Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ortho ST3 Interview > Miscellaneous tips > Flashcards

Miscellaneous tips Flashcards

1
Q

How to prep a patient for theatre?

A

NBM
Mark + consent
If capacitous consent form 1
If child- 2, Local 3, acapacitous 4
Alert CEPOD (Anaesthetist, theatre team)
Recent bloods, ecg, 2xG&S
Alert NOK
Brief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When to give Abx at induction in Orthopaedics?

A

Any arthroplasty surgery
Open fractures
Open surgery for closed fractures
Infection surgery
Spinal surgery

Not needed for purely soft tissue surgery or no implant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How to brief for theatre?

A

Patient Details
operation + indication
Positioning
Lights
Diathermy
Tourniquet
TXA
Abx
Gear
Closure/Dressings?

Pitfalls
Anticipate
Write plan up on whiteboard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What to say if asked to assess or manage a patient?

A

ATLS vs CCRISP
Initial A2E

Focused Hx/Examination
Bloods/VBG
Imaging
CT/MRI
Referral/help
Theatre
Mx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How to consent for any operation?

A

Consent form 1-4
Procedure name +- options
Benefits
Risks
Alternatives
Questions
Sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Important steps to remember for any operation?

A

M+C
Team brief
WHO checklist
Patient position
Prep and drape
Equipment
Post op care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Aims of reduction?

A

Length
Alignment
Rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What to do when investigating a bony lesion?

A

BOAST guidelines
Full history and examination

Preceeding bone pain
Wt loss, fever, night sweats

Systems review

Bisphosphonate use
PMHx
Carcinogens

O/E
Spinal/any other bony tenderness
Lymphadenopathy

Ix
Obs
Urine dip for blood
Stool sample for blood
Bloods- Bone profile/LFTs/PSA/Myeloma screen/cancer markers

Ix
Xrays
CT CAP within 24 hours of ortho assessment
MRI
Lesion sampling- liaising with sarcoma service- should be done by operating surgeon if concerns re sarcoma
PET

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Management of bony lesion

A

Identify primary (ie is it a met) vs is it a primary bone lesion

If 1o bone- sarcoma unit, MDT approach, bone biopsy performed by operative surgeon

If 2o- metastatic disease
Prophylactic fixation of impending fracture (Mirel >/8)
MDT decision needed pre op re Neoadjuvant treatment
DTx/Chemo
MDT approach
Use curretage + cement if internal fixation and bone loss- send reamings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Mirel’s criteria?

A

Guides if fore prophylactic fixation

Pain
Site of lesion
Size comparted to bone (1/3s)
Appearance of lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the commonest bony lesions?

A

Mets!!!
Thyroid
Breast
Lung
Renal
Prostate

Prostate is sclerotic in appearance
Breast- mixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How can you describe a bony lesion?

A

Location
Size
Transition zone
Periosteal reaction
Cortical involvement
Bony destruction
Lytic vs sclerotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you classify Periprosthetic fractures?

A

Vancouver/ UCS

A- Apophyseal, above stem
B- Bed-around stem
1- well fixed
2- loose
3- loose + poor bone
C- Clear- below tip/cement mantle
D-Dividing- between 2 implants
E-Each of 2 bones supporting the implant
F-facing the implant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Course of sciatic nerve

A

L4-S3- sacral plexus
Exits via greater sciatic foramen, ant to piriformis
Post to SER
Posterior compartment
To popliteal fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the anatomy of the greater sciatic notch?

A

Suprapiriform foramen:
Superior gluteal artery and vein
Superior gluteal nerve
Infrapiriform foramen:
Sciatic nerve
Pudendal nerve
Inferior gluteal artery and vein
Inferior gluteal nerve
Posterior femoral cutaneous nerve
Nerve to obturator internus
Nerve to quadratus femoris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe anatomy of lesser sciatic notch?

A

Internal pudendal artery and vein
Pudendal nerve
Obturator internus tendon
Nerve to obturator internus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

4Cs of debridement?

A

Contractility
Consistency
Colour
Capillary Bleeding

18
Q

What radiological features would suggest a primary bone tumour?

A

Bone destruction
New bone formation
Periosteal reaction
Soft tissue swelling

19
Q

Medial parapatellar approach to knee?

A

WHO, M +C
Prepped and drapped
Sandbag under hip
Knee roll + side supports
Tourniquet

Intermuscular plane between rectus femoris and vastus medialis

5cm above superior pole of patella to tibial tuberosity

Vastus medialis and quads tendon

Expose and dislocate patella
Flex knee to expose knee joint

Dangers- infrapatellar branch of saphenous nerve
Superior lateral genicular artery

20
Q

Rheumatoid arthritis and OA xray findings?

A

LESS
Loss, erosions, subluxations, swelling

LOSS
Loss, osteophytes, sclerosis, cysts

21
Q

Total hip and knee replacement consenting risks?

A

General
Bleeding, infection, Blood clots, poor wound healing, intraoperative fracture, pain, stiffness, dislocations/instability, neurovascular/tendon damage

Loosening wear, long term failure
Leg length discrepancies
Squeaking

Blood transfusion
Death

22
Q

Knee examination

A

Look, feel, move

ACL- lachmann’s/ant draw
PCL- post draw
MCL/LCL- varus/valgus stress

Meniscus- McMurray’s test

Walk`

23
Q

How many months post corticosteroid injection can you do a TKA?

A

3 months

24
Q

How would you examine a patient’s distal neurovascular status?

A

Look for any signs of ischaemia
Feel for DP and PT + assess CRT
Dopplers in unable to palpate pulses- listening to see if mono/bi/triphasic pulses

Assess Tibia nerve by asking for plantarflexion of ankle and sensation over plantar aspect of foot

SPN- sensation over dorsum + eversion of foot

DPN- sensation in 1st web space + dorsiflexion

25
Q

ATLS spiel

A

I would approach this patient with full ATLS precautions. I would perform a primary survey looking to identify any life or limb threatening injuries.
If this was an isolated closed injury I would

Take an AMPLE History
2o survey

Focused examination on joint above and below

26
Q

How to place a delta frame ex fix?

A

Insert steinmann calcaneal pin- 2cm ant to calcaneal tip + 2cm superior to plantar aspect of heel- avoid PT bundle + medial calcaneal N

Place tibial screws- pre drill. More than 3-5cm Outside zone of injury. Medial to tibial crest through safe zones. Insert shanz pins by hand

Attach rods+ reduce fracture and tigthen clamps

1st metatarsal pins to augment structure

27
Q

Which mets are sclerotic, mixed and lytic?

A

Sclerotic is prostate
Mixed is breast
Lytic is Renal, Lung, Thyroid

28
Q

Aims of surgery for metastatic disease?

A

Survive surgery
Immediate weight bearing
Prosthesis outlives patients
Protect entire bone

29
Q

Pre operative considerations in patients with RA for TKR/THR?

A

Age/activity- prosthesis may need to last longer
Medications- steroids- poor bone quality, methotrexate- local guidelines (hold in low renal fnx patients), biologics- hold perioperatively
Multi joint involvement- need other joint replacement

Healing issues- soft tissue/bone
Infection risk
Deformity

30
Q

Why can you DAIR an acute PJI?

A

No biofilm?

31
Q

Recent changes in PJI?

A

MDT managed with micro input
Referred to regional PJI centre for revisions

32
Q

What does the bulbocavernosus reflex actually tell you?

A

If you can assess whether there is reversibility of symptoms

If present- then no reversibility

If no present- then cant say

33
Q

Difference between MCA and MHA?

A

MHA for someone who has a mental health disorder impeding their judgement and needs for assessment and treatment

MCA for someone who lacks capacity- best interest, help them be involved, allow them to make a mistake

IMCA if no NOK

34
Q

30 day mortality and 1 year mortality for NOF?

A

6-7% (used to be 10%)
30%

35
Q

Hard vs soft vascular signs

A

Ischaemia signs, arterial bleeding, pulselessness

Soft- bleeding at the scene, reduced pulse, non-expanding hematoma, injury close to a blood vessel or bone fracture

36
Q

Probable first thing you would repair in soft tissue knee dislocation?

A

PLC

Leave ACL/MCL for elective situation

37
Q

Approach for supracondylar fracture if needing to open?

A

Anterior if vascular/neuro concerns
Lateral if periosteum is torn
Medial if needing to put medial K wire

38
Q

Treatment options for femoral shaft fractures in kids?

A

Conservative:
Hip Spica if <6 years
Traction
Pavlik harness if <6 months

Operative
TENS (titanium elastic nail) nailing from 6-13 years old
IM Nailing >14 years old

Submuscular plating if shortened/comminuted

Ex fix if polytrauma

39
Q

Metabolic bone disease investigations?

A

Bone profile
PTH
Ca
ALP
Vit D
TFTs

Imaging
Bowing

40
Q

NAI DDx?

A

Infection
Tumour
Metabolic Bone Disease
Osteogenica Imperfecta

41
Q

NAI Mx?

A

Admit- paediatrics as lead team
Involve Safeguarding team
Escalate
Child protection services

Analgesia
Splint
?operative Mx

Ortho ST3 Interview (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions