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Specialities > Orthopaedics 2 > Flashcards

Orthopaedics 2 Flashcards

1
Q

How long after a hip fracture should surgery take place?

A

<36 hours

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2
Q

What measures and drug is used to stop life threatening bleeding in someone with a high INR?

A

Stop warfarin

Vitamin K

Prothrombin complex concentrate
or
FFP if PCC not available

*this is usually indicated in patients with INR >8

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3
Q

If someone presents with a hip fracture, what important thing should be done if they are on warfarin?

A

It should be withheld and vitamin K started

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4
Q

What is the most common cause if a locked knee?

A

Meniscal tear

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5
Q

What test is conducted for an ACL tear? and for a PCL?

A

Lachman’s test - ACL: femur over the tibia

Anterior drawer test - PCL: Tibia over femur

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6
Q

What will be a defining features seen on an x-ray of a knee following a tibial plateau fracture?

A

lipohaemoarthrosis

  • fat and blood from bone marrow in the joint. Highly indicative of a tibial plateau fracture or distal femur fracture.
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7
Q

Following an injury to the knee which began to swell and was extremely painful - what things do you want to ask?

A

Position of knee at injury and rotation it moved

Was foot planted

How quickly did the swelling appear

ROM, is there a mechanical block

Pain, any specific site

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8
Q

In the setting of a knee injury which is acutely painful and unable to move due to swelling, - what procedure can be done in the clinical to improve this? Also outwith a fracture what is blood in the joint a very strong suggestive factor for?

A

Knee joint aspiration

  • allows for movement
  • reduces pain

hemarthrosis out with a fracture is very suggestive of an ACL

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9
Q

Name two significant differences in the radiological appearance of a patella tendon rupture and quadricep tendon rupture:

A

Patella tendon: Patella Alta
- proximal high patella

Quadriceps tendon: Patella Baja
- Low riding patella due to unopposed pull

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10
Q

What is the best imaging modality for assessing intra-articular fractures?

A

CT

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11
Q

What is the definition of a fracture:

A

Loss of continuity of the cortex bone

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12
Q

How should neurological damage in spinal damage be documented?

A

ASIA chart

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13
Q

What are you checking for when logrolling someone?

A

Tenderness

Boggyness

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14
Q

If you are unable to attain a CT scan for the cervical neck, what x-rays should you request?

A

AP
Lateral
Peg view

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15
Q

What muscle does the palmer aponeurosis come off?

A

Palmaris longus

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16
Q

What muscle tendons join into the PIPJs and which to the DIPJs?

A

PIPJs - flexor digitorum superficialis

DIPJs - flexor digitorum profundus

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17
Q

What structures are found within the carpel tunnel?

A

Tendons of:

  • flexor digitorum profundus
  • Flexor digitorum superfiscialias

Tendon of:
- Flexor pollocis longus

Median nerve

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18
Q

What is the anatomical line used to guide incisions on the hand to avoid the blood supply?

A

Kaplan’s cardial line

- should incise proximal to it

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19
Q

Which muscle tendons make up the De Quervains?

A

Abductor pollocis longus

Extensor policis brevis

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20
Q

The radial nerve branches to become what nerve, and what muscle is not supplied by this?

A

Posterior interosseous nerve

  • Extensor carpi radials is not supplied by the PIN. it is supplied directly of the radius nerve.
  • Brachioradiulus is also supplied by the PIN
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21
Q

What muscle does the ulnar nerve pass through at the cubital fossa? and what motor branches does it through off in the forearm?

A

Flexor carpi ulnaris

throws off branches to the flexor digitorum profundus for the digits 4 and 5.

22
Q

What muscles in the hand does ulnar supply?

A

Hypothenar muscles
Lumbricals 4&5
Adductor pollicis
Interossie Muscles - via the deep branch

23
Q

What must you think if there is excessive pain on passive stretching following a fracture? and what area is most associated with this?

A

Compartment syndrome

Supracondylar fractures

24
Q

What is the imaging modality most utilised to diagnose a Achilles tendon rupture? What is the diagnostic test done?

A

Ultrasound initially used

MRI is used for further investigation into partial tendon rupture

Diagnostic test:
- Simmonds’s triad

25
Q

Which mononeuropathy are steroid injections not recommended for?

A

Cubital tunnel syndrome

26
Q

What are the top differentials for a prolonged painful shoulder in a 50 year old male?

A 
OA of the glenohumoural joint 
OA of the AC joint 
Impingement syndrome 
Adhesive capsulitis
Rotator cuff injury 
Referred pain from neck
27
Q

What are the symptoms of impingement syndrome?

A

Pain associated with overhead activity
Pain perceived on the lateral aspect of the shoulder
Pain at night when lying on the shoulder

28
Q

What are the key symptoms of adhesive capsulitis?

A

Pain and stiffness in all active and passive movements but especially true for external rotation and to a lesser degree internal rotation

History of:

  • trauma
  • diabetes
29
Q

What are the main diagnostic tests for impingement syndrome?

A

Neer’s test
- pain on passive forward flexion within an arc of 60-120 degrees whilst arm is pronated

Painful arc
- pain on passive abduction from 60-120 degrees

Empty can test

30
Q

What would weakness supraspinatus suggest? and what investigations would you consider to diagnosis this?

A

tear or damage to the tendon of it

Ultrasound can usually identify a tear but not much more.
MRI is more sensitive and gives more details around other structures
- MRI is therefore usually the preferred choice

31
Q

How is degeneration of the supraspinatus muscle treated?

A

Conservative:

  • Physiotherapy
  • Steroid injections into the subacromial space

Surgical:
- arthroscopic subacromial decompression

32
Q

What is the best management for a Weber A ankle fracture?

A

CAM boot

33
Q

What are the complicating issues and lesions that can occur complicating an anterior dislocation of the shoulder?

A

Bankart lesion
- damage to the anterior labrum

Hill Sach’s defect
- a posterior-lateral fracture to the humeral head as it passes over the anterior labarum following an anterior dislocation

Axillary nerve damage

34
Q

What sign may be seen posteriorly in supraspinatus injury?

A

Early scapular rotation

35
Q

What are the stages of adhesive capsulitis and what investigations must you do into it? How is it going to be managed?

A
  1. painful and freezing stage (1 year)
  2. freezing stage but no pain
  3. thawing phase (1-3years)

MRI - if clinically unsure
HbA1c
TFTs

  • very important to do blood glucose and TFTs as its highly associated with the syndrome
  • both hyper and hypothyroidism are risk factors

Management:

  • NSAIDs
  • physiotherapy
  • Corticosteroid injection
  • <6 week course of steroids

Surgical:
- Arthroscopic arthrolysis (loosening of adhesions)

**reassurance of the phases

36
Q

What does SLAP tear stand for, what is the diagnostic examination and how is it treated?

A

Superior Labrum tear from Anterior to Posterior

Examination:
- O’Briens test

Management:

  • NSAIDs
  • Physiotherapy
  • Surgical repair
37
Q

Other than the tendons of the flexor palmar superfiscialis and profundus what other tendon is present in the carpal tunnel? and what structure is near by but not in it?

A

Flexor Pollicis Longus

Flexor capri radials is near by but not part of the tunnel.

38
Q

Define the different types of neuronal injuries which can occur:

A

Neurapraxia:

  • Transient loss of conduction due to damage to the membrane
  • Demyelination

Axonotmesis:

  • Damage to axon with preservation to the endoneurium and perineurium
  • Distal end undergoes Wallerian degeneration.
  • recovery is possible

Neurotmesis:

  • Complete transection through the axon with no sparing of endoneurium or perineurium
  • recovery not possible without surgical intervention
39
Q

What are three associated conditions of subacromial impingement and what clinical examinations can be done to diagnose subacromial impingement?
if you an order an x-ray what are you looking for?

A

Hooked shaped acromion

Glenohumoral instability

Greater tuberosity fracture - malunion

Examination:

  • Painful arc test
  • Neer’s test
  • Hawkins test

X-ray:

  • Type 3 hook
  • ACJ osteoarthritis
  • Sclerosis/ cystic changes to greater tuberosity
40
Q

What are the surgical options for subacromial decompression?

A

Arthroscopic subacromial decompression

Acromioplasty

41
Q

What are the risk factors for rotator cuff tear?

A

Age (grey hair = rotator cuff tear)

Hyperthyroidism

Hypercholesterolemia

Smoking

42
Q

What are the maternal complications and fetal complications of multiple pregnancy (not including the specific twin complications)?

A

Maternal complications:

  • Hyperemesis gravida
  • Anaemia
  • Pre-eclampsia
  • Antepartum haemorrhage
  • C-section (breech presentation)

Fetal:

  • Chromosomal abnormalities
  • Structural abnormalities (only in monozygotic)
  • Premature birth (most go into labour 37 weeks)
  • Fetal growth restriction
43
Q

What is the management for multiple pregnancies?

A

Supervision under MDT

  • specialist obstetrician
  • Midwife

*early establishment of chronicity

Regular visits (every 2 weeks for monochorionic twins after 16 weeks)
(every 4 weeks for dichorionic from 16 weeks)
- mother monitored for complications

  • Planned delivery (37 weeks dichorionic, 36 for mono chorionic)
44
Q

What is the major complication of induction of labour and how is this managed?

A

Uterine hyperstimulation

  • removal of PGE2 if possible
  • Tocolytics to stop/ slow down uterine contraction
45
Q

What is the intra-vaginal pessary used for induction of pregnancy?

A

Prostin - PGE2

46
Q

Typically when is a spinal used in obstetrics, and where is this injected? when else may it be used? and where should it not be injected above?

A

C- section

Into the subarachnoid space

also used when:

  • repairing 3rd/ 4th degree tears
  • instrumental deliveries
  • management complications of PPH

**should not be injected above T4 as this can cause bradycardia which on top of hypotension side effects can be dangerous

47
Q

What peripheral nerve can be blocked during labour and how is it accessed?

A

Pudendal nerve

accessed via he sacrospinal ligament

48
Q

What angle are episiotomies done at? and when are they indicated?

A

Right (sometimes left) posteriolateral angle

Indication:

  • Rigid perineum preventing birth
  • If large tear is likely
  • instrumental delivery
  • Fetal compromise
  • shoulder dystocia
49
Q

When is the fetal head said to be engaged during labour?

A

When less then 2/5ths of the head is palpable abdominally

50
Q

Engagement can be measured by the depth of the fetal head to what structure and what may artificially make you think the baby is more engaged that what it is?

A

ischial spines

Caput succedaneum can make falsely make the baby is more engaged than what they are

51
Q

What colour of meconium during labour is worrying, what does it suggest?

A

Pea soup colour

- suggests fetal distress

52
Q

What are some side effects of epidurals?

A

Puncture of CSF causing spinal headaches

Hypotension

Urinary retention

Respiratory depression

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