orthopedics Flashcards

1
Q

golfers vs tennis elbow

A

golfers (medial epicondyle)

tennis (lateral epicondyle)

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2
Q

Fever/back pain with pain on extension of the hip

A

iliopsoas abscess

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3
Q

what is the FRAX score?

A

FRAX estimates the 10-year risk of fragility fracture for 40-90year olds based on various risk factors such as age, sex, weight etc and bone mineral density measurements
FRAX score >10% needs a DEXA scan

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4
Q

scores for fracture risk

A

FRAX or QFracture

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5
Q

knee pain and swelling after exercise, locking and ‘clunking’

A

Osteochondritis dissicans

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6
Q

shortened and externally rotated leg

A

hip fracture

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7
Q

open fracture management

A

After primary wound debridement of an open fracture with or without temporary fixation (e.g. external fixation), a secondary inspection and debridement after 24-48 hours is warranted before definitive surgical fixation.

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8
Q

causes of fracture

A

trauma (Excessive force applied to healthy bone)
stress (repetitive low velocity injury)
pathological (minimal force to abnormal bone)

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9
Q

open fractures classification

A

Gustilo and Anderson classification

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10
Q

falls on outstretched hands cause fractures where?

A
scaphoid
colles fracture (distal radius)
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11
Q

risk factors for Baker’s cysts

A

arthritis or gout and following a minor trauma to the knee

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12
Q

what is Foucher’s sign?

A

the increase in tension of the Baker’s cyst on extension of the knee. the cyst becomes hard as the pressure changes

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13
Q

Mx non-specific lower back pain

A
  1. NSAIDS eg Ibuprofen (paracetamol is ineffective!)
  2. proton pump inhibitors should be co-prescribed for patients over the age of 45 years who are given NSAIDs!!!
  3. physio, rest etc
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14
Q

Pencil in cup appearance X ray

A

psoriatic arthritis

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15
Q

X ray changes osteoarthritis

A

Loss of joint space (narrowing),
osteophytes,
Subchondrol sclerosis
Subchondrol cysts

DIPs, base of thumb, glenohumeral shoulder

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16
Q

X ray changes RA

A

soft tissue swelling
joint effusions
bony erosions
secondary osteoarthritis

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17
Q

light bulb sign x ray

A

posterior shoulder dislocation

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18
Q

nerve roots affected most commonly affected areas for cauda equina syndrome

A

L4, L5, S1

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19
Q

what is the most common cause is septic emboli/ septicaemia from Staphylococcus aureus?

A

endocarditis

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20
Q

investigations for discitis

A

MRI - gold standard diagnosis
CT guided biopsy - to target treatment
echocardiogram - look for source (endocarditis)

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21
Q

Mx scaphoid fracture

A

undisplaced fractures of the scaphoid waist
cast for 6-8 weeks — union is achieved in > 95%

displaced scaphoid waist fractures: requires surgical fixation

proximal scaphoid pole fractures: require surgical fixation

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22
Q

what is charcot joint?

A

aka. neuropathic joint
weight bearing joint which has become badly disrupted and damaged (midfoot remodelling) secondary to a loss of sensation (repeated damage to foot)

causes: ***diabetes, alcohol, syphillis, leprosy, spinal cord injury
signs: months of swollen, red, warm joint (not as painful to patient because of sensory damage)

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23
Q

complications of discitis

A

sepsis, epidural abscess

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24
Q

definitive management of compartment syndrome

A

fasciotomy.

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25
Q

Twisting sporting injuries followed by delayed onset of knee swelling. diagnosis?

A

meniscal tear

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26
Q

high twisting force is applied to a flexed knee. Rapid joint swelling

A

Anterior cruciate ligament rupture

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27
Q

classification of tibial plateau fractures? how many levels are there?

A

Schatzker

6

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28
Q

azathioprine + allopurinol interaction

A

bone marrow suppression
azathioprine is metabolised into mercaptopurine which inhibits purine synthesis
allopurinol inhibits xanthine oxidase which normally inactivates mercaptopurine
so with allopurinol, higher levels of mercaptopurine which incorporates into DNA and causes pancytopenia

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29
Q

before starting azathioprine

A

thiopurine methyltransferase (TPMT) for individuals prone to azathioprine toxicity

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30
Q

sjogrens antibodies

A

anti-Ro, anti-La

31
Q

Leriche syndrome

A

claudication of buttocks and thicks
atrophy of the musculature of the legs
impotence

due to atherosclerotic disease of the abdominal aorta and iliac arteries

32
Q

what nerve at risk in shoulder dislocation/ fracture

A

axillary nerve

33
Q

patient fell off roof and held onto gutter for a few seconds. which nerve is damaged?

A

Klumpke’s paralysis
brachial trunks c8-T1 – weakness of hand muscles
T1 – horner’s syndrome

abducted arm pulled away from body in traction

34
Q

new name for waiter’s tip palsy and which nerves are damaged

A

erb’s palsy
C5-6 brachial
pronated arm that is medially rotated

35
Q

Neck of femur fracture - what do you look for on x ray

A

Shenton’s line

Mcdonalds

36
Q

Ankle X rays

A

AP
Lateral
Mortise - turn ankle AP 10* so you can see space between fibula and tibia

37
Q

types of gait

A

antalgic - reduce stance due to pain
trendelenberg -
waddling gait - BOTH abductor muscles are weak
swinging gait - ankylosis of hip results in patient needing to swing the lower limb forwards and backwards from the lumbar spine
unevent gait - leg length discrepency
high stepping gait - sciatic nerve/ peroneal nerve injury

38
Q

why does apparent leg shortening happen

A

posture problem

  • adduction contracture at the hip
  • compensatory lordosis at the spine
39
Q

where do you look with the sweep test?

A

medial gutter

40
Q

lateral ligament tests

A

to test medial aspect - abduct stress
to test lateral aspect - adduction stress on knee

test is positive with knee flexed to 30* but negative on straight knee, it implies the medial collateral ligament has been damaged

if test is positive in both positions it means the the cruciate and the medial colateral ligament has been damaged

41
Q

Mcmurray’s test explanation

A

test the menisci (posterior or middle thirds)

flex the knee
external rotation + abduction — extend
internal rotation + adduction — extend

painful click = positive test

42
Q

Apley’s grind test

A

patient prone
hip extended and knee flexed to 90*
internally and externally rotate the knee while compressing downwards and then an upward contraction

pain on downwards = meniscal tear
pain on upward traction = ligament injury

43
Q

structure for MSK pathology

A

infection

  • septic arthritis
  • lyme arthritis
  • hep B,C
  • rheumatic fever

joints

  • osteoarthritis
  • crystal arthritis: gout, pseudogout
  • RA
  • spondyloarthritis (ank spond, psoriatic, IBD, reactive arthritis following GI/GUM)

multisystem

  • connective tissue: SLE, sjreogens, sclerosis, idiopathic polymyositis
  • vasculitis

Bone/Soft tissue

  • metabolic bone: osteoporosis, osteomalacia
  • inherited (ehler’s danlos, marfans)
  • soft tissue: bursitis, tendinopathy
  • fibromyalgia
44
Q

osteoarthritis
definition
signs
treatment

A

Osteoarthritis = degenerative joint disorder in which there is progressive loss of hyaline cartilage + inflammation with synovitis and effusions + new bone formation at the joint surface and its margin.

  • RFs: age, obesity, joint abnormality
  • ## 1ary vs 2ary (underlying cause e.g. obesity)Sxs: pain (++ by movement/end of day), stiffness/ gelling (esp after rest – lasts around 30min), deformity (genu varu), reduced

Ix
inspection - squaring of the 1st CMC, nodes in the hands, valrus/ valgus, effusions, fixed flexion
antalgic gait
palpation - cool bony swelling, +/- joint line tendernes
ROM
+ crepitus (knee, 1sr carpometacarpal joint)
reduced function

Mx: (MDT – GP, physio, OT, dietitian, orthopod) - Modification of ADLs
o Stop smoking (osteoblasts inhibited by smoking), reduce weight, incr exercise
o OT: walking aids, supportive footwear, home modifications
Physiotherapy - Muscle strengthening
o WHO analgesic ladder > paracetamol, NSAIDs (check renal function), weak opioid, strong opioid - Steroid injection
- topical capsaicin cream, NSAID gel, lignocaine patches
o Do not inject steroids if there is metal work (i.e. had a replacement)
Surgery: Arthroplasty (OA) – hemi or total, arhroscopy

45
Q

telescoping of fingers

A

arthritismultilans - psoriatic arthritis

46
Q

causes of gout

A
  1. diet, alcohol
  2. higher BMI — Hx osteoarthritis
  3. drugs eg. thiazides, loop diuretics
  4. familial - polymorphisms in URAT1 affecting urate resorption in kidney tubules
47
Q

presentation of gout

A
1st MTP (podagra)
severe inflammation, pain, red, swelling 

may spontaneously settle over a week

future presentations involving other large joints and become polyarticular

tophi deposits in tissues

48
Q

Ix. gout/ pseudogout

A

serum uric acids (may not be raised during acute attack)

raised ESR/ CRP

synovial fluid aspiration and microscopy- negatively birefringent for gout and positively birefringent for pseudogout

+ cytology to rule out septic arthritis

X rays - may show joint erosions + calcinosis in pseudogout

renal functions - renal impairment may cause hyperuricaemia
fasting lipids, and glucose and BP

49
Q

Mx of gout

A

review drugs - thiazides, loop diuretics
weight loss, low purine diet (low meat, alcohol, liver, sardines)

acute: analgesia, NSAIDs, colchicine, prednisolone, steroid injections, splint joint

long term (recurrent episodes) - after acute attacks start allopurinol (xanthine oxidase inhibitor)

50
Q

simmond’s test

A

squeeze calves
should cause plantar flexion

detects achilles rupture

51
Q

how to diagnose joint prosthesis infection

A
X ray 
periprosthetic lucency (infection or prosthetic loosening)
bone destruction
52
Q

mx of prosthetic infection and likely organisms

A

excisional arthroplasty
debridement/ implant retention or removal and replacement in one or two stage revision

causes staph and strep

53
Q

mx of prosthetic infection and likely organisms

A

excisional arthroplasty
debridement/ implant retention or removal and replacement in one or two stage revision

causes staph and strep

54
Q

fixed flexion deformities causes

A

osteoarthritis

NOF

55
Q

finkelstein’s test positive causes

A
De Quervain's tenosynovitis
scaphoid fracture (FOOSH)
56
Q

name the fingers

A

thumb, index, middle, ring, little

57
Q

carpal bones

A

sally left the party to take cathy home

***scaphoid - fracture
lunate
triquetrum
pisiform
trapezium
trapezoid
capitate
hamate
58
Q

scaphoid blood supply

A

radial blood supply enters through the waist
retrograde blood supply
fracture of the proximal pole –> avascular necrosis of the proximal pole

  • 70% of the fractures occur through the waist
59
Q

Mx. colles’ fracture

A

reduction under local/regional anaesthesia

set in plaster

60
Q

pseudogout aka acute calcium pyrophosphate crystal arthritis

  • which crystals
  • risk factors
  • x ray images
A

calcium pyrophosphate crystals
form in joint carilage
more common in elderly, osteoarthritis, hyperparathyroid, haemochromatosis

the crystals are visible “whifts/ bands” of hyper- white calcinosis on X rays

61
Q

presentation of acute calcium pyrophosphate crystal

A

acute calcium pyrophosphate crystal arthritis (pseudogout)

  • acute monoarthritis
  • severe hot swollen joint
  • wrist/ knee
  • DDx septic arthritis

osteoarthritis WITH calcium pyrophosphate
- inflammation with OA joint due to crystal deposition

62
Q

Mx of pseudogout

A

same as acute mx of gout
NSAIDs, colchicine, splint joint, intraarticular steroid injections, prednisolone

no long-term prevention

63
Q

rheumatoid arthritis defintion/ classification

A

ACR/ EULAR 2010 classification

synovitis in at least one joint without alternative explanation
+ at least 6 points to make a diagnosis

assigned for number of joints involved, >6 weeks of symptoms, acute phase response (CRP/ ESR), sero positive for RF or CCP

if sero-negative for RF/CCP need at least 10 joints (at least 1 small) for RA diagnosis

64
Q

what is a Reactive arthritis

A

A sterile joint inflammation which occurs due to a bacterial infection taking place elsewhere in the body.

The infection will result in cross-reactivity resulting in a warm, painful and swollen joint.

Often there will be multiple extra-articular features such as conjunctivitis or urethritis which are also due to cross-reactivity.

65
Q

pathogenesis of RA

A

synovial membrane invaded by lymphocytes
activation of synoviocytes
synovial proliferation (pannus) –> ++ synovial fluids (joint effusion)
pannus may invade bode causing erosion
inflammation damages cartilage –> 2* osteoarthritis

66
Q

3 signs of RA + other features

A
  1. joint pain - MCP, PIPs — NEVER DIP!
  2. stiffness/ worse after rest
  3. joint swelling and effusions

malaise, fatigue, fevers, sweats, Interstial lung disease

chronic disease = joint deformity

67
Q

serological test for RA

A

Rheumatoid factor (antibody for IgG Fc) - 60% sensitive & specific for RA

anti-cyclic citrullinated peptide antibody - 60% sensitive, 95% specific

68
Q

RA disease activity scoring

what is the target?

A

DAS28 score
points for number of tender, swollen joints, patient global assessment of disease and ESR

score >5.1 is a high disease activity score

treat to target = regular monitoring and disease activity scoring with esclation of drug treatment to achieve a target DAS 28 (2.6 is remission or 3.2 is low disease activity)

69
Q

causes of carpal tunnel syndrome

signs

A

causes: idiopathic, pregnancy, hypoT, cardiac failure, previous wrist trauma, RA, OCP

signs - sensory + pins and needles to first three fingers palmar aspect + wasting in thenar eminence

70
Q

assessing X rays of C-cervical spine

A

need to be able to see all the way down to T1

draw 3 vertical lines - anterior vertebral, posterior vertebral, spinolaminar (anterior spinous processes) to check for alignment

71
Q

what is a Hangman’s fracture

A

bilateral spondylothiesis (fracture) of C2 (axis)

72
Q

complications of intravenous drug injectors into thighs

Management

A

abscess formation
crepitus if gas forming organism (e.coli, klebsiella, c. perfringes)

  • DVTs –> PEs –> pulmonary infarctions
  • false aneurysm (arteriography)
  • osteomyelitis
  • infective endocarditis
  • hep B/C –> cirrhosis
  • sepsis

Mx
treat with IV Abx, surgical excision
treat withdrawal
treat complications - Infective endocarditis
treat likely other eg. TB, HIV, hepatiits

73
Q

borders of anatomical snuff box

A

extensor policus longus
extensor policus brevis
abductor policus longus