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Finals - Systems Paper > Orthopaedics/Rheumatology > Flashcards

Orthopaedics/Rheumatology Flashcards

1
Q

Compartment syndrome diagnose

A

Measure intracompartment pressure

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2
Q

Treatment compartment syndrome

A

Fasciotomy and aggressive IV fluid resus

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3
Q

Septic arthritis cause

A

Overall - staph aureus

Young sexually active - neisseria gonorrhoea

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4
Q

Septic arthritis diagnose

A

Synovial fluid sampling

Joint imaging

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5
Q

Septic arthritis treatment

A

Flucloxacillin

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6
Q

OA signs in hands

A 
Heberdens node (DIP joint)
Bouchard node (PIP joint)
Squaring base thumb
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7
Q

OA xray features

A

LOSS:

  • loss of joint space
  • osteophytes
  • subchondral sclerosis
  • subchondral cysts
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8
Q

OA treatment

A

1) Paracetamol and topical NSAID
2) NSAIC/opiods/corticosteroid injections
3) Joint replacement

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9
Q

Osteomyelitis cause

A

Overall - staph aureus

Sickle cell - salmonella

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10
Q

Osteomyelitis diagnosis

A

MRI scan

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11
Q

Osteomyelitis treatment

A

Surgical debridement and fluxlocacillin

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12
Q

Open fracture grading

A

Gustile and anderson:

1) <1cm
2) >1cm and moderate soft tissue damage
3) >1cm and extensive soft tissue damage

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13
Q

Open fracture treatment

A

ABCDE
Imaging
Cover with dressing
Early debridement

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14
Q

Common causes pathological fracture

A 
Prostate
Breast
Lung
Renal
Thyroid
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15
Q

Common location pathological fracture

A

Femur

Vertebral bodies

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16
Q

Treatment olecranon bursitis

A

RICE
Analgesia
Aspiration fluid
Antibiotics if infection

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17
Q

Identify osteosarcoma

A

Children/teens

Metaphyseal region long bones

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18
Q

Identify Ewing sarcoma

A

Children/teens
Pelvis and long bones
“onion skin”

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19
Q

Identify chrondosarcoma

A

Middle aged

Axial

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20
Q

Most common malignant bone tumour

A

Osteosarcoma

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21
Q

Most common benign bone tumour

A

Oseochrondroma

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22
Q

Treatment carpal tunnel

A

1) 6w conservative - wrist splint at night and joint injection
2) Flexor retiniculum division

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23
Q

Most common shoulder dislocation

A

Anterior

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24
Q

Identify anterior shoulder dislocation

A

External rotation and abduction

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25
Identify posterior shoulder dislocation
Electric shock/seizure | Light bulb sign
26
Treatment shoulder dislocation acute
Open/closed reduction Analgesia Sling for immobilisation
27
Identify de quervain tenosynovitis
Pain radial side wrist Pain over styloid process Positive finkelstein test
28
What is de quervains tenosynovitis
Inflammation of sheath containing extensor pollicis brevis and abductor pollicis
29
Commonly affected by dupuytrens contracture
Ring and little finger
30
Identify subluxation radial head
Elbow pain | Limited supination and extension elbow
31
Identify adhesive capsulitis (AKA frozen shoulder)
Associated diabetes Develops over few days: - external rotation affected most - active and passive movement affected Phases: - painful freezing phase then adhesive phase then recovery
32
Rotator cuff injuries - action each muscle
Supraspinatus (most common) - abduction Infraspinatus - external rotation Tere minor - external rotation and adduction Subscapularis - adduction
33
Identify rotator cuff injuries
Symptoms worse when shoulder in abduction | Painful arc
34
Identify trigger finger
Initial stiffness, snapping when extending | Palpable nodule
35
Features malignant soft tissue tumour
Size >5cm Pain Deep
36
Colles fracture
Fall onto outstretched hand Transverse fracture of distal radius - dorsally displaced distal fragment (dinner fork deformity)
37
Smiths fracture
Fall onto outstretched hand Transverse fracture of distal radius - volar displacement distal fragement (garden spade deformity)
38
Bartons fracture
Fall onto extended and pronated wrist Colles or smith with radiocarpal dislocation
39
Montagia fracture
Fall onto outstetched hand with forced pronation Ulna fracture with dislocation of proximal radioulna joint
40
Galleizi fracture
Fall onto outstretched hand with rotational force Radial shaft fracture with dislocated radioulnar joint
41
Bennets fracture
Fist fight Base on thumb metacarpal
42
Identify scaphoid fracture
Fall onto outstretched hand Pain along radial aspect wrist Pain pushing pulling thumb Tenderness anatomical snuffbox
43
Treatment scaphoid fracture
Immobilisation with futuro splint and refer Undisplaced - cast 6-8w Displaced or proximal - surgical fixation
44
Identify achilles tendinopathy
Posterior heal pain, gradual onset, worse with activity | Morning stiffness
45
Simmonds triad for achilles tendon rupture
>dorsiflexion of foot Gap in tendon Calf squeeze causes no movement
46
Diagnose achilles tendon rupture
US to diagnose
47
Identify lateral ankle ligament sprain
Inversion injury Pain and swelling over ligament Able to weight bear
48
Treatment lateral ankle ligament sprain
RICE | Maybe orthososis
49
Identify medial ankle ligament sprain
Eversion injury Weight bearing painful Hopkins squeeze test positive (pain when tibia and fibula pushed together)
50
Treatment medial ankle ligament sprain
No diastasis - non weight bearing orthostasis | Diastasis - Operative fixation
51
Most common injured knee ligament
Ruptured anterior cruciate
52
Identify anterior cruciate rupture
Sudden twisting or lateral blow | Sudden popping sound
53
Identify posterior cruciate rupture
Hyperextension injuries - dashboard
54
Investigation knee ligament rupture
MRI
55
Identify meniscal tear
Twisting injury Pain worse on straightening knee Tender over joint line
56
Identify chrondomalacia patellae
Teenage girls following injury | Pain on going downwards
57
Identify posterior and anterior hip dislocation
Posterior (most common) - shortenned, adducted and internally rotated Anterior - abducted and externally rotated, no shortening
58
Treatment hip dislocation
ABCDE Analgesia Reduction under GA Physiotherapy
59
Identify plantar fasciitis
Heel pain
60
Identify mortons neuroma
Forefoot pain - most common third intertarsalphalangeal space
61
Identify hallux valgus
Progressive foot deformity - subluxation 1st metatarsophalangeal joint Abduction first metatarsal, adduction phalanges
62
Leg in hip fracture
Shortened, abducted and externally rotated | Not able to weight bear
63
Diagnosis hip fracture
1) Xray - disrupted shellon line | 2) MRI - CT
64
Intracapsular hip fracture treatment
Undisplaced - internal fixation | Displaced - hip replacement
65
Extracapsular hip fracture treatment
Stable intertrochanteric - dynamic hip screw | Unstable/subtrochanteric - intramedullary nail
66
Classification hip fracture
Gardens: 1) Stable 2) Complete but undisplaced 3) Displaced but still bone contact 4) Complete bony disruption
67
Ankle facture classification
Webers: A) below ankle joint, syndesmosis in tact B) level ankle joint, syndesmosis in tact or partially disrupted C) above ankle joint, syndesmosis disrupted
68
Ottowa rules
For ankle xray: - pain malleolus region and one of - bony tenderness lateral or medial malleolus to 6cm superior - cannot walk >4 weight beared steps
69
Weber A treatment
CAM boot
70
Weber B treatment
Displaced - surgery | Stable - CAM boot
71
Weber C treatment
Surgery
72
Most common site stress fracture
2nd metatarsal
73
Most common metatarsal fracture
5th metatarsal - assocaied with lateral ankle sprain
74
Cauda equina diagnosis
MRI
75
Identify lumbar spinal stenosis
Back pain relieved by sitting/learning forwards
76
Diagnose lumbar spinal stenosis
MRI
77
Treatment lumbar spinal stensosis
Laminectomy
78
Identify Erb palsy
C5/6 damage Winged scapula Waiter tip
79
Identify klumpkes palsy
T1 damage | Loss intrinsic hand muscles
80
Diagnose iliopsoas abscess
CT abdomen
81
Froments sign of
Ulner nerve palsy
82
Identify osteochondritis dissecans
Usually children/young adults Knee pain and swelling typically after exercise Knee locking
83
Mechanism axillary nerve damage
Humeral neck fracture/dislocation
84
Radial nerve damage mechanism
Humeral midshaft fracture
85
Ulner nerve damage mechanism
Medial epicondyle fracture
86
Toddlers fracture
Oblique tibial in infants
87
Plastic deformity
Stress on bone causing deformity without cortical disruption
88
Greenstick fracture
Unilateral cortical breech
89
Buckle fracture
Incomplete cortical disruption
90
Identify talipes equinovarus
AKA clubfoot - inverted and plantar flexed foot
91
Treatment clubfoot
Manipulation and progressive casting from birth
92
Action and mechanism injury femoral nerve
Action - knee extension and hip flexion | Mechanism - hip fracture
93
Action and mechanism injury obturator nerve
Action - thigh adduction | Mechanism - anterior hip dislocation
94
Action and mechanism injury common peroneal nerve
Action - foot dorsiflexion and eversion | Mechanism - injury neck fibul
95
Action and mechanism injury tibial nerve
Action - plantarflexion and inversion | Mechanism - posterior knee dislocation
96
Action and mechanism superior gluteal nerve injury
Action - hip abduction | Mechanism - Pelvic fracture
97
Deposition in gout
Monosodium urate
98
Diagnosis gout
Synovial fluid - needle shaped negative monosodium urate crystals
99
Treatment acute gout
1) NSAID or colchine | 2) Prednisolone
100
Prophylaxis gout
Allopurinol - add NSAID/colchine for first 6m
101
Pseudogout deposition
Calcium pyrophosphate crystals
102
Diagnosis pseudogout
Joint aspiration - weakly positive rhomboid crystals | Xray - chondrocalcinosis
103
Seronegative arthritis gene
HLA B27
104
Systemic features ankylosing spondylitis
The As: - anterior uveritis - apical fibrosis - aortic regurgitation - achilles tendonitis - AV node block
105
Diagnosis ankylosing spondylitis
1) xray | 2) MRI
106
Xray features ankylosing spondylitis
Squaring lumbar vertebra Sacroiliatis Syndesmophytes
107
Treatment ankylosing spondylitis
1) NSAID, regular exercise and physio 2) Different NSAID 3) Anti-TNF therapy
108
Identify psoriatic arthritis
Onycholysis (seperation nail from bed) Dactylitis (inflammation full finger) Nail pitting Plaque psoriasis
109
Xray features psoriatic arthritis
"Pencil in cup" | Osteolysis
110
Treatment psoratic arthritis
Similar RA
111
Treatment reactive arthritis
1) NSAID 2) Joint injection 3) Sulfasalazine and methotrexate
112
RA genes
HLA DR4 | HLA DR1
113
Antibodies RA
``` Cyclic citrullinated peptide (anti-CCP) - most sensitive and specific Rheumatoid factor (RF) ```
114
Identify RA
Never affects DIP | Symetrical
115
RA signs in hands
``` Z shaped deformity Ulnar deviation MCP (knuckle) Swan neck ( extension PIP, flexed DIP) and boutenniers deformity (flexed PIP, extended DIP) late ```
116
Diagnosis RA
Clinical but: - RF if CCP negative - xray - joint aspiration - inflammatory markers
117
RA xray changes
Early: - juxtraarticular osteoporosis Late: - periarticular erosion - subluxation
118
RA check response to treatment
DAS28 score | HAQ
119
Treatment flares RA
Corticosteroids
120
Treatment long term RA
DMARDs: 1) Methotrexate, leftunonide or sulfasalazine 2) 2 in combination 3) Methotrexate + biologic therapy (usually TNF) 4) Plus rituximab
121
Identify felty syndrome
RA + splenomegaly + decreased WCC
122
Cancer linked to Sjorens
Lymphoid malignancy
123
Antibodies Sjorens
anti-Ro/anti-La | RF/ANA
124
Treatment Sjorens
Artificial tears | Pilocarpine - saliva production
125
SLE antibody
Anti-nuclear most sensitive but not specific | Anti-dsDNA most specific
126
Monitoring SLE
ESR used, CRP may be normal | Complement C3,C4
127
Treatment acute flare SLE
1) NSAID | 2) Consider prednisolone/cyclophosphamide if internal organ involvement
128
Treatment long term SLE
Hydroxychloroquine
129
Identify polymyositis
Symetrical proximal weakness Raynauds Lung disease
130
Identify dermatomyositis
Polymyositis + gottron lesions and skin involvement
131
Identify CREST syndrome
Oesophageal problems and sclerosis features - Limited systemic sclerosis ``` Calcinosis Raynaud’s Oesophageal dysmotility Sclerodactyly Telangiectasia ```
132
Antibodies systemic sclerosis
Diffuse - anti-scl-70 | Limited - anti-centromere
133
Identify polymyalgia rheumatica from investigation
Diagnosis of exclusion | CK normal, ESR raised
134
Treatment polymyalgia rheumatica
Prednisolone - if no effect consider other diagnosis
135
Treatment fibromyalgia
CBT and neuropathic analgesia
136
Osteomalacia bloods
Decreased vit D Decreased calcium Decreased phosphate Increased ALP
137
Pagets blood
isolated rise ALP
138
Pagets most common bones
Skull Spine/pelvis Long bones
139
Treatment pagets
Bisphosphonates
140
Treatment osteoporosis
1) Bisphosphonates 2) Denosumab, strantium randate, raloxifene, HRT Everyone lifestyle, vit D and calcium
141
Antiphospholipid syndrome bloods
Thrombocytopenia | Prolonged APTT
142
Treatment antiphospholipid syndrome
Primary - low dose aspirin | Secondary - warfarin
143
Osteopetrosis bone profile
All normal
144
CKD bone profile
Ca decreased PTH increased Phosphate increased ALP increased
145
Primary hyperparathyroidism bone profile
Ca increased PTH increased ALP increased PTH increased
146
Time to diagnose chronic fatigue syndrome
4m
147
Ig to pass to foetal circulation
IgG
148
First Ig to be made in response
IgM
149
Predominent Ig in breast milk
IgA
150
Identify osteogenesis imperfecta
Childhood Following trauma, blue sclera Bone profile normal AKA brittle bone disease

Finals - Systems Paper (20 decks)

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