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EOY3 > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

where do bone metastases arise from?

A

THE PUBLIK
Thyroid
H?
E oesophageal

Prostate (!)
Urinary bladder
Breast (!)
Lung (!)
Intestines
Kidneys

(!) indicated most common

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2
Q

features of a benign bone lesion

A

a geographic border (well demarcated)
narrow zone of transition
single layered periosteal reaction

e.g. non-ossifying fibroma (common in children and adolescents), osteochondroma (owergrowth near growth plate, common in ages 10-30) and endochondroma (ages 10-30)

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3
Q

features of malignant bone lesions

A

a poorly demarcated border
wide zone of transition
multi-layered periosteal reaction (types –> codman triangle, onion-peel, sunburst)
e.g. osteomyelitis, Ewing’s sarcoma (5-15 y/o), osteosarcoma (10-30 y/o - second commonest primary bone tumour) and multiple myeloma (>40 y/o - the commonest primary bone tumour - spine, skull, ribs and pelvis)

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4
Q

NOF O/E

A

abducted, externally rotated and shortened

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5
Q

NOF location and risk of AVN

A

displaced intracapsular # - high risk of AVN (total hip replacement/ hemi-arthroplasty)
undisplaced intracapsular # - moderate risk of AVN (pin)
intratrochanteric or subtrochanteric extracapsular # - low risk of AVN (dynamic hip screw)

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6
Q

mortality risk after a #NOF

A

10% in 1 month

33% in 1 year

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7
Q

what is Cauda Equina syndrome

A

compression of the nerves below the level of L1
can be due to malignancy, a slipped disc, vertebral #, trauma, infection

symptoms - bilateral sciatica pain, numbness around anus, painless urinary retention leading to overflow incontinence and bowel retention
must check sensation, muscle tone, muscle weakness and the rectal cough reflex

–> MRI to confirm and surgery within 48hrs

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8
Q

Salter-Harris classification of epiphyseal injuries

A

SALT CRUSH
1 - Straight across (sheer injury of growth plate)
2 - Above (above GP with metaphysis #)
3 - Lower (# of epiphysis
4 - Through (# through epiphyseal GP and metaphysis)
5 - CRUSH (crush injury to GP)

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9
Q

median nerve

A

sensory: lateral palm, thumb and lateral 2.5 fingers
motor: LOAF hand muscles
movement thumb abduction against resistance
injury: carpal tunnel
palsy: thenar eminence wasting, hand of benediction (can’t make a fist), weak thumb abduction (ape hand - can’t oppose)
tests: Tinel/Phalen +ve

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10
Q

ulnar nerve

A

sensory: medial hand and medial 1,5 fingers
motor: small muscle of the
movement: finger abduction against resistance
injury: elbow (Golfer’s elbow - medial)
palsy: hypothenar eminence and 1st web wasting, claw hand (can’t straighten), weak finger abduction
tests: +ve Froment’s sign

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11
Q

radial nerve

A

sensory: lateral dorsum of hand
motor: extensors - fingers, wrist and elbow
movement: wrist/ finger extension against resistance
injury: humeral shaft #
palsy: Saturday night palsy. wrist drop, weak inger and wrist extension

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12
Q

where in the finger does a Mallet finger deformity affect?

A

the DIP joint (bent forward)

can be due to an avulsion injury or due to the extensor tendon rupture

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13
Q

where in the finger does a Boutonniere deformity affect?

A

the PIP joint (will not straighten and the DIP is bent back)can be due to trauma or RA

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14
Q

causes of Carpal Tunnel syndrome?

A

MEDIAN TRAP

Myxoedema 
E - oedema premenstrual 
Diabetes
Idiopathic
Acromegaly 
Neoplasm

Trauma
RA
Amyloidosis
Pregnancy

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15
Q

Compartment Syndrome

A

> 20mmHg pressure is abnormal but >40mmHg is abnormal

6Ps
Pain (excessive for injury present)
Paraesthesia
Paresis (muscle weakness)
Poikilothermia (impaired temperature, very cold)
Pallor
Pulseless

–> emergency fasciotomy

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16
Q

what classification is used to classify open fractures?

A

the Gustilo and Anderson classification

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17
Q

how would you manage an open fracture?

A 
ABCDE
Ax, analgesia and tetanus booster
control bleeding - fluid/ blood replacement
assess soft tissue and NV status 
cover wound with sterile saline gauze
splint # and reassess NV status 
surgical debridement and stabilisation
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18
Q

Weber’s classification of distal fibular #s

A

A - below syndesmosis (usually stable - reduce and cast)
B - at level of syndesmosis (variable stability - may require open reduction and internal fixation ORIF)
C - above level of syndesmosis (unstable - ORIF required)

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19
Q

Osgood Schlatter’s disease

A

inflammation of the area just below the knee where the patellar tendon attaches to the tibia
most often occurs during growth spurts (10-14)
conservative treatment - ice, analgesics and NSAIDs

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20
Q

Perthes Disease

A 
rare childhood (4-10) condition of the hip causing AVN 
~15% of cases are bilateral

stages:
initial/ necrosis: limb and change of gait (several months)
fragmentation: woven bone replaces dead bone (1-2 years)
re-ossification: stronger bone develops
healed:

symptoms - limp/ change of gait, pain in hip/groin, muscle spasm, if untreated can lead to early onset arthritis

treatment –> observation and limited activity, NSAIDSs, physio, casting and bracing

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21
Q

septic arthritis

A

50% of cases are in the knee, the most common organism is Staph Aureus
bacterial seeding via bacteraemia, direct inoculation or contiguous spread
causes irreversible cartilage destruction

symptoms - pain, fever, erythema, effusion, warm and tender, inability to weight bear and unable to do PROM

extremity is FABER (flexed, abducted and externally rotated)

–> IV Ax. .operative irrigation and drainage

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22
Q

tendonopathies

A

disease of the tendon, pain on palpation and on movement

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23
Q

spinal stenosis

A

narrowing of the spinal canal or neural foramina producing root ischaemia and neurogenic claudication
DDx - cauda equina syndrome

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24
Q

osteoarthris

A

degenerative joint disorder, progressive loss of hyaline cartilage and new bone formation at the joint surface
risk factors: age, female, obesity and developmental dysplasia of the hip
–> analgesics, intracapsular injections and total hip replacement
main signs on X-ray (LOSS): loss of joint space, osteophytes, subchondral cysts and subchondral sclerosis

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25
Q

osteoporosis risk factors

A

Age + SHATTERED

Steroids
Hyper-para/thyroidism 
Alcohol and cigarettes
Thin (BMI <22)
Testosterone low
Early menopause
Renal/liver failure
Erosive/ inflammatory bone disease (RA, myeloma)
DM or dietary Ca low/ malabsorption

often presents with pathological fractures
–> bisphosphonates

26
Q

what organism is present after an animal bite?

A

Pasturella multocida

27
Q

how do you work out risk of shoulder re-dislocation?

A

100-age = %age chance that the shoulder will re-dislocate

28
Q

how much must a humeral fracture be angulated by before it is classified as ‘angulated’?

A

> 45 degrees

29
Q

which ligament is the most likely to damage in an ankle injury?

A

the anterior talo-fibula ligament

30
Q

vaRus

A

knees apart, lower leg Reaching towards each other

31
Q

vaLgus

A

knees together, lower legs Leaving each other

32
Q

which tendon is at risk of rupture during a Colles’ fracture?

A

the extensor pollicis longus

33
Q

prostate bone met characteristic

A

sclerotic

34
Q

kidney bone met characteristic

A

lytic

35
Q

tetanus

A

incubation period of 10 days
blocks NT release from spinal inhibitory neurones
causes muscle stiffness and spasm, dysphagia, breathing problems and suffocation

36
Q

complication of #s

A

early (compartment syndrome, NV compromise)
middle (DVT/PE, infection)
late (malunion, AVN)

37
Q

what sling should be used for a clavicle #

A

a broad arm sling

38
Q

what sling should be used for a mid humeral #

A

a collar and cuff

39
Q

joint fluid analysis

A

normal (clear, WCC <200, low neutrophils <25%)
non-inflammatory arthritis (clear/yellow, WCC <2000, low neutrophils <25%)
inflammatory arthritis (clear/cloudy yellow, WCC >2000, neutrophils <50%)
septic arthritis (opaque, WCC >50000, neutrophils >75%)

40
Q

gout vs psuedogout on microscopy

A 
gout = negatively birefringent needles
pseudogout = positively birefringent needles
41
Q

DEXA scan score interpretation

A

T score is the standard deviations against a average from a 20-something population
Z score is adjusted for the patient’s sex and age
t score -1.0 to -2.5 is osteopenia,

42
Q

Paget’s disease of the bone

A

a disease of increased but uncontrolled bone turnover, - primarily a disorder of osteoclasts with excessive osteoclast reabsorption followed by increased osteoblastic activity.
possibly triggered by paramyxovirus
only 1 in 20 are symptomatic
predisposing factors include increased age, male, northern latitude and family history
features bone pain, untreated fractures, increased ALP,
Rx: bisphosphonates, oral risedronate or If zoledronate
complications: deafness (due to CN entrapment), bone sarcoma, #s, skull thickening, high-output cardiac failure)

43
Q

osteomalacia and rickets

A

normal bony tissue but reduced mineral content - due to vitamin D deficiency
rickets (when growing - get knock-knees, bow legs and features of hypocalcaemia, x-ray: cupped ragged metaphysical surfaces), osteomalacia (bone pain, fractures, muscle tenderness and proximal myopathy, x-ray: translucent bands - looser’s zones/ pseudofractures)
Rx: calcium and vitamin D tablets

44
Q

osteogenesis imperfecta

A

brittle bone disease - disorder of (type 1) collagen metabolism resulting in bone fragility and fractures - autosomal dominant
mildest and most common form is type1
presents in childhood, may be mistaken for non-accidental injury, get blue sclera and deafness secondary to otosclerosis
Rx: IM rods in long bones, bisphosphonates may increase cortical thickness

45
Q

gangrene

A

death of tissue from poor vascular supply and is a sign of critical limb ischaemia - tissues are black and may slough

46
Q

dry gangrene

A

necrosis in the absence of infection
a line demarcates the living and dead tissue
Rx: restoration of blood supply +/- amputation

47
Q

wet gangrene

A

tissue death and infection (associated with discharge)

Rx: analgesia, broad-spectrum IV ABx, surgical debridement +/- amputation

48
Q

gas gangrene

A

subset of necrotising myositis caused by spore forming clostridial species often clostridium perfringens
rapid onset of myonecrosis, muscle swelling, gas production, sepsis and severe pain
risk factors include DM, trauma, and malignancy
Rx: amputation, benzylpenicillin +/- clindamycin, hyperbaric O2 can improve survival and reduce the number of debridement needed

49
Q

Back pain red flags

A 
age <20 or >50 
history of malignancy 
nocturnal pain 
history of trauma, steroids or HIV
systemically unwell
non-mechanical pain
thoracic pain
50
Q

spinal stenosis

A

usually gradual onset, unilateral or bilateral leg pain (may have back pain), numbness and weakness - worse on walking, relieved by sitting down
requires an MRI to confirm

51
Q

ankylosing spondylitis

A

typically a younger male patient who presents with lower back pain and stiffness - usually worse in the morning and improves with activity

52
Q

peripheral artery disease

A

claudication when walking, relieved by rest, absent or weak foot pulses and other signs of limb ischaemia
past history may include smoking and other vascular diseases/ risk factors

53
Q

osteomyelitis

A

a bacterial infection of the bone - may be spread haematogenously, traumatically or from a soft tissue infection
commonest is staph aureus (haemophilus influenzae in children and salmonella in HbS)
Rx: flucloxacillin for 6 weeks

54
Q

what is the unhappy triad/

A

lateral force to an extended knee

medical collateral ligament, anterior collateral ligament and medial meniscus damage

55
Q

Ottawa ankle rules

A

only need to X-ray if pain in malleolar zone and:

  • inability to weight bear for four steps
  • tenderness over distal tibia
  • bone tenderness over distal fibular

most likely to injure the anterior talo-fibular ligament

56
Q

Charcot Joint

A

aka neuropathic joint
the arch of the foot collapses due to damage secondary to sensory loss
typically swollen, red and warm but less painful than expected
due to DM, tabes doralis, leprosy, syringomyelia, cauda equina lesion

57
Q

adhesive capsulitis

A

aka frozen shoulder
painful on active and passive with reduced ROM, difficulty sleeping on affected side
pain with freezing > thawing > resolution (can take up to 2 years)
commonly the supraspinatus is torn

58
Q

tennis vs golfer’s elbow

A

Tennis is played on the Lawn (lateral epicondylitis)

Golf is played in the Meadow (medial epicondylitis)

59
Q

scoliosis vs kyphosis

A

scoliosis (lateral curvature)
kyphosis (exaggerated anterior curvature of thoracic spine)

both can cause restrictive lung disease (due to reduced expansion) and nerve/cord compression, and have psychological effects

60
Q

common nerve damage that causes foot drop

A

common fibular nerve damage

61
Q

developmental dysplasia of the hip

A 
risks (7F's) 
fetal factors e.g. multiple pregnancy 
floppy (hypotonia)
feet first (commoner in breech presentation)
first born
female
family history 
freezing (commoner in winter born babies)
62
Q

ASA classification for anaesthesia

A

ASA I = a normal healthy patient
ASA II = patient with mild systemic disease
ASA III = patient with severe systemic disease
ASA IV = patient with a severe systemic disease that is a constant threat to life
ASA V = moribund patient who is not expected to live without the operation
ASA VI = brain dead patient, operation is for organ harvesting

EOY3 (20 decks)

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