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Yr 6 PACES knowledge > Ortho, Vascular, breast > Flashcards

Ortho, Vascular, breast 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

Define Thrombophlebitis

A

Inflammation of a superficial vein, due to a thrombus

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6
Q

Hard + painful vein

A

Thrombophlebitis

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7
Q

Management of thrombophlebitis

A

NSAID + compression stocking + increased mobility

if infected –> flucloxacillin QDS

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8
Q

Most common pathogen causing cellulitis

A

Strep pyogenes

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9
Q

Green dischARGE + mass under nipple

USS shows duct dilatation and inflammation

  • Diagnosis? Mx?
A

Duct ectasia (widened ducts due to inflammation)

Mx: usually goes away w paracetamol
If troublesome –> excision of duct

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10
Q

RFs for periductal mastitis

A

eczema, smoking, psoriasis, piercings

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11
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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12
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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13
Q

Fracture classification

A

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

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14
Q

Greenstick fracture

A

Young soft bone which bends + breaks

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15
Q

Comminuted fracture

A

> 2 fragments

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16
Q

Angulation - how is it described

A

the direction of the distal portion of the distal fragment

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17
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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18
Q

Garden classification

A

Intracapsular NOF#

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

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19
Q

Distal radius articulates with

A

Scaphoid, lunate, ulna

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20
Q

Distal radial fracture with dorsal angulation

A

Colles fracture

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21
Q

Distal radial fracture with volar angulation

A

Smith fracture

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22
Q

Distal radial fracture involving the joint (intraarticular)

A

Barton fracture

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23
Q

Distal radial fracture + distal radioulnar dislocation

A

Galeazzi fracture

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24
Q

ulnar fracture + proximal radial head dislocation

A

Monteggia fracture

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25
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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26
Q

Most dangerous complication of an open #?

Features?

A

clostridium perfringens

Gas gangrene + shock

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27
Q

4 pillars of fracture management

A

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

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28
Q

Methods of fracture reduction

A

Open (i.e. surgical incision)

or closed

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29
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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30
Q

Indications for external fixation device

A

Open #s
Burns
Tissue loss

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31
Q

Rehabilitation for fracture management

A

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

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32
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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33
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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34
Q

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

A

COMPARTMENT SYNDROME

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35
Q

Causes of malunion

A

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

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36
Q

Cause of cubitus varus

A

Gunstock deformity from malunion of a supracondylar #

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37
Q

AVN - what is the consequence

A

Soft + deformed bone –> pain + stiffness + OA

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38
Q

Scaphoid fracture - common method of injury?

O/E?

A

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

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39
Q

Scaphoid fracture - how long until visible on XR?

A

10 days after injury

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

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40
Q

Mx of scaphoid fracture? Main complication?

A

Plaster

Risk of scaphoid AVN –> pain + stiffness

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41
Q

2 types of shoulder dislocation?

Common causes of both?

A

Anterior: trauma, falling on hand
Posterior: epileptics

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42
Q

Bankart lesion

A

Associated w should dislocation

Damage to anteroinferior glenoid labrum

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43
Q

Hill Sach lesion

A

Associated w anterior shoulder dislocation

Cortical depression of posterolateral humeral head

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44
Q

Presentation of shoulder dislocation

A

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

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45
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

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46
Q

2 complications of shoulder dislocation

A

Recurrent dislocation

Axillary nerve palsy

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47
Q

Impingement syndrome - pathology?

A

Entrapment of supraspinatus tendon + subacromial bursa

Trapped btw ACROMION + GREATER TUBEROSITY of humerus

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48
Q

Presentation of impingement syndrome

A

Painful arc 60-120

+ve Hawkins test

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49
Q

Mx of impingement syndrome

A

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

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50
Q

Differential of painful arc

A

Impingement syndrome
Partial rotator cuff tear
OA of acriomoclavicular joint

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51
Q

Findings on examination of frozen shoulder

A

reduced ROM, esp EXTERNAL ROTATION and shoulder abudction

52
Q

Rotator cuff tear: O/E

A

Partial: painful arc

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

53
Q

Commonest type of supracondylar fracture

A

Extension i.e. distal fragment is posteriorly displaced

54
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)

55
Q

Mx of ruptured ACL

A

autograft from SEMITENDINOSUS

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

56
Q

Definition of disc prolapse

A

Herniation of nucleus pulposus through annulus fibrosis

57
Q
  • Loss of sensation on inner dorsum of foot
  • Foot drop and weak inversion
    Intact reflexes
A

L5 root compression

58
Q

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

A

Spinal stenosis

59
Q

Spinal stenosis - presentation

A

Pain on spine extension

Heavy, aching buttock on walking (spinal claudication)

60
Q

Sx of acute cord compression

A

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

61
Q

Sx of cauda equina syndrome

A

Asymmetrical symptoms

  • radicular pain
  • Saddle anaesthesia
  • Faecal/urinary incontinence
62
Q

2 causes of painless genital ulcers

A

Syphilis

Chlamydia

63
Q

How to examine a pt post-mastectomy

A

Scar: location? healed?
Skin + axilla
LNs + arm swelling
Pec major - ask pt to press down on hips

Palpate the other side

Check sensation in T1

palpate spine for mets + listen to lung bases

palpate for hepatomegaly

64
Q

Indications for mastectomy

A

Usually, WLE + SNL to conserve as much breast as possible

Indications:

  • Large tumour in small breast
  • Patient preference
  • Nipple involvement
  • Multifocal disease
65
Q

Types of mastectomy

A

Simple = most common. Breast only

Radical = breast + pec major + minor + axilla

66
Q

Examination of post-breast reconstruction

A

Look:
Scar, surrounding skin, does breast lie higher/rounder? Radiotherapy tattoos?

  • Ask pt to lift head off bed (TRAM flap?)
67
Q

Hx of a pt post-mastectomy or breast reconstruction

A
  • Presentation of the breast cancer, RFs

- Current Sx: paraesthesia, lymphedema, psych, mets

68
Q

2 types of breast reconstruction? what are their positives and negatives

A

Either implant or myocutaneous flaps

Implant:
\+ easier surgery
- need lots of skin
- worse cosmetic result
- can get leakage, capsular contracture
Flaps:
\+ aesthetic
\+ don't need loads of skin
- Blood loss
- Higher risk of complications
- CI if previous abdo surgery
69
Q

3 types of Flap reconstruction for breast

A

Lat Dorsi or TRAM flap or DIEP flap

Lat Dorsi = usually augmented w an implant. pedicled = skin, fat, muscle + blood supply

TRAM flap = Transverse rectus abdominis muscle. -ve = risk of hernia.

DIEP flap = modified TRAM flap, where only skin + fat is taken. Spares the rectus!

70
Q

Signs of chronic venous insufficeincy

A 
Haemosiderosis
Atrophie Blanche
Swelling
Lipodermatosclerosis
Eczema
Gaiter ulcers
Stars - venous
71
Q

Varicosities on inner thigh - which vein is involved?

A

Great saphenous

72
Q

Varicosities over the calf - which vein is involved

A

Short saphenous

73
Q

CEAP classification

A

1) telangiectasia
2) Varicose veins
3) Oedema
4a) skin change = haemosiderosis, eczema
b) LDS, atrophié blanche
5) healed ulcer
6) active ulcer

74
Q

3 main points of valve incompetencd

A

Saphenofemoral junction
Sapheno popliteal junction
Deep perforators (these drain the great saphenous vein(

75
Q

Mx of Chronic venous insufficiency

A

Conservative:

  • weight loss
  • avoid prolonged standing
  • compression bandages for ULCERS
  • emollients for skin
  • analgesia
  • piriton for pruritis

Minimally invasive:
Laser
Sclerotherapy

Surgery:
Ligation + stripping of superficial veins

76
Q

Ix of choice for ?venous disease

A

Duplex USS

77
Q

what is post-phlebitic limb

A

Long term symptoms following a previous DVT

78
Q

what is CVI?

A

Chronic venous insufficiency = effects on leg from persistent venous HTN

79
Q

Pathophysiology of lipodermatosclerosis

A
  • Chronic inflammation –> fibrosis –> distal shrinkage

- Venous obstruction –> proximal leg swelling

80
Q

Leriche’s syndrome

A

Occlusion of abdominal aorta + iliac

Buttock claudication and wasting
Erectile dysfunction
Absent femoral pulses

81
Q
  • Buttock claudication and wasting
  • Erectile dysfunction
  • Absent femoral pulses
A

Leriche’s syndrome

occlusion of abdominal aorta + iliac

82
Q

Posterior tibial artery - where is it?

A

Behind the medial malleolus

83
Q

ABPI readings

A

> 1.2 = calcification (DM)

  1. 8-0.9 = asymptomatic + manage RFs
  2. 5-0.8 = Claudication + routine specialist referral

<0.5 = severe + urgent referral

84
Q

How to measure ABPI

A

Measure both arms - take highest measurement

Measure post tibial + dorsalis pedis - take highest mesurement

85
Q

Ix for ?Periph arterial disease

A 
ABPI
Bloods: FBC, U+Es (renovascular disease), glucose, lipids
Imaging: 
Colour duplex US
CT/MR angiography (gold standard)
86
Q

Mx of peripheral arterial disease

A

Conservative:
RFs - HTN, DM, lipids, smoking, weight loss
Physio - walk through pain
FOOT CARE

Medical:
- Aspirin/clopidogrel = FOR ALL PATIENTS

Surgical:

  • Angioplasty + stenting
  • Endarterectomy
  • Bypass
  • -> amputation
87
Q

surgical Mx of peripheral artery disease

A

Angioplasty + stenting
Endarterectomy
Bypass
Amputation

88
Q

Diff btw intermittent claudication and Critical limb ischemia

A

Claudication
Pain relieved by rest

CLI
Rest pain + tissue loss

89
Q

Indications for arterial bypass grafting

A

Sx arise from v short distance of walking/rest pain

Affecting QoL

90
Q

significant stenosis at aortic bifurcation - what bypass may be done?

A

aortobifemoral

91
Q

significant stenosis in one femoral artery - what bypass may be done?

A

Fem-popliteal bypass

92
Q

Definition of AAA

A

Dilatation of the aorta to >50% of normal (>3cm)

93
Q

Indications for AAA repair

A

Symptomatic = back pain, distal emboli, leak

Asymptomatic:

  • > 5.5cm
  • expanding >1cm/year
94
Q

Screening for AAA

A

Abdo US for 65M

<3cm = no more scans
3-4.5 = annual scans
4.5-5.4 = 3monthly 
>5.5cm = surgical referral
95
Q

Ix in AAA

A

Abdo USS

CT/MRI = ix of choice

96
Q

Complications of AAA repair

A 
Death
MI
Renal failure
Spinal/mesenteric ischemia
Trash foot
Anastomotic leak
Graft infection
Aorto-enteric fistula
97
Q

Popliteal aneurysm = other findings O/E

A

Distal emboli on feet
examine the other knee = 50% bilateral
AAA = in 50%

98
Q

Mx of popliteal aneurysm

A

Acutely: embolectomy or fem-distal bypass
Stable: excision bypass

99
Q

Causes of aneurysms

A

Congenital: PCKD, Marfan’s, Ehlers Danlos

Acquired: atherscleoriss, trauma,

100
Q

Complications of aneurysms

A

Rupture
Thrombosis
Distal emboli –> trash foot
Fistula = with GIT or IVC

101
Q

Indications for amputation - give 4

A

Trauma
PVD
Sepsis
Neurological damage

102
Q

EVAR vs open repair

A

EVAR = has less post-op mortality

at 5 years - no difference in mortality

103
Q

Types of amputation

A 
Digital
Transmetatarsal
Ankle
Below knee
Above knee
104
Q

Complications of amputation

A

Early:
mortality
infection
haemorrhage

Late:
Contractures
Phantom limb pain
Poor healing --> difficult to use prosthesis
Psych
105
Q

Most common type of repair used for below knee amputation

A

Long posterior flap of Burgess

106
Q

Arterial supply to leg

A

Aorta –> external iliac –> common femoral –> superficial femoral –> popliteal artery –> posterior tibial

107
Q

Complications of carotid endarterectomy

A

3% risk stroke/death

Haematoma
MI
Nerve injury - Rec laryngeal, hypoglossal (tongue)

108
Q

Why is CKD associated with PVD

A

CKD –> hyperphosphatemia –> atherosclerosis

109
Q

Features of diabetic foot

A
  • Neuropathy –> trauma –> ulcers
  • Vasculopathy –> ulcers
  • Amputations esp digits
  • Charcot joints
110
Q

Causes of gangrene

A

DM = most common
Embolism eg trash foot from AAA repair
Raynauds
Injury

111
Q

Colour changes in Raynaud’s phenomenon

A

White –> blue –> crimson

112
Q

Secondary causes of Raynaud’s

A
  • Systemic disease: SLE, SS, RA
  • Atherosclerosis
  • Blood: polycythemia
  • Trauma: vibration injury
113
Q

Mx of Raynaud’s

A

Conservative: avoid cold, wear gloves, stop smoking

Medical: nifedipine

114
Q

Ulcers - types of tissue at base of ulcer

A

Granulation tissue = red + shiny

Slough = stringy + white

Eschar = necrotic + black

or bone/tendon

115
Q

Examination of an ulcer

A

Site
Size
Shape

  • Edges = sloping, punched out, undermined
  • Base = granulation, slough
  • Discharge = serous/sanguinous

Surrounding skin = dermatitis, excoriations, LNs, sensation

Assess neurovascular status

116
Q

Mx of venous ulcer

A

Conservative:
Optimise RFs: weight loss, smoking
Leg elevation

If ABPI >0.8 –> 4 LAYER COMPRESSION BANDAGING
- Dressing + wool bandage + crepe bandage + blue line bandage + cohesive compression bandage

Bandages changed 1-2x/week

Once healed –> grade 2 compression stockings for LIFE

117
Q

Technical term for bunions

A

Hallux valgus

118
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

119
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

120
Q

Flattened medial arch of foot + ulcer on medial foot

A

Charcot joint

121
Q

Features O/E of charcot joint

A

Painless deformed joint
Ulcers/necrosis
Swelling

122
Q

Causes of charcot joints

A

Due to sensory loss

  • DM
  • peripheral neuropathy: B12, folate, alcohol
123
Q

Acute limb ishemia - thrombosis vs embolism ?

A

Embolism: more sudden, no Hx of claudication, commonly AF or post AAA surgery, profound ischemia, CLINICAL Dx!!

124
Q

Mx of ALI- thrombosis vs embolism

A

Both:
1) O2, analgesia 2) NBM 3) IV fluids 4) IV heparin

Embolism:
clinical Dx!
Urgent embolectomy!! + warfarin

Thrombosis: Doppler USS + CT angiography
Thrombolysis or stenting

125
Q

Carpal bones

A

Scaphoid Lunate Triquetrum Pisiform

Trapezium Trapezoid Capitate Hamate

126
Q

Septic arthritis:

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

A

Ceftriaxone

127
Q

Which Abx for IVDU w septic arthritis?

A

?Pseudomonas

Ceftazidime!!

Yr 6 PACES knowledge (14 decks)

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