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Medicine > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

What is golfers elbow?

A

Over use injury causing pain over the medial epicondyle

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2
Q

What is tennis elbow?

A

Over use injury causing pain over the lateral epicondyle

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3
Q

What is Radial nerve palsy?

A

Compression of the radial nerve

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4
Q

What can be the cause of radial nerve palsy?

A

Mid shaft humeral fracture

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5
Q

Common symptoms of radial nerve palsy?

A

Loss of sensation in dermatomes and loss of function to muscles in wrist, hand and fingers

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6
Q

What is gout?

A

Hyperuricemia due to deposits of monosodium urate crystals in the joint space

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7
Q

How does gout present?

A

Sudden severe attack of pain (normally found in the 1st metatarsal joint) , hot, tender, red and swollen

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8
Q

What in the history makes gout more likely?

A

Previous gout and high alcohol intake

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9
Q

What is pseudo-gout?

A

Calcium pyrophosphate crystals in and around the joint

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10
Q

What is the first line treatment for acute gout? (2 drugs dependent on patient)

A

NSAIDs (not aspirin) - and give a PPI alongside for gastric protection. Or oral colchicine.

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11
Q

Common osteoarthritis presentation?

A

Worsening pain on activity and over the course of the day. Stiffness after inactivity that is quickly relieved. Joint instability and loss of function.

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12
Q

What is the first line treatment for preventing/chronic gout?

A

Allopurinol

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13
Q

What is osteopetrosis?

A

Marble bone disease - due to defect of the osteoclasts. Increased bone density. Rare inherited disease.

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14
Q

What is a positive anterior drawer sign of the knee indicative of?

A

Anterior cruciate ligament rupture

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15
Q

What are the 4 changes which may be seen on a X-ray of a osteoarthritic joint?

A

Joint space narrowing (must be weight bearing), subchondral sclerosis, subchondral cysts, osteophytes.

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16
Q

What are the treatment options for osteoarthritis?

A 
Offload joint
Analgesia - WHO ladder, steroid injections, nerve block 
physio 
orthotics 
anti-depressants 
osteotomy - young patients to readjust the joint so it is on the healthy part 
Joint replacement - knee and hip only. 
Debridement 
Fusion
17
Q

What is the pathology of osteoarthritis?

A

Focal destruction of articular cartilage without inflammation.
Increased chondrocytes - excess cartilage - oedema - erosions - chondrocyte apoptosis - fistula and fibrilles - microfractures and cysts. Tries to repair itself = osteophytes and possible excess bone growth.

18
Q

What is avascular necrosis?

A

Death of bone tissue due to reduced blood supply

19
Q

What are the risks of avascular necrosis?

A 
TISH-SI
Trauma 
Irradiation 
Sickle cell 
Haematological disease 
Dysbaric disease 
Alcoholism 
Steroids 
Hypercoagulable 
SLE 
Idiopathic
20
Q

What can be the cause of groin pain (+thigh and butt) with a limited range of movement?

A

Osteonecrosis of the femoral head

21
Q

What are the treatment options for osteonecrosis?

A

Early - bisphosphonates
Early surgery = joint preserving core decompression
Late surgery = replacement joint

22
Q

What is the gold standard investigation for avascular necrosis?

A

MRI

23
Q

What is Neuropraxia?

A

Reversible conduction block with no wallerian degeneration

24
Q

What is axonotmesis?

A

Reversible conduction block with wallerian degeneration. Axon and myelin sheath are disrupted but endoneurium is intact.

25
Q

What is neurotmesis?

A

Complete nerve division. Irreversible unless surgically repaired.

26
Q

What injury is related with the ulnar nerve?

A

Cubital tunnel syndrome

27
Q

What injury is related with the median nerve? What are the symptoms, investigations and treatment?

A 
Carpal tunnel syndrome 
- numb/tingling first 3.5 fingers 
Thenar muscle wasting 
Pain - worse at night, gradual and intermittent 
Loss of grip and sensation 
Decreased strength 
Dry skin 
Phalen's test, Tinels test, Durkans test 
EMG or nerve conduction 
Splint - analgesia - steroid injection
Open or endoscopic decompression
28
Q

In what fracture is radial nerve damage likely?

A

Humeral shaft fracture.

29
Q

Who is at risk of developing osteoporosis? (ACCESS)

A 
Alcohol 
Corticosteroids 
Calcium low 
Estrogen 
Smoking 
Sedentary
30
Q

What is the pathology behind osteoporosis?

A

Increased osteoclast resorption without increased osteoblast action. Increased porosity of bones = weaker.

31
Q

What are advanced signs of osteoporosis?

A

Kyphosis, Short stature, back pain

32
Q

What investigations would be completed to confirm osteoporosis?

A 
Bloods - calcium, phosphate, PTH, ALP = normal. vitamin D may be low. 
DEXA scan (gold standard) of femoral neck and spine- T score is SD compared with a normal 30 yr old.
33
Q

When would you treat osteoporosis?

A

Vertebral or hip fracture with low impact trauma
Other fracture with a T score of 1.5
T score of >2.5

34
Q

What are the 3 possible treatments for osteoporosis?

A

HRT - very effective but comes with lots of SE’s and not to be used long term.
Bisphosphonates - alendronic acid. Decrease osteoclast activity. S/E = osteonecrosis of the jaw or oesophagitis (sit up 2hrs after having)
Denosumab - RANKL monoclonal antibody. Check calcium and phosphate before starting. S/E =osteonecrosis of the jaw

35
Q

A child comes in limping what are the possible diagnosis?

A 
Septic arthritis 
Transient synovitis 
CHILD ABUSE (under 5s) 
SUFE (slipped capital femoral epiphysis) 
LCPD
36
Q

What makes a child more likely to get developmental dysplasia of the hip?

A

1-5
female
Family history
breech presentation

37
Q

What is Legg-calvé-Perthes Disease?

A

Avascular necrosis of the femoral epiphysis

38
Q

What increases the risk of developing SUFE (slipped capital femoral epiphysis)

A

10-15 yr olds
Male increased risk
Obesity
Overweight white girls or athletic black girls also.

39
Q

What is the difference between pes planus and pes cavus?

A

Pes planus = flat feet. Don’t have arches until 5 yrs old.

Pes cavus = high arch - normally due to neuromuscular cause

Medicine (26 decks)

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