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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 (Unilateral cortical breach only)
Buckle (Incomplete cortical disruption resulting in periosteal haematoma only)
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 major criteria for fat embolism?

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
Q

What are the two categories of hip fractures?

A

Intra-capsular and extra- capsular

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26
Q

What is a complication of fracturing the intra-capsular neck of femur?

A

Avascular necrosis

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27
Q

Which classification system is used to describe intra-capsular hip fractures?

A

The garden classification

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28
Q

What are the grades of garden classification?

A

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

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29
Q

How can non-displaced intra-capsular fractures be managed?

A

Internal fixation

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30
Q

How should displaced intracapsular fractures be managed?

A

If low mobility/ high morbidity then hemiarthroplasty

if good health, total hip replacement

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31
Q

How are intertrochanteric fractures managed?

A

Dynamic hip screw

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32
Q

How are subtrochanteric fractures managed?

A

Intermedullary nail

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33
Q

What is the classic sign on presentation with NOF fracture?

A

Shortened, abducted and externally rotated leg

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34
Q

What is a key sign of fractured NOF on X-ray?

A

Disruption of shentons line

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35
Q

What is compartment syndrome?

A

Pressure within a fascial compartment is abnormally high which cuts off blood flow to the contents of that compartment

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36
Q

How does acute compartment syndrome present?

A

5 Ps-
Pain
Paresthesia
Pale
Pressure
Paralysis

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37
Q

How can the pressure in a compartment be measured?

A

Needle manometry

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38
Q

What is the initial management of compartment syndrome? (pre-surgical)

A

Escalating to ortho consultant
Removing external dressing and bandages
Elevating the leg to heart level
Avoid hypotension

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39
Q

What is the definitive management of compartment syndrome?

A

Emergency fasciotomy

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40
Q

Where is the most common site for sarcoma to metastasise to?

A

The lungs

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41
Q

What is torticollis?

A

Waking up with a unilaterally stiff and painful neck due to muscle spasm

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42
Q

Where do the spinal nerves come together to form the sciatic nerve?

A

L4-S3

43
Q

Where does the sciatic nerve exit?

A

Greater sciatic foramen

44
Q

What does the sciatic nerve divide into at the back of the knee?

A

Tibial nerve and common peroneal nerve

45
Q

What does the sciatic nerve supply?

A

Sensation to the lateral lower leg and motor to the posterior thigh, lower leg and foot.

46
Q

What is bilateral sciatica a red flag for?

A

Cauda equina syndrome

47
Q

Which test can be done on examination to aid a diagnosis of sciatica?

A

Sciatic stretch test

48
Q

Where does the spinal cord terminate?

A

L2/L3

49
Q

What do the nerves of cauda equina supply?

A

Sensation to perineum, bladder and rectum
Motor innervation to lower limbs

50
Q

What is the management of cauda equina?

A

immediate hospital admission
Emergency MRI
Lumbar decompression

51
Q

What is a feature of metastatic cord compression which differentiates it from cauda equina?

A

Back pain is worse on coughing or straining

52
Q

What is spondylolisthesis?

A

Anterior displacement of a vertebra out of line with one below

53
Q

What is the key feature of spinal stenosis and what are its features?

A

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
Q

What are the investigations for spinal stenosis?

A

MRI is the primary imaging investigation

Other investigations to rule out peripheral arterial disease should be done

55
Q

What is the management of spinal stenosis?

A

Exercise and weight loss
Analgesia
Physiotherapy
Decompression surgery

56
Q

Which nerve is compressed in meralgia paraesthetica?

A

lateral femoral cutaneous nerve

57
Q

What is the presentation of meralgia paraesthetica?

A

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
Q

What is the presentation of trochanteric bursitis?

A

Resisted abduction, internal and external rotation of the hip

Pain- worsens with activity or with sitting for a long time

59
Q

What are the management options of trochanteric bursitis?

A

Rest
Ice
Analgesia
Physio
Steroid therapy

60
Q

Which type of movement most commonly causes meniscal tears?

A

Twisting movements

61
Q

What are the two special tests for meniscal tears?

A

McMurray’s and Apley grind test

62
Q

What are the ottowa knee rules for X-ray?

A

Age 55 or above
Patella tenderness
Fibular head tenderness
Cannot flex knee to 90 degrees
cannot weight bear

Any= xray

63
Q

What is the gold standard for diagnosing meniscal tear?

A

Arthroscopy

64
Q

What are the classic symptoms of meniscal tear?

A

A “pop”
Rapid swelling
Instability
Locking

65
Q

In an ACL injury, how does the instability of the joint present?

A

The tibia can move anteriorly below the femur

66
Q

Which test can be performed on examination which can assess for ACL damage?

A

Anterior drawer test

67
Q

What is the first line investigation for ACL damage?

A

MRI

68
Q

What is the management of ACL injury?

A

RICE
NSAIDs
Crutches and braces
Arthroscopic surgery

69
Q

What is Osgood-Schlatter disease caused by?

A

Inflammation of the tibial tuberosity

70
Q

What is the presentation of osgood schlatter disease?

A

Visible or palpable lump at tibial tuberocity
Pain on the anterior aspect of the knee
Pain is exacerbated by physical activity

71
Q

What is Foucher’s sign?

A

When a patient with a Baker’s cyst flexes their knee to 45 degrees, the cyst becomes lest apparent

72
Q

Which test can be performed on examination to confirm achilles tendon rupture?

A

Simmonds’ calf squeeze test

73
Q

Which medication has a strong association with achilles tendinopathy and rupture?

A

Fluroquinalone antibiotics e.g. ciprofloxacin

74
Q

What is the typical presentation of achilles tendon rupture?

A

Sudden onset calf pain
Snapping sensation
Feeling as though something has hit them in the back of the leg

75
Q

What is the management of achilles tendon rupture?

A

RICE

VTE prophylaxis

Immobilise for 6-12 weeks or reattach the achilles in theatre

76
Q

What type of crystals cause gout?

A

Urate

77
Q

What does joint fluid aspiration in gout show?

A

Needle shaped crystals which are negatively bifringent of polarised light

78
Q

What is the other name for frozen shoulder?

A

Adhesive capsulitis

79
Q

What causes frozen shoulder?

A

Inflammation and fibrosis in the joint which leads to adhesions which binds to the capsule and causes it to tighten around the joint

80
Q

What are the 3 phases of the course of disease in frozen shoulder?

A
  1. Painful phase
  2. Stiff phase
  3. Thawing phase
81
Q

What is the management of frozen shoulder?

A

Analgesia
Physio
Steroid injections (intra-articular)
Hydrodilatation
Athroscopy

82
Q

Which pathology is the empty can test positive in?

A

Supraspinatus tedinopathy

83
Q

Which muscles make up the rotator cuff?

A

S- supraspinatus
I- infraspinatus
T- teres minor
S- Subscapularis

84
Q

How does a rotator cuff tear present?

A

Shoulder pain
Weakness and pain associated with the specific muscle which is related to the site of tear

85
Q

What are the diagnostic tests for rotator cuff tear?

A

X rays dont show soft tissue tears

Ultrasound or MRI scans are diagnostic

86
Q

What are the management options for rotator cuff tears?

A

rest, analgesia and physio

or

surgery

87
Q

What is subluxation?

A

Partical dislocation of the shoulder. The ball does not fully come out of the socket and pops back into place

88
Q

Which type of shoulder dislocation makes up ~90% of cases?

A

Anterior

89
Q

Which mechanisms of injury are usually associated with a posterior shoulder dislocation?

A

Electric shocks and seizures

90
Q

Which nerve can be damaged in shoulder dislocation and what is the presentation of this?

A

Axillary nerve damage

Loss of sensation in the “regimental badge area” and motor weakness in the deltoid and teres minor

91
Q

Which special test can be used to assess for shoulder instability?

A

The apprehension test

92
Q

What is “student’s elbow”?

A

Olecranon bursitis

93
Q

What is the management of olecranon bursitis?

A

Aspiration, microscopy and culture.

Flucloxacillin (clarithromycin as an alternative)

94
Q

What is another name for lateral epicondylitis?

A

Tennis elbow

95
Q

What is another name for medial epicondylitis?

A

Golfer’s elbow

96
Q

What is DeQuervain’s tenosynovitis?

A

Inflammation and swelling of the tendon sheaths in the wrist

97
Q

Which two tendons are primarily affected in DeQuervain’s tenosynovitis?

A

Abductor pollicis longus

Extensor pollicis brevis

98
Q

Which test can confirm DeQuervain’s tenosynovitis?

A

Finkelstein’s test.

99
Q

How does trigger finger present?

A

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
Q

What is a test for dupuytren’s contracture on examination?

A

Table-top test

101
Q

What is the management of dupuytren’s contracture?

A

Needle fasciotomy
Limited fasciectomy

102
Q

Which nerve is compressed in carpal tunnel syndrome?

A

Median nerve

103
Q

What are the 2 special tests for carpal tunnel syndrome?

A

Phalen’s test and Tinnel’s test

Alice's finals cards (23 decks)

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