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Yr 6 PACES knowledge COPY RJ Challenger > Ortho, just ortho (MSK) > Flashcards

Ortho, just ortho (MSK) Flashcards

1
Q

Osteoarthritis- definition

A

Degenerative disease –> loss of hyaline cartilage + new bone formation at joint surface

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2
Q

Symptoms of osteoarthritis

A

Pain - worse at night + after movement
- Commonly affects knees, hip, PIP, DIP, base of thumb

Reduced ROM: ‘gelling’ after rest for -30min

Deformity (mild)

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3
Q

Investigations for suspected osteoarthritis

A

Bloods:
U+Es (renal function before giving NSAIDs)
Autoantibodies (exclude inflammatory arthritis)

X-Ray

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4
Q

Mx of osteoarthritis

A

Conservative: weight loss, PTOT
Medical: paracetamol, NSAIDs (+PPI), joint injection
Surgical: Hip/knee replacement, osteotomy for younger pt w medial knee OA + thumb OA,

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5
Q

2 types of bone

A

Woven bone - disorganised bone (embryonic skeleton + fracture callus)

Lamellar bone - mature bone. can be either CORTICAL (dense, outer layer) or CANCELLOUS (porous, central)

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6
Q

Fracture healing - 3 phases

A 
Reactive phase (-48hrs)
- Haematoma + inflammatory cell recruitment

Reparative phase (-2 weeks)

  • Callus formation (osteoblasts + fibroblasts proliferate)
  • Endochondral ossification (formation of lamellar bone)
Remodelling phase (- years)
- Remodelling of lamellar bone to cope w mechanical stresses (Wolff's law)
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7
Q

Fracture classification

A

Traumatic
Stress (repeated strain –> bone fatigue)
Pathological (due to diseased bone)

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8
Q

Greenstick fracture

A

Young soft bone which bends + breaks

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9
Q

Comminuted fracture

A

> 2 fragments

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10
Q

Angulation - how is it described

A

the direction of the distal portion of the distal fragment

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11
Q

Fracture in the growth plate?

What types are there

A 
Salter Harris fracture
(Straight, Above, Lower, Through, crush)
Type 1: growth plate fracture
2: growth plate + metaphysis
3: growth plate + epiphysis
4: growth plate + meta + epiphysis
5: crush fracture
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12
Q

Garden classification

A

Intracapsular NOF#

1: incomplete
2: complete, undisplaced
3: complete, partially displaced
4: complete, totally displaced

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13
Q

Distal radius articulates with

A

Scaphoid, lunate, ulna

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14
Q

Distal radial fracture with dorsal angulation

A

Colles fracture

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15
Q

Distal radial fracture with volar angulation

A

Smith fracture

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16
Q

Distal radial fracture involving the joint (intraarticular)

A

Barton fracture

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17
Q

Distal radial fracture + distal radioulnar dislocation

A

Galeazzi fracture

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18
Q

ulnar fracture + proximal radial head dislocation

A

Monteggia fracture

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19
Q

Mx of an open fracture

A 
Analgesia
Asses: N+V status, photograph
Alignment: splint
Antisepsis: wound swab, irrigation, Abx
Anti-tetanus
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20
Q

4 pillars of fracture management

A

Resus (ABC)
Reduction (closed or open)
Restriction (slings, plaster, bracing, internal)
Rehabilitation (PTOT)

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21
Q

Methods of fracture reduction

A

Open (i.e. surgical incision)

or closed

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22
Q

Methods of fracture restriction

A

Hold = sling, plaster

Fixation = either external or internal

  • External = monoplane or multiplanar
  • Internal = inter medullary or extramedullary
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23
Q

Indications for external fixation device

A

Open #s
Burns
Tissue loss

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24
Q

Rehabilitation for fracture management

A

Physiotherapy - strengthen muscles
OT - mobility aids, splints
Social services - home help

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25
Q

Common palsies from the following #s:

  • Shoulder dislocation
  • Humeral shaft
  • Elbow
  • Hip dislocation
  • Neck of fibula
A

-Shoulder dislocation = AXILLARY (weak shoulder abduc)

  • Humeral shaft = RADIAL (wrist drop)
  • Elbow = ULNAR (ulnar claw)
  • Hip dislocation = SCIATIC (foot drop)
  • Neck of fibula = COMMON PERONEAL (Foot drop)
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26
Q

Pathophysiology of compartment syndrome

A

Oedema from fracture –> increased compartment pressure –>reduced venous drainage

As compartment pressure > capillary pressure –> ischemia!

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27
Q

Post-op patient
w extreme pain
Pain on passive muscle stretching
Reduced pulses

A

COMPARTMENT SYNDROME

28
Q

Causes of malunion

A

Infection
Ischemia - AVN
Interposition of tissue between fragments
Disease - malignancy, malnutrition

29
Q

Cause of cubitus varus

A

Gunstock deformity from malunion of a supracondylar #

30
Q

AVN - what is the consequence

A

Soft + deformed bone –> pain + stiffness + OA

31
Q

Scaphoid fracture - common method of injury?

O/E?

A

FOOSH
tenderness in anatomical snuffbox
Tenderness on scaphoid tubercle (volar surface)

32
Q

Scaphoid fracture - how long until visible on XR?

A

10 days after injury

Therefore, return to # clinic 10 days later for re-XR

33
Q

Mx of scaphoid fracture? Main complication?

A

Plaster

Risk of scaphoid AVN –> pain + stiffness

34
Q

2 types of shoulder dislocation?

Common causes of both?

A

Anterior: trauma, falling on hand
Posterior: epileptics

35
Q

Bankart lesion

A

Associated w should dislocation

Damage to anteroinferior glenoid labrum

36
Q

Hill Sach lesion

A

Associated w anterior shoulder dislocation

Cortical depression of posterolateral humeral head

37
Q

Presentation of shoulder dislocation

A

Severe pain
Shoulder appears square
Bulge in subclavicular fossa
Arm supported by other hand

38
Q

Ix + Mx of shoulder dislocation

A

NEUROVASCULAR ASSESSMENT
- Regimental badge area for axillary nerve damage

XR: AP and lateral view

Reduction: under sedation (propofol)
Restriction: Sling for 3-4 weeks
Rehab: Physio

39
Q

2 complications of shoulder dislocation

A

Recurrent dislocation

Axillary nerve palsy

40
Q

Impingement syndrome - pathology?

A

Entrapment of supraspinatus tendon + subacromial bursa

Trapped btw ACROMION + GREATER TUBEROSITY of humerus

41
Q

Presentation of impingement syndrome

A

Painful arc 60-120

+ve Hawkins test

42
Q

Mx of impingement syndrome

A

Conservative: rest + physio
Medical: NSAIDs, steroid injection
Surgical: Arthroscopic acromioplasty

43
Q

Differential of painful arc

A

Impingement syndrome
Partial rotator cuff tear
OA of acriomoclavicular joint

44
Q

Findings on examination of frozen shoulder

A

reduced ROM, esp EXTERNAL ROTATION and shoulder abudction

45
Q

Rotator cuff tear: O/E

A

Partial: painful arc

Full tear: Active abudction possible after passive abduction up to 90 degrees

46
Q

Commonest type of supracondylar fracture

A

Extension i.e. distal fragment is posteriorly displaced

47
Q

Complication of supracondylar fracture

A

1) Neuromuscular damage: -Brachial artery, Radial nerve, Median nerve
2) COMPARTMENT SYNDROME: pain on passive extension of fingers
3) Gunstock deformity (cubitus varus)

48
Q

Mx of ruptured ACL

A

autograft from SEMITENDINOSUS

Tendon threaded through heads of tibia + femur, held using screws

49
Q

Definition of disc prolapse

A

Herniation of nucleus pulposus through annulus fibrosis

50
Q
  • Loss of sensation on inner dorsum of foot
  • Foot drop and weak inversion
    Intact reflexes
A

L5 root compression

51
Q

Aching buttock on walking
Rapid onset
Pain on spine extension (leaning back\0

A

Spinal stenosis

52
Q

Spinal stenosis - presentation

A

Pain on spine extension

Heavy, aching buttock on walking (spinal claudication)

53
Q

Sx of acute cord compression

A

Pain - bilaterally at back + radicular
UMN signs below lesion
LMN signs at compression level

54
Q

Sx of cauda equina syndrome

A

Asymmetrical symptoms

  • radicular pain
  • Saddle anaesthesia
  • Faecal/urinary incontinence
55
Q

Colour changes in Raynaud’s phenomenon

A

White –> blue –> crimson

56
Q

Secondary causes of Raynaud’s

A
  • Systemic disease: SLE, SS, RA
  • Atherosclerosis
  • Blood: polycythemia
  • Trauma: vibration injury
57
Q

Mx of Raynaud’s

A

Conservative: avoid cold, wear gloves, stop smoking

Medical: nifedipine

58
Q

Technical term for bunions

A

Hallux valgus

59
Q

Hallux valgus - how to examine?

A 
Look:
Degree of valgus
Unilateral/bilateral
Swelling
Calluses on heel

Feel:
Swelling? - active bursitis

Move:
Toe joint ROM

Extras: look at shoes, assess gait

60
Q

Hallux valgus - aetiology?
Ix?
Mx?

A

Aetiology: tight fitting shoes, familial, assoc with RA

Ix:
Weight bearing x ray w orthogonal views
- Assess degree of valgus + OA at MTP joint

Mx:

conservative: footwear, physic
surgical: bunionectomy, 1st metatarsal realignment osteotomy

61
Q

Flattened medial arch of foot + ulcer on medial foot

A

Charcot joint

62
Q

Features O/E of charcot joint

A

Painless deformed joint
Ulcers/necrosis
Swelling

63
Q

Causes of charcot joints

A

Due to sensory loss

  • DM
  • peripheral neuropathy: B12, folate, alcohol
64
Q

Carpal bones

A

Scaphoid Lunate Triquetrum Pisiform

Trapezium Trapezoid Capitate Hamate

65
Q

Septic arthritis:

which abx for elderly/recurrent UTI/recent abdo surgery?

A

Ceftriaxone

66
Q

Which Abx for IVDU w septic arthritis?

A

?Pseudomonas

Ceftazidime!!

Yr 6 PACES knowledge COPY RJ Challenger (16 decks)

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