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4th Year SB > Ortho > Flashcards

Ortho Flashcards

1
Q

Tx cascade for OA

A

1st line = topical analgesia i.e. topical NSAID (diclofenac)

2nd line = paracetamol + local analgesia

3rd line = NSAID + paracetamol + local analgesia (+PPI)

4th line = Opioid (e.g. oxycodone) + paracetamol + NSAID + local analgesia

Adjunct = IA Corticosteroid injection

Surgical options = arthrodesis, THR/TKR

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2
Q

what is mnemonic for OA on x-ray

A

L – loss of joint space
O – osteophytes
S – sclerosis
S - subchondral cysts

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3
Q

what are the Ix results for RA (antibodies)

A

Auto-Ab – Rheumatoid factor, Anti-CCP

Bloods – CRP raised

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4
Q

how does RA present

A 
swelling,
morning stiffness, 
pain, 
deformity, 
loss of function, 
nodules

affects small joints and c-spine

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5
Q

what might be seen in hands in RA

A

Boutonniere deformity
Ulnar deviation
Swan-Neck deformity

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6
Q

Mx of RA

A

DMARD monotherapy +/-bridging prednisolone
= Methotrexate

TNF inhibitors
- infliximab

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7
Q

side effects of methotrexate

A

myelosuppression – monitor FBC + LFTs

pneumonitis

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8
Q

what are the seronegative/HLA B27 arthritis

A

AS
Psoriatic arthritis
Reactive arthritis
Inflammatory Bowel Disease arthritis

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9
Q

how does AS present

A

Chronic inflammation – spine and sacroiliac joints  fusion of joints
Young males
Symptoms – pain, stiffness, hip/knee arthritis

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10
Q

Ix of AS

A

X-Ray

Key Buzzwords = ‘sacroiliitis’ ‘bamboo spine’, ’squaring of lumbar vertebrae’

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11
Q

Mx of AS

- important

A

1st line = NSAIDs, physio, EXERCISE [gets much better w/ exercise]
2nd line = Anti-TNF therapy = etanercept/adalumumab

DMARDS only useful if peripheral joint disease

Adjunct = IA corticosteroids

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12
Q

how does psoriatic arthritis present

A

30% skin psoriasis

Asymmetrical, oligoarthritis, sacroiliitis, spondylitis, dactylitis and enthesitis

nail changes: pitting, onycholysis, arthritis DIP joints

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13
Q

Ix of psoriatic arthritis

A

x-ray

- pencil-in-cup appearance

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14
Q

what are common causative organisms for reactive arthritis

A

GI - campylobacter, shigella, salmonella, yersinia

GU - chlamydia, gonorrhoea

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15
Q

Sx of reactive arthritis

A

urethritis, uveitis, arthritis

“can’t see, can’t pee, can’t climb a tree”

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16
Q

Mx of reactive arthritis

A

Rx underlying infection, symptomatic relief, +/- DMARDS

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17
Q

what is gout and what causes it

A

Urate crystals in joints – hyperuricaemia

Renal underexcretion or excessive intake of alcohol, red meat, seafood

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18
Q

how does gout present

A

Classic site – 1st MTP joint, ‘podagra’

CF – intensely painful, hot, swollen joint, tophi

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19
Q

Ix for gout

A

1st line = joint aspiration

- Synovial fluid with needle shaped, negative birefringence

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20
Q

Mx of gout

A

Acute = NSAIDS, colchicine, intra-articular corticosteroid

Long term = allopurinol

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21
Q

what can allopurinol interact with and what can it cause

A

Azathioprine

- can cause pancytopenia

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22
Q

what is pseudogout

A

1 - Calcium pyrophosphate crystals – causing acute arthritis

2 - Chondrocalcinosis - deposits in cartilage/soft tissue, but no inflammation

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23
Q

Ix of pseudogout

A

joint aspirate

= Synovial fluid w/ positively birefringent crystals

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24
Q

Mx of pseudogout

A

NSAIDS, corticosteroids, +/- colchicine

hydroxychloroquinine

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25
Q

causes of septic arthritis by age = adults/ivdu, children, young adult

A

Staphylococcus aureus – adults/IVDU
Haemophilus influenza – children
Neisseria gonorrhea – young adults

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26
Q

Mx of septic arthritis

A

Ix – urgent joint aspirate BEFORE giving Abx

Tx – Abx, surgical washout

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27
Q

SLE antibodies

A

anti-dsDNA.

Remember C3/C4 low in active disease

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28
Q

sjogrens antibodies

A

anti RO/anti LA

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29
Q

systemic sclerosis antibodies

A

limited = anti-centromere

diffuse = anti-scl-70

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30
Q

polymyositis antibodies

A

anti-Jo-1

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31
Q

mixed connective antibodies

A

anti-RNP

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32
Q

Sx of Anti-Phospholipid Syndrome

A

CLOT

Coagulation defect
Levido reticularis 
Obstetric problems (miscarriages)
Thrombocytopenia
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33
Q

what is surgery reserved for in back pain

A

nerve root compression

single level disc degeneration/prolapse

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34
Q

?Sudden shooting pain while performing heavy lifting

A

prolapsed disc

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35
Q

?Lowgrade fever, local tenderness at L3

A

discitis

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36
Q

?Lorry driver, stiff, tender

A

mechanical back pain

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37
Q

?Person with sciatica and back pain and wants something to be done . They are also obese

A

weight loss programme + physiotherapy 1st line

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38
Q

what causes radiculopathy and how does it present

A

Gelatinous nucleus pulposis can ‘herniate’ or ‘prolapse’ = impinge on nerve

Neuralgic burn, severe tingling

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39
Q

what does an L3/4 prolapse cause and what are the Sx

A

L4 root entrapment

  • pain to medial ankle, loss of quad power, reduced knee jerk
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40
Q

what does an L4/5 prolapse cause and what are the Sx

A

L5 root entrapment

  • pain to dorsum of foot, reduced power on dorsiflexion
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41
Q

what does an L5/S1 prolapse cause and what are the Sx

A

S1 root entrapment

  • pain to sole of foot, reduced foot plantar flexion, reduced ankle jerks
42
Q

what are Sx of Cauda Equina

A

Bilateral leg pain
Paraesthesia
Saddle anaesthesia
Urinary retention / faecal incontinence

43
Q

Ix and Tx for Cauda Equina

A

Ix – PR mandatory, urgent MRI

Mx – surgical intervention

44
Q

generally, what are the issues in shoulders related to young, middle age, and eldery

A

Young adult – instability

Middle aged – rotator cuff tears, frozen shoulder

Elderly – glenohumeral joint OA

45
Q

how does frozen shoulder present, who is likely to get it, and what is buzzword clinical sign

A

Progressive pain and stiffness.

Pain subsides, stiffness increased and then ‘thaws’

Affects aged 40-60. Diabetics.

Loss of external rotation

46
Q

how does RC tear present, who is likely to get it

A

Shoulder dislocation, degenerative changes in tendons

”Sudden jerk” = pain and weakness

47
Q

what tendon is affected in painful arc syndrome

A

supraspinatus

48
Q

broadly, what are the two classifications of hip fractures

A

intracapsular

extracapsular

49
Q

summary of intracapsular hip fractures

A

Affect arterial supply of femoral head

Risk of avascular necrosis and non-union

Replace femoral head – hemi-arthroplasty or THR

50
Q

summary of extracapsular hip fractures

A

Not at risk of AVN and high union rate

Fixed with Dynamic Hip Screw

51
Q

how is a clavicle fracture managed

A

broad arm sling/ORIF

52
Q

how is a proximal humerus fracture managed

A

collar + cuff/ORIF

53
Q

how is an olecranon fracture managed

A

tension band wiring

54
Q

how is an colles fracture managed

A

splintage/plaster cast

55
Q

how is a femoral shaft fracture managed

A

IM nail

56
Q

A 40-year-old man is investigated for back pain. For the past few months he has been troubled with pain in his lower back which is typically worse in the morning and better by the end of the day. There is some radiation of pain to the right buttock but no leg pains. What is the likely diagnosis?

A

Ankylosing Spondylitis

57
Q

59-year-old man with a history of gout presents with a swollen and painful first metatarsophalangeal joint. He currently takes allopurinol 400mg od as gout prophylaxis. What should happen to his allopurinol therapy?

A

Continue at reduced dose

58
Q

45-year-old lady presents with a 6 month history of pain in the joints of her right hand. On examination she has tenderness in the right distal interphalangeal joints. An X-ray shows erosions in the centre of the right distal interphalangeal joints, which are described as having a pencil in cup appearance.

A

Psoriatic arthritis

59
Q

75-year-old woman presented to her GP with shoulder pain and discomfort. She had a full shoulder examination performed, during which she was unable to abduct her shoulder when it was flat against her body while standing. She was, however, able to fully abduct the shoulder after the doctor passively abducted it during the first 20 degrees. Which muscle is most likely to have been affected?

A

Supraspinatus

60
Q

65-year-old lady presents to her GP complaining of sudden onset of pain and paraesthesia in her left leg. On further questioning, she reports that the pain radiates down to the dorsum of her foot. On examination, you identify sensory loss in the dorsum of her left foot and reduced power upon performing dorsiflexion of her left ankle. Her reflexes remain intact.

A

L5 radiculopathy

61
Q

Treatment of necrotizing fasciitis

A

Surgical debridement

Iv Amox + clarithromycin + Gentamicin

62
Q

? Rotator cuff – unable to initiate abduction

A

supraspinatus

63
Q

hitting knee on dashboard

A

PCL injury

64
Q

ankle jerk nerve roots

A

S1-S2

65
Q

knee jerk nerve roots

A

L3-L4

66
Q

Biceps jerk nerve roots

A

C5-C6

67
Q

triceps jerk nerve roots

A

C7-8

68
Q

brachioradialis/supinator jerk nerve roots

A

C5-C6

69
Q

tx for Osteomyelitis - not pen allergic

A

Flucloxacillin IV 2g qds
2 weeks minimum IV followed by oral therapy
Total course 4-6 weeks

70
Q

Tx for osteomyelitis - pen allergic

A

Clindamycin IV 600mg qds

Total Course 4-6 weeks

71
Q

tx for Osteomyelitis - MRSA

A

Vancomycin IV

72
Q

tx for septic arthritis

A

IV flucloxacillin 2g qds for 2 weeks
then oral therapy
Total course 4-6 weeks

73
Q

1st line for mechanical back pain

A

NSAIDs

74
Q

Mx of paget’s disease

A

Biphosphonates

75
Q

best imaging for achilles tendon

A

USS

76
Q

what are the Ottawa rules for ankle injury and deciding if an x-ray is needed

A

x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:

  • bony tenderness at the lateral malleolar zone
  • bony tenderness at the medial malleolar zone
  • inability to walk four weight bearing steps immediately after the injury and in the emergency department
77
Q

tx for Intracapsular fracture, displaced, when person is mobile

A

THR

78
Q

tx for Intracapsular fracture, displaced, when person is not mobile

A

Hemiarthroplasty

79
Q

what fractures is compartment syndrome common in

A

supracondylar and tibial shaft fractures

80
Q

what nerve roots make up the sciatic nerve

A

L4 to S3

81
Q

left leg is shortened, adducted and internally rotated = ?

A

posterior hip dislocation

= risk of sciatic nerve damage

82
Q

what are the muscles of the rotator cuff and their function

A

supraspinatus = 0-15 degrees of shoulder abduction [deltoid does 15-90]

teres minor = shoulder extension

subscapularis = shoulder internal rotation

infraspinatus = shoulder external rotation

83
Q

what is spondylothesis

A

slippage of one vertebrae over another

84
Q

what is spondylolysis

A

defect in pars interarticularis of a vertebra

85
Q

what is spondylosis

A

degenerative disease of the spine

86
Q

Tx for rotator cuff tear

A

if complete = arthroscopic repair

if not = physio + pain relief

87
Q

brown sequard injury

A

ipsilateral loss of proprioception, vibration and motor function

contralateral loss of temp and pain

88
Q

where is most likely fractured at humeral neck, what nerve is at risk and what is the management

A

Surgical neck = axially nerve

Mx

  • if minimally displaced = sling and conservation
  • if displaced = manipulation/ORIF
89
Q

mx of anterior shoulder dislocation

A

closed reduction + pain relief
sling for 2-4 weeks
physio

90
Q

mx of # = humeral shaft

A

splint + immobilise = 8-12 weeks

if polytrauma = I.F. w/ IM nail/plate

91
Q

mx of # = olecranon

A

tension wire banding = ORIF to repair tricep function

92
Q

mx of # = supracondylar

A

ORIF

93
Q

mx of # = radial head/neck

A

Collar and cuff sling + physio

ORIF

94
Q

mx of = pulled elbow

A

forced supination

95
Q

mx of # = colles

A

if minimally displaced = splint

if displaced + old = closed reduction + cast

if displaced + young = ORIF

96
Q

mx of # = scaphoid

A

XR lateral, AP and 2x oblique

if unsure = splint and further XR in 2 weeks
if sure = plaster for 6-12 weeks
if displaced = compression screw

97
Q

mx of # = intracapsular hip

A

undisplaced + young = internal fixation
undisplaced + old = hemiarthroplasty

displaced + < 70y/o = internal fixation + hemiarthroplasty
displaced + > 70y/o and mobile = THR
displaced + > 70y/o and immobile = hemiarthroplasty

98
Q

mx of # = extracapsular hip

A

dynamic hip screw

99
Q

mx of # = proximal femoral

A

IM nail

100
Q

mx of # = femoral shaft

A

thomas splint

IM nail

4th Year SB (22 decks)

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