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finals > ortho > Flashcards

ortho Flashcards

1
Q

commonly replaced joints

A

knee
hip
shoulder

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2
Q

indications for joint replacement

A

OA
fracture
septic arthritis
bone tumour
RA

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3
Q

hemiarthroplasty

A

half the joint is replaced

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4
Q

what happens in a total hip replacement

A

lateral incision
metal/ceramic replacement head of femur
stem cemented or uncemented
acetabulum hollowed out and replaced with metal socket

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5
Q

what happens in a total knee replacement

A

vertical anterior incision
articular surfaces of femur and tibia removed and replaced with metal
spacer added

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6
Q

what happens in a total shoulder replacement

A

usually anterior incision
head of humerus replaced and glenoid socket replaced my metal

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7
Q

what is a reverse shoulder replacement

A

sphere in glenoid and cup to replace head of humerus

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8
Q

VTE prophylaxis THR

A

LMWH 28d

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9
Q

VTE prophylaxis TKR

A

LMWH 14d

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10
Q

common cause prosthetic joint infection

A

staph aureus

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11
Q

RF prosthetic joint infection

A

prolonged operation
obese
DM

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12
Q

mx prosthetic joint infection

A

irrigation
debridement
replacement

+abx

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13
Q

what is a compound #

A

skin broken

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14
Q

what is a stable #

A

sections of bone still in allignment

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15
Q

types of fracture

A

transverse
oblique
spiral
segmental
comminuted
compression

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16
Q

typically only in children

A

greenstick
buckle

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17
Q

what # can only happen in children

A

salter-harris (growth plate)

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18
Q

what is a colles fracture

A

transverse # distal radius and the distal portion displaces posteriorly (up) = dinner fork deformity

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19
Q

cause colles #

A

fall onto outstretched hand

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20
Q

common cause scaphoid #

A

fall onto outstretched hand

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21
Q

sx scaphoid #

A

tenderness in anatomical snuffbox

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22
Q

why is there a risk of avascular necrosis and non union with scaphoid #

A

retrograde blood supply

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23
Q

bones with vulnerable blood supply

A

scaphoid, femoral head, humeral head, talus, navicular, 5th metatarsal

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24
Q

weber classification for # lateral malleolus

A

A=below ankle joint therefore syndesmosis intact
B=at joint therefore syndesmosis intact or partially torn
C=abive joint therefore syndesmosis disrupted

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25
Q

major complication pelvic ring #

A

intra abdo bleeding

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26
Q

what bones commonly # in pathological #

A

femur
vertebral bodies

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27
Q

cause of pathological #

A

osteoporosis
pagets
tumour - prostate, renal, thyroid, breast, lung metastasise to bone

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28
Q

fragility #

A

withou approproate trauma, due to osteoporosis

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29
Q

ix for #

A

2 view XR
CT if inconclusive

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30
Q

fracture mx

A
  1. mechanical aligment: open or closed reduction
  2. relative stability: cast, k wire, intramedullary nail, screw
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31
Q

early # complications

A

damage to local structures
haemorrhage
compartment syndrome
fat embolism
VTE

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32
Q

long term # complications

A

delayed union
malunion
non-union
avascular necrosis
infection
joint instability/stiffness
contractures
arthritis
chronic pain
complex regional pain syndrome

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33
Q

when/how does a fat embolism occur

A

24-72hr after #
# long bone -> fat globules released ->lodged in vessels->obstruction

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34
Q

criteria for fat embolism

A

GURDS
major=resp distress, petechial rash, cerebral involvement
minor inc jaundice, thrombocytopenia, fever, tachycardia

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35
Q

RF hip #

A

age
osteoporosis
F

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36
Q

mx hip #

A

sugrery within 48h
analgesia
VTE mx
orthogreis MDT
wt bear and physio

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37
Q

types hip #

A

extracapsular
intracapsular-femoral neck

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38
Q

extracapsular hip #

A

outside capsule so blood supply to head of femur intact

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39
Q

mx extracapsular hip #

A

intertrochanteric=screw
subtrochanteric=nail

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40
Q

intracapsular hip # classification

A

GARDEN
1. incomplete # non displaced
2. complete # non displaced
3. partial displacement
4. full displacement

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41
Q

intracapsular hip # mx

A

non-displaced=screw
if 3 and 4 then vessels damaged so head of femur needs replacing

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42
Q

sx hip #

A

> 60y
fall - why
pain in groin/hip
cant wt bear
shortened, abducted externally rotated leg

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43
Q

ix hip #

A

XR - AP and lateral views
on AP seee disruption to shentons line in nof

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44
Q

what causes compartment syndrome

A

usually # or crush injury
increased pressure in fascial compartment due to bleeding/oedema
cuts off blood supply

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45
Q

where does compartment syndrome usually occur

A

legs

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46
Q

sx compartment syndrome

A

5 PS!!
disproportionate pain
paraesthesia
pale
pressure
paralysis

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47
Q

ix compartment syndrome

A

needle manometry

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48
Q

mx compartment syndrome

A

elevate
good BP
emergency fasciotomy
debridement every few d
wound closure in weeks

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49
Q

chronic compartment syndrome

A

on exertion

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50
Q

sx chronic compartment syndrome

A

pain, numbness, paraesthesia

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51
Q

mx chronic compartment syndrome

A

fasciotomy

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52
Q

what is osteomyelitis

A

inflammation bone and bone marrow

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53
Q

common cause osteomyelitis

A

staph aureus

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54
Q

RF osteomyelitis

A

open#
operation
DM
PAD
IVDU
immunosuppressed

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55
Q

sx osteomyelitis

A

fever
pain
erhythema
swelling

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56
Q

XR findings osteomyelitis

A

none
periosteal rxn
localised osteopenia
destruction

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57
Q

best ix osteomyelitis

A

MRI

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58
Q

mx osteomyelitis

A

surgical debridement + abx (6w fluclox)

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59
Q

most common bone tumour

A

osteosarcoma

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60
Q

chondrosarcoma

A

cancer from cartilage

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61
Q

ewing sarcoma

A

cancer of bone and soft tissue in children and young aduls

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62
Q

rhabdomyosarcoma

A

skeletal muscle tumour

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63
Q

leimyosarcoma

A

smooth muscle tumour

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64
Q

sx sarcoma

A

soft tissue lump, bone swelling, persistant bone pain

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65
Q

ix sarcoma

A

XR
CT or MRI
biopsy

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66
Q

mx sarcoma

A

surgery
chemo
radio

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67
Q

causes mechanical backpain

A

muscle/ligament sprain
facet joint dysfunction
SIJ dysfunction
herniated disc
spondylolisthesis
scoliosis
degeneration

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68
Q

spondylolisthesis

A

anterior displacement vertrba

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69
Q

causes neck pain

A

muscle/ligament strain
torticollis
whiplash
cervical spondylosis

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70
Q

red flag causes back pain

A

spinal #
cauda equina
spinal stenosis
ankylosing spondylitis
infection

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71
Q

other causes of back pain

A

pneumonia
ruptured AAA
kidney stone
pyelonephritis
pancreatitis
prostatitis
PID
endometriosis

72
Q

sciatic nerve root

A

L4-S3

73
Q

sx sciatica

A

unilateral pain from buttock down
paraeshtesia
numbness
weakness

74
Q

causes of sciatica

A

compression sciatic nerve - herniated disc, spinal stenosis, spondylolisthesis

75
Q

mx sciatica

A

physio
analgesia
amitryptiline
duloxetine
injections
surgical decompression

76
Q

mx lower back pain

A

if mechanical no further ix
if unsure cause - XR, CT
STarT screening=risk developing chronic
educated, exercise, physio, analgesia (NSAID, codeine)

77
Q

cauda equina cause

A

compression (herniated disc, tumour) of cauda equina

78
Q

sx cauda equina

A

saddle anaesthesia
loss bladder/bowel sensation and control
urinary retention
bilateral sciatica
weakness
decreased anal tone
LMN SIGNS

79
Q

mx cauda equina

A

emergency
MRI and surgucal decompression

80
Q

features metastatic spinal cord compression

A

UMN SIGNS AS HIGHER
back pain and motor and sensory deficits
worse when cough/strain

81
Q

mx metastatic spinal cord compression

A

MRI
high dose dexamethasone
surgery
chemo
radio

82
Q

what is spinal stenosis

A

narrowing spinal cannal
usually cervical or lumbar

83
Q

types of spinal stenosis

A

central stenosis=central canal
lateral stenosus=nerve root canals
foraminal stenosis=intervertebral foramina

84
Q

causes spinal stenosis

A

congenital
degeneration
herniated disc
thickened ligamentum flavum or post longitudinal ligament
spinal #
spondylolisthesis
tumour

85
Q

sx spinal stenosis

A

gradual onset
in central stenosis=intermittent neurogenic claudication (LBP, buttock and leg pain, weakness)
worse standing/walking, better bending forward

86
Q

ix spinal stenosus

A

MRI

87
Q

mx spinal stenosis

A

exercise
analgesia
physio
decompressive surgery

88
Q

what is meralgia paraesthetica

A

compression lateral femoral cutaneous nerve (L1-3)

89
Q

sx meralgia paraesthetica

A

sensory sx on anterior upper outer thigh - burning, numbness, paraesthesia
aggravated by walking/standing/hip extension

90
Q

mx meralgia paraesthetica

A

wt loss
physio
analgesia - paracetamol, nsaids, amitriptyline
injection
surgery

91
Q

sx trochanteric bursitis

A

middle aged
lateral hip/thigh pain
aching
worse with activity
tender
trendelenburg positive
pain on resisted abduction/internal rotation/external rotation hip

92
Q

mx trochanteric bursitis

A

ice
rest
analgesia
physio
steroid injections

93
Q

causes bursitis

A

friction from movement
trauma
RA
infection = septic bursitis

94
Q

cause meniscal tear

A

sport
twisting ->pop

95
Q

sx meniscal tear

A

pain
swelling
stiffness
decreased ROM
locking
instability
O/E: tender joint line, Mc Murrays and Apley grind test

96
Q

mx meniscal injury

A

conservatibe
nsaids
physio
surgery - arthroscopic repair or resection

97
Q

ottawa knee rules

A

XR if: >55y, patella tenderness, fibular head tenderness, cant felx knee to 90 degrees, cant wt bear

98
Q

ACL

A

originated from lateral aspect intercondylar notch of femur and attaches to anterior intercondylar area tibia
stops tibia sliding forward

99
Q

PCL

A

originates from medial aspect intercondylar notch of femur and attaches to posterior intercondylar area tibia
stops tibia sliding back

100
Q

cause ACL inury

A

twist

101
Q

sx ACL injury

A

pop when happens
pain, swelling, instability
positive anterior draw and lachmans

102
Q

mx ACL injury

A

conservatibve
nsaids
physio
arthroscopic surgery often required - tendon graft from hamstrong/quad

103
Q

osgood schlatters

A

inflammation at tibial tuberosity where patella ligament inserts due to multiple small avulsion #

104
Q

sx osgood schlatters

A

10-15y
m
hard tender lump
ant knee pain in activity/kneeling/extension

105
Q

mx osgood schlatters

A

rest
ice
nsaids
physio

106
Q

what forms popliteal fossa

A

semimembranosus and semintendanosus tendons, biceps femoris tendon, medial and lateral heads gastrocnemius

107
Q

where is bakers cyst

A

popliteal fossa

108
Q

causes bakers cyst

A

non
secondary to degeneration - meniscal tear, OA, RA

109
Q

sx bakers cyst

A

pain
palpable lump
reduced rom
fouchers sign=lump smaller when knee flexed to 45 degrees
can rupture = swelling and pain (rarely compartment syndrome)

110
Q

ix bakers cyst

A

uss

111
Q

mx bakers cyst

A

none
nsaids
physio
injecion

112
Q

types achilles tendinopathy

A

insertion (within 2cm of insertion)
mid-portion (2-6cm from insertion)

113
Q

RF achilles tendinopathy

A

certain sports
inflammation -RA
DM
high cholesterol
flouroquinolone abx - ciprofloxacin

114
Q

sx achilles tendinopathy

A

pain
stiff
tender
swelling

115
Q

mx achilles tendinopathy

A

rice
physio
extracoroporeal shock wave
AVOID steroid injection s- increased risk rupture

116
Q

RF achilles tendon rupture

A

sports
increased age
achilles tendinopathy
fhx
fluoroquinolone abx
systemic steroids

117
Q

sx achilles tendon ruptire

A

pain
snapping sound
feel like hit in back of leg
O/E: dorsiflexed, palpable gap, weak plantar flexion, cant tip toe
positive simmonds calf squeeze

118
Q

mx achilles tendon rupture

A

rice
non-surgical: 6-12 weeks in boot, start in plantarflexion the move to neutral and rehab
surgery: reattach then rehab

119
Q

sx plantar fascitis

A

gradual onset pain in plantar heel and tender

120
Q

mx plantar fasciits

A

rice
nsaids
physio

121
Q

cause fat pad atrophy

A

impact
obesity
steroid injecyions

122
Q

sx fat pad atrophy

A

pain and tender on plantar heel

123
Q

mx fat pad atrophy

A

custom shoes
lose wt

124
Q

what is mortons neuroma

A

dysfunctional nerve between 3rd and 4th metatarsal

125
Q

sx mortons neuroma

A

pain
sensation of alump
burning
paraethesia
O/E: deep pressure, metatarsal squeeze=pain, mulders sign=painful click

126
Q

mx mortons neuroma

A

analgesia
insoles
steroid injection
surgery

127
Q

hallux valgus

A

bunions
deformity at 1st MTP ->bony lumo

128
Q

mx hallux valgus

A

bunion pad inshoe
analgesia
surgery

129
Q

adhesive capsulitis

A

frozen shoulder
primar or secondary to trauma
inflammation and fibrosis in joint capsule ->adhesion

130
Q

RF adhesive capsulitis

A

middle age
DM

131
Q

phases of sx in adhesive capsulitis

A

1=pain
2=stiff - ext rptation
3=thawing - improves

132
Q

ix adhesive capsulitis

A

USS=thickened joint capsule

133
Q

mx adhesive capsulitis

A

nsaids, physion, intra articular steroid injection, surgery

134
Q

rotator cuff mucles

A

supraspinatus - abducts
infraspinatus - ext rotation
teres minor - int rotation
subscapularis - int rotatio

135
Q

cause rotator cuff tear

A

injury
degeneration
overhead activities

136
Q

sx rotator cuff tear

A

shoulder pain and weakness

137
Q

mx rotator cuff tear

A

surgery useful in acute or full thickness
rice
nsaids
physio

138
Q

subluxation

A

partial shoulder dislocation

139
Q

types shoulder dislocation

A

mostly anterior
posterior - electrc shocks and epilpesy

140
Q

associated injuries with shoulder dislocation

A

labrum tear
bankart lesion
hills sachs lesion
axillary nerve damage
#
rotator cuff tear - older adults

141
Q

bankart lesion

A

tear to ant labrum, occur with repeated anterior subluxation od dislocation

142
Q

hills sachs lesion

A

compression # posterolateral head of humerus
less stable so risk further dislocations

143
Q

sx shoulder disliocation

A

patient usually knows
acute
deltoid appears flattened
apprehension test for instability - not in acute phase

144
Q

mx shoulder dislocation

A

relocate
sling
physio
+/- stabilisation surgery

145
Q

cause olecranon bursitis

A

leaning on elbow
students, certain jobs

146
Q

sx olecranon bursitis

A

swollen, warm, tender, fluctuant at elbow

147
Q

mx olecranon bursitis

A

aspirate if think infection
rice
avoid leanin gon
aspiraye
steroid injections

148
Q

what is a repetitive strain injury

A

soft tissu irritation, microtrauma and strain due to repetitive activities (small movements, vibration, awkward)

149
Q

sx repetitive strain injury

A

pain
ache
weak
cramping
numbness

150
Q

mx repetitive strain injuet

A

rice
rest and adapt activity
nsaid
phusio

151
Q

lateral epincondylitis

A

tennis elbow
where extensory attach

152
Q

test for lateral epicondylitis

A

pain ain weakness
mills test=palpate lateral epincondyle and flex their wrist
cozens test=resistance with hand in fist

153
Q

medial epincondylitis

A

golfers elbow
where flexers attach

154
Q

mx epindondylitis

A

rest and adapt activities
physio
steroid/FRP injection

155
Q

what is de quervains tenosynovitis

A

swelling and inflammation of abductor pollicus longus and extensor pollicus brevis tendons

156
Q

sx de quervains tenosynovitis

A

at radial aspect base of thumb-pain, weak, numb
finkelsteins test: make fist with thumb in and adduct wrist

157
Q

mx de quervains tenosynovitis

A

rest
spints
nsaids
physio
steroid injectin
rarely surgery to release extensory retinaculum

158
Q

what is trigger finger

A

stenosing tenosynovitis
nodule on tendon at A1 pulley at MCP catches tendon in extension so gets stuck

159
Q

sx trigger finger

A

finger stuck flexed and pops when released

160
Q

mx trigger finger

A

rest
splint
steroid injection
surgery

161
Q

dupuytrens contracture

A

nodules and thickening and tighetning palmsar fascia so flexes
ring finger most affected, index lease

162
Q

RF dupuytrens contracture

A

agre
fhx
m
vibrating tools
DM
epilepsy
smoking
alcojol

163
Q

test for dupuytrens conctracture

A

table top test - cant flatten

164
Q

mx dupuytrens contracture

A

none
surgery

165
Q

carpal tunnel syndrome

A

compression median nerve in carpal tunnel

166
Q

RF carpal tunnel syndrome

A

obesity
repetitive
strain
perimenopause
RA
DM
acromegaly
hypothyroid

167
Q

sx carpal tunnel

A

start with at night
worse at night
sensory sx on thumb and 1st, 2md and half 3rd fingers
motor sx = weakness and wasting thernal muscles

168
Q

tests for carpal tunnel

A

phalens
tinnels

169
Q

ix carpal tunnel

A

nerve conduction studies

170
Q

mx carpal tunnel

A

rest
splint
steroid injections
surgery

171
Q

thernal muscles

A

abductor pollicis brevis
opponens pollicis
flexor pollicis brevis

172
Q

bilateral carpal tunnel causes

A

screen for - RA, DM, acromegaly, hypothyroid

173
Q

ganglion cysts

A

synovial fluid from tendon sheath or joint
often in wrist and fingers

174
Q

sx ganglion cysts

A

painless
well circumscribed
transilluminate

175
Q

mx ganglion cysts

A

USS
resolve spontaneously
needle aspiration
surgucal excision

176
Q

Describing a fracture

A

Site: bone and which bit (metaphyses, diaphyses, articular)
Displacement: distal relative to proximal
Soft tissue: open or closed, complications

177
Q

Principles fracture management

A

Reduce
Stabilise
Rehab

finals (31 decks)

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