MSK & Ortho Flashcards
L3 nerve root compression
Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
L4 nerve root compression
Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
symptoms of L5 nerve root compression
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
symptoms of S1 nerve root compression
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
loss of foot dorsiflexion and dorsal foot sensory loss?
L5 nerve root compression
nerve roots of sciatic nerve
L4 to S3
most common part of the bone affected in osteomyelitis in children
metaphysis
most common part of the bone affected in osteomyelitis in adults
epiphysis
when is a cast used?
to maintain the reduction of a displaced fracture
how long are stable fractures managed with a CAM boot?
6 weeks
Bennett’s fracture
intra-articular fracture at the base of the thumb metacarpal which commonly results from forced abduction of the first metacarpal.
Mr Bennett Thumb in the Butt
Galeazzi fracture
a radial shaft fracture associated with dislocation of the distal radioulnar joint.
On x-ray, we would expect to see a displaced fracture of the radius and a prominent ulnar head due to dislocation of the inferior radio-ulnar joint.
Pott’s fracture
a bimalleolar ankle fracture that occurs when there is forced foot eversion
what is a late sign of caudal equina syndrome indicating irreversible damage?
urinary incontinence
most common nerve injury with posterior hip dislocation
sciatic nerve
mechanisms of ACL injury
- lateral blow to knee
- sudden twisting
- awkward landing
which test for ACL injury is superior
Lachman»_space; Anterior Drawer (sensitivity)
difference is the knee is kept at 20-30 at the test, rather than 90 degrees in supine
Test used to identify meniscal tear
McMurray’s test
Test used to assess integrity of supraspinatus muscle
Empty can test
causes of Dupuytrens contracture [5]
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
how is a undisplaced scaphoid fracture treated?
cast for 6-8 weeks
union is achieved in > 95%
certain groups e.g. professional sports people may benefit from early surgical intervention
how is a displaced scaphoid waist fracture treated?
surgical fixation
two complications of scaphoid fracture
non union
avascular necrosis
how is a proximal scaphoid pole fracture treated?
surgical fixation
first line treatments for ankylosing spondylitis
NSAIDs and regular exercise like swimming
also physiotherapy
when should DMARDs be used in ankylosing spondylitis
if there is peripheral joint involvement
which radiological sign is indicative of bamboo spine
dagger sign
ossification of the supraspinous and interspinous ligaments
when should anti TNF alphas be started in someone with axial ankylosing spondylitis
when 2 different NSAIDs have failed
and meets criteria for active disease on 2 occasions 12 weeks apart.
5 Ankylosing spondylitis X-ray findings
sacroiliitis: subchondral erosions, sclerosis
squaring of lumbar vertebrae
‘bamboo spine’ (late & uncommon)
syndesmophytes: due to ossification of outer fibers of annulus fibrosus
chest x-ray: apical fibrosis
difference between rheumatoid arthritis and psoriatic arthritis
PsA can be asymmetrical and can affect the DIP
RA spares the DIP and it most symmetrical
what needs to be monitored regularly in the bloods of someone taking methotrexate?
FBC
U&Es
LFTs
how often is methotrexate taken?
once weekly
what should be co-prescribed with methotrexate?
folic acid 5mg once weekly
which medications should be not be prescribed alongside methotrexate? [3]
trimethoprim
co-trimoxazole
high dose aspirin
LESS signs of Rheumatoid Arthritis
Loss of joint space
Erosions (periarticular)
Soft bones
Soft tissue swellings
first line treatment for OA
topical diclofenac
second line treatment for OA
oral NSAID with PPI
what infection is associated with Polyarteritis nodosa
Hep B
what does polyarteritis nodosa lead to the formation of
aneurysm
polyarteritis nodosa presenting features
fever, malaise, arthralgia
weight loss
hypertension
mononeuritis multiplex, sensorimotor polyneuropathy
testicular pain
livedo reticularis
haematuria, renal failure
What scoring system would be most helpful to determine if a patient has a secondary cause of osteoporosis
Z-score
describe the optic disc in anterior ischaemic optic neuropathy
swollen pale disc and blurred margins
which artery is affected in anterior ischaemic optic neuropathy
inflammation in the posterior ciliary artery (a branch of the ophthalmic artery) causing ischaemic to the anterior optic nerve
Indications for an ankle x ray
Inability to walk four steps immediately after the injury or in the emergency department
Bony tenderness at the medial malleolar zone (tip of medial malleolus to lower 6cm of posterior border of tibia)
Bony tenderness at the lateral malleolar zone (tip of lateral malleolus to lower 6cm of posterior border of fibula).
which AB is sensitive for SLE
ANA
poorly specific though
which AB is specific for SLE
anti-dsDNA
associated with poor prognosis
How should patients on long term corticosteroids under 65 be monitored for their DEXA
T score dependent:
Greater than 0–>Reassure
Between 0 and -1.5–>Repeat bone density scan in 1-3 years
Less than -1.5 –> offer bone protection
which malignancy are Sjogrens patients at more risk of
lymphoma
treatment of Sjogren’s
artificial saliva and tears
pilocarpine may stimulate saliva production
endocrine causes of osteoporosis [5]
hyperthyroidism
hypogonadism (e.g. Turner’s, testosterone deficiency)
growth hormone deficiency, hyperparathyroidism
diabetes mellitus
common cause of lateral knee pain in keen runners.
Iliotibial band syndrome
tenderness 2-3cm above the lateral joint line
treatment of lumbar spinal stenosis
laminectomy
What relieves pain in spinal stenosis
sitting down or leaning forward
also find it easier to walk uphill
How is compartment syndrome diagnosed
made by measurement of intracompartmental pressure measurements.
Pressures in excess of 20mmHg are abnormal and >40mmHg is diagnostic
Initial management of compartment syndrome [3]
Keep limb level to the body
aggressive IV fluids
pain control
Investigations for Sjogrens:
bloods and extra
rheumatoid factor (RF)
ANA
anti-Ro (SSA)
anti-La (SSB)
Schirmer’s test: filter paper near conjunctival sac to measure tear formation
histology: focal lymphocytic infiltration
also: hypergammaglobulinaemia, low C4
which tools are used in assessing the risk of fragility fractures
FRAX and QFRACTURE
how does back pain progress during the day in ankylosing spondylitis
Stiffness is usually worse in morning and improves with activity
most common causative agent of disci tis
Staph aureus
2 complications of discitis
sepsis
epidural abscess
how is discitis diagnosed
MRI and CT guided biopsy
what other investigation must be done for those with discitis
screening for endocarditis therefore an echo
How is mild SLE treated
NSAIDS and hydroxychloroquine
How is SLE with organ involvement treated
long term corticosteroids with DMARDs
How is severe SLE with renal, neuro and haem effects treated?
high dose corticosteroids and immunosuppression e.g. cyclophosphamide
hand joints involved in RA
MCP
PIPS
MTP
hand joints involved in OA
MCP
DIPS
CMC
which examination sign is highly sensitive for scaphoid fracture
anatomical snuffbox tenderness
what is the ulnar paradox
proximal lesions of the ulnar nerve produce a less prominent deformity than distal lesions
explanation: When the ulnar nerve is damaged at the wrist, the medial two lumbrical muscles are affected (the lateral two being supplied by the median nerve). Denervation of the lumbricals, which flex the metacarpal phalangeal joints (MCPJ) and extend the interphalangeal joints (IPJ), causes unopposed extension of the MCPJ by extensor digitorum longus and flexion of the IPJ by flexor digitorum profundus and superficialis. This gives the hand a claw like appearance.
When the ulnar nerve is damaged at the elbow, the ulnar half of flexor digitorum profundus is also affected resulting in a less marked clawing due to reduced unopposed flexion at the IPJ.
As the patient recovers, the deformity will get worse, as flexor digitorum is reinnervated, before getting better.
The most common classification system for open fractures
Gustilo and Anderson classification system
When should open fracture be repaired when there is soft tissue injury
once the soft tissue has recovered an ORIF can be done. in the interim, an external fixation device is used
What is a late sign of caudal equine syndrome that indicates an irreversible state
urinary incontinence
Red flags for back pain according to The UK Royal College of Emergency Medicine (RCEM) [7]
- non-mechanical back pain
- past history of cancer/HIV
- generally unwell
- unexplained weight loss
- widespread neurological symptoms
- structural deformity
- thoracic back pain
why is thoracic spine pain serious? what are the possible differentials?
spinal cord compression, spinal osteomyelitis, or epidural abscess
The thoracic spine is less prone to mechanical stress compared to the cervical and lumbar region therefore is more likely to have some underlying pathology
features of compartment syndrome [4]
- Pain, especially on movement (even passive)
- excessive use of breakthrough analgesia
- Parasthesiae
- Pallor
- Arterial pulsation may still be felt as the necrosis occurs as a result of microvascular compromise
-Paralysis of the muscle group
If scaphoid fracture is suspected, but imaging is inconclusive, what should be done
referral to ortho and follow up imaging in 7-10 days
what is trigger finger?
also known as stenosing tenosynovitis, occurs when inflammation or nodules develop in the flexor tendon sheath of a finger, causing pain and difficulty in movement.
treatment of trigger finger
steroid injection is successful in the majority of patients. A finger splint may be applied afterwards
treatment of Talipes equinovarus
Ponsenti method
manipulation and progressive casting which starts soon after birth. The deformity is usually corrected after 6-10 weeks
what is talipes equinovarus
club foot, describes an inverted (inward turning) and plantar flexed foot. It is usually diagnosed on the newborn exam.
which age groups should be assessed for osteoporosis [3]
all women aged >= 65 years and all men aged >= 75 years
Younger patients should be assessed in the presence of risk factors
Risk factors in young patients that warrant assessment for osteoporosis
previous fragility fracture
current use or frequent recent use of oral or systemic glucocorticoid
history of falls
family history of hip fracture
other causes of secondary osteoporosis
low body mass index (BMI) (less than 18.5 kg/m²)
smoking
alcohol intake of more than 14 units per week for women and more than 14 units per week for men.
If the FRAX assessment was done without a bone mineral density (BMD): how would a low risk patient be treated
reassure and give lifestyle advice
If the FRAX assessment was done without a bone mineral density (BMD): how would a intermediate risk patient be treated
offer Bone Mineral Density test
If the FRAX assessment was done without a bone mineral density (BMD): how would a high risk patient be treated
offer treatment
Golfer’s elbow
medial epicondylitis
Tennis elbow
lateral epicondylitis
what aggravates Golfer’s elbow
wrist flexion and forearm pronation
what aggravates Tennis elbow
wrist extension with elbow extended and forearm supination with elbow extended
most common cause of heel pain in adults
plantar fasciitis
exacerbated when walking on tip toes
where on the foot is the pain worse in plantar fasciitis?
medial calcaneal tuberosity
management of plantar fasciitis
rest the feet where possible
wear shoes with good arch support and cushioned heels
insoles and heel pads may be helpful
definition treatment of hip OA
total hip replacement
how does meralgia parasthetica present
what nerve is compressed that causes this
what worsens the symptoms
burning and tingling sensation over the upper lateral area of the thigh, which is supplied by the lateral femoral cutaneous nerve. Most commonly originates from the L2/3 segments.
Symptoms are usually aggravated by standing, and relieved by sitting
risk factors of meralgia parasthetica [5]
obesity and sudden weight gain
pregnancy
tense ascites
trauma
antidote fro methotrexate toxicity
IV folinic acid (Leucovorin)
when should external fixation be used
when there is extensive soft tissue damage
poor prognostic indicator of rheumatoid arthritis [3]
positive RhF
early erosions
HLA DR4
when is stiffness worse in RA
in the morning, for hour +
better with exercise
features of RA in the hands [5]
ulnar deviation of MCPs
radial deviation at wrsit
swan neck
boutonieniere
Z thumb
investigation of RA [4]
DAS28
squeeze test
serology for AB: RhF, anti CCP, ANA
imaging: XR
what is Felty Syndrome
a triad of rheumatoid arthritis, neutropenia and splenomegaly
how is synovitis detected in RA
USS or MRI
treatment of acute RA flare
steroids
long term treatment of RA [3]
Monotherapy with methotrexate, leflunomide or sulfasalazine
Combination treatment with multiple cDMARDs
Biologic therapies (usually alongside methotrexate)
DMARDs safe in pregnancy [2]
Hydroxychloroquine and sulfasalazine (with folic acid)
Biologics used in RA [4]
adalimumab, infliximab and etanercept (TNF inhibitors)
rituximab (a monoclonal antibody that targets the CD20 proteins on the surface of B cells)
They cause immunosuppression, increasing the risk of infection, certain cancers (e.g., skin) and reactivation of latent TB.
acute management of gout
NSAID, colchicine
chronic management of gout
1st line: allopurinol
2nd: febuxostat
probenecid, lorsartan, rasburicase
drugs that can cause gout [4]
loop and thiazide diuretics
aspirin
cytotoxics
pyrazinamide
signs and symptoms of Behcets [4]
treatment
recurrent oral and/or genital ulceration
uveitis
erythema nodosum
VTE
treatment: immunosuppression
adverse effects of methotrexate [5]
mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver fibrosis
CK levels and EMG in temporal arteritis
normal
heart issues in those with Marfans [2]
dilation of the aortic sinuses (seen in 90%) which may lead to aortic aneurysm, aortic dissection, aortic regurgitation
mitral valve prolapse (75%),
What should you do with allopurinol during an acute attack
continue taking it
when should gout prophylaxis be started
a couple weeks after the acute attack to prevent another attack
features of PMR
- age
- onset
- symptoms
typically patient > 60 years old
usually rapid onset (e.g. < 1 month)
aching, morning stiffness in proximal limb muscles; also mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats
treatment of pagets disease
bisphosphonates
oral risedronate or IV zoledronate
complications of pagets [5]
deafness (cranial nerve entrapment, both Sens and cond)
bone sarcoma (1% if affected for > 10 years)
fractures
skull thickening
high-output cardiac failure
investigation of stress fracture
x-ray look for callus
how do bones in Paget’s appear on X-ray
thickened and sclerotic
most common reason for hip replacement revision
aseptic loosening
features of ACL rupture [3]
sudden ‘popping’ sound
knee swelling
instability, feeling that knee will give way
name a risk factor for adhesive capsulitis
diabetes
how does a patient present with an iliopsoas abscess
how do you investigate
laying supine with their knees flexed and hips mildly externally rotated
investigate with CT abdo
how does caudal equina syndrome present [5]
possible symptoms:
low back pain
bilateral sciatica (around 50% of cases)
reduced sensation/pins-and-needles in the perianal area
decreased anal tone (poor sensitivity and specificity for CES)
urinary dysfunction
the most common upper limb injury in children under the age of 6
management?
subluxation of the radial head (pulled elbow)
Signs include elbow pain and limited supination and extension of the elbow. The child usually refuses examination on the affected elbow due to the pain.
analgesia and passively supination of the elbow joint whilst the elbow is flexed to 90 degrees
what is a ganglion
Swelling in association with a tendon sheath commonly near a joint
what parts does limited cutaneous systemic sclerosis affect
face and distal limbs predominately
what parts does diffuse cutaneous systemic sclerosis affect
affects trunk and proximal limbs predominately
which antibodies are present in diffuse cutaneous systemic sclerosis
anti-scl-70 antibodies
which antibodies are present in limited cutaneous systemic sclerosis
anti-centromere antibodies
what should patients with diffuse cutaneous systemic sclerosis be started on if they have renal disease
ACEi
most common cause of death in diffuse cutaneous systemic sclerosis
pulmonary: interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH)
features and complications of Ehlers Danlos syndrome
elastic, fragile skin
joint hypermobility: recurrent joint dislocation
easy bruising
aortic regurgitation, mitral valve prolapse and aortic dissection
subarachnoid haemorrhage
angioid retinal streaks
how is hypermbility tested
Beighton score
Beighton score is positive if at least 5/9 in adults, or at least 6/9 in children.
which bones are most commonly affected in Pagets
skull
spine/pelvis
long bones lower limbs
adverse effect of hydroxychloroquine
bull’s eye retinopathy - may result in severe and permanent visual loss
therefore baseline examination needed by opthalmologist
first line treatment for reactive arthritis
NSAIDs
features of polymyositis
proximal muscle weakness +/- tenderness
Raynaud’s
respiratory muscle weakness
interstitial lung disease
e.g. fibrosing alveolitis or organising pneumonia
seen in around 20% of patients and indicates a poor prognosis
dysphagia, dysphonia
key investigations in polymyositis
elevated creatine kinase
other muscle enzymes (lactate dehydrogenase (LDH), aldolase, AST and ALT) are also elevated in 85-95% of patients
EMG
muscle biopsy
anti-synthetase antibodies
anti-Jo-1 antibodies are seen in pattern of disease associated with lung involvement, Raynaud’s and fever
management of polymyositis
high-dose corticosteroids tapered as symptoms improve
azathioprine may be used as a steroid-sparing agent
investigation of gout in the acute setting
uric acid
≥ 360 umol/L is seen as supporting a diagnosis
< 360 umol/L during a flare and gout is strongly suspected, repeat the uric acid level measurement at least 2 weeks after the flare has settled
what would Synovial fluid analysis show in gout
needle shaped negatively birefringent monosodium urate crystals under polarised light
features of CREST syndrome
Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia
hand deformities seen in OA o
Painless nodes (bony swellings)
Heberden’s nodes at the DIP joints
Bouchard’s Nodes at the PIP joints
these nodes are the result of osteophyte formation.
Squaring of the thumbs
morning stiffness comparison between OA and RA
OA lasts a few minutes
RA lasts for a while (1 hr+)
Skin features of SLE
malar (butterfly) rash: spares nasolabial folds
discoid rash: scaly, erythematous, well demarcated rash in sun-exposed areas. Lesions may progress to become pigmented and hyperkeratotic before becoming atrophic
photosensitivity
Raynaud’s phenomenon
livedo reticularis
non-scarring alopecia
General features of SLE
fatigue
fever
mouth ulcers
lymphadenopathy
Musculoskeletal features of SLE
arthralgia
non-erosive arthritis
Cardiovascular features of SLE
pericarditis: the most common cardiac manifestation
myocarditis
Respiratory features of SLE
pleurisy
fibrosing alveolitis
Renal features of SLE
proteinuria
glomerulonephritis (diffuse proliferative glomerulonephritis is the most common type)
Neuropsychiatric features of SLE
anxiety and depression
psychosis
seizures
definition of open fracture
refers to a disruption of the bony cortex associated with a breach in the overlying skin
what score helps predict the need of primary amputation in Type IIIc injuries
Mangled Extremity Scoring System (MESS)
overall management of open fracture
- immobilise including the proximal and distal joints
- check for associated injuries
- control of haemorrhage
- imaging
- neurovascular status check following reduction and immobilisation
- dressing and Abx IV broad spec
- ?tetanus
- early debridement and lavage within 6 hours of injury (removal of foreign material)
- wound irrigation with 6L saline
- fracture stabilised and external fixator used
oblique fracture
Fracture lies obliquely to long axis of bone
comminuted fracture
> 2 fragments
segmented fracture
more than one fracture along a bone
transverse fracture
perpendicular to long axis of bone
spiral fracture
Severe oblique fracture with rotation along long axis of bone
causes of drug induced lupus
Hydralazine, Procainamide
Isoniazid,Minocycline,Phenytoin
investigation: anti histone ABs
how is disease activity monitored in SLE
anti-dsDNA titres
complement levels
ESR levels
ESR and CRP levels in SLE
ESR will be elevated
in active disease CRP will be normal usually unless there is an underlying infection
which complement are investigated in SLE and what do they mean
low C4 in moderately active SLE
low C3 in very active SLE
treatment of severe SLE flares
prednisolone and IV cyclophosphamide
Proteinuria → ACEi
Aggressive GN (lupus nephritis) → immunosuppression
what are the manifestations of severe SLE flare
AIHA
nephritis
CNS disease
pericarditis
maintenance treatment of SLE
hydroxychloroquine is mainstay
can include DMARDs and low dose steroids
treatment of Raynaud’s
gloves/avoid cold
CCBs (nifedipine)
PDE V inhibitors (sildenafil)
IV prostacyclin (iloprost)
features of dermatomyositis
photosensitive
macular rash over back and shoulder
heliotrope rash in the periorbital region
Gottron’s papules - roughened red papules over extensor surfaces of fingers
‘mechanic’s hands’: extremely dry and scaly hands with linear ‘cracks’ on the palmar and lateral aspects of the fingers
nail fold capillary dilatation
proximal muscle weakness +/- tenderness
Raynaud’s
respiratory muscle weakness
interstitial lung disease: e.g. Fibrosing alveolitis or organising pneumonia
dysphagia, dysphonia
investigations for dermatomyositis
CK raised
EMG
biosy
malignancy screen
myositis panel:
80% ANA positive
30% aminoacyl-tRNA synthetases (anti-synthetase antibodies), including:
antibodies against histidine-tRNA ligase (also called Jo-1)
antibodies to signal recognition particle (SRP)
anti-Mi-2 antibodie
which are the large vessel vasculitides
GCA
Takayasu arteritis
which are the medium vessel vasculitides
Polyarteritis nodosa
Kawasaki disease
which are the small vessel vasculitides
- c-ANCA
- p-ANCA [2]
- ANCA -ve [3]
c-ANCA +ve:
Granulomatosis with polyangitis (Wegener)
p-ANCA +ve:
Eosinophilic granulomatosis with polyangitis (Churg Strauss)
Microscopic polyangitis
ANCA -ve:
HSP
Goodpasture’s
cryoglobulinaemia
investigation of GCA
temporal artery USS–> halo sign
if negative –> biopsy, will see skip lesions
features of GCA
scalp tenderness
jaw claudication
headaches
amaurosis fugal
key features of Takayasu arteritis
- Asian
systemic features of a vasculitis e.g. malaise, headache
unequal blood pressure in the upper limbs
carotid bruit and tenderness
absent or weak peripheral pulses
upper and lower limb claudication on exertion
aortic regurgitation (around 20%)
what needs to be followed up in HUS
BP and urine dipstick
features of fibromyalgia
chronic pain: at multiple site, sometimes ‘pain all over’
lethargy
cognitive impairment: ‘fibro fog’
sleep disturbance, headaches, dizziness are common
treatment of fibromyalgia
explanation
aerobic exercise: has the strongest evidence base
cognitive behavioural therapy
medication: pregabalin, duloxetine, amitriptyline
treatment of diabetic neuropathy
duloxetine
key rash in Still’s disease
what are some other features
salmon pink rash
elevated serum ferritin
RF -ve
pyrexia and lymphadenopathy
management of Still’s disease
NSAIDs
should be used first-line to manage fever, joint pain and serositis
they should be trialled for at least a week before steroids are added.
steroids
may control symptoms but won’t improve prognosis
if symptoms persist, the use of methotrexate, IL-1 or anti-TNF therapy can be considered
investigations in septic arthritis
synovial fluid sampling
blood cultures
joint imaging
triad in Still’s disease
joint pain, spiking fevers, and a pink bumpy rash
other:
high serum ferritin and leucocytosis
3 features of Colle’s fracture
- Transverse fracture of the radius
- 1 inch proximal to the radio-carpal joint
- Dorsal displacement and angulation
what dislocation is associated with a Hill Sachs lesion
glenohumeral dislocation
which rotator cuff muscle is torn most often
supraspinatus
Menisceal tear
Rotational sporting injuries
Delayed knee swelling
Joint locking (Patient may develop skills to ‘unlock’ the knee
Recurrent episodes of pain and effusions are common, often following minor trauma
Arthroscopic menisectomy is the usual treatment.
De Quervain’s tenosynovitis
pain on the radial side of the wrist
tenderness over the radial styloid process
abduction of the thumb against resistance is painful
adverse effects of azathioprine
bone marrow depression
consider a full blood count if infection/bleeding occurs
nausea/vomiting
pancreatitis
increased risk of non-melanoma skin cancer
is azathioprine safe in pregnancy
yes
how does a meniscal tear present
pain worse on straightening the knee
knee may ‘give way’
displaced meniscal tears may cause knee locking
tenderness along the joint line
delayed knee swelling
Thessaly’s test - weight bearing at 20 degrees of knee flexion, patient supported by doctor, postive if pain on twisting knee
how is the tibia positioned to the femur in a PCL injury
tibia lies back on the femur and can be drawn forward during a paradoxical draw test.
treatment of undisplaced intracapulsar hip fracture
internal fixation, or hemiarthroplasty if unfit.
treatment of displaced intracapsular hip fracture
arthroplasty (total hip replacement or hemiarthroplasty) to all patients with a displaced intracapsular hip fracture
total hip replacement is favoured to hemiarthroplasty if patients:
were able to walk independently out of doors with no more than the use of a stick and
are not cognitively impaired and
are medically fit for anaesthesia and the procedure.
treatment of extracapsular hip fracture
stable intertrochanteric fractures: dynamic hip screw
if reverse oblique, transverse or subtrochanteric fractures: intramedullary device
Occupational exposure to industrial dyes and rubber chemicals may increase risk of which renal cancer
Transitional cell carcinoma
what parts of the bone does a Salter Harris 4 fracture involve
Fracture involving the physis, metaphysis and epiphysis.
features of Leriche syndrome
- Claudication of the buttocks and thighs
- Atrophy of the musculature of the legs
- Impotence (due to paralysis of the L1 nerve)
Leriche syndrome, is atherosclerotic occlusive disease involving the abdominal aorta and/or both of the iliac arteries. Management involves correcting underlying risk factors such as hypercholesterolaemia and stopping smoking. Investigation is usually with angiography.
