ortho on passmed year 5 Flashcards
long term steriod use risk for what
avascular necrosis of fem head
sx of avn fem head
vdevelopment of anterior hip pain and stiffness
relevant rf such as steriods, chemo, obesity, trauma and alcohol
ix of choice for avn
MRI
findings on hip XR of avn
This X-ray shows avascular necrosis of the femoral head (AVNFH), visible as flattening and a decrease in volume of the right femoral head. Additionally, a small but pathognomonic ‘crescent’ sign is visible in the lateral articular surface of the femoral head - this describes a curvilinear lucent line below the articular surface, caused by a subchondral fracture typical of AVNFH.
what is the crescent sign
The crescent sign refers to a linear cleft due to a subchondral fracture in the setting of osteonecrosis.
obvious ankle injury with neuro compromise what do you do
X-rays should not be taken of obvious ankle injuries if neurovascular compromise is present - immediate reduction / stabilisation instead
A DEXA scan should be offered without calculating the fragilty risk score in the following situations:
> 50 years of age with a history of fragility fracture
< 40 years of age who have a major risk factor for fragility fracture - these patients should be referred to a specialist depending on the T-score
before starting treatments that may have a rapid adverse effect on bone density (for example, sex hormone deprivation for treatment for breast or prostate cancer)
Greater trochanteric pain syndrome is also referred to as trochanteric bursitis
due to what seen in who
It is due to repeated movement of the fibroelastic iliotibial band and is most common in women aged 50-70 years.
what node is this
A 42-year-old lady who has systemic lupus erythematosus presents to the clinic with a 5 day history of a painful purple lesion on her index finger. On examination she has a tender red lesion on the index finger.
osler
A 62-year-old lady presents with an non tender lump overlying the distal interphalangeal joint of the index finger. On examination she has a hard, non tender lump overlying the joint and deviation of the tip of the finger.
what node is this
herbedens
most common type of fracture in the foot which is a stress fracture
2nd metatarsal
what is lumbar spinal stenosis and sx
Lumbar spinal stenosis is a condition in which the central canal is narrowed by tumour, disk prolapse or other similar degenerative changes.
Patients may present with a combination of back pain, neuropathic pain and symptoms mimicking claudication.
how do you differentiate lumbar spinal stenosis from true claudication
One of the main features that may help to differentiate it from true claudication in the history is the positional element to the pain. Sitting is better than standing and patients may find it easier to walk uphill rather than downhill.
simmonds triad for achilles tendon rupture
Calf squeeze test, observation of the angle of declination, palpation of the tendon
what is an ORIF
Open reduction internal fixation (ORIF) is a surgical procedure commonly done to repair bone fractures, especially those in which the broken bone fragments are not properly aligned or displaced. This procedure involves making an incision (an ‘open’ approach) to access the fracture site, realigning the fractured bones, and using internal fixation devices such as screws, plates, rods, or pins to stabilise and hold the bone fragments in their correct positions
what is charcots joint
Also termed neuropathic arthropathy, is characterised by the destruction of joints secondary to nerve damage. It frequently occurs in individuals with peripheral neuropathy. Alcoholic neuropathy may result in a loss of sensation and proprioception, rendering the joint vulnerable to unrecognised injuries and subsequent deformities.
Weber A fractures -
patients with minimally displaced, stable fractures may weight bear as tolerated in a CAM boot
Children and young people with unexplained bone swelling or pain: even if dont remember injury from gymnastics or something like that
consider very urgent direct access X-ray to assess for bone sarcoma
causes of carpal tunnel syndrome
pregnancy
oedema e.g. heart failure
lunate fracture
rheumatoid arthritis
Positive examination findings are that direct pressure on the coracoid elicits pain and there is impairment of active and passive external rotation.
adhesive capsulitis
psoas abcess source of infection
pyelonephritis or inflammatory bowel disease
psoas irritation indicated by what movements
Psoas irritation is evidenced when the position of comfort is the patient lying on their back with slightly flexed knees. Inability to weight bear or pain when moving the hip is usually evident.
what is the most common reason total hip replacements need to be revised
Aseptic loosening is the most common reason total hip replacements need to be revised
long term steriod use rf for
avascular necrosis of hip
hip replacement complications
perioperative
venous thromboembolism
intraoperative fracture
nerve injury
surgical site infection
leg length discrepancy
posterior dislocation
may occur during extremes of hip flexion
typically presents acutely with a ‘clunk’, pain and inability to weight bear
on examination there is internal rotation and shortening of the affected leg
- aseptic loosening (most common reason for revision )
prosthetic joint infection
Axillary nerve palsy can also occur due to shoulder dislocation.
anterior
what does imaging of lateral epicondylitis look like
imaging typically shows calcification or microtears at the origin of the extensor tendons.
mixed features of SLE, systemic sclerosis and myositis.
sharp syndrome
Fever
Joint pain - especially the knees, wrists and ankles
Maculopapular salmon rash
Other - lymphadenopathy, sore throat, hepatosplenomegaly, myalgia, pericarditis.
ferritin and ESR raised
adult onset still disease
unexplained lump increasing in size of forearm for exmaple what is the diff between adults and children in examination time
adults - urgent USS 2ww
children USS in 48hr
when do you do an LP in CT head
NICE : If CT head done within 6 hours of symptom onset shows no evidence of SAH, do not routinely offer an LP and consider alternative causes
If CT head is done > 6 hours and is negative, consider LP
LP should be performed at least 12 hours after injury to identify xanthochromia
