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Alice's finals cards > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What is haematogenous osteomyelitis?

A

When a pathogen is carried through the blood and is seeded in the bone

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2
Q

What is the most common cause of osteomyelitis?

A

Staphlococcus aureus

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3
Q

What is the presentation of ostoemyelitis?

A

Fever
Pain and tenderness
Erythema
Swelling

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4
Q

What are the X-ray changes in osteomyelitis?

A

Periosteal reaction
Localised osteopenia
Destruction

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5
Q

What is the best form of imaging to establish a diagnosis of osteomyelitis?

A

MRI

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6
Q

What is the management of osteomyelitis?

A

Surgical debridement
Antibiotic therapy
(6 weeks of flucloxacilin)

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7
Q

What is a compound fracture?

A

when the skin is broken and the broken bone is exposed to the air

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8
Q

What is a salter harris fracture?

A

Growth plate fracture

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9
Q

Which 3 types of fractures occur more commonly in children

A

greenstick and buckle. Salter harris can only happen in children

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10
Q

What is the colle’s fracture? What is its common mechanism of injury?

A

Transverse fracture of the distal radius near the wrist. This causes the distal portion to displace posteriorly causing a “dinner fork deformity”

Usually causes by fall onti outstretched hand (FOOSH)

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11
Q

What is the key sign of a scaphoid fracture?

A

Tenderness in the anatomical snuffbox

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12
Q

What is the classification system used to grade ankle fractures?

A

Weber classification

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13
Q

What are the 3 levels of weber classification?

A

Type A – below the ankle joint – will leave the syndesmosis intact

Type B – at the level of the ankle joint – the syndesmosis will be intact or partially torn

Type C – above the ankle joint – the syndesmosis will be disrupted

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14
Q

What are the most common sites for pathological fracture?

A

femur and vertebral bodies

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15
Q

Which cancers can commonly metastasise to bone?

A

My PB KTL

Myeloma
Prostate
Breast
Kidney
Thyroid
Lung
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16
Q

What does a T score of >-1 correlate to?

A

Normal bone

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17
Q

What does a T score of -1 to -2.5 correlate to?

A

osteopenia

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18
Q

What does a T score of less than -2.5 correlate to?

A

Osteoporosis

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19
Q

What are the first line medical treatments for reducing the risk of fragility fractures?

A

Calcium and vitamin D

Bisphosphonates

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20
Q

What are the potential side effects of bisphosphonates?

A

Reflux and oesophageal erosions

Atypical fractures

Osteonecrosis of the jaw

Osteonecrosis of the external auditory canal

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21
Q

What is the first line investigation of a suspected fracture?

A

X ray from 2 views

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22
Q

Which criteria are used to diagnose fat embolism syndrome?

A

Gurd’s criteria

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23
Q

What are Gurd’s major criteria?

A

Resp distress
Petechial rash
Cerebral involvement

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24
Q

What is the time target for surgery when someone has been diagnosed with a hip fracture?

A

Within 48 hours

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25
What are the two categories of hip fractures?
Intra-capsular and extra- capsular
26
What is a complication of fracturing the intra-capsular neck of femur?
Avascular necrosis
27
Which classification system is used to describe intra-capsular hip fractures?
The garden classification
28
What are the grades of garden classification?
Grade I- incomplete and non displaced Grade II- complete and non-displaced Grade III- partially displaced (trabuclae are at an angle Grade IV- fully displaced
29
How can non-displaced intra-capsular fractures be managed?
Internal fixation
30
How should displaced intracapsular fractures be managed?
If low mobility/ high morbidity then hemiarthroplasty if good health, total hip replacement
31
How are intertrochanteric fractures managed?
Dynamic hip screw
32
How are subtrochanteric fractures managed?
Intermedullary nail
33
What is the classic sign on presentation with NOF fracture?
Shortened, abducted and externally rotated leg
34
What is a key sign of fractured NOF on X-ray?
Disruption of shentons line
35
What is compartment syndrome?
Pressure within a fascial compartment is abnormally high which cuts off blood flow to the contents of that compartment
36
How does acute compartment syndrome present?
``` 5 Ps- Pain Paresthesia Pale Pressure Paralysis ```
37
How can the pressure in a compartment be measured?
Needle manometry
38
What is the initial management of compartment syndrome? (pre-surgical)
Escalating to ortho consultant Removing external dressing and bandages Elevating the leg to heart level Avoid hypotension
39
What is the definitive management of compartment syndrome?
Emergency fasciotomy
40
Where is the most common site for sarcoma to metastasise to?
The lungs
41
What is torticollis?
Waking up with a unilaterally stiff and painful neck due to muscle spasm
42
Where do the spinal nerves come together to form the sciatic nerve?
L4-S3
43
Where does the sciatic nerve exit?
Greater sciatic foramen
44
What does the sciatic nerve divide into at the back of the knee?
Tibial nerve and common peroneal nerve
45
What does the sciatic nerve supply?
Sensation to the lateral lower leg and motor to the posterior thigh, lower leg and foot.
46
What is bilateral sciatica a red flag for?
Cauda equina syndrome
47
Which test can be done on examination to aid a diagnosis of sciatica?
Sciatic stretch test
48
Where does the spinal cord terminate?
L2/L3
49
What do the nerves of cauda equina supply?
Sensation to perineum, bladder and rectum | Motor innervation to lower limbs
50
What is the management of cauda equina?
immediate hospital admission Emergency MRI Lumbar decompression
51
What is a feature of metastatic cord compression which differentiates it from cauda equina?
Back pain is worse on coughing or straining
52
What is spondylolisthesis?
Anterior displacement of a vertebra out of line with one below
53
What is the key feature of spinal stenosis and what are its features?
Pseudoclaudication Symptoms of lower back pain, buttock and leg pain and leg weakness are absent at rest but occur with standing and walking. Bending forward improves the symptoms
54
What are the investigations for spinal stenosis?
MRI is the primary imaging investigation Other investigations to rule out peripheral arterial disease should be done
55
What is the management of spinal stenosis?
Exercise and weight loss Analgesia Physiotherapy Decompression surgery
56
Which nerve is compressed in meralgia paraesthetica?
lateral femoral cutaneous nerve
57
What is the presentation of meralgia paraesthetica?
Sensation of the skin on the upper-outer thigh is affected. Patients may describe burning, numbness, pins and needles and cold sensation. Worsens with extension of the hip
58
What is the presentation of trochanteric bursitis?
Resisted abduction, internal and external rotation of the hip Pain- worsens with activity or with sitting for a long time
59
What are the management options of trochanteric bursitis?
``` Rest Ice Analgesia Physio Steroid therapy ```
60
Which type of movement most commonly causes meniscal tears?
Twisting movements
61
What are the two special tests for meniscal tears?
McMurray's and Apley grind test
62
What are the ottowa knee rules for X-ray?
``` Age 55 or above Patella tenderness Fibular head tenderness Cannot flex knee to 90 degrees cannot weight bear ``` Any= xray
63
What is the gold standard for diagnosing meniscal tear?
Arthroscopy
64
What are the classic symptoms of meniscal tear?
A "pop" Rapid swelling Instability Locking
65
In an ACL injury, how does the instability of the joint present?
The tibia can move anteriorly below the femur
66
Which test can be performed on examination which can assess for ACL damage?
Anterior drawer test
67
What is the first line investigation for ACL damage?
MRI
68
What is the management of ACL injury?
RICE NSAIDs Crutches and braces Arthroscopic surgery
69
What is Osgood-Schlatter disease caused by?
Inflammation of the tibial tuberosity
70
What is the presentation of osgood schlatter disease?
Visible or palpable lump at tibial tuberocity Pain on the anterior aspect of the knee Pain is exacerbated by physical activity
71
What is Foucher's sign?
When a patient with a Baker's cyst flexes their knee to 45 degrees, the cyst becomes lest apparent
72
Which test can be performed on examination to confirm achilles tendon rupture?
Simmonds' calf squeeze test
73
Which medication has a strong association with achilles tendinopathy and rupture?
Fluroquinalone antibiotics
74
What is the typical presentation of achilles tendon rupture?
Sudden onset calf pain Snapping sensation Feeling as though something has hit them in the back of the leg
75
What is the management of achilles tendon rupture?
RICE VTE prophylaxis Immobilise for 6-12 weeks or reattach the achilles in theatre
76
What type of crystals cause gout?
Urate
77
What does joint fluid aspiration in gout show?
Needle shaped crystals which are negatively bifringent of polarised light
78
What is the other name for frozen shoulder?
Adhesive capsulitis
79
What causes frozen shoulder?
Inflammation and fibrosis in the joint which leads to adhesions which binds to the capsule and causes it to tighten around the joint
80
What are the 3 phases of the course of disease in frozen shoulder?
1. Painful phase 2. Stiff phase 3. Thawing phase
81
What is the management of frozen shoulder?
``` Analgesia Physio Steroid injections (intra-articular) Hydrodilatation Athroscopy ```
82
Which pathology is the empty can test positive in?
Supraspinatus tedinopathy
83
Which muscles make up the rotator cuff?
S- supraspinatus I- infraspinatus T- teres minor S- Subscapularis
84
How does a rotator cuff tear present?
Shoulder pain | Weakness and pain associated with the specific muscle which is related to the site of tear
85
What are the diagnostic tests for rotator cuff tear?
X rays dont show soft tissue tears Ultrasound or MRI scans are diagnostic
86
What are the management options for rotator cuff tears?
rest, analgesia and physio or surgery
87
What is subluxation?
Partical dislocation of the shoulder. The ball does not fully come out of the socket and pops back into place
88
Which type of shoulder dislocation makes up ~90% of cases?
Anterior
89
Which mechanisms of injury are usually associated with a posterior shoulder dislocation?
Electric shocks and seizures
90
Which nerve can be damaged in shoulder dislocation and what is the presentation of this?
Axillary nerve damage Loss of sensation in the "regimental badge area" and motor weakness in the deltoid and teres minor
91
Which special test can be used to assess for shoulder instability?
The apprehension test
92
What is "student's elbow"?
Olecranon bursitis
93
What is the management of olecranon bursitis?
Aspiration, microscopy and culture. Flucloxacillin (clarithromycin as an alternative)
94
What is lateral epicondylitis?
Tennis elbow
95
What is medial epicondylitis?
Golfer's elbow
96
What is DeQuervain's tenosynovitis?
Inflammation and swelling of the tendon sheaths in the wrist
97
Which two tendons are primarily affected in DeQuervain's tenosynovitis?
Abductor pollicis longus Extensor pollicis brevis
98
Which test can confirm DeQuervain's tenosynovitis?
Finkelstein's test.
99
How does trigger finger present?
When the finger is extended from a flexed position, the finger locks or gets stuck in a bent position. It then may release suddenly with a painful pop or click
100
What is a test for dupuytren's contracture on examination?
Table-top test
101
What is the management of dupuytren's contracture?
Needle fasciotomy | Limited fasciectomy
102
Which nerve is compressed in carpal tunnel syndrome?
Median nerve
103
What are the 2 special tests for carpal tunnel syndrome?
Phalen's test and Tinnel's test

Alice's finals cards (21 decks)

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