 20 degrees
external rotation
external rotation
internal rotation
rotator cuff innervations supraspinatus infraspinatus teres minor subscalpularis
supra scapular nerve
suprascapular nerve
axillary
subscapular nerve
signs for posterior dislocation
Rim’s sign
lightbulb sign
when to use the FRAX tool
Any woman >65 or any man >75 unless:
basically any risk factor is present (family history, smoking, alcohol, falls, low BMI,)
Abx causing awhiles tendon rupture
CIPROFLOXACIN
what side is congenital hip dislocation more common
left
also more common in: girls breech family history firstborn oligohydraminos
rotator cuff tear vs impingmenet
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
positive scarf test
acromioclavicular degenration
Lloyd-Davies position nerve damage risk
peroneal nerve
Hip replacement nerve damage risk
sciatic (posterior approach)
groin pain following inguinal hernia repair
Ilioinguinal nerve may have been entrapped in the mesh causing a neuroma
management of osteomyelitis
Flucloxacillin for 6 weeks
Clindamycin if penicillin allergic
features of osteopetrosis
recurrent infections and lethargy
brittle bones with no differentiation between cortex and medulla (marble bone)
features of osteogenesis imperfecta
hypermobility
multiple fractures of long bones with irregular patches of ossification (wormian bones)
trefoil pelvis
supracondylar fracture worry
brachial artery and median nerve
types of osteogenesis imperfecta
quality + quantity 1 + - 2 - - 3 - + 4 - +
Anti-Jo antibodies in polymyositis meaning
found in 20%
worse prognosis
more likely to get interstitial lung disease, Raynaud’s and fever
treatment for first venous/arterial thromboembolic event in anti-phospholipid syndrome
6 months of warfarin INR 2.5
If arterial, lifelong warfarin INR 2.5
treatment for second venous thromboembolic event in anti-phospholipid syndrome
lifelong warfarin INR 2.5
treatment for any thromboembolic event whilst on warfarin with a target fo 2.5 in anti-phospholipid syndrome
increase warfarin with INR 3.5
score for hypermobility
Beighton score. positive if 5/9 in adults and 6/9 in children
% of patients with polymyositis with Anti-Jo
20%
Complications of Paget’s
deafness bone sarcoma (1% >10 years) fractures skull thickenning high output cardiac failure
stills disease and treatment
Triad of:
spiking fevers before bed
salmon coloured rash
polyarthalgia
NSAIDs
acute attack of gout
high dose NSAID (Aspirin or coxib)
if NSAID CI, colchicine.
If allopurinol is CI or not tolerated
Febuxostat (also a XOi)
CIs of using NSAIDs in acute flare of gout
Peptic ulcer
Elderly and taking warfarin
SLE is what type of hypersensitivity
3 (antigen/antibody complexes)
Aspirin and gout
Fine at prophylactic doses 75-150mg
Interferes with uric acid excretion in analgesic doses (600-2400mg)
Causes of drug induced lupus
Procainamide
Hydralazine
Less common:
Isoniazid
Minocycline
Phenytoin
inheritance of Marfan’s
AD of fibrillin gene
Luflunomide SEs
liver impariemnt
lung disease
hypertension
when to offer allopurinol
4 weeks after the first attack of gout has settled.
start at 100mg OD and titrate for a serum uric acid of <300umol/l
Lifestyle modifications for gout
reduce alcohol
lose weight if obese
avoid food high in purines (liver, kidney, seafood, oily fish)
serotypes A-C of chhlamydia
Trachoma
Serotypes D-K chylamydia
adult inclusion conjunctivitis
Mx of inclusion conjunctivitis
topical erythromycin
Mx of allergic conjunctivitis
Levocabastine (topical antihistamine)
Sodium cromoglycate (topical mast cell stabiliser)
Olopatadine (combination of above)
Mx episcleritis
Observation + lubricants
topical steroids only used in persistent cases
Mx of scleritis
Oral prednisolone
Immunosuppression (mycophenolate/azathioprine)
Mx bacterial keratitis
Broad spectrum topical ofloxacin (every hour)
Mx viral keratitis
dendritic ulcer HSV one
Topical acyclovir
Mx adenospots
Adenoviral conjunctivitis is self limiting but topical steroids can be used to speed up resolution
Mx fungal keratitis
Topical anti-fungals
Natamcin
Amphotericin
Corneal graft in unresponsive cases
Disproportionate pain compared to ocular signs (red eye, dendritiform epithelial lesions) in someone who has been swimming with contact lenses
Acanthamoeba keratitis
Mx Anterior uveitis
Topical prednisolone
Dilating cyclopentolate
Mx AACG
Medical
Acetazolamide
Beta blockers (topical)
Pilocarpine constrictor
Surgical
Iridotomy
Trabeculectomy
Mx Orbital cellulitis
CT scan and IV Abx
Mx Preseptal cellulitis
Borad spectrum oral antibiotics
Mx of rentinal vein occlusion
- reverse underlying cause (smoking, pill, tumours, hypertension etc)
- laser treatment for macular oedema or neovascularisation
Mx of rental artery occlusion
Low dose aspirin
Send for carotid ultrasound
?drop intraocular pressure to restore vision using ocular massage, paracentesis or acetazolamide
