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1
Q

Stages of Fracture Healing

A
  1. Bleeding into Fracture
  2. Inflammatory Reaction Set Up
  3. Cells Proliferate and Callus Formed (Early Bone and Cartilage)
  4. Consolidation (woven bone to stronger lamellar bone)
  5. Bone Remodelling Under Normal Stresses
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2
Q

What is a fracture?

A

Break in the continuity of Bone

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3
Q

4 Principles of Fracture Management

A

Resuscitation
Reduction
Restriction
Rehabilitation

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4
Q

Problems with Fracture Union

A 
5 I's
Infection
Ischaemia
Interfragmentary Movement
Interposition of Soft Tissues
Intercurrent Illness
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5
Q

3 Arches in Foot

A

Medial Longitudinal Arch
Lateral Longitudinal Arch
Transverse Arch

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6
Q

Parts of the Foot

A

Forefoot: Metatarsals and Phalanges
Midfoot: 5 tarsals (Navicular, Cuboid and 3 Cuniforms)
Hindfoot: Talus and Calcaneus

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7
Q

Which artery supplies the head of the femur?

A

Superior Retinacular Artery

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8
Q

Causes of Scoliosis

A

Functional vs Structural

Functional=reversible:
pain or muscle spasm, difference in leg length

Structural=irreversible:
idiopathic, injuries, infection, tumour, nerve or muscle disorders, congenital eg Spina Bifida

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9
Q

Carpal Bones of the Hand

A

8 Bones
Some Lovers Try Positions That They Cannot Handle
Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapeziod, Capitate, Hamate

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10
Q

Causes of Erythema Nodosum

A 
PIMPS
Poisons: COCP, Penicillins, Sulphonamides
Infection: TB, Strep
Malignancy or Lymphoma
Pregnancy
Systemic: Sarcoidosis, IBD
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11
Q

Common Tumour Markers

A

19-9 Pancreatic
15-3 Breast
125 Ovarian
CEA Colorectal (better for follow up than screening)

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12
Q

Features of MEN1

A

Pituitary Adenoma
Parathyroid (Hypercalcaemia)
Pancreatic

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13
Q

Features of HONK

A

severe hyperglycaemia
dehydration and renal failure
mild/absent ketonuria

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14
Q

GOLD classification

A

Global Initiative for Obstructive Lung Disease–to tailor therapy
Airflow limitation (FEV1)
no of exacerbations per year
mMRC Dyspnoea Score

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15
Q

BODE Index

A

BMI
Obstruction: FEV1
Dyspnoea MRC Score
Exercise Capacity on 6min walk

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16
Q

Causes Bilateral Spastic Paraperesis

A

Cerebral Palsy
Trauma
MS
Cord Compression (trauma, TB, malignancy–>Dexamethasone)

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17
Q

Causes of Gout

A

Drugs: Thiazides and Cytotoxics
Drinking
Diet rich in Purines
Decreased Excretion eg Chronic Renal Failure
Death of Cells eg Leukaemia, Lymphoma, Psoriasis

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18
Q

Indications for vascular bypass

A

Short claudication distance, rest pain

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19
Q

Complications of a bypass

A

Haematoma
Distal Embolism
Thrombosis

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20
Q

Grafts used for bypass

A

Above inguinal ligament = Dacron

Below= Saphenous vein (less susceptible to infection and last longer), PTFE

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21
Q

What is retinitis pigmentosa?

A

dispersion and aggregation of retinal pigement

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22
Q

Light’s Criteria

A

Exudate if 1 or more of
Pleural Fluid Protein/Serum Protein>0.5
Pleural Fluid LDH/Serum LDH >0.6
Pleural Fluid LDH> 0.66x upper limit normal serum LDH

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23
Q

Indications for a lobectomy

A

90% bronchial cancer
bronchiectasis
COPD bullae
TB (historic surgery)

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24
Q

What is the mechanism behind clubbing?

A

chronic upregulation of prostaglandins and growth factors

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25
Q

Techniques for breast reconstruction

A

Implants
Myocutaneous flaps:
- Latissiumus Dorsi Myocutaneous flap
- Transvese Rectus Abdominis Myocutaneous Flap (TRAM)
- Deep Inferior Epigastric Perforator Flap (DIEP)

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26
Q

Advantages and disadvantages of implants

A

Advantages:
Simpler technique

Disadvantages:
Cosmetic result not as good
Requires plenty of available skin
Lies higher than other breast
Late: capsular contracture, implant leak, infection
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27
Q

Advantages and disadvantages of Myocutaneous flaps

A

Advantages:
Useful when little remaining skin or muscle
Good cosmetic result

Disadvantages:
Increased blood loss
Increased op time and complications
Use of Rectus impossible if patient has had abdo surgery
Late complications–flap necrosis and infection

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28
Q

Muscles of the Quadriceps

A

Rectus Femoris
Vastus lateralis
Vastus Medialis
Vastus Intermedius

All supplied by femoral nerve

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29
Q

Causes of carpal tunnel syndrome

A

I WRIST

Idiopathic
Water eg pregnancy, hypothyroidism
Radial Fracture
Inflammation: RA, gout
Soft tissue swelling eg lipomas, acromegaly
Toxic: DM, alcohol
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30
Q

Causes of oral ulcers

A

Infective: herpes simplex, candida
Neoplastic: SCC
Aphthous: B12, Behcets, IBD

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31
Q

Causes knee effusion

A

Synovial fluid = synovitis
Pus = septic arthritis
Blood = 90% ACL rupture, PCL rupture, intrarticular fracture, meniscal tear, bleeding diathesis

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32
Q

Surgical management of RA knee

A

Synovectomy and debridement (often arthroscopic)

Removal pannus and cartilage

Supracondylar osteotomy

Total knee arthroplasty

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33
Q

Systemic Inflammatory Response Syndrome

A

Temp >38 or 90
Resp rate >20
WCC >12 or

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34
Q

Causes bronchiectasis

A

Congenital:
CF
Kartageners
Youngs

Acquired:
Post infections
Obstruction
RA, IBD

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35
Q

Qualities of a good screening test

A

Wilson’s Criteria

Important health problem
Recognised latent/early symptomatic stage
Recognised treatment
Test is acceptable to the population
Case finding should be cost effective
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36
Q

What is pre tibial myxoedema?

A

Elevated shin lesions with well defined edges and thickened orange peel appearance

1-2% of Graves

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37
Q

Complications of hyperthyroidism

A

High output cardiac failure

Thyroid storm

Fixed gaze (usually painful): surgical emergency due to risk optic nerve compression

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38
Q

Eye signs in Graves

A

Exophthalmos
Chemosis
Exposure keratitis (due to poor eye closure)
Ophthalmoplegia

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39
Q

Causes of an absent pulse

A

Acute: embolism, aortic dissection, trauma
Chronic: atherosclerosis, coarctation, Takayasu’s arteritis

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40
Q

Features of a VSD

A

thrill at LLSE

systolic murmur loudest at LLSE

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41
Q

causes of VSD

A

Congenital

Acquired: traumatic, post-operative or post-MI

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42
Q

Associations with VSD

A

Fallot’s Tetralogy
Coarctation
Patent Ductus Arteriosus

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43
Q

Management of VSD

A

Closed percutaneously or surgically

+- antihypertensive therapy if coarctation

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44
Q

Features of Yellow Nail Syndrome

A

Yellow Nail discolouration and dystrophy
lymphoedema
recurrent pleural effusions
BRONCHIECTASIS

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45
Q

Causes of pulmonary hypertension

A

Left heart disease
Lung parenchymal disease eg COPD
Pulmonary Vascular disease eg PE, pulmonary vasculitis
Hypoventilation eg Neuromuscular or Obesity

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46
Q

Investigations of Pulmonary Hypertension

A

ECG
ECHO
Gold standard= Right heart catheterisation (PA>25mmHg)

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47
Q

Definition of Cor Pulmonale

A

Right heart failure due to chronic pulmonary hypertension–> dyspnoea, syncope, fatigue

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48
Q

What is asthma?

A

episodic, reversible airway obstruction due to bronchial hyper-reactivity to a variety of stimuli

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49
Q

General measures for asthma control

A 
TAME
Technique for inhalers
Avoidance of precipitants
Monitor with Peak flow diary
Educate and liaise with specialist nurse, Emergency action pack
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50
Q

Pathology behind asthma

A

Acute: Mast cell- Antigen interaction leading to histamine release, bronchoconstriction, mucus plugs and mucosal swelling
Chronic: Th2 cells release interleukins resulting in mast cell, eosonophil and B cell recruitment and airway remodelling

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51
Q

What is Motor Neurone Disease

A

Progressive disease of unknown aetiology with axonal degeneration of upper and lower motor neurones

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52
Q

Investigations of Motor Neurone Disease

A

Brain and Cord MRI to exclude structural lesions
LP to exclude inflammatory cause
EMG shows acute denervation

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53
Q

Management of Motor Neurone Disease

A

MDT, Palliative Care team
Supportive for drooling (Amitryptaline), Dysphagia, Respiratory Failure, Pain, Spasticity
Specific: Riluzole= glutamatergic

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54
Q

Different types of Motor Neurone Disease

A

Amyotrophic Lateral Sclerosis (most common)
Progressive Bulbar Palsy
Progressive Muscular Atrophy (LMN signs only), better prognosis than ALS
Primary Lateral Sclerosis (mainly UMN signs)

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55
Q

Bulbar Palsy

A

diseases of nuclei of CN 9-12 in the medulla–> LMN lesions of tongue, talking and swallowing

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56
Q

Causes of bulbar palsy

A

Motor Neuron Disease
Guillain Barre
Myasthenia Gravis
Central Pontine Myelinolysis

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57
Q

Pseudobulbar Palsy

A

bilateral lesions above mid-pons–> UMN lesions of swallowing and talking

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58
Q

Features of pseudobulbar palsy

A

brisk jaw jerk
hot potato speech
spastic tongue
emotional incontinence

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59
Q

Causes of Pseudobulbar Palsy

A

MS
Motor Neurone Disease
Stroke
Cerebral Pontine Myelinolysis

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60
Q

Indications for Pacing

A

Temporary:
Asystole
Prevention/Override Arrhytmia
Prior to high risk cardio intervention

Permanent:
Heart Failure
Heart Block
Long QT syndrome

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61
Q

Polio

A

RNA virus affecting anterior horn cells–>

Asymmetric LMN paralysis with no sensory involvement. Respiratory muscle paralysis may lead to death.

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62
Q

Myopathy Definition

A

Gradual onset, symmetrical PROXIMAL weakness with preserved tendon reflexes.

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63
Q

Muscular Dystrophies

A

Duchenne’s and Becker’s
Both X linked recessive.
Duchenne’s completely non-functional dystrophin, Becker’s partly functional so present later.
Investigation= Increased CK

64
Q

Causes of peripheral neuropathy

A 
ABCDE-I
Alcohol and Toxins (Isoniazid, Phenytoin)
B12 deficiency
Chronic Kidney Disease
Diabetes
Every Vasculitis
Infections eg HIV, Leprosy, Lyme

Large myelinated fibres=Aalpha (proprioception loss)
Small unmyelinated fibres= C (pain and temp lost)

65
Q

What is Chorea and some causes?

A

Non-rhythmic, purposeless, jerky, flitting movements

Huntington’s
Sydenham’s
Wilson’s
L-DOPA

66
Q

What is Guillain Barre?

A

An acute autoimmune demyelinating polyneuropathy with symmetrical ascending flaccid weakness

67
Q

Investigations and Management in GBS?

A

Immune serology for anti-gangleoside antibodies
Slow conduction velocities on Nerve Conduction Studies
Protein in CSF

Supportive: Airway, Analgesia, Autonomic support, Antithrombotic

Immunosuppression: IVIg, Plasma exchange

Physiotherapy

68
Q

What is hereditary haemorrhagic telangiectasia?

A

AKA Osler Weber Rendu Syndrome
Autosomal Dominant vascular dysplasia leading to telangiectasias and AVM formations.
Can have frequent nosebleeds and at risk of haemorrhage.

Manage with transfusion +- surgical/laser ablation if acute haemorrhage. Tranexamic acid may help day to day.

69
Q

What is Pemphigus Vulgaris?

A

Autoimmune blistering disease due to auto antibodies against desomosomes.
May be precipitated by drugs such as NSAIDs, ACEi, L-DOPA
Nikolsky Sign Positive. Mucosa is often affected and bullae rupture easily

70
Q

Bullous Pemphigoid

A

Autoimmune blistering disease due to autoantibodies against hemidesmosomes.

Biopsy shows linear IgG along the Basement Membrane and subepidermal bullae

71
Q

Treatment Pemphigus vs Pemphigoid

A

Pemphigus=
Predinisolone
Rituximab
IVIg

Pemphigoid=
Clobetasol (Dermovate)

72
Q

What is Erythema Multiforme?

A

Symmetrical target lesions on palms, soles and limbs.
IgM deposition
Infections: HSV, Mycoplasma
Drugs: SNAPP (Sulphonamides, NSAIDS, Allopurinol, Penicillin, Phenytoin)

73
Q

What is a keloid scar?

A

Overgrowth of dense fibrous tissue after injury has healed. Commoner in dark skins and tends to recur after excision.

Mx: local steroid injection, cryotherapy

74
Q

Causes of parotid swellings

A

Diffuse swelling:
Systemic (CLD, DM, anorexia, bulimia), Infection (Parotitis), Autoimmune (Sjogren’s), Infiltration (Sarcoid)

Localised swelling:
Lipoma, Salivary gland neoplasm (benign pleiomorphic ademona 80% or malignant Warthin’s tumour), leukaemia (ALL) or calculus

75
Q

Causes of Duputren’s

A 
BIFADE
Booze
Idiopathic
Family History (Autosomal dominant)
AIDS
Diabetes Melitus
Epilepsy and Epilepsy Meds

Mx: Physio and Allopurinol
Surgery indicated if contracture>30 degrees. Partial fasciectomy or fasciotomy

76
Q

What is a hypertrophic scar?

A

Arises on site of injury, excess collagen deposit.
Stays within margin and gradually fades with time.
Across flexor surfaces and skin creases.

Mx: mechanical pressure therapy, topical silicone gel sheets, intralesional steroid and LA injections

77
Q

Lipoma

A

Benign tumour of mature adipocytes. Occur anywhere fat can expand.
Mx: Surgical excision and non-surgical

78
Q

Dercum’s Disease

A

Multiple Painful lipomas
peripheral neuropathy
obese post-menopausal women

79
Q

Sebaceous Cyst

A

epithelial lined cyst containing keratin occuring at sites of hair growth
Two types: epidermal or trichelemmal

Complications: infection, ulceration, calcification

80
Q

What is Compartment Syndrome?

A

Oedema leads to increased compartment pressure and decreased venous drainage, further increasing compartment pressure.
If Compartment pressure>capillary pressure= ischaemia

Muscle infarction–> Rhabdo and ATN, fibrosis and Volkman’s ischaemic contracture

81
Q

Management of Compartment Syndrome

A

Elevate limb
Remove all bandages and casts
Fasciotomy

82
Q

Knee Ligament Repairs

A

Meniscal:
Arthroscopic or Open Partial Meniscectomy or Meniscal repair (predisposes to Osteoarthritis)

ACL:
Autograft repair (Semitendinosus +-Gracilis)
83
Q

Features of Prolactinoma

A

Prolactin>5000
Symptoms of amenorrhoea, infertility, galactorrhoea, mass effects from tumour
Exclude drug history (Dopamine Antagonists eg antiemetics and antipsychotics)

84
Q

Management of Prolactinoma

A

1st: Cabergoline and Bromocriptine (Dopamine agonists)
SE–nausea, postural hypotension and lung fibrosis

2nd: transphenoidal excision

85
Q

Features of Primary Hyperaldosteronism

A

Hypokaemia, raised BP, paraesthesia

70% bilateral adrenal hyperplasia
30% Conn’s= Adrenocortical adenoma

86
Q

Management of Primary Hyperaldosteronism

A

Ix: Raised aldosterone:renin ratio; Adrenal CT/MRI

Conn’s laparoscopic adrenelectomy
Hyperplasia: Spironolactone, Amiloride

87
Q

What is Sarcoidosis?

A

Multisystem granulomatous disorder of unknown cause

Non-caseating granulomas

60% resolve within 2 years

88
Q

Management Sarcoid

A

Acute: bed rest and NSAIDs

Chronic: Steroids and additional immunosuppresion (Methotrexate, Ciclospirin, Cyclophosphamide)

89
Q

Features of Sarcoid

A

fever, anorexia, lymphadenopathy and weight loss,

Cutaneous: erythema nodosum, lupus pernio

Polyarthralgia, Dactylitis

Increased Calcium–> Stones

Hepatomegaly, Splenomegaly

90
Q

Differentials for Granulomatous Disease

A

Infections: TB, leprosy
Autoimmune: PBC
Vasculitis: Wegener’s, Giant Cell Arteritis
Idiopathic: Sarcoid, Crohn’s

91
Q

Causes of bilateral hilar lymphadenopathy

A

Sarcoidosis
Infection: TB, Mycoplasma
Malignancy: Lymphoma, Carcinoma
Interstitial Disease: EAA, Silicosis

92
Q

What is Behcet’s Disease?

A 
Systemic Vasculitis of unknown cause
Turks, Mediterranean, Japanese
Recurrent oral and genital ulceration
\+ Erythema Nodosum
\+ GI features + Eye uveitis

Ix skin pathergy test (formation of papule)
Mx Immunosuppression

93
Q

What is obstructive sleep apnoea?

A

Intermittent closure/collapse of pharyngeal airway leading to apnoeic episodes during sleep
Complications: Pulmonary hypertension

Ix Polysomnography, SpO2
Mx reduce weight, stop smoking, CPAP, surgery to relieve pharyngeal obstruction

94
Q

Risk factors for Obstructive Sleep Apnoea

A 
Obesity
male
Smoker
Alcohol
Idiopathic pulmonary fibrosis
95
Q

Management Rotator Cuff Tear

A

Physio

Analgesia, steroid injections

Open/arthroscopic repair

96
Q

Management Adhesive Capsulitis

A

NSAIDs, steroid or LA injection

97
Q

Impingement Syndrome Management

A

Rest + physio

NSAIDs, bursa steroid or local anaesthetic

Arthroscopic acromioplasty

98
Q

Differentials for a Painful Arc

A

Impingement Syndrome
Supraspinatus tear
AC joint osteoarthritis

99
Q

Complications of knee arthroplasty

A 
Immediate:
Fracture
Cement reaction
Nerve injury to peroneal
Vascular injury to SFA, popliteal or genicular

Early:
DVT
Deep infection

Late:
Loosening
Decreased range of movement and instability

100
Q

Types of knee arthroplasty

A

Unicompartmental (one side)

Unconstrained bicompartmental= femoral, tibial, patellar

Constrained bicompartmental= for tumours, less physiological

101
Q

Sclerosis

A

Increased bone density in subchondral layer of joint

102
Q

Subchondral cyst

A

Well defined lyric lesion in the periarticular surface

103
Q

Management for Ankylosing Spondylitis

A

Encourage swimming and regular exercise
Physio
NSAIDs first line
Dmards only if peripheral joint involvement
TNFalpha if severe disease, eg Etanercept and Adalimumab

104
Q

Pancoast Syndrome

A

Invasion of thoracic inlet structures:

Cervical sympathetic plexus
Brachial plexus
Arm oedema due to blood vessel compression
Recurrent laryngeal nerve palsy

105
Q

Lung mets come from

A 
Bowel
Breast
Kidney
Melanoma
Bone
106
Q

Paraneoplastic features of lung disease

A 
SIADH
Cushings
Carcinoid
PTHrP (small cell)
Dermatomyositis
107
Q

Investigations in lung cancer

A
  1. Diagnose mass: cx, ct thorax
  2. Determine cell type: induced sputum cytology, biopsy by bronchoscopy
  3. Stage
  4. Lung function tests for operability assessment
108
Q

Contraindications for lung cancer surgery

A

SVC obstruction
Malignant pleural effusion
Vocal cord paralysis
FEV

109
Q

Auschpitz sign

A

Picking skin and it bleeds (psoriasis)

110
Q

Features of inguinal hernia

A 
ABCR
Above pubic tubercle
Bowel sounds
Cough impulse
Reducible
111
Q

Indications for CABG

A

Left stem stenosis
Triple vessel disease
Angina refractory to medication
Unsuccessful angioplasty

112
Q

Complications of CABG

A 
Thromboembolic: mi or stroke
Post-perfusion syndrome
Stenosis of graft
Bleeding: pericardial tamponade or haemothorax
Non Union of sternum
Death
113
Q

Pneumothorax types

A

Traumatic (open or closed= no defect in chest wall)
Spontaneous: primary or secondary. Primary with no underlying lung disease
Iatrogenic

114
Q

Contents of carpal tunnel

A

Median nerve
4 tendons of Flexor Digitorum Profundis
4 tendons of Flexor Digitorum Superficialis
1 tendon Flexor Pollicis Longus

115
Q

Complications of Mitral stenosis

A

Atrial fibrillation
Emboli
Pulmonary hypertension
Left atrium enlargement–> compression surrounding structures

116
Q

Causes of Mitral Regurgitation

A 
FARM
Functional (IHD)
Annular calcification
Rheumatic heart disease
Mitral valve prolapse
117
Q

Causes of aortic regurgitation

A

Valve leaflet:
Endocarditis
Rheumatic fever

Aortic root:
Type A dissection
Dilatation (Marfans or hypertension)
Aortitis (syphilis or Ankylosing spondylitis)

118
Q

Austin Flint murmur

A

Mid diastolic murmur due to regurgitant flow impeding mitral opening (found in AR)

119
Q

Euroscore

A 
Risk model for operative mortality in cardiac surgery.
Takes into account
Patient factors
Heart factors
Operation
120
Q

TAVI

A

Transcatheter Aortic Valve Implantation

121
Q

Minor Criteria for Duke’s

A

FIRE-almost!
Fever
Immune Phenomena: Osler nodes, Roth spots, Glom Neph
Risk Factors: IVDU
Emboli: Janeway lesions, splinter haemorrhages
Almost= Positive blood culture not meeting major criteria

122
Q

Virchow’s Triad

A

Stasis of Blood Flow
Hypercoagulability
Endothelial Injury

123
Q

Causes of AF

A

Cardiac:
IHD
Valve Pathology
Hypertension

Metabolic:
Hyperkalaemia
Thyrotoxicosis
Alcohol

Infection eg Pneumonia

124
Q

Complications of Pacemaker

A

Insertion:
Bleeding
Arrhythmia

Post Insertion;
Erosion
Lead Migration
Pocket Infection
Malfunction
125
Q

Causes of Heart Failure

A

Left:
IHD,
Systemic Hypertension
Mitral or Aortic Valve Pathology

Right:
Left Ventricular Failure
Pulmonary Hypertension
Tricuspid or Pulmonary Valve Pathology

126
Q

New York Heart Failure Classification

A
  1. No Breathlessness
  2. Breathless with Moderate Exertion
  3. Breathless with Mild Exertion
  4. Breathless at Rest
127
Q

Management for Heart Failure

A

First line = beta blocker + ACEi (+ Loop)
Second line = add Spironolactone/ARB
Third= Consider Digoxin
4th= Cardiac Resynchronisation

128
Q

Lots of Chadsvasc and lots of Hasbled criteria met?

A

Consider Left Atrial Appendage Occlusion

129
Q

CHA2DS2VASc

A 
Congestive Cardiac Failure
Hypertension
Age over 75
Diabetes
Stroke or TIA
Vascular disease
Age over 65
Sex is Female
130
Q

Pathology behind Rheumatic Fever

A

Antibody cross reactivity following Strep Pyogenes infection leading to MOLECULAR MIMICRY

antibodies cross react with Myosin, Muscle Glycogen and Smooth Muscle Cells.

Formation of Aschoff bodies and Anitschkow Myocytes

131
Q

Complications of Prosthetic Valves

A 
FIBAT
Failure:
--Acute (dehiscence, breakage, thrombus)
--Chronic (stenosis, incompetence)
Infective Endocarditis (Staph Epidermidis early, Strep Pyogenes late)
Bleeding
Anaemia (from haemolysis or Warfarin)
Thromboembolism
132
Q

Management of osteoarthritis joints (surgical)

A 
Arthroscopic washout (mainly knees, trim cartilage and remove loose bodies)
Realignment osteotomy (
133
Q

Posterior vs Anterior approach for hip

A

Posterior reflects short external rotators and gives better access but has higher dislocation rate cause Sciatic Nerve Injury

Anterior reflects abductors with incision over greater trochanter dividing fascia lata. Superior gluteal nerve may be injured

134
Q

Preventing DVT in surgery

A

Pre op:
Ted stocking
Stop OCP
Aggressive optimisation and hydration

Intra op:
Minimise length of surgery
Pneumatic compression boots

Post op:
LMWH
Early mobilisation
Good analgesia
Adequate hydration
135
Q

Indications, pros and cons of hip resurfacing

A

Indicated in young (

136
Q

Management of bunion

A

Non surgical:
Appropriate footwear: wide, soft
Physio

Surgical:
Bunionectomy
1st metatarsal realignment osteotomy
Excision arthroplasty

137
Q

Management of lesser toe deformities

A

Caused by imbalance between intrinsic and extrinsic toe muscles

Non surgical: appropriate footwear

Surgical:
Flexor to extensor tendon transfer
Arthrodesis
Resection of proximal phalangeal head

138
Q

What is a Charcot joint?

A

Progressive destructive joint arthropathy secondary to disturbance of sensory inner action to the joint resulting in painless deformed joint due to repetitive minor trauma.

139
Q

Phases of gait

A

Heel strike
Stance
Toe off
Swing

140
Q

Bakers cyst + management

A

Posterior herniation of knee joint capsule,
Associated with degenerative knee joint disease

Aspirate but high recurrence

141
Q

Boutonnière deformity

A

PIP flexion with DIP hyper extension

142
Q

Swan neck deformity

A

DIP hyper flexion with PIP hyperextension

143
Q

Z deformity of thumb

A

Hyperextension of interphalangeal joint with fixed flexion and subluxation of the metacarpophalangeal joint

144
Q

Pathophysiology behind Dupuytren’s

A

Local micro vessel ischaemia leading to increased Xanthine Oxidase activity leading to ROS production.
ROS production results in Collagen 3 formation and chronic inflammation leading to continued fibrosis.

145
Q

Locations of median nerve entrapment

A

Carpal tunnel

Deep head of pronator teres (Anterior Intraosseous Syndrome) –muscle weakness only

146
Q

Causes of Boutonnière and Swan neck deformity

A

Boutonnière = rupture of central slip of extensor expansion

Swan= rupture of lateral slips

147
Q

Bouchard vs Heberdens nodes

A

Heberdens at DIPs

Bouchards at PIPs

148
Q

Management of ulnar nerve palsy

A

Non surgical:
Avoid repetitive flexion extension of elbow
Night splinting if elbow in extension

Surgical:
Ulnar nerve decompression
Medial epicondylectomy

149
Q

Management of mallet finger

A

Splint with distal phalanx in extension for six weeks to allow tendon reattachment
If avulsed bone is large may fix it with a Kirschner wire

150
Q

Trigger finger

A

Tendon nodule which catches on proximal side of tendon sheath causing triggering on forced extension
Causes:
Idiopathic
Trauma
Activities requiring repetitive forceful flexion
Secondary to RA

151
Q

Management trigge finger

A

Steroid injection

Tendon release by sheath incision

152
Q

Management of lumbar disc herniation

A

Conservative:
Max 2day bed rest
Keep active and physio (back school)

Medical: analgesia, muscle relaxant (low dose diazepam)

Surgical: if progressive neurological deficit or incapacitating pain
Permutations microdiscectomy
Endoscopic discectomy
Hemilaminotomy plus discectomy

153
Q

Post Op recovery for hernia repair

A 
Pee before leaving 
Early mobilisation
Analgesia
Avoid constipation so give Lactulose
Work in 1-2 weeks
Keep area clean and dry
154
Q

Why do 98% of varicoceles occur on the left?

A

Left testicular vein more vertical
Left renal vein can be compressed by colon
Left testicular vein longer than right and lacks terminal valve to prevent back flow

155
Q

Post Op recovery for hernia repair

A 
Pee before leaving 
Early mobilisation
Analgesia
Avoid constipation so give Lactulose
Work in 1-2 weeks
Keep area clean and dry
156
Q

Why do 98% of varicoceles occur on the left?

A

Left testicular vein more vertical
Left renal vein can be compressed by colon
Left testicular vein longer than right and lacks terminal valve to prevent back flow

PACES (4 decks)

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