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MSK key points Flashcards

1
Q

What classifcation system is used to grade open fractures?

A

Gustilo

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2
Q

What is an open fracture?

A

fracture with direct communication to the external environment

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3
Q

What are the features of a type I open fracture

A

simple fracture

wound <1cm

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4
Q

What are the features of a type II open fracture

A

simple fracture 1-10cm

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5
Q

What features automatically make an open fracture grade III

A 
farmyard contamination
neurovascular compromise
periosteal stripping
comminuted fracture
>10cms
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6
Q

What are the features of a type IIIa open fracture

A

comminuted fracture
high energy mechanism
covered from existing tissue on repair

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7
Q

What are the features of a type IIIb open fracture

A

comminuted
needs plastic surgery
periosteal stripping

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8
Q

What are the features of a type IIIc open fracture

A

neurovascular compromise

comminuted

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9
Q

What is the immediate management of an open fracture

A 
cannulate - bloods, analgesia, antiemetics, fluids
assess neurovascular status!!!
remove obvious contamination
take photos
cover with saline dressing
realign and splint
recheck neurovascular status!!!
tetanus status
x ray
NBM
call orthopaedic reg, anaesthetist and plastic surgeon
drug chart - antibiotics, analgesia, fluids, antiemetics, thromboprophylaxis
surgery within 24hrs
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10
Q

What are the indications for immediate surgery in an open fracture

A

neurovascular compromise
farmyard contamination
compartment syndrome

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11
Q

What does a higher grade of open fracture increase the risk of

A

infection
amputation
longer healing time

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12
Q

Why does periosteal stripping often result in non-union

A

the bone relies on the periosteum to provide a blood supply for healing

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13
Q

How can the risk of infection be decreased in an open fracture

A

antibiotics!

surgical debridement

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14
Q

What is septic arthritis?

A

acute infection of a joint capsule

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15
Q

What can cause septic arthritis

A

bacteraemia
direct inocculation
contiguous spread from adjacent osteomyelitis

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16
Q

What are the risk factors for septic arthritis

A 
>80y
diabetes
HIV
immunosupression
recent joint surgery
IVDU
history of crystal arthropathies
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17
Q

Which joints are commonly affected by septic arthritis

A 
knee
hip
shoulder
elbow 
ankle
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18
Q

Which joint is commonly affected in IVDUs with septic arthritis

A

sternoclavicular

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19
Q

Which organisms are commonly present in septic arthritis

A

Staphylococcus aureus
Stahpylococcus epidermis
Neisseria gonorrheae

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20
Q

What are the signs and symptoms of septic arthritis

A 
pain
effusion
erythema
tenderness
warmth
inability to weight bear
inability to complete full range of passive movements
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21
Q

Describe the pathophysiology of septic arthritis and what makes it an emergency

A

acute irreversible destruction of the cartilage at joints by proteolytic enzymes from inflammatory cells
can be within 8 hours

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22
Q

What are the differential diagnoses in septic arthritis

A

gout
pseudogout
cellulitis

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23
Q

What investigations need to be done in suspected septic arthritis

A

FBC, CRP, ESR
blood cultures
xray joint
joint aspiration

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24
Q

What are the findings on xray in septic arthritis

A

joint space widening

periarticular osteopenia

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25
Q

What are the tests you want to do on the joint aspirate in septic arthritis

A 
cell count
gram stain
culture
glucose leve;
crystal analysis
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26
Q

What cell count is diagnostic for septic arthritis in joint aspiration?

A

WCC >50000

>1000 if there is a joint replacement

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27
Q

What is the management of septic arthritis

A

urgent surgical irrigation and debridement

IV abx for 3-4weeks

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28
Q

What is a fragility fracture?

A

fractures that result from mechanical forces that would not ordinarily result in fracture, known as low-level (or ‘low energy’) trauma

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29
Q

Define compartment syndrome

A

increased pressure within a myofascial compartment that exceeds capillary perfusion pressure, which exceeds the venous pressure and so impairs blood outflow. Lack of oxygenated blood and accumulation of waste products results in muscle ischaemia

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30
Q

What are the causes of compartment syndrome

A 
trauma 
tight bandages/casts
crush injuries
extravasation of IV fluids 
post ischaemic swelling after revascularisation
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31
Q

What are the early symptoms of compartment syndrome

A

pain out of proportion

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32
Q

How do you test for pain on passive stretch of the calf?

A

moving the big toe upwards stretches flexor hallucis longus (FHL) in the deep flexor compartment of the calf;

moving the big toe downwards stretches extensor hallucis longus (EHL) in the anterior compartment

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33
Q

What are the signs of compartment syndome

A

pain on passive stretch of compartment

swollen and tense leg

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34
Q

What are the late signs and symptoms of compartment syndrome

A

pins and needles
paresthesia
loss of sensory function
absent pulses

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35
Q

When measuring the compartment pressure, what pressure counts as compartment syndrome

A

> 40mmHg

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36
Q

What is teh treatment for compartment syndrome

A

release any external compression
Fasciotomy
IV fluids - risk of myoglobinuria causing AKI

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37
Q

Describe the fasciotomy in the treatment of compartment syndrome

A

The muscle compartments are decompressed via long incisions along the limb, opening the skin, fat and fascia. If pressure is elevated, the muscle bulges out through the incisions.
The wounds are not closed at the initial operation. Instead, the swelling is allowed to settle and the patient is returned to theatre after 48–72 hours for a second look.
If the skin can be closed without tension this is done. If not, skin grafts may be required.

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38
Q

Which injuries most commonly cause compartment syndrome

A

supracondylar fractures of the humerus

tibial shaft injuries.

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39
Q

What can happen if compartment syndrome is missed

A

muscles undergo necrosis
leads to irreversible scarring and contraction of muscles
= Volkmann’s ischaemic contracture

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40
Q

What is the pathophysiology of developmental dysplasia of the hip

A

shallow and underdeveloped acetabulum

leads to subluxation and dislocation of the hip

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41
Q

How are babies examined for DDH

A

barlow
ortalani
galezzi

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42
Q

How is the barlow test done

A

adduct and depress flexed femur

+ve = dislocates posteriorly

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43
Q

How is the ortalani test done

A

abduction and elevation flexed femur

+ve = reduction

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44
Q

What is the galezzi sign?

A

patient supine
knees and hips flexed, feet on table
look at knee heights
if one knee lower = dislocation of that hip causing leg shortening

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45
Q

What is the treatment for DDH

A

pavlick harness

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46
Q

What is the proper name for club foot

A

Talipes equinovarus

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47
Q

How is teh foot positioned in talipes equinovarus

A

inverted

plantarflexed

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48
Q

How is club foot treated

A

Ponseti method = manipulation and progressive casting

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49
Q

Describe the mechanism of action of bisphosphonates

A

inhibit bone reabsorption by osteoclasts

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50
Q

Name a bisphosphonate

A

alendronic acid

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51
Q

When are bisphosphonates prescribed

A

osteoporosis

prevention of steroid induced osteoporosis

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52
Q

How should alendronic acid be taken

A

30 minutes before any other food and drink
with large glass of plain water
standing/sitting
remain upright for 30 mins afterwards

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53
Q

When might alendronic acid be contraindicated

A

Abnormalities of oesophagus;
hypocalcaemia;
other factors which delay emptying (e.g. stricture or achalasia)

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54
Q

What are the common side effects of alendronic acid

A 
indigestion, abdominal pain, bloating, wind (flatulence), acid regurgitation, feeling sick (nausea)
Diarrhoea	
Constipation
Headache, muscle or joint pain
Feeling dizzy, itching
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55
Q

What are some serious side effects of alendronic acid

A

gastric ulcers
osteonecrosis of the jaw or ear
increased risk of atypical stress fractures of the proximal femoral shaft
Severe oesophageal reactions (oesophagitis, oesophageal ulcers, oesophageal stricture and oesophageal erosions)

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56
Q

What advice should be given to patients who are taking alendronic acid

A

report any thigh, hip, or groin pain to a doctor

maintain good oral hygiene, receive routine dental check-ups, and report any oral symptoms - osteonecrosis of jaw

report ear pain, discharge from ear or an ear infection

to stop taking alendronic acid and to seek medical attention if they develop symptoms of oesophageal irritation such as dysphagia, new or worsening heartburn, pain on swallowing or retrosternal pain.

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57
Q

When are NSAIDs contraindicated

A

Active gastro-intestinal bleeding;
active gastro-intestinal ulceration;
history of gastro-intestinal bleeding related to previous NSAID therapy;
history of gastro-intestinal perforation related to previous NSAID therapy;
history of recurrent gastro-intestinal haemorrhage (two or more distinct episodes);
history of recurrent gastro-intestinal ulceration (two or more distinct episodes);
severe heart failure - due to impairment of renal function

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58
Q

Describe the mechanism of action of NSAIDs

A

inhibition of COX2 enxyme
decreased prostaglandin synthesis
decreased pain and inflammation

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59
Q

What affect does NSAID use have on the CVS

A

increased risk of thrombotic events eg MI, stroke

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60
Q

How are NSAIDs most safely prescribed

A

The lowest effective dose
for the shortest period of time to control symptoms

the need for long-term treatment should be reviewed periodically.

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61
Q

What are the different mechanisms of fracture healing

A

primary

secondary

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62
Q

describe primary fracture healing

A

can only occur if there is absolute stability

intramembranous ossification occurs with internal Haversian remodelling

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63
Q

describe secondary fracture healing

A

occurs with relative stability and fixation

callus formation, endochondral healing

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64
Q

Describe the stages of endochondral fracture healing

A

haematoma - inflammatory cascade and granulation tissue

soft callus - fibroblasts and chondroblasts lay down fibrous tissue and cartilage. intramembranous ossification to close gap

hard callus - endochondral ossification of callus to form woven bone

remodelling - woven to lamellar, sufrace erosion and osteonal remodelling

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65
Q

How long does is take for each of the stages of endochondral fracture healing to occur

A

haematoma - 1-7d
soft callus - 2-3weeks
bony callus - 3-4m
remodelling -

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66
Q

What can delay fracture healing

A 
poor blood supply
diabetes
smoking - nicotine
steroids
NSAIDs
Ischaemia: poor blood supply or AVN
infection
interfragmentary strain
Interposition of tissue between fragments
Intercurrent disease: e.g. malignancy or malnutrition
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67
Q

What can be used to stimualte fracture healing

A

bone morphogenetic protein - member of TNF beta superfamily

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68
Q

When is open reduction and internal fixation of a fracture required?

A 
intra-articular #s
Open #s 
2 #s in 1 limb 
Failed conservative Rx
Bilat identical #s
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69
Q

Why do we fixate fractures

A

fixation increases strain leading to bone formation

Fixation also decreases pain, and increases stability and ability to function

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70
Q

What are the principles of rehabilitation after a fracture

A

Immobility decreases muscle and bone mass and leads to joint stiffness
Need to maximise mobility of uninjured limbs
Quick return to function reduces later morbidity

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71
Q

What neurological complication does a humeral shaft fracture lead to

A

radial nerve palsy
unopposed flexion of wrist = wrist drop
loss of sensation over posterior forearm and hand

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72
Q

Describe Erb’s palsy

A

waiter’s tip
arm adducted and internally rotated, wrist flexed

due to damage to C5/C6 over stretch of neck

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73
Q

What antibiotics be given after an open fracture

A

co-amoxiclav 1.2g within 3 hours

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74
Q

What is the relevance of the mangled extremity score?

A

used to distinguish between salvageable and doomed limbs in lower extremity fracture

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75
Q

How do you test the function of the median nerve in the hand

A

abduction of thumb (up to sky)

dorsal surface middle finger

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76
Q

How do you test the function of the radial nerve in the hand

A

extension of thumb at interphalangeal joint

interdigital webbed space between thumb and index

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77
Q

How do you test the function of the ulnar nerve in the hand

A

abduction of index finger

dorsal surface of little finger

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78
Q

How do you test the function of the FDS tendon

A

hold other fingers flat in extension, palm up
ask pt to bend fingers
+ve = flexion at PIP

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79
Q

How do you test the function of the FDP tendon

A

hold middle phalanx of finger
ask pt to bend finger
flexion at DIP

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80
Q

How do you test the function of the Flexor carpi ulnaris tendon

A

ulnar deviation at wrist against resistance

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81
Q

How do you test the function of the Flexor carpi radialis tendon

A

radial deviation at wrist

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82
Q

How do you test the function of the flexor pollicis longus tendon

A

flexion at IPJ of thumb

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83
Q

How do you test the function of the extensor digitorum tendon

A

extension at MCP

84
Q

How do you test the function of the extensor indicis tendon

A

palm flat on table

lift index finger

85
Q

How do you test the function of the extensor digiti minimi tendon

A

palm flat on table

lift little finger

86
Q

How do you test the function of the extensor pollicis longus tendon

A

extension of thumb at IPJ

87
Q

What deformity does cutting the ulnar nerve at the wrist cause

A

ulnar claw

in medial 2 digits
hyperextension at MCP, flexion at IPJ

88
Q

What muscles groups cause the problems in ulnar claw

A

loss of innervation to ulnar lumbricals
would normally flex at MCP and extend at IPJs

loss of innervation leads to unopposed extension at MCP by extensor digitorum and flexion at IPJs by FDS and FDP

89
Q

If the ulnar nerve is cut higher up the arm, why is the ulnar claw less pronounced

A

loss of innervation to the FDP
loss of flexion at DIPJ
less pronounced flexion!

90
Q

What does the nottingham n=hip fracture score used for

A

used to calculate risk of death following #NOF using pre-op patient characteristics

91
Q

What parameters does the nottingham hip fracture score use

A 
age
sex
AMTS
Hb on admission
residence - ?living in an institution
comorbidities - >2
active malignancy in last 20y
92
Q

why is lactate measured in #NOF

A

prognostic indicator

>3mmol/l on admission is a sign of high risk of death

93
Q

What do you need to find out on clerking a #NOF

A 
neurovascualr status of limb
drug history
past medical history - cardiac/lung probs
prev cancer
MSE
94
Q

What investigations should be done in #NOF

A

ECG
FBC, U+E, glucose, G+S, cross match, bone profile
AP and lateral pelvis. full length femur if ?cancer
CXR pre-op

95
Q

whihch vessel is at risk of being damaged in an intracapsular #NOF

A

medial femoral circumflex

96
Q

What is the immediate management of a #NOF

A 
analgesia + antiemetic
IV FLUIDS
mechanical prophylaixis
LMWH (unfractionated if renal probs) - stop 12hrs pre-op
surgery within 48hrs
97
Q

What is the management of an undisplaced intracapsular #NOF

A

internal fixation - dynamic hip screw

98
Q

What is the management of an displaced intracapsular #NOF

A

if uoung and fit - fynamic hip screw
if mobilise with no more than stick, no cognitive impairment, medically fit for op = THR
if mobilise with more than stick, frail, chronic health probs = hemiarthroplasty

99
Q

What is the management of an extracapsular #NOF

A

sliding hip screw

100
Q

What is the 30 day hospital mortality of #NOF

A

10%

101
Q

What is the 12 month mortality of #NOF

A

30%

102
Q

What is the normal volar tilt at the wrist

how is this measured?

A

11 degrees

lateral xray, from perpendicular line through long axis of radius
to tangent along radial articular surface

103
Q

What is the normal radial inclination at the wrist

how is this measured?

A

22 degrees

AP xray from perpendicular line through long axis of radius
to line from most distal point of radial styloid to distal most point of ulnar articular surface

104
Q

What is the normal relationship between the distal radius and ulnar

A

11mm between line perpendicular to tip of radial styloid
and line perpendicular to distal articular surface of ulnar head

= radial length

105
Q

What does deformity of the wrist joint after a fracture lead to in the long term

A

shortening leads to instability
loss of radial inclination lead to pain
loss of volar tilt leads to reduced mobility

106
Q

What is a Galezzi fracture?

A

Isolated fracture of the distal radius shaft with disruption of the distal‐radio‐ulnar joint

107
Q

What is a Monteggia facture

A

isolated proximal third ulnar fracture with dislocation of the radial head

The radial head should be aligned with the capitellum, and on an elbow X‐ray (AP or lateral) a line drawn up the shaft of the radius should transect the middle of the capitellum (known as the radiocapitellar line).

108
Q

What is a Colles fracture

A

simple extra‐articular transverse fracture of the distal radius one inch (2.5cm) from the joint line with dorsal displacement and a ‘dinner‐fork deformity’

109
Q

What is a smith’s fracture

A

extra‐articular fracture of the distal radius with palmar displacement

110
Q

What is a Barton’s fracture

A

a partial intra‐articular fracture in which either the dorsal or palmar rim of the radius is left intact

111
Q

How are distal radius fractures managed

A

Undisplaced extra‐articular fractures = below‐elbow cast for a total of 6 weeks.

displaced extra‐articular = closed reduction may be attempted with a trial of conservative treatment in plaster. there is a risk of redisplacement! so monitor with weekly X‐rays. If there is sig-nificant instability, K‐wires may be used to hold the distal fragment in position.

Intra‐articular fractures require anatomical reduction by ORIF using a plate and screws

112
Q

What are the red flag symptoms for back pain

A 
>65
thoracic pain
recent cancer
fever
weight loss
night sweats
night pain
neurological sx
113
Q

State the yellow flags for back pain

A

A negative attitude that back pain is harmful or potentially severely disabling
Fear avoidance behaviour and reduced activity levels
An expectation that passive, rather than active, treatment will be beneficial
A tendency to depression, low morale, and social withdrawal
Social or financial problems

114
Q

What are yellow flag symptoms

A

pyschosocial factors shown to be indicative of long term chronicity and disability

115
Q

define radiculopathy

A

compression of a nerve root leading to shooting pain, numbness or weakness
= sciatica!

116
Q

describe the pathophysiology of disc hernitaion

A

annulus fibrosis degeneration, splits

nucleus pulposus herniates out

117
Q

What are the signs and symptoms of L4 disc compression

A

weakness of ankle dorsiflexion
loss of sensation on medial aspect lower leg
loss of patellar reflex

118
Q

What are the signs and symptoms of L5 disc compression

A

weakness of great toe dorsiflexion

loss of sensation to lateral aspect lower leg and dorsum of foot

119
Q

What are the signs and symptoms of S1 disc compression

A

weakness of ankle plantarflexion
loss of sensation to sole of foot
loss of ankle reflex

120
Q

What is the management of a disc hernation

A

conservative
MRI if >6 weeks of symptoms
consider discectomy if sx have lasted >3m

121
Q

What can cause cauda equina

A 
disc herniation
spinal stenosis
cancer
trauma
epidural abscess
122
Q

Describe the pathophysiology of cauda equina

A

compression of cauda equina LMN L2-34

123
Q

What are the examination findings in cauda equina

A 
palpable bladder - due to urinary retension
lower extremity weakness or sensory loss
decreased leg reflexes
perianal loss of sensation
decreased rectal tone on DRE
124
Q

What is the investigation and management of cauda equina

A

MRI

urgent surgical decompression <48Hrs

125
Q

What can cause spinal stenosis

A

osteophytes
hypertrophic ligamentum flavum
spondylolisthesis
bulging disc

126
Q

DEscribe the pathophysiology of spinal stenosis

A

narrowing of spinal canal and neural foramina leads to root ischaemia and neurogenic claudication

127
Q

What tumours can occur in the spine

A

primary - mulitple myeloma

secondary - breast, prostate, lung, kidney, thyroid

128
Q

which tumours most commonly metastasis to bone

A 
breast 
prostate
kidney
thyroid
lung
129
Q

What makes a vertebral fracture unstable

A

if more than one of the columns of the spine are fractured

130
Q

What makes up the ankle ring

A 
medial malleolus
deltoid ligament
calcaneus
lateral ligaments
lateral malleolus
syndesmosis
tibial plafond
131
Q

Name the lateral ligaments of the ankle joint

A

anterior talofibular - most important for stability!
posterior talofibular
calcaneofibular

132
Q

Describe the Weber classification

A

A - # below level of syndesmosis, deltoid intact
b - # at level of syndesmosis
C - # above level if syndesmosis

133
Q

What features deem an ankle fracture to be unstable

A

presence of a medial malleolar fracture,
presence of a posterior malleolar fracture
presence of talar shift.

134
Q

Describe the management of an ankle fracture

A

weber A - stable so weight bearing below knee cast or boot

Weber B - stable :non‐weightbearing below‐knee cast for 6–8 weeks
- unstable: ORIF

Weber C - ORIF

135
Q

What are the actions of the rotator cuff muscles

A

supraspinatus - first 30 degrees abduction
infraspinatus - external rotation
teres minor - external rotation
subscapularis - internal rotation

136
Q

How do you test the rotator cuff muslces

A

supraspinatus - empty can test
infraspinatus and teres minor - resisted external rotation
subscapularis - belly press

137
Q

What is a Bankart lesion

A

loss of anterior/inferior portion of glenoid labrum due to dislocation of head of humerus anteriorly

138
Q

What is a Hil-sachs lesion

A

depession in posterosuperior head of humerus due to hitting glenoid rim causing chondral impaction injury

139
Q

Calcualate the beighton score

A

extension little finger beyong 90 degrees /2
extension elbow >10 /2
thumbs to flexor surface /2
hyperextension knees /2
touch floor with hands flat with straight knees /1

> 4 = abnormal

140
Q

Describe how to do a Hawkin’s test and what it shows

A

shoulder flexion to 90
elbow flexed to 90
move forearm down

pain = subacromial impingement

141
Q

How should i assess a bite injury?

A 
when/what/how
location and depth
?damage to nerves, vessels or tendons
/redness, swelling, discharge, cellulits
lymphadenopathy or fever
ROM of adjacent joints
tetanus profile
142
Q

What immediate management should be given in a bite injury

A

analgesia
tetanus prophylaxis
irrigation
Abx - co-amoxiclav or doxycycline+metronidazole

143
Q

What is the most common infection due to a bite injury

A

Pastuerella multocida

144
Q

How might a displaced tibial shaft fracture be managed?

A

reduction and stabilisation.
Intramedullary nailing - nail is inserted proximally, through or adjacent to the patellar tendon.
The nail allows the patient to be free of plaster, and depending on fracture configuration, weightbearing may be allowed immediately!

145
Q

How might an undisplaced tibial shaft fracture be managed?

A

above‐knee cast for 6–8 weeks
converted to a below‐knee cast for a further 6–8 weeks.
Regular monitoring with X‐rays is essential to ensure alignment is maintained

146
Q

What is the difference between an upper and lower motor neuron lesion

A

UMN - within spinal cord, cellbody in cortex/brain stem
present with increased tone, hyperrelfexia, extensor plantar response

LMN - outside spinal cord. cell body in ventral horn of spinal cord
presents with decreased tone, weak reflexes, normal plantar reflex, fasciculations

147
Q

What is the difference between nerve root impingement and peripheral nerve entrapment

A

nerve root impingement - affects dermatomes/myotomes of the nerve root

peripheral nerve entrapment - signs are in distribution of perioheral nerve

148
Q

What is myelopathy

A

compression of the spinal cord

149
Q

should you xray patients with back pain

A

do not xray to diagnose non-specific mechanical back pain if no red flags to suggest malignancy or infection

150
Q

What is a root block

A

injection of local anaesthetic adn steroid into nerve root as it exits vertebral foramen

151
Q

What is an epidural

A

epidural needle inserted into epidural space between ligamentum flavum and dura to administer anaesthetic

152
Q

What are the signs of RA on xray

A 
loss of joint space 
juxtaarticular osteopenia
joint deformity
soft tissue swellings
marginal erosions
153
Q

What questions need to be asked in a history of OA

A 
pain - site, intensity, timing, aggravating, relieving
night pain
stiffness
neuro probs? - tingling, weakness
ADLs - walking, shoes and socks, wa;king aids
prev surgery
prev trauma
occupation
154
Q

When asking about PMH what is it important to know about eh conditions

A

how long they’ve had it
how was it picked up
what the treatment is
how well controlled

155
Q

What should i look for on examination in OA

A 
muscle wasting
varus/valgus
pelvis tilted
antalgic gait/Trendelenberg
walking aids
scars
external rotation
fixed flexion
adduction contracture

reduced ROM
pain on movement

156
Q

How should a walking stick be held

A

on contralateral side, furthest point away from body

takes weight off affected side and help to balance

157
Q

What should be done at pre-assessment clinic

A 
consent form
drug histroy - change/stop pre-op?
write drug chart up
allergies?
reaction to anaethetic?
general examination
ECG, urine dipstick, BP, height and weight
FBC, U+E, HbA1c, G+S,
xray joint, CXR

MRSA screen!!!!

158
Q

What are the risks of THR

A 
infection 1%
DVT 15% with prophylaxis
PE
death <1% in 30 days
blood trasnfusion - 10-15%
no relief of pain
bleeding
damage to nerves
dislocation
re-operate due to wear
159
Q

What is the 30 day mortality following THR

A

30%

160
Q

What is the risk of infection following THR

A

1%

161
Q

What should be prescribed on the srugs chart pre-op in THR

A 
LMWH SC 6pm on day of surgery
TED stockings
analgesai
regular meds
prophylactic Abx
laxatives - fybogel and senna
antiemetics
162
Q

What antibiotics are given prophylactically in THR

A

IV co-amoxiclav in induction room on day of surgery

then at 8h and 16h post op

163
Q

If the patient is penicillin allergic, What antibiotics are given prophylactically in THR

A

IV teicoplanin and gentamicin in induction room

only given once

164
Q

On teh day of surgery what question should you ask the patient when you review them on the ward

A 
how have you been? 
doctor/dentist visits
check procedure + understanding
check consent form
check NBM
have they taken meds today?
baseline obs
examine joint
check blood results
check drug chart
165
Q

What is hte plan post THR

A 
obseve every 4 hours
pain relief
FBC/U+E after 2 days
thromboprophylaxis
IV 
Abx
xray
mobilse
wound check
166
Q

What is the suggested management of OA

A

weight loss, given advice about local muscle strengthening exercises and general aerobic fitness

first line = paracetamol and topical NSAIDs - only for OA of the knee or hand

second-line treatment = oral NSAIDs/COX-2 inhibitors, opioids, capsaicin cream and intra-articular corticosteroids. A proton pump inhibitor should be co-prescribed with NSAIDs and COX-2 inhibitors.

non-pharmacological treatment options include supports and braces, TENS and shock absorbing insoles or shoes

if conservative methods fail then refer for consideration of joint replacement

167
Q

What tests should he done in a patient with suspected bone metastasis

A

ECG
FBC, U+E, PTH, calcium, phosphate, ALP, CRP, ESR
xray, urine electrophoresis
CTCAP

168
Q

Nasme some primary bone cancers

A

multiple myeloma
osteosarcoma
ewing’s sarcoma
chondrosarcoma

169
Q

What is the most common site for osteosarcoma

A

proximal tibia

distal femur

170
Q

Which bone tumours are common in children

A

osteosarcoma

chondrosarcoma

171
Q

Describe hallux valgus

A

medial deviation first metatarsal

lateral deviation proximal phalanx of great toe

172
Q

DEscribe hallux rigidus

A

OA of first MTPJ

dorsal osteophytes adn irregular joint articulation

173
Q

What causes flat foot?

A

physiological

tibialis posterior insufficiency, would normally attach to plantar surfaceof midfoot bones to maintain arch

174
Q

What are the signs of flat foot

A

loss of longitudinal arch
-ve heel raise test
too many toes sign - abduction forefoot
valgus hindfoot

175
Q

What is seen on examination of Tennis elbow

A

tenderness at lateral epicondyle

pain on resisted wrist extension

176
Q

What is seen on examination of Golfer’s elbow

A

tenderness at medial epicondyle

pain on resisted pronation and wrist flexion

177
Q

What can cause greater trochanteric pain syndrome

A

tendinopathy gluteus medius
muscular tear gluteus medius
trochanteric bursitis

178
Q

Describe the symptoms of greater trochanteric pain syndrome

A

pain on lateral side of leg - worse on lying on side or with activity

179
Q

What can cause osteomyelitis

A

haematogenous spread
direct inoculation
contiguous spread

180
Q

What organism most commonly causes osteomyelitis

A

Staphylococcus aureus

181
Q

Describe the pathophysiology of osteomylitis

A

infection of bone leading to progressive inflammatory destruction

182
Q

What are the most common sites for osteomyelitis to occur. Why?

A

adults: spine
children: proximal tibia, distal femur

slow blood flow!

183
Q

What are the risk factors for osteomyeleits

A 
diabetes
steroids
immunosupression
IVDU
renal disease
children
vascular/neurological compromise
184
Q

How are acute, subacute and chronic osteomyelitis defined?

A

<2weeks
subacute one-3m
chronic >3m

185
Q

What are the symptoms of osteomyelitis

A

pain, worse on movement
fever
immobile limb

186
Q

What are the signs of osteomyelitis

A 
walk with limp
erythema
tenderness
oedema
draining sinus tract if chornic
effusion of neighbouring joints
187
Q

What investigations should be done in osteomyelitis

A

urine dipstick
FBC, U+E, CRP
blood culture
xray

188
Q

What is seen on xray in osteomyelitis

A

lytic lesions surrounded by sclerosis
sequestrum in centre = dead devitalised detached bone
involucrum = new bone that form around the sequestrum

189
Q

What is the management of osteomyeleits

A

conservative: IV Abx for 3-6 weeks Flucloxacillin
operative: irrigation and debridement

190
Q

Hoe should a fracture be described on xray

A 
Pattern - transverse, oblique, spiral
Angulation
Rotation
Translation
Shortening (impaction if no loss of alignment)
191
Q

Describe the features of slipped upper femoral epiphysis

A

pain in hip/groin/medial thigh/knee

acute: cannot walk/stand, ext rot, reduced ROM

192
Q

What are the risk factors for slipped upper femoral epiphysis

A

obesity

hypothyroid

193
Q

Describe the management of slipped upper femoral epiphysis

A

immobilise
analgesia
screw fixation across growth plate

194
Q

What is a Salter Harris fracture

A

one that occurs across a growth plate

195
Q

Describe a type I Salter Harris #

A

transphyseal slip

stem cells undamaged
growth disturbance unlikely

196
Q

Describe a type II Salter Harris #

A

along growth plate, extends into metaphysis

stem cells undamaged
growth disturbance unlikely

197
Q

Describe a type III Salter Harris #

A

along growth plate, extends into epiphysis

risk of stem cell damage
angular deformity

198
Q

Describe a type IV Salter Harris #

A

crosses growth plate into metaphysis and epiphysis

risk of stem cell damage
angular deformity

199
Q

Describe a type V Salter Harris #

A

crush injury of growth plate

stem cells crushed and damaged
complete growth arrest

200
Q

What is Perthes disease

A

idiopathic AVN femoral head

collapses, loss of spherical shape

201
Q

What are the typical features of perthes disease

A

caucaisan
4-8y
pain in hip/groin
antalgic gait

202
Q

Describe the stages of Perthes disease seen on xray

A

initial - widened joint space
fragmentation - crescent sign, subchondral #
reossification - new bone laid down
remodelling

203
Q

What is the tx of perhtes

A

activity modification
partial weight bearing
osteotomy if head not contained within acetabulum

204
Q

pathophysiology of De Quervain’s tenosynovitis

A

the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed

205
Q

What are the features of De Quervain’s tenosynovitis

A

pain on the radial side of the wrist
tenderness over the radial styloid process
abduction of the thumb against resistance is painful
Finkelstein’s test: with the thumb is flexed across the palm of the hand, pain is reproduced by movement of the wrist into flexion and ulnar deviation

Finals (32 decks)

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