Ortho Flashcards
Mechanism of action of colchicine
Inhibits microtubule polymerisation by binding to tubulin
It also inhibits neutrophil activity and motility, so anti inflammatory
Tubulin is essential in mitosis, so it inhibits mitosis (useful in genetic studies)
X-ray findings of osteoarthritis
LOSS Loss of joint space Osteophytes Subchondral sclerosis Sunchondral cysts
X-ray findings of RA
Early findings:
Loss of joint space
Juxta articular osteoporosis
Soft tissue swelling
Late findings:
Peri articular erosions
Subluxation
What are bouchards nodes?
Hard bony outgrowths or gelatinous cysts on PIP joints
From calcific Spurs of articular cartilage in OA
What are Heberdens nodes
Typically seen in middle age after chronic swelling
Painful inflammatory onset, loss of manual dexterity
Pain subsides, but left with bony outgrowth
Often skews finger sideways
DIP
Management of osteomyelitis
80% of osteomyelitis is staph aureus (so give Fluclox)
Salmonella more likely in sickle patients
Acute management of gout (remember contraindications)
➡️NSAIDs (remember to check about kidney function, ulcers, asthma etc)
➡️intra articular steroid
➡️colchicine, but slower onset of action
➡️if colchicine and NSAIDs contra then oral steroid
What drug predisposes patients to tendonopathy? Eg patient jogging and has achilis tendon rupture…
Ciprofloxacin
Patient with pain and Difficulty in holding a heavy object at arm’s length. the arm feels stiff, heavy, andweak.
OE: Pain worse when patient asked to flex fingers and wrist, and pronate hand.
Tennis elbow (lateral epicondylitis) Confirmed by: pain when patient’s extended wrist pulled. Avoidance precedent repetitive movement, RICE, local injections
Tea coloured urine…
Rhabdo
- AKI
- elevated CK
- myoglobinuria (therefore hypocal as myoglobin binds Ca)
Give IV fluids!
Healing time of child with closed upper limb metaphyseal fracture
3 wk, double it every difference
Cyst found distal dorsal aspect of finger…
Myxoid cyst - benign ganglion cyst
usually OA in surround joint and common in middle aged women
Sports injuries of knee. Twisting force applied to bent knee
Ruptured anterior cruciate ligament
Typically loud crack, RAPID joint swelling (haemoarthrosis)
Sport injury of knee. Rotate injury but joint locking (delayed swelling)
Miniscal injury
Indications for open reduction and internal fixation of fracture (ORIF)
If near a joint (OA is inevitable if not)
If failed conservative tx
If 2 fractures on one limb
Open fracture
Fracture definition
Any loss of continuity of bone
Movement lost first in hip osteoarthritis
Internal rotation lost first
Description of pagets bone and long term risk of
High bone turnover replaced by crap spongy bone
Risk of deafness from cranial nerve compression
Slight increased risk of osteosarcoma
Pelvic and hip X-ray description
Shentons line…curvature of infromedial neck of femur and inferior border of superior pubic Ramus
Femoral head alignment with acetabulum
Sacroiliac joint…should be equal
Then look through bones
Intracapsular fracture management
Over 60 and with-it and mobile, then THR
under 60 or undisplaced, try cannulated screws
Foot bones
Calcaneus, with talus on top
Cuboid (lateral)
Navicular medial
Cuneiform - medial, intermed, and Lat
high ALP… differentials and distinguishing!
if with high calcium: bone mets or hyperparathy
normal calcium: Paget’s, liver, preg etc
low calcium: osteomalacia, renal disease
High ALP low calcium
osteomalacia… renal bone disease…
High ALP and HIGH calcium
hyperparathyroidism and bone metastases
(most myeloma has normal ALP)
