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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
Management of osteomyelitis
Debridement Abx - fluclox Revision of prosthetics
26
Define sarcoma
Cancers originating in the muscles, bines or other connective tissue
27
History of sarcoma
Soft tissue lump Painful Large Growing Bone swelling Persistent bone pain.
28
Investigations in sarcomas
X-ray US CT Biopsy
29
Management of sarcoma
Surgery Radio Chemo Palliative
30
Red flag causes of back pain
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
31
Define cauda equina
Surgical emergency where the nerve roots of the cauda equina at the bottom of the spine are compressed.
32
What is the level of the cauda equina
L2/L£
33
What do the nerves of the cauda equina supply
Sensation - lower limbd, perineum, bladder and rectum Motor - lower limbs, anal and urethral sphincters. Parasympathetic to bladder and rectum.
34
Common causes of cauda equina syndrome
Herniated disc - most common Tumours Spondylolisthesis Abscess Trauma
35
Red flags for cauda equina syndrome
Saddle anaesthesia Loss of sensation in bladder and rectum Urinary retention/incontinence Faecal incontinence Bilateral sciatica Bilateral motor weakness Reduced anal tone
36
Management of cauda equina syndrome
MRI and surgery! Lumbar decompression
37
Management of metastatic spinal cord compression
High dose dexamethasone Analgesia Surgery Radio/chemo
38
Define spinal stenosis
Narrowing of part of the spinal cord resulting in spinal cord or nerve root compression
39
Common causes of spinal stenosis
Congenital Degenerative Herniation Thickening ligaments Fractures Spondylolisthesis Tumours
40
History of spinal stenosis
Gradual onset Intermmittent neurogenic claudication Lower back pain Leg weakness Symptoms occur on standing and walking Bending forward improves symptoms
41
Define radiculopathy
Compression of the nerve roots as the exit the spinal cord and spinal column, leading to motor and sensory symptoms
42
Management of spinal stenosis
Exercise Weight loss Analgesia Physio Decompression surgery
43
History of meniscal tear
During twisting movement Pain swelling Stiffness Restricted range of movement Locking or giving way of knee
44
Clinical signs of meniscal tear
Localised tenderness Welling Restricted range of movement
45
What are the Ottawa Knee Rules
Decide if need xray >55 y/o Patella tenderness Fibula head tenderness Cannot flex knee to 90 degrees Cannot weigh bare
46
Management of meniscal tears
RICE NSAIDs Physio Arthroscopy
47
Where does the ACL attach
Anterior intercondylar area on the tibia and lateral aspect of the intercondylar notch
48
What is the purpose of ACL
Prevents the tibia from sliding forward
49
Where does the PCL attach
Posterior intercondylar area on the tibia and the medial aspect of the intercondylar notch of the femur
50
What is the purpose of the PCL
Prevents the tibia sliding backwards
51
History of ACL injury
Twisting injury to knee - playing sports Pain Swelling Pop sound or sensation Instability in knee
52
Clinical signs of ACL injury
Positive anterior draw test.
53
Management of ACL injury
RICE NSAIDs Knee brace + crutches Physio Arthroscopic reconstruction
54
Define bakers cyst
A fluid filled sac in the popliteal fossa - back of knee
55
Common causes of bakers cysts
2dry to degenerative changes Meniscal tears Osteoarthritis Knee injuries Inflammatory arthritis
56
History of bakers cysts
Pain Fullness Pressure Lump/swelling Restricted motion
57
Management of bakers cysts
Modified activity Analgesia Physio Ultrasound aspiration Steroid injection Arthroscopic treatment of cause
58
Define Achilles tendinopathy
Damage swelling inflammation and reduced function of the achilles tendon
59
Where is the Achilles tendon
Connects the gastrocnemius and soleus to the calcaneus
60
Risk factors for Achilles tendonopathy
Sports Inflammatory conditions Diabetes Raised cholesterol Fluroquinolones
61
Management of Achilles tendonopathy
RICE Analgesia Physio Orthotics Extracorporeal shock wave therapy Surgery to remove nodules and adhesions
62
Signs of Achilles tendon rupture on examination
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
Management of Achilles rupture
RICE VTE prophylaxis Boot Surgical reattachment
64
Define frozen shoulder
Adhesive capsulitis. Loss of range of motion and function in the shoulder. Inflammation and fibrosis in the joint capsule lead to adhesions
65
History of frozen shoulder
Painful phase - often first symptoms Stiff phase - in both active and passive movement, most commonly affecting external rotation Thawing phase - gradual improvement
66
Management of frozen shoulders
Continue to use arm Analgesia Physio Intra-articular steroid injection Hydrodilation Surgical manipulation or arthroscopy
67
What are the muscle of the rotator cuff
SITS Supraspinatus Infraspinatus Teres minor Subscapularis
68
Most common type of shoulder dislocation
Anterior! Posterior dislocations associated with electric shocks and seizures
69
Define epicodylitis
Inflammation of the epicondyles at the elbow at the point where tendons insert.
70
What action is cased by the tendon in each epicondyl
Medial - flexes wrist Lateral - extends wrist
71
Define tennis elbow
Lateral epicondylitis pain on extension of the wrist
72
Define golfers elbow
Medial epicondylitis - pain on flexion of the wrist
73
Management of epicondylitits
RICE Adapt activity Analgesia Physio Elbow braces Steroid injections Platelet rich injections Extracorporeal shockwave therapy
74
Define De Quervain's Tensosynovitis
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
History of De Quarvains Tensosynovitis
Pain - radiates to fore arm Aching Burning Weakness Numbness Tenderness
76
Clinical signs of De Quervain's tensosynovitis
Finkelstin's test - fist with tumb inside and adducting wrist.
77
Define trigger finger
Condition causing pain and dificulty moving a dinger - stenosing tenosynovitis. Thickening of the tendon or tightening of sheath
78
History of trigger finger
Painful adn tender Does not move smoothly Gest stuck in flexed position Makes popping or clicking sound
79
Management of trigger finger
RICE Splinting Steroid injections Surgery
80
Define Dupuytren's Contracture
Condition where the fascia of the hand becomes thickened and tight leading to contracutres - shortening of the soft tissue leading to restricted movement.
81
Risk factors for Dupuytren's Contracture
Age FH Male Manual labour - vibrating tools Diabetes Epilepsy Smoking Alcohol
82
Management of dupuytren's contracture
Conservative or surgical Needle fasciotomy Limited fasciectomy Dermofasciectomy
83
Define carpal tunnel syndrome
Compression of the medial nerve as it travels through the carpal tunnel causing pain and numbness in the median nerve distribution
84
What is the sensory innervation of the median nerve
Thumb Index and middle finger Lateral half of ring finger
85
What is the motor function of the median nerve
Thenar muscles - Abductor pollicis brevis Opponens Flexor pollicis brevis
86
Risk factors for carpal tunnel syndrome
Repetitive strain Obesity Perimenopausal Rheumatoid Diabetes Acromegaly Hypothyroidism
87
What are some special tests for capral tunnel syndrome
Phalen's - full flexion and hold (backward prayer), Triggers sensory symptoms Tinel's test - tapping over carpal tunnel causes sensory symptoms
88
Management of carpal tunnel syndrome
Rest Wrist splints Steroid injections Surgery - removal or flexor retinaculum

Med Finals - Surgery (7 decks)

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