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Med Finals - Surgery > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

Define osteoarthritis

A

Non inflammatory degeneration of the joints. Wear and tear..

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2
Q

Risk factors for osteoarthritis

A

Obesity
Age
Occupation - sendentry
Trauma
Female
FH

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3
Q

Xray changes in osteoarthritis

A

LOSS
Loss of joint space
Osteophytes - bone spurs
Subarticular sclerosis - increased density of bone along joint line
Subchondreal cysts - fluid filled holes in bone

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4
Q

History of osteoarthritis

A

Pain and stiffness in joints
Worse on activity and at the end of the day
Deformity, instability and reduced function
Bulky bony enlargement
Restricted range of motion
Crepitus
Effusions

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5
Q

Clinical signs in of osteo arthritis in hands

A

Heberden’s nodes - DIP
Bouchard’s nodes - PIP
Weak grip
Reduced range of motion

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6
Q

Management of osteoarthritis

A

Lifestyle
Weight loss
Physio
Ocupational therapy
Orthotics
Analgesia - topical NSAIDs
Intraarticular steroid injection
Joint replacement

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7
Q

Define Colle’s Fracture

A

Transverse fracture of the distal radius. Causes Distal portion to displace posteriorly (upwards). Caused by FOOSH,

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8
Q

Define smith fracture

A

Transverse fracture of the distal radius. Causes distal portion to displace anteriorly, fall on back of out stretched hand.

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9
Q

Main cancers that metastasise to bone

A

PoRTaBLe
Prostate
Renal
Thyroid
Breast
Lung

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10
Q

Main types of hip fracture

A

Intra-capsular
Extra-capsular

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11
Q

Define intra-capsular fracture

A

The capsule is a strong fibrous structure that attaches to the acetabulum of the pelvis and the intertrochanteric line - surrounds the head of the femur. The fracture occurs within this capsule.

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12
Q

What hip fracture leads to avascular necrosis

A

Intra-capsular

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13
Q

Management of intra-capsular fracture

A

Non-displaced - internal fixation
Displaced - Avascular necrosis so need to have femoral head replaced - hemiarthroplasty or total hip replacement

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14
Q

Classification of intra-capsular fractures

A

Garden classification
Grade I - incomplete fracture and non-displaced
Grade II - Complete fracture and non-displaced
Grade III - Partial displacement
Grade IV - Full displacement

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15
Q

Management of extra-capsular fractures

A

Intertrochanteric - dynamic hip screw
Subtrochanteric - intramedullary nail

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16
Q

History of hip fracture

A

Pain
Unable to weight bare
Acute illness - reason for falling, anaemia, electrolytes, arrhythmias, HF, MI, stroke, infection

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17
Q

Define compartment syndrome

A

Pressure within a fascial compartment is abnormally elevated, cutting off blood flow within that compartment.

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18
Q

History of compartment syndrome

A

Pain
Paraesthesia
Pale
Pressure
Paralysis
(Not pulseless - separating from ischaemia)

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19
Q

Management of compartment syndrome

A

Remove external dressing/bandages
Elevate leg
Maintain good blood pressure
Emergency fasciotomy

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20
Q

Define osteomyelitis

A

Inflammation of the bone - usually caused by bacterial infection

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21
Q

Risk factors for osteomyelitis

A

Open fractures
Orthopaedic - prosthetic joints
Diabetic ulcers
Peripheral arterial disease
IV drug use
Immunosuppression

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22
Q

History of osteomyelitits

A

Fever
Pain and tenderness
Erythema
Swelling

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23
Q

Investigations in osteomyelitis

A

X-ray
MRI
Bloods - WCC, CRP, Cultures!
Bone cultures

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24
Q

Signs seen on xray in osteomyelitis

A

Periosteal reaction - changes to surface of the bone
Localised osteopenia - thinning
Destruction of bone

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25
Q

Management of osteomyelitis

A

Debridement
Abx - fluclox
Revision of prosthetics

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26
Q

Define sarcoma

A

Cancers originating in the muscles, bines or other connective tissue

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27
Q

History of sarcoma

A

Soft tissue lump
Painful
Large
Growing
Bone swelling
Persistent bone pain.

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28
Q

Investigations in sarcomas

A

X-ray
US
CT
Biopsy

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29
Q

Management of sarcoma

A

Surgery
Radio
Chemo
Palliative

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30
Q

Red flag causes of back pain

A

Spinal fracture - major trauma
Cauda equina - saddle, urinary, neurological signs
Spinal stenosis - intermittent neurogenic claudication
Ankylosing spondylitis - <40, insidious, morning stiff
Spinal infection - fever IVDU

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31
Q

Define cauda equina

A

Surgical emergency where the nerve roots of the cauda equina at the bottom of the spine are compressed.

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32
Q

What is the level of the cauda equina

A

L2/L£

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33
Q

What do the nerves of the cauda equina supply

A

Sensation - lower limbd, perineum, bladder and rectum
Motor - lower limbs, anal and urethral sphincters.
Parasympathetic to bladder and rectum.

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34
Q

Common causes of cauda equina syndrome

A

Herniated disc - most common
Tumours
Spondylolisthesis
Abscess
Trauma

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35
Q

Red flags for cauda equina syndrome

A

Saddle anaesthesia
Loss of sensation in bladder and rectum
Urinary retention/incontinence
Faecal incontinence
Bilateral sciatica
Bilateral motor weakness
Reduced anal tone

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36
Q

Management of cauda equina syndrome

A

MRI and surgery!
Lumbar decompression

37
Q

Management of metastatic spinal cord compression

A

High dose dexamethasone
Analgesia
Surgery
Radio/chemo

38
Q

Define spinal stenosis

A

Narrowing of part of the spinal cord resulting in spinal cord or nerve root compression

39
Q

Common causes of spinal stenosis

A

Congenital
Degenerative
Herniation
Thickening ligaments
Fractures
Spondylolisthesis
Tumours

40
Q

History of spinal stenosis

A

Gradual onset
Intermmittent neurogenic claudication
Lower back pain
Leg weakness
Symptoms occur on standing and walking
Bending forward improves symptoms

41
Q

Define radiculopathy

A

Compression of the nerve roots as the exit the spinal cord and spinal column, leading to motor and sensory symptoms

42
Q

Management of spinal stenosis

A

Exercise
Weight loss
Analgesia
Physio
Decompression surgery

43
Q

History of meniscal tear

A

During twisting movement
Pain swelling
Stiffness
Restricted range of movement
Locking or giving way of knee

44
Q

Clinical signs of meniscal tear

A

Localised tenderness
Welling
Restricted range of movement

45
Q

What are the Ottawa Knee Rules

A

Decide if need xray
>55 y/o
Patella tenderness
Fibula head tenderness
Cannot flex knee to 90 degrees
Cannot weigh bare

46
Q

Management of meniscal tears

A

RICE
NSAIDs
Physio
Arthroscopy

47
Q

Where does the ACL attach

A

Anterior intercondylar area on the tibia and lateral aspect of the intercondylar notch

48
Q

What is the purpose of ACL

A

Prevents the tibia from sliding forward

49
Q

Where does the PCL attach

A

Posterior intercondylar area on the tibia and the medial aspect of the intercondylar notch of the femur

50
Q

What is the purpose of the PCL

A

Prevents the tibia sliding backwards

51
Q

History of ACL injury

A

Twisting injury to knee - playing sports
Pain
Swelling
Pop sound or sensation
Instability in knee

52
Q

Clinical signs of ACL injury

A

Positive anterior draw test.

53
Q

Management of ACL injury

A

RICE
NSAIDs
Knee brace + crutches
Physio
Arthroscopic reconstruction

54
Q

Define bakers cyst

A

A fluid filled sac in the popliteal fossa - back of knee

55
Q

Common causes of bakers cysts

A

2dry to degenerative changes
Meniscal tears
Osteoarthritis
Knee injuries
Inflammatory arthritis

56
Q

History of bakers cysts

A

Pain
Fullness
Pressure
Lump/swelling
Restricted motion

57
Q

Management of bakers cysts

A

Modified activity
Analgesia
Physio
Ultrasound aspiration
Steroid injection
Arthroscopic treatment of cause

58
Q

Define Achilles tendinopathy

A

Damage swelling inflammation and reduced function of the achilles tendon

59
Q

Where is the Achilles tendon

A

Connects the gastrocnemius and soleus to the calcaneus

60
Q

Risk factors for Achilles tendonopathy

A

Sports
Inflammatory conditions
Diabetes
Raised cholesterol
Fluroquinolones

61
Q

Management of Achilles tendonopathy

A

RICE
Analgesia
Physio
Orthotics
Extracorporeal shock wave therapy
Surgery to remove nodules and adhesions

62
Q

Signs of Achilles tendon rupture on examination

A

When relaxed ankle will rest in more dorsiflexed position
Tenderness
Palpable gap
Weakness on plantar flexion
Unable to stand on tiptoes
Positive Simmonds’ calf squeeze - when squeezing calf there will be plantar flexion of the ankle. If no plantar flexion Achilles is ruptured

63
Q

Management of Achilles rupture

A

RICE
VTE prophylaxis
Boot
Surgical reattachment

64
Q

Define frozen shoulder

A

Adhesive capsulitis. Loss of range of motion and function in the shoulder. Inflammation and fibrosis in the joint capsule lead to adhesions

65
Q

History of frozen shoulder

A

Painful phase - often first symptoms
Stiff phase - in both active and passive movement, most commonly affecting external rotation
Thawing phase - gradual improvement

66
Q

Management of frozen shoulders

A

Continue to use arm
Analgesia
Physio
Intra-articular steroid injection
Hydrodilation
Surgical manipulation or arthroscopy

67
Q

What are the muscle of the rotator cuff

A

SITS
Supraspinatus
Infraspinatus
Teres minor
Subscapularis

68
Q

Most common type of shoulder dislocation

A

Anterior!
Posterior dislocations associated with electric shocks and seizures

69
Q

Define epicodylitis

A

Inflammation of the epicondyles at the elbow at the point where tendons insert.

70
Q

What action is cased by the tendon in each epicondyl

A

Medial - flexes wrist
Lateral - extends wrist

71
Q

Define tennis elbow

A

Lateral epicondylitis pain on extension of the wrist

72
Q

Define golfers elbow

A

Medial epicondylitis - pain on flexion of the wrist

73
Q

Management of epicondylitits

A

RICE
Adapt activity
Analgesia
Physio
Elbow braces
Steroid injections
Platelet rich injections
Extracorporeal shockwave therapy

74
Q

Define De Quervain’s Tensosynovitis

A

Contition where there is swelling and inflammation of the tendon sheaths in the wrist - primarily affefting the tendons of abductor pollicic longus and extensor pollicis brevis.

75
Q

History of De Quarvains Tensosynovitis

A

Pain - radiates to fore arm
Aching
Burning
Weakness
Numbness
Tenderness

76
Q

Clinical signs of De Quervain’s tensosynovitis

A

Finkelstin’s test - fist with tumb inside and adducting wrist.

77
Q

Define trigger finger

A

Condition causing pain and dificulty moving a dinger - stenosing tenosynovitis.
Thickening of the tendon or tightening of sheath

78
Q

History of trigger finger

A

Painful adn tender
Does not move smoothly
Gest stuck in flexed position
Makes popping or clicking sound

79
Q

Management of trigger finger

A

RICE
Splinting
Steroid injections
Surgery

80
Q

Define Dupuytren’s Contracture

A

Condition where the fascia of the hand becomes thickened and tight leading to contracutres - shortening of the soft tissue leading to restricted movement.

81
Q

Risk factors for Dupuytren’s Contracture

A

Age
FH
Male
Manual labour - vibrating tools
Diabetes
Epilepsy
Smoking
Alcohol

82
Q

Management of dupuytren’s contracture

A

Conservative or surgical
Needle fasciotomy
Limited fasciectomy
Dermofasciectomy

83
Q

Define carpal tunnel syndrome

A

Compression of the medial nerve as it travels through the carpal tunnel causing pain and numbness in the median nerve distribution

84
Q

What is the sensory innervation of the median nerve

A

Thumb
Index and middle finger
Lateral half of ring finger

85
Q

What is the motor function of the median nerve

A

Thenar muscles -
Abductor pollicis brevis
Opponens
Flexor pollicis brevis

86
Q

Risk factors for carpal tunnel syndrome

A

Repetitive strain
Obesity
Perimenopausal
Rheumatoid
Diabetes
Acromegaly
Hypothyroidism

87
Q

What are some special tests for capral tunnel syndrome

A

Phalen’s - full flexion and hold (backward prayer), Triggers sensory symptoms
Tinel’s test - tapping over carpal tunnel causes sensory symptoms

88
Q

Management of carpal tunnel syndrome

A

Rest
Wrist splints
Steroid injections
Surgery - removal or flexor retinaculum

Med Finals - Surgery (7 decks)

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