R2 LOCO3 Flashcards
Which species of your normal skin flora:
Makes up 90% of the flora? [1]
Is found in nose, perineum, vulvar skin? [1]
Feeds off sebum and cellular debris and colonisation starts when sebaceous glands become more active?
Makes up 90% of the flora: Staphylococcus epidermidis
Is found in nose, perineum, vulvar skin: Staphylococcus aureus
Feeds off sebum and cellular debris and colonisation starts when sebaceous glands become more active: Propionibacterium acnes
Which pathogen causes hot tub folliculitis? [1]
Pseudomonas aeruginosa
Treatment for folliculitis? [3]
Oral antibiotic
Retinoic acid & Vit. A: reduces amount of sebum
Two primary pathogens that cause impetigo? [2]
Staphylococcus aureus or Streptococcus pyogenes
Tx of impetigo?:
Simple cases [1]
Severe cases? [1]
Most people? [1]
Oral or topical antibiotic for severe cases that have spread to other body areas
NICE recommends 1% hydrogen peroxide cream for simple cases
But most people will get better without treatment within 3 weeks
What is cellulitis in the face called? [1]
How does it differ to cellulitis in location? [1]
Most common pathogen? [1]
Erysipelas (cellulitis of the face) but just in the dermis and not in subcutaneous fat
Streptococcus pyogenes
What is this skin infection? [1]
Which pathogen causes this? [1]
Scalded skin syndrome:
Staphylococcus aureus
Describe the pathophysiology of scalded skin syndrome [2]
Exotoxins are proteases that destroy desmosomes holding keratinocytes in granulosum and spinosum layers together:
Causes widespread fluid filled blisters that easily break
Treatment of scalded skin syndrome? [2]
Treatment:
* Conservative: rehydration antipyretics
* Parenteral antibiotics
What is Nikolsky sign and what does it test? [1]
Nikolsky sign is a test of how weak the blister is.
Pencil eraser placed on top of blister and turned if blister ruptures the blister is intraepidermal. Or you turn the eraser on unblistered skin and new blister forms.
Therapy for Necrotising fascitis? [3]
Treatment:
* Surgical debridement
* Empiric antibiotics
* Hyperbaric oxygen (Add on therapy)
Describe pathophysiology of HPV causing warts and verrucas [3]
DNA virus
Infects basal cells of the epidermis
Lesions arise from proliferation of infected basal keratinocytes
Causes hyperkeratosis, acanthosis and hypergranulosis, rete ridge elongation and large blood vessels at dermoepidermal junction
Treatment for HPV: viral warts and veruccas? [5]
Topical salicylic acid
Fluorouracil cream
Cryosurgery
Surgical curettage
Laser treatment (CO2 laser 582nm)
Describe the pathophysiology of Pityriasis versicolour [1]
Which populations does it impact more? [1]
Overgrowth of commensal yeast Pityrosporum orbiculare; young adults, brown/pink scaly patches, hypopigmented if suntanned
Affects young adults and slightly more men than women:
It is not contagious infection is not due to poor hygiene usually occurs in warmer months white, salmon or light brown patches chest,back, arms and legs
More common in hot humid climates and only affects people that sweat heavily
Often clears during the winter months and reappears each summer
Treatment of Pityriasis versicolour (tinea versicolour)? [3]
- Antifungal shampoo (ketoconazole)
- Selenium sulphide (off-label)
- For small areas antifungal creams
Describe what Postherpetic neuralgia (PHN) is [2]
Unpredictable complication of varicella zoster virus- (VZV-) induced herpes zoster (HZ) which often occurs in elderly and immunocompromised persons
The main symptom of post-herpetic neuralgia is intermittent or continuous nerve pain in an area of your skin previously affected by shingles.
Leprosy is caused by which pathogens? [2]
Mycobacterium leprae or mycobacterium lepromatosis
Treatment for leprosy? [3]
Rifampicin, dapsone and clofazimine
The femoral head recieves blood supply from which arteries? [3]
State the source of each of these arteries [2]
Medial and lateral circumflex arteries, from profunda femoris
Acetabular branch of obturator artery
Which type of prosthetic material has a narrower stem
Cemented
Uncemented
Cemented
Is nerve damage an intraoperative or postoperative complication?
postoperative complication
Which ligament is removed in a total hip replacement? [1]
Acceptable responses: Ligamentum teres
During a total knee replacement state what the femoral component [1] and tibial components [2] are made from
Femoral: Metal
Tibial: Metal tray that attaches directly to bone; plastic spacer that proves the bearing surface which replaces the mensici
State 3 potential complications of using plaster of paris casts for fixation [3]
Muscle atrophy
DVT
Compartment syndrome
State what type of internal fixation is present [1]
When would this type of internal fixation be used? [2]
Plates and screws
Used for :metaphyseal fractures of long bones and diaphyseal fractures of the radius and ulna
Define the terms [3]
Isograft
Allograft
Alloplast
Isograft: A form of allograft. A graft between genetically identical individuals.
Alloplast: using an inert material to reconstruct a tissue
Allograft:A graft from person to another e.g using tendon or ligament or chondrocytes from a donor
Which of the following best fits the description for:
Using an inert material to reconstruct a tissue
Allograft
Xenograft
Autograft
Alloplast
Isograft
Alloplast
Name 2 sites of autografts commonly used for anterior cruciate ligament replacement [2]
Acceptable responses: Patella ligament, Semitendinosus, Semitendinosus tendon, Gracilis, Gracilis tendon
Define arthrodesis
surgical fusion of a joint
State two reasons why arthrodesis may be given [2]
Pain relief in a joint severely damaged.
Stabilisation of a joint which has lost stability from ligamentous damage or paralysis.
Describe the mechanisms that arthrodesis may be given [2]
The joint may be fused by either clearing the articular cartilage and bringing the bone together and holding it in place until fusion occurs
Extra articular where fusion bypasses the joint.
What form of management has been performed here? [1]
Arthrodesis of knee joint
Which imaging technique is preferred in diagnosing DDH in young patients?
MRI
Ultrasound
X-ray
CT
Ultrasound
A barlow test would is assessing which developmental problem? [1]
Developmental dysplasia of the hip (DDH)
What is the name for this line? [1]
Hilgenreiner’s Line
This is a horizontal line along inferior aspect of triradiate cartilage.
What is the name for this angle? [1]
Between which points is it measured between? [2]
Acetabular index
Hilgenreiner’s line and the acetabular index line
State what the acetabular angle should be for each of the following ages?
0 - 1 year old < []
1 > 4 year old < []
> 4 year old < []
The acetabular angle should decrease with age:
0 - 1 year old < 34
1 > 4 year old < 28
> 4 year old < 25
DDH:
What acetabular angles would correct with splintage [1] and would require surgery [1]
An angle of < 45 deg will spontaneously correct with splintage, whereas angle of > 60 deg will usually require surgery.
On the left, the femoral head is located more laterally and the acetabulum appears underdeveloped.
Describe how you would manage CDH in a
Newborn [1]
6-18 months [2]
Newborn
* Splintage in abduction (Pavlik harness, Von Rosen splint)
6 - 18 months
* Closed reduction – Traction, Splintage
* Open reduction and Splintage
Describe the pathophysiology of Perthes disease [1]
Idiopathic avascular necrosis of the femoral head
What is the typical age of presentation for Perthes disease? [1]
4-10 yrs old
Describe the pathophysiology of slipped upper femoral epiphysis [2]
Displacement of femoral epiphysis: predominately distal portion due to femoral neck roating externally off the head
What is this line called? [1]
Which two parts is it from? [2[
Line of klein: line of Klein is drawn along the lateral most aspect of the femoral neck.
What is the name of this deformity? [1]
Talipes Equinovarus (Clubfoot)
What is the name of this deformity? [1]
Talipes Equinovarus (Clubfoot)
Ankle arthrodesis is the fusion of the [] most commonly performed for end-stage arthritis of the joint.
Ankle arthrodesis is the fusion of the tibiotalar joint most commonly performed for end-stage arthritis of the joint.
This line is:
Hilgenreiner’s Line
Shenton’s Line
Kline’s Line
Hilgenreiner’s Line
State the effect of:
Barlow test [1]
Ortalini test [1]
What are positive results for each test? [2]
Barlow test:
* dislocates / subluxes the hip
* Positive if the hip can be popped out of the socket with this maneuver.
Ortalini test:
* if the hip was dislocated, a distinctive clunk will be heard as the hip relocates.
Name this apparatus being used [1]
What pathology is it treating? [1]
What ages would this be used for? [1]
Pavlik harness: treats CDH for newborns - 6 months
Name this apparatus being used [1]
What pathology is it treating? [1]
What ages would this be used for? [1]
Von Rosen splint: CDH between newborn - 6 months
