Ortho Flashcards
what is multiple myeloma?
- malignancy of plasma cells
- accumulation in bone marrow
- Ig secretion in the blood or urine + associated tissue / end organ damage
what type of cell is a myeloma plasma cell?
post-germinal centre plasma B cell
what type of protein may be secreted in the urine by myeloma plasma cells?
bence jones proteins
- deposition of theses in distal tubules in kidney causes kidney disease
summarise management of a patient with multiple myeloma:
Non-pharam
- MDT
- annual influenza vaccine + one off pneumococcal vaccine
Pharma
- analgesia (avoid NSAIDS due to renal impairment)
- chemo
- corticosteroid
- bisphosphonates
- thromboprophylaxis
Other
- blood transfusion
- local radiotherapy
- stem cell transplantation
what is pancytopenia?
condition in which a person’s body has too few red blood cells, white blood cells, and platelets
an injury involving the anatomical snuff box is most likely to damage the?
radial artery
this nerve can be compressed when passing through the cubital fossa.
can cause
- numbness and tinging in the 4th and 5th fingers.
ulnar nerve
patient with an anterior shoulder dislocation may hold their arm:
- externally rotated
- slightly abducted
patient with posterior dislocation of shoulder may hold their arm?
- internally rotated
- slightly adducted
the spine of scapula is found at what vertebral level:
T3
the most inferior aspect of scapula is found at what vertebral level:
T7
the most superior aspect of iliac crest is found at what vertebral level:
L4
the posterior superior iliac spine is found at what vertebral level:
S2`
what is Pagets disease?
- accelerated rate of bone turnover
- subsequent rapid new bone formation
- bone does not have normal matrix and is disorganised
what is the pharmacological mainstay of treatment for Pagets disease:
bisphosphonates
- inhibit osteoclast activity , cause osteoclast apoptosis
example
- Zoledronic acid (IV infusion)
- alendronate (oral)
what might be given to a patient with Paget’s disease who may not be able to tolerate bisphosphonates?
- calcitonin
- causes osteoclasts to shrink, decreases their resorptive activity
name the bones in the wrist
so long to pinky, here comes the thumb
S-scaphoid L-lunate T-triquetral P-pisiform H-hammate C-capitate T-trapezoid T-trapezium
patient has FOOSH fracture w/ pain just below thumb.
however no fracture is visualised when AP lateral and scaphoid X-rays are taken.
what would be the most appropriate management for this patient:
application of a scaphoid plaster and sling
- repeat x-ray in 14 days
56 F w/ osteoarthritis
pc: extreme pain at night
, knee really bad
pmh: total knee replacement , peptic ulcer disease
dx: paracetamol, has tried topical capsaicin
next step in management of this patient:
add codeine
NSAIDs are contraindicated in peptic ulcer disease!
footballer, knee swells immediately , unable to weight bear.
positive anterior drawer sign!
findings consistent with:
anterior cruciate ligament injury
- immediate swelling, strongly suggestive of bleeding into synovial cavity
4 muscles which make up the rotator cuff
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
management of rotator cuff tendinopathy:
- rest
- physio
- paracetamol /NSAID
this is an important bony feature of the calcaneus:
- located on upper margin of medial surface of calcaneus
sustentaculum tail
McMurrays test is used to indicate:
meniscal tears
- MRI to visualise soft tissues of knees would be required
what are the three muscles of elbow flexion:
BBB
Brachialis
Biceps
Brachioradialis
musculoskeletal nerve
tennis player
- unable to abduct arm voluntarily
- doctor passively abducts a few degrees, then patient can continue abduction through full range of motion
likely cause of patients symptoms:
SUPRASPINATUS TEAR
- needed to abduct first 15 degrees , then deltoid takes over
what is a very typical feature of steroid induced osteoporosis on x-ray:
exuberant callus formation
damage to which nerve might have caused weakness in the first 30 degrees of shoulder abduction
suprascapular nerve
damange to what nerve results in winging of the scapula:
serratus anterior
