Pastest Flashcards
Most common cause of osteomyelitis in a patient with sickle cell?
Salmonella
staph aureus for everyone else
First line for carpal tunnel syndrome?
Corticosteroid injection
no role for NSAID
What is the commonest # of childhood?
Supracondylar # of the humerus
Often involve brachial artery compromise and involvement of median, radial or ulnar nerve
How are supracondylar # classified?
Garland classification
Type 1 = non displaced
Type 2 = angulated with intact posterior cortex
Type 3 = posterior displacement
Back pain worse on extension of the back?
Facet joint pain
Ottawa ankle rules
X-ray is only required if bony tenderness in the malleolar zone +
Inability to weight bear for 4 steps
Bony tenderness in distal tibia
Bony tenderness in distal fibula
What tests do patient need before starting hydroxychloroquine?
Ophthalmology exam due to risk of retinopathy
First line treatment for new RA?
Methotrexate + another DMARD e.g. leflunomide
+ a short dose of oral prednisolone to control acute flare
What does anti-Jo 1 antibodies in polymyositis mean?
Worse prognosis and increased risk of interstitial lung disease
Syringomeylia
Formation of a cystic cavity within the spinal cord
Commonest is with Arnold-chairi malformation
Typically affected the spinothalamic tract —>pain and sensory loss in the upper limbs
Feature of Brown - Sequard syndrome?
Hemisection of spinal cord e.g. stab injury Ipsilateral paralyses (pyramidal tract) and loss of proprioception and fine touch (dorsal column)
Pain and temperature loss is on the contralateral side (spinthalamic tract cross below the injury)
APTT will be increased in anti-phospholipid syndrome. Associated with anit-cardioplipi and lupus anti-coagulant antibodies. What are the features?
C - coagulation defects
L - livedo reticularis
O - obstetric loss
T - thrombocytopenia (low platelets)
1ST DVT = warfarin for 6 months
>1 = lifelong warfarin
Management of reactive arthritis?
NSAIDs- can’t pee, can’t see, can’t climb a tree
Which test is used to assess for hyper mobility?
Brighton score
Features of anti-synthetase syndrome?
Myositis
Cracked hands
Raynauds
Interstitial lung disease
Anti-jo 1
ESR and CK in polymyalgia rheumatica?
ESR is elevated
CK is normal (no true myositis)
Remember there is no true weakness - it is limited by pain
Most common eye complication of RA
Keratoconjunctiva sicca
Most likely bone tumour in middle age?
Chondrosarcoma
‘Popcorn calcification’ and axial skeleton
Distal radial # with volar angulation?
Smiths
Intra-articulate # of the base of the 1st MCP
Bennets
Bi-malleolar ankle fracture. Often after fall from height?
Potts #
Dislocation of the proximal radio-ulnar joint with ulnar #
Monteggia #
(usually occurs after fall on outstretched hand with forced pronation)
(PM)
Radial shaft # fracture with dislocation of the radio-ulnar joint
Galeazzi #
GD
Retinal haemorrhage after femoral #?
Fat embolism
Intra-arterial fat globules is also suggestive
What test is used to conform de quervains tenosynovitis?
Finklesteins test (put thumb in closed fist then extend wrist down)
What is de quervains tenosynovitis?
Inflammation of the sheath containing the extensor policis brevis and abductor policis longus
Treat with analgesia or steroid injection
Positive lachman test?
ACL rupture
Remember that PCL occurs due to hyperextension
The sciatic nerve divides into the tibial and commonest peroneal nerves. Features of common peroneal nerve damage?
Foot drop
Sensory loss over dorsum of foot
Weakness of dorsiflexion, foot eversion and extensor hallucis longus
Hills Sach lesion visible of x-ray
Anterior glenohemoral dislocation
Rim’s sign, light bulb sign. Trough sign…
All suggestive of a posterior shoulder dislocation
IVDU with back pain, fever and likes to lie on back with knees flexed?
Psorias abscess
What is the expected calcium and alk phos in pagets disease?
Calcium = Normal
Alk phos = high
Alk phos and calcium in osteomalacia?
Low calcium and phosphate
Alk phos is high
First line analgesia for managing low back pain?
NSAIDs such as naproxen
RF for DDH
- Female
- First born
- FH
- breech
- oligohydramnios
Teenager hit in knee with hockey stick. Knee is tense and swollen but no # on x-ray. Likely diagnosis?
Patellar disclocation
often spontaneously reduce
What is the investigation of choice in suspected osteomyelitis?
MRI
Epidural abscess is a complication of discitis
Suspect in a patient with discitis who continues to spike a fever/ is not improving
What is osteopetrosis?
Autosomal recessive
Present with anaemia or low platelets
‘Marble bone’ - no differentiation between cortex and medulla
1 year old presents with FTT, small, big head, and cupping of the epiphysis of long bones
Rickets
Childhood form of osteomalacia (Weak bones due to vitamin D deficiency)
Treatment of talipes equinovarus?
Club foot
Treat with manipulation and progressive casting e.g. the Ponsetti method
Night time braces until 4 years old
What is club-foot associated with?
Spina bifida
Edwards
Cerebral palsy
L5 lesion
Loss of foot dorsiflexion and sensory loss dorsum of the foot
Remember if L3/L4 then the knee reflex would be reduced
If S1 then ankle jerk is reduced
Common complication of anterior shoulder dislocation?
Axillary nerve damage - badge patch
Red, hot swollen joint with reduced sensation in a patient with a history of poorly controlled DM?
Charcot joint - as there is lots of peripheral neuropathy it is not as painful as might be expected
Wasting of the thenar eminence is characteristic of carpal tunnel. Remember the rest of the hand is innervated by ulnar nerve - except…
LOAF muscles
- lateral 2 lumbricals
- opponens pollicis
- abductor pollicis
- flexor pollicis brevis
Dupuytrens is associated with….
Alcohol excess FH Liver disease Manual labour Male
Classic symptoms of frozen shoulder
Active and passive movement restricted
External rotation worse
Treatment of choice for a sub-trochanteric hip #
Interdmedullary nail
Suspected cauda equina syndrome
MRI ASAP
Within 6 hours
How does the management of an intra-capsular hip fracture vary depending on age/ mobility?
Younger and more active —> total hip replacement
Old and less mobile —> hemiarthroplasty
Define AVN. What are the risk factors?
Death of bone tissue secondary to loss of blood supply
RF = steroids, chemotherapy, alcohol excess and trauma
How does AVN present?
Can occur in any joint
Often long bones such as femur
Asymptomatic —> joint pain
Osteopenia, microfractures and collapse of intra-articulate surfaces are seen early on
Test with MRI
Which antibiotic is associated with tendinitis and new tendon rupture?
Ciprofloxacin
What clinical examination should be done in a patient with suspected Achilles’ tendon rupture?
Simmonds triad
- look —> altered angle of dangle
- feel —> palpate for a gap
- move —> squeeze calf - normally there will be plantar-flexion of foot
Describe the gustilo and Anderson tissue classification?
Classification of low open #
1 - low energy wound <1cm
2 - >1cm wound with moderate soft tissue damage
3 - high energy >1cm with extensive tissue damage
3a - adequate tissue coverage
3b - inadequate tissue coverage
3c = associated arterial injury
Foot drop in an old man who has had a total hip replacement revision?
Sciatic nerve damage
remember common peroneal is an important branch
Remember the entire posterior compartment of the lower leg is innervated by the tibial nerve
E.g. soles, gastrocnemius, tibialis posterior and flexors digitorum and hallucis longus
Sensation on lateral aspect of foot and weakness of plantar-flexion?
S1
Knee = L4 Ankle = S1
Bicpes = C5 Brachioradialies = C6 Triceps = C7
All reflexes are normal but there is reduced dorsiflexion of big toe?
L5 nerve involvement
Can’t be L3/4 or S1/S2 as they are involved in reflexes
Sensory loss over dorsum of foot =
L5
Also weakness in foot and big toe dorsiflexion but reflexes are ok
Burning thigh pain…
Meralgia parasthetica due to compression of the lateral cutaneous nerve of the thigh
Oslers nodes?
Painful pink/ purple lesions on the fingers and toes
Caused by immune complex deposition and associated with infective endocarditis and SLE
Action in suspected hip fracture (clinically) but x-ray is normal?
MRI is best (but CT may be done to wider availability)
Triad of:
Claudication in buttocks and thighs
Atrophy of leg muscles
Impotence
Leriche syndrome
Athersosclerotics occlusive disease of abdominal aorta +/or both iliac arteries
Investigations in a patient with suspected spinal stenosis?
MRI
Describe the different types of nerve damage which can occur following a forceps delivery
Femoral = weak knee extension, loss patella reflex and numb thigh
Sciatic = weak knee flexion and foot movement
Obturator = weak hip adduction
Which nerve supplies biceps brachii?
Musculocutanoues nerve
(C5-C7)
Elbow flexion
Which nerve supplies deltoid muscle?
Axillary
C5/C6
Shoulder abduction
Which nerve in the upper limb does extension?
Radial
Weakness of dorsiflexion, eversion and extensor hallucis longus can all be explained by…
Common peroneal nerve palsy
Which muscle does the first 20 degrees of shoulder abduction?
Supraspinatous
after that, deltoid takes over
SI
SA
IE
TE
How does serotonin syndrome present?
Cause by excess SSRI, TCA act
Features = restlessness, hyperthermia, tachycardia, confusion, increased reflexes and movement (basically everything increases and D&V is common)
Foot drop..
Common peroneal nerve palsy - often due to tight fitting plaster cast
What is the correct management for a perforated eardrum?
Discharge and advice to keep dry for 6 weeks while it heals.
See GP in 6-8 weeks
Surgery is only considered if not healing
Patient on metronidazole develops vomiting after having a few drinks. What is happening?
Disulfarim reaction
The activity of acetaldehyde is blocked —> large increase in serum acetaldehyde levels following alcohol
Patients are sick, dizzy and have a terrible headache.
This is how Antabuse (the drug that makes alcohol very unpleasant works
Adrenaline in anaphylaxis….
Adult= 500 micgrogram IM
Child = 300 microgram IM
Child >6 = 150 microgram IM
Best investigation in a patient with suspected phaeochromocytoma but normal MRI?
MIBG scan
MIBG labelled with radioactive iodine resembles nor-adrenaline and concentrates in adrenals or areas of adrenal phaeochromocytoma
What is Waterhouse Friederichsen syndrome?
Primary adrenal failure which is most commonly caused by neisseria meningitidis
Remember, LFT and UE are taken from the same blood tube. If LFT could not be performed due to haemolysis then it is possible that a raised K is due to haemolysis too
Take repeat bloods but probably do an ECG just in case
Which type of shock is most common in acute pancreatitis?
Fluoxetine d depletion or hypovolaemic due to loss of fluid into the intra abdominal space
What is Charcots triad?
Fever, jaundice and RUQ pain which is suggestive of acute cholangitis
Likely diagnosis in an ICU patient who develops sudden onset haematemesis with no underlying peptic ulcer disease?
Stress ulceration due ischaaemic injury to the gastric mucosa and disruption of the mucosal barrier
Prevent by using PPI/ ranitidine
Remember that a central venous line can be really useful in patients with heart failure who need carful fluid balance e.g. you want them hydrated but not overloaded
Remember that a central venous line can be really useful in patients with heart failure who need carful fluid balance e.g. you want them hydrated but not overloaded
Type 2 reaction = antibody mediated hypersensitivity e.g. haemolytic anaemia
Type 3 = immune complex mediated e.f. RA or SLE
TyPE 4 = T cell medicated e.g.g contact dermatitis
Which drug is used for radiation emergencies?
Potassium iodide
used if significant exposure to radioactive iodine
Target BP in a patient with a pelvic #
Ideally 100/70 as lower pressure = less bleeding and less clot destruction
Smith # are usually managed with MUA or ORIF
Colles fractures are often managed conservatively
How is an acute dystonic reaction managed? E.g. after ingestion of metoclopramide?
Drugs such as benztropine or procyclidine
Procyclidine is most likely (it is more available and is used as an anti-Parkinsonism drug)
