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*** Exam Medicine > Ortho/Rheum Summary Q's > Flashcards

Ortho/Rheum Summary Q's Flashcards

1
Q

Key facts about Shoulder dislocation

A

anterior is most common
posterior is as result of seizure or electric shock

always check nerves and pulses (before reducing)

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2
Q

complications of shoulder dislocation

A

hill-sacks (chunk of humeral head)
bankhart (labrum injury)
Slap-tear (labrum)
Axillary nerve injury

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3
Q

Key facts about proximal humerus fx

A

assess if humeral head in several pieces

either CONS = sling / 8-12 weeks + splint
or SURG int fixation

Radial nerve injury can occur = wrist drop
AVN can also occur // axillary artery

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4
Q

Key facts about Supra Cond Fx

A

often kiddo’s falling
assess post fat pad/radio-cap + ant hum lines

keep elbow in extension so as no damage to brachial artery
*radial/median nerve palsies are rare!

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5
Q

Key facts about Elbow Fx

A

often not seen on X-ray, look for anterior fat pad (sail sign)
joint is swollen and tender

if no fx seen, but effusion seen on X-ray, sling for 14 days then repeat xray

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6
Q

Key facts about Radial Head Fx

A

sup and pronation hurts, effusion seen on X-ray + assess ant hum/radio cap line

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7
Q

what is the concern about a medial area clavicle fracture?

A

damage to neurovascular: brachial plexus, subclavian vessels +/- pneumothorax

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8
Q

young patient presents after falling, pain and lump in upper chest suspected clavicle fracture, with assoc tachpnea. what other condition may be present?

A

pneumothorax

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9
Q

most common fracture with FOOSH of older patient

A

colles wrist

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10
Q

Key facts about clavicle fx

A

usually young person FOOSH
managed conservatively unless very lateral and requires int fixation (non-union)

cuff and collar / 3 weeks

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11
Q

risk factors for fractures

A

osteoporosis, falls risk?, post-menopausal?

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12
Q

scphoid Fx CF and management

A

tender snuff box

hard to see on xray so ??CT, or POP cast and return in 14 days for repeat xray

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13
Q

concern with scaphoid fractures

A

AVN –> SNAC and SLAC

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14
Q

distal radius fx - key facts

A

elderly FOOSH
dinner fork/ dorsal deformity

if displaced, reduce (GA or Haematoma block) +/- ORIF
then immob in dorsiflexion

possible complication - median nerve damage, ruptured tendon, mal-union

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15
Q

blood supply to femoral head

A

branch of femoral art –> medial and lateral circumflex artery is main supply // branch of obturator artery supplies head

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16
Q

management of patient with hip fracture

A

ABC - patient can be shocked so RESUS

  • analgesia (10-15mg morphine IM) + anti-emetic (metaclop)
  • cross-match/ FBC/ U&E/ ECG
  • radiography (xray/CT)
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17
Q

Contra-Ind to surgery

A

Severe Dementia/ severe functional disability / current infection/ ??osteoporosis/ alcoholism (wont rehab properly)

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18
Q

Why might a hemi arthro be done instead of total?

A

Poor general health
Severe osteoporosis
Mentally handicapped
Pre-existing hip disease

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19
Q

how might hip fractures in elderly be prevented?

A

decrease osteoporosis -bisphos/ calcium/ vit D
more exercise = better balance
better lighting in house

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20
Q

RF for pathological fx’s

A 
Bone Mets
Osteoporosis
osteomalacia
myeloma
rheumatoid arthritis
21
Q

patient attends A&E with open fracture, what intial steps will you take in managing once ABC are complete?

A
  • control any bleeding from wound
  • give abx’s cover
  • immobilise fracture
  • analgesia +/- anti-emetic
  • examine for neurovasc compromise
  • radiograph once stable
22
Q

what might be seen on examination of patient with ??fracture

A

swollen, deformed, tender area, with decreased ROM, decreased sensation and no weight bearing.

23
Q

what will crush syndrome eventually result in if untreated?

A

HYPERkal + HYPOvol –> AKI/ DIC/ Met Acidosis

24
Q

where might compartment syndrome affect?

A

ant low leg/ deep post low leg/ volar forearm

25
Q

CF of compartment syn?

A

Pain (even passively) , parasthesia, paralysis, pallor (pulse will still be felt)

26
Q

why might a patient be initially immobilised in a backslab before a full cast applied?

A

decrease risk of compartment syn

27
Q

what is important to exclude when assessing acute knee?

A

Multi Lig Inj/ Fractures/ Tendon Inj/ Dislocation (damage pop art)/ ((in kids epiphyseal fracture))

28
Q

best imaging for soft tissue inj?

A

MRI

29
Q

Neurovasc Inj from Diff Fractures?

  • Shoulder Dis
  • Humeral
  • Distal Radial
  • Distal Ulnar
  • elbow
  • hip dis
  • upper fibular
A

shoulder - axillary nerve damage = numb deltoid
humeral - radial nerve damage = wrist drop
Distal Rad - Median = NO Pincer sign
Distal Ulnar - Ulnar = claw hand/ numb pinky
Elbow - brachial art = must be kept in extension
Hip dis - sciatic nerve = foot drop
upper fib - perineal = foot drop

30
Q

mortality of hip fracture

A

50% in elderly

31
Q

Patient attends with pain in shoulder, there is NO fracture, name 3 possible causes?

A
  • rotator cuff damage (partial or complete tear) painful arc
  • nerve impingement (pain on abduction resistence)
  • frozen shoulder (won’t move active or passively)
32
Q

swollen elbow that isnt fractured, causes? also what might you do in clinic to relieve any pain?

A
  • bursitis (tennis-lat or golfers-med)
  • olecrenon bursitis

intra artic steroid injection

33
Q

3 common sites for AVN?

A

Hip, Scaphoid, knee, ankle

34
Q

what abx’s might be used for osteomyelitis?

A

IV Cefotaxime and Vanc until cultures known.

35
Q

indications for total hip replacement (in context arthritis)

A
  • prox neck of femur fracture
  • non-operative treatment failure
  • pain causing decreased function
  • joint disease severly impacts quality of life
36
Q

why might a hemi arthroplasty be done instead of a total?

A
  • poor health
  • severe osteoporosis
  • pathological hip fx
  • pre-existing hip disease
37
Q

risk factors for septic arthritis

A

prosthetic joint, ivdu, DM, recent intra-artic injection, joint disease, immunocomp

38
Q

main differentials of hot swollen red joint?
what is key investigation?
what shown in each condition?

A

septic and gout (+/- haemarthrosis)
joint fluid aspirate BEFORE abx’s started
septic = pyogenic fluid
gout = negatively birifringent needles/urate crystals

39
Q

what is the basic pretense of causing gout?

A

anything that causes the increased leaving of fluid from the body:
Diuretics, dehydration, alcohol excess, dietary (fasting/purine rich-meats)

40
Q

treatment of gout?

A

NSAIDS (diclofenac) but if CI then give Colcihine (slower)
if patient has renal problems give steroids instead

Prevent further attacks by lifestyle mods and Allopurinol

41
Q

why not use allopurinol straight away?

A

can cause an attack, so wait 3 weeks thn give with NSAIDS cover

42
Q

diagnostic test (s) for SLE

A

anti DS-DNA / ANA / C3-C4

43
Q

reiter triad?

A

arthritis, conjunctivitis, urethritis

44
Q

psor arthritis CF/ o/e

A

sacroilitis, unilateral DIP, nail changes, psoriasis, swelling, dactylitis,

45
Q

GCA signs? and immediate management?

A

jaw claudication, scalp tenderness, headache +/- unilat blindness

ESR and give oral PRED

46
Q

red flags back pain?

A

neuro defecit, hx of CA, age 55, bladder incont, weight loss/ systemic

47
Q

RF for osteoporosis

A

SHATRD

Steroids
Hormones (sex hormones)
Alcohol excess
Thin
Rheumatoid Arth
Dietary
48
Q

clinical features of spinal cord compression

A

saddle anaes, bladder, buttock pain,

49
Q

bamboo spine = ?

A

ank spond

*** Exam Medicine (20 decks)

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