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ICSM Year 6 COPY Helen Lashwood > Surgery - Ortho basics (longer deck in other class) > Flashcards

Surgery - Ortho basics (longer deck in other class) Flashcards

1
Q

In the major haemorrhage protocol, what baseline bloods should be taken pre-transfusion?

A

FBC
Group and save
Clotting
Clauss fibrinogen assay (measures function of fibrinogen)

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2
Q

In which major haemorrhage scenarios can tranexamic acid be given, and how should it be prescribed?

A

If trauma within 3 hours
Dose is 1g bolus over 10 mins followed by 1g infusion over 8 hours

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3
Q

When examining a joint, what 3 things should you assess for?

A

Pain
Effusion
Temperature

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4
Q

What are the 3 main tests to do when examining any joint?

A

Look
Feel
Move

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5
Q

Describe the tests for each muscle of the rotator cuff

A

Supraspinatus tendon: Empty can test
Infraspinatus: External rotation against resistance
Teres minor: Hornblower test
Subscapularis: Internal rotation against resistance

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6
Q

What 2 special tests can be doe on examination for carpel tunnel syndrome? Describe them

A

Tinel’s test: tap along nerve from index finger down through wrist towards antecubital fossa, is positive if tingling or paraesthesia down median nerve as is tapped

Phalen’s test: put hands in like a downwars pray position with backs of hands together, positive if tingling/ paraesthesia in distribution of median nerve

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7
Q

What does the Trendelenburg test assess?

A

Abductor (gluteus medius and minimus) abnormality

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8
Q

What is a positive trendelenburg test?

A

Dip in hip when lifting GOOD side leg

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9
Q

How do you perform Thomas’ test, and what does it assess?

A

Ask pt to lie down, and to bring their knee up to their chest to ‘hug’ it
Positive test = other leg lifts off bed
Tests for fixed flexion deformities eg iliopsoas tightness, ACL tear, osteoarthritis…

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10
Q

How can you identify if leg shortening is tibial or femoral in nature?

A

Galeazzi test
Get pt to lie down, flex hips to 45 degrees and knees to 90 degrees
Test is positive when knees are a different heights
If lower knee displaced towards foot = shortened tibia, if displaced towards body = shortened femur

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11
Q

What can you do on examination to test for Achilles tendon rupture?

A

Simmond’s test
Calf squeeze –> foot movement

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12
Q

What can you do on examination to test for Morton’s neuroma?

A

Mulden’s test
Clasp metatarsals and poke plantar side of foot - positive test will be pain/ tingling

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13
Q

After an orthopaedic examination in PACES, what can you say you would like to do to finish your examination?

A

Assess neurovascular status
Assess joints above and below
Test the contralateral joint

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14
Q

What are the 4 stages of fracture healing and how long does each one last?

A
  1. Reactive: first 48 hours
    Reparative phase = 2 days - 2 weeks
  2. Proliferation (reparative phase part 1)
  3. Consolidation (reparative phase part 2)
  4. Remodelling = 1 week - 7 years
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15
Q

What is an avulsion fracture?

A

When small chunk of bone attached to a tendon/ligament gets pulled away from the main part of the bone. Common in young athletes

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16
Q

What radiographs do you need to image a fracture properly?

A

Orthogonal radiographs (at right angles) –> request AP and lateral films

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17
Q

What is an open vs closed fracture?

A

Open breaks the skin, closed doesn’t

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18
Q

What is an extraarticular fracture?

A

One that doesn’t cross the surface of a joint

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19
Q

What is fracture angulation?

A

Where the normal axis of the bone has been altered such that the distal portion of the bone points off in a different direction

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20
Q

What is fracture translation?

A

Movement of the fractured bones away from each other

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21
Q

What are the 4 elements of fracture ‘deformity’ you might comment on?

A

Translation (‘translocation’)
Angulation
Rotation
Impaction

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22
Q

What are the ‘four Rs’ of fracture management?

A

Resuscitation
Reduction
Restriction
Rehabilitation

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23
Q

Recall the principles of resuscitation in fracture management

A
  1. ATLS - Trauma assessed in primary survey (C spine, chest, pelvis) with secondary survey addressing #
  2. Assess neurovascular status and look for dislocations
  3. Stabilise BEFORE imaging
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24
Q

Recall the ‘6 As’ of managing open fractures

A

Analgesia

Assess: NV status, soft tissues, photograph

Alignment: align # and splint

Anti-sepsis: wound swab, copious irrigation, cover with betadine-soaked dressing

Anti-tetanus: check status (booster lasts 10 years)

Antibiotics: flucloxacillin 500mg IV/IM, benzylpenicillin 600mg IV/IM)

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25
Q

What system can be used to classify open fractures?

A

Gustilo classification

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26
Q

Differentiate the 3 types of fracture in the Gustilo classification in terms of size

A

Type 1: <1cm
Type 2: 1-10cm
Type 3: >10cm

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27
Q

When describing the possible complications of fracture management, under what sub-headings can you classify them? Name some complications under each subheading

A

Anaesthetic - anaphylaxis, damage to teeth, aspiration

Intra-operative - bleeding, damage to local structures (eg neurovascular injury), treatment failure

Early post-operative - compartment syndrome, infection (surgical site, UTI, bed sores), VTE, ABx colitis

Late post-operative - scarring, fx loss, neuropathy, pain, myositis ossificans

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28
Q

What is myositis ossificans?

A

A condition where bone tissue forms inside muscle or other soft tissue after an injury at sites of haematoma formation

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29
Q

Describe how compartment syndrome develops

A

Oedema from fracture –> increased pressure –> decreased venous drainage –> increased pressure –> ischaemia

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30
Q

What are the signs and symptoms of compartment syndrome?

A

Pain on passive stretching
Warmth, erythema, swelling, weak pulses, increased CRT

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31
Q

Recall 2 fracture sites that are most associated with compartment syndrome

A

Suprachondylar fractures
Tibial shaft fractures

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32
Q

How should compartment syndrome be managed?

A

Elevate limb, remove all bandages/ splint etc – fasciotomy

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33
Q

How should myositis ossificans be managed?

A

Excision

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34
Q

Recall 2 criteria that can be used to diagnose complex regional pain syndrome

A

Budapest criteria
IASP criteria

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35
Q

What are the signs and symptoms of complex regional pain syndrome?

A

Affects a NEIGHBOURING area to the area affected by trauma
Hyperalgesia
Allodynia
Vasomotor disturbance (may be hot + sweaty or cold + cyanosed)
Swollen, atrophic and shiny skin
Hyperreflexia/ contractures/ dystonia

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36
Q

Recall some medical and surgical options for managing complex regional pain syndrome

A

Medical: amitriptyline + gabapentin
Surgical: regional nerve block

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37
Q

Recall the signs and symptoms of fat embolism

A

Looks like a PE but with neurological signs
Onset of dyspnoea, hypoxia and tachypnoea within 24 hours of multiple fractures
CNS signs: confusion, agitation, retinal haemorrhage
Dermatological: 25-50% develop a petechial rash

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38
Q

How should fat embolism be managed?

A

DVT prophylaxis

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39
Q

What are the Ottawa rules used for?

A

To decide if an x ray is needed

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40
Q

Recall the 4 criteria of the Ottawa knee rule

A
  • Over 55 years old
  • Isolated patellar tenderness
  • Cannot flex to 90 degrees
  • Inability to weight bear both immediately and in A&E for >4 steps
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41
Q

Recall the Ottawa ankle rule (much more complicated than knee!)

A

LMN FUN
Malleolar zone pain +
- Lateral malleolus posterior edge tenderness
- Medial malleolus posterior edge tenderness
- No weight bearing - both immediately and for 4 steps in A&E

Mid foot zone +
- Fifth metatarsal base pain
- Unable to weight bear immediately or for 4 steps in A&E
- Navicular tenderness

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42
Q

Recall the risk factors for #NOF

A

SHATTERED
Steroids
Hyperthyroidism/hyperparathyroidism
Alcohol/ smoking
Thin (BMI<22)
Testosterone LOW
Erosive bone disease (eg RhA, MM)
Renal failure
Early menopause
Dietary calcium low, DM

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43
Q

What is the key examination finding in #NOF?

A

Leg is shortened with external rotation

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44
Q

If someone’s leg is shortened and internally rotated, what is this indicative of?

A

Posterior dislocation of the hip

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45
Q

What are the 3 types of intracapsular NOF#?

A

Subcapital
Transcervical
Basicervical

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46
Q

What are the 3 types of extracapsular NOF#?

A

Intertrochanteric
Subtrochanteric
Reverse oblique

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47
Q

What is the best analgesia for a #NOF?

A

Iliofascial nerve block

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48
Q

What is the surgical management of intertrochanteric #NOF?

A

Dynamic hip screw

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49
Q

How should extracapsular NOF# be managed?

A

ORIF (although intertrochanteric # can be managed with a DHS)

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50
Q

How can the degree of displacement of an intracapsular NOF# be classified?

A

Using Garden classification (grades I-IV)

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51
Q

What is the difference between a total hip replacement and a hemiarthroplasty?

A

THR = replaces femoral head and acetabulum
Hemiarthroplasty = replaces femoral head

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52
Q

What is the 1 year mortality for NOF#?

A

30%

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53
Q

What type of NOF# is most likely to be complicated by osteonecrosis and why?

A

Transcervical fracture
Retinacular artery is disrupted from medial circumflex femoral artery

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54
Q

What are the signs and symptoms of osteonecrosis of the hip?

A

Anterior hip pain on climbing the stairs
Insidious onset

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55
Q

How can osteonecrosis of the hip be medically managed?

A

Bisphosphonates

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56
Q

Recall 4 options for managing humeral fracture and the general indications for each one

A

Collar & cuff: 2 parts, minimally displaced, high surgical risk
ORIF: >2 parts but not highly comminuted
Arthroplasty: large displacement of humeral head and high risk of non-union
Reverse arthroplasty - irreprable rotator cuff/ previous unsuccessful replacement

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57
Q

What is the most common type of paediatric elbow fracture?

A

Suprachondylar humeral #

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58
Q

How will a suprachondylar humeral # appear on examination?

A

Elbow swollen and hand semi-flexed

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59
Q

What is the most likely artery to be severed by a suprachondylar humeral #?

A

Brachial artery (by sharp edge of proximal humerus)

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60
Q

What is the most likely nerve to be damaged by a suprachondylar humeral #?

A

Median nerve

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61
Q

What are the signs and symptoms of subluxation of the humeral head?

A

Elbow pain and limited supination and extension of the elbow

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62
Q

What is the ‘dinner fork’ deformity associated with?

A

Colle’s #

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63
Q

What is Colle’s #?

A

Posterior displacement and angulation of the distal radius fragment

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64
Q

What is Smith’s #?

A

Anterior displacement and angulation of the distal radius fragment

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65
Q

What is the typical history of Colle’s vs Smith’s #?

A

Colle’s = fall on an extended wrist
Smith’s fall on a flexed wrist

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66
Q

Recall 5 signs of scaphoid fracture

A

[1] Pain in the anatomical snuffbox
[2] Wrist joint effusion
[3] Pain on telescoping thumb
[4] Tenderness on scaphoid tubercle
[5] Pain on ulnar deviation of wrist

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67
Q

Why are scaphoid fractures particularly vulnerable to avascular necrosis?

A

Retrograde blood supply
80% is from the dorsal carpal branch of the radial artery

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68
Q

What is the most common long bone fracture?

A

Tibial

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69
Q

Which bone articulates with the tibia and fibula at the ankle joint?

A

Talus

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70
Q

What is Pott’s fracture?

A

Bimalleolar #

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71
Q

What is a Lisfranc injury?

A

An injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus

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72
Q

Recall some signs and symptoms of Lisfranc injury

A

Medial plantar bruising
Unable to weight bear
Gross midfoot swelling with severe pain

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73
Q

What is the most common metatarsal to be fractured in children vs adults?

A

Children: 1st
Adults: 5th

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74
Q

Recall 3 signs/symptoms of fractured patella

A
  1. Palpable patellar defect
  2. Significant haemarthrosis
  3. Loss of straight leg raise
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75
Q

What 3 x ray views are recommended to image a patellar fracture?

A

AP
Lateral
Skyline (inferior-superior)

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76
Q

How should patellar # be managed if the # is comminuted and ORIF is not possible?

A

Partial patellectomy, or total patellectomy if no salvage potential

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77
Q

What are the main signs and symptoms of compartment syndrome?

A

Excessive use of breakthrough analgesia due to significant pain

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78
Q

Why might arterial pulses still be palpable in compartment syndrome?

A

Necrosis occurs as a result of microvascular compromise

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79
Q

How can a manometer be used to help diagnose compartment syndrome?

A

Can use to measure intracompartmental pressure (ICP)
Normal pressure = 0-10mmHg
Delta pressure <30mmHg = compartment syndrome
Absolute pressure >30mmHg = compartment syndrome

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80
Q

Recall some non-operative options for managing compartment syndrome

A
  • Fluid resuscitation to ensure normotension (as hypoperfusion accelerates tissue injury)
  • Remove circumferential bandages and casts
  • Maintain limb at level of heart
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81
Q

How can compartment syndrome be managed operatively?

A

Fasciotomy

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82
Q

Which tendon is impinged in ‘subacromial impingement’?

A

Supraspinatus tendon

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83
Q

What is Hawkin’s test used to diagnose, and how is it performed?

A

For shoulder impingement
90 degrees shoulder and elbow flexion
Passive internal rotation of the arm –> pain

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84
Q

Recall some differentials for subacromial impingement

A

Adhesive capsulitis
Supraspinatus tear
Osteoarthritis/ Rheumatoid/ Septic arthritis
Gout/ Pseudogout

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85
Q

Recall some management options for subacromial impingement under the headings of ‘conservative’, ‘medical’ and ‘surgical’

A

Conservative: rest, phyisio
Medical: NSAIDs, subacromial bursa steroid
Surgical: athroscopic acromioplasty

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86
Q

What are the 3 stages of calcific tendonitis of the shoulder?

A
  1. Pre-calcific (pain-free fibrocartilaginous metaplasia of tendon)
  2. Calcific (phases of varying levels of pain)
  3. Post-calcific
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87
Q

What imaging is useful in calcific tendonitis of the shoulder?

A

XR (shows deposits on AP)
US (shows extend of calcification and targets therapy)

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88
Q

What are the 4 muscles of the rotator cuff?

A

Supraspinatus
Infraspinatus
Subscapularis
Teres minor

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89
Q

Recall 4 risk factors for a rotator cuff tear

A

Age >60
Smoking
Family history
Hypercholesterolaemia

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90
Q

How can you differentiate between a partial and complete rotator cuff tear?

A

Partial –> painful arc

Complete –> shoulder tip pain, FULL RANGE of passive movement but with inability to abduct arm. Active abduction IS possible following passive abduction to 90 degrees. ‘Drop arm’ sign (lowering arm beneath 90 degrees abduction –> sudden drop)

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91
Q

Recall which muscles are involved in each stage of arm abduction

A

0-15 degrees = supraspinatus
15-90 degrees = deltoid
>90 degrees = serratus anterior + trapezius

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92
Q

What test can be used to test teres minor and how is it performed?

A

Hornblower’s test
Shoulder in 90 degrees abduction and elbow in full flexion
Positive test = pain/ inability to maintain

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93
Q

What is adhesive capsulitis?

A

Condition characterised by loss of active AND passive movement with no clear cause

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94
Q

Recall the stages of adhesive capsulitis

A

Stage 1: Freezing - gradual onset of diffuse pain
Stage 2: Frozen - decreased ROM
Stage 3: Thawing - gradual return of ROM

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95
Q

What is the main associated condition with adhesive capsulitis?

A

Diabetes

96
Q

What % of shoulder dislocations are anterior vs posterior vs inferior?

A

Anterior: 90%
Posterior: 6%
Inferior: 2-4%

97
Q

Which direction of shoulder dislocation is associated with seizures?

A

Posterior

98
Q

How does acromioclavicular joint dislocation appear on examination?

A

‘Step’ deformity and prominent clavicle

99
Q

What are the signs of glemohumeral dislocation on examination?

A

Shoulder contour lost (‘square shoulder’)
Bulging infraclavicular fossa

100
Q

What is the management of glenohumeral dislocation?

A

Reduction with sedation
Rest in sling for 3-4 weeks
Physio

101
Q

Which tendon of the biceps is much more likely to get ruptured?

A

Long

102
Q

What is a ‘popeye deformity’?

A

Caused by proximal biceps tendon rupture - muscle bulk results in a bulge in the middle of the upper arm

103
Q

How can you test for biceps tendon rupture on examination?

A

Biceps squeeze test –> supination if tendon is intact

104
Q

What is the best form of imaging for initial assessment of a proximal biceps tendon rupture?

A

USS

105
Q

What is the best form of imaging for initial assessment of a distal biceps tendon rupture?

A

MRI - it’s a difficult clinical diagnosis and requires surgery

106
Q

What are the colloquial names for lateral vs medial epicondylitis?

A

Lateral = tennis
Medial = golfer’s

107
Q

Which movements will worsen pain in lateral vs medial epicondylitis?

A

Lateral: worse on wrist extension
Medial: worse on wrist flexion

108
Q

What is the best form of imaging to investigate epicondylitis?

A

USS

109
Q

What is the main symptom of olecranon bursitis?

A

Swelling over posterior aspect of elbow

110
Q

Which nerve is compressed in radial tunnel syndrome, and what symptoms does this nerve compression produce?

A

Posterior interosseous branch of radial nerve
Symptoms very similar to lateral epicondylitis (pain in lateral epicondyle, worse on wrist extension, decreases grip strength)

111
Q

Recall 6 associations with carpal tunnel syndrome

A

People who play DA HARP
Diabetes
Acromegaly

Hypothyroidism
Amyloidosis
Rheumatoid arthritis
Pregnancy

112
Q

Which nerve is entrapped in carpal tunnel?

A

Median

113
Q

Which digits get paraesthesia in carpal tunnel syndrome?

A

1st, 2nd and medial half of 3rd

114
Q

What is the best investigative test for carpal tunnel syndrome?

A

EMG

115
Q

How can carpal tunnel be managed conservatively?

A

Wrist splints at night

116
Q

How can carpal tunnel be managed if conservative management is unsuccessful?

A

Corticosteroid injection –> surgical decompression

117
Q

What is cubital tunnel syndrome?

A

Ulnar nerve entrapment at elbow

118
Q

What is Guyon canal syndrome?

A

Ulnar nerve entrapment at wrist

119
Q

Recall some risk factors for both Cubital Tunnel Syndrome and Guyon Canal Syndrome

A

Cubital tunnel: cycling, ganglion cyst pressure
Guyon canal: leaning on elbow

120
Q

What are the signs and symptoms of ulnar nerve entrapment?

A

Pins and needles in 4th and 5th digit
Claw hand

121
Q

Recall some conservative and surgical options for managing ulnar nerve entrapment

A

Conservative: wrist splints at night
Surgical: Corticosteroid injection –> surgical decompression

122
Q

What is the aetiology of De Quervain’s Tenosynovitis?

A

Sheath containing extensor pollicis brevis + abductor pollicis longus tendons becomes inflamed

123
Q

Recall some signs and symptoms of De Quervain’s Tenosynovitis

A

Tenderness over radial styloid and radial side of wrist

Abduction of thumb is painful

124
Q

What is Finkelstein’s test used to investigate and how is it performed?

A

Used to investigate De Quervain’s Tenosynovitis

Examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction –> pain in the radial styloid and along the length of EPB and APL

125
Q

How can De Quervain’s Tenosynovitis be managed?

A

Analgesia + activity modification

Steroid injections + thumb splint –> surgery (if conservative measures have failed after 6 months)

126
Q

What is Dupuytren’s contracture?

A

Progressive, painless and fibrotic thickening of the palmar fascia

127
Q

What is the aetiology of Dupuytren’s contracture?

A

Fibroblasts replaced by myofibroblasts which produce a contractile element

128
Q

Recall the associations of Dupuytren’s contracture

A

BAD FIBRES

Bent penis (Peyronie’s)
AIDS
Diabetes mellitus

Family history
Idiopathic (most common)
Booze (ALD)
Riedel’s thyroiditis
Epilepsy and anti-epileptics
Smoking

129
Q

What is a trigger finger?

A

Tendon nodule which catches on proximal side of tendon sheath –> triggering on forced extension

130
Q

How can a trigger finger be managed?

A

Steroid injection (high recurrence)
Surgical release of 1st pulley

131
Q

What is a ganglion?

A

Smooth, multilocular cystic swellings

132
Q

What is the aetiology of ganglions?

A

Mucoid degeneration of joint capsule / sheath which may communicate with joint capsules/ tendons

133
Q

What are the signs and symptoms of ganglion?

A

Subdermal swellings, fixed to deeper structures + limits planes of movement +/- pain on nerve pressure symptoms

134
Q

How should ganglions be managed?

A

50% disappear spontaneously
Aspiration +/- steroid and hyaluronidase injection
Surgical excision

135
Q

If someone has the symptom of knee locking, what are the differentials?

A

Obstructive causes:
- Meniscal/ cruciate tear
- Osteochondritis dissecans
- Osteophytes

136
Q

What is the O’Donoghue Unhappy Triad?

A

Describes 3 soft tissue injuries that commonly occur together following a lateral blow to the knee on a fixed foot (eg football/ rugby)
- Ruptured ACL
- Ruptured MCL
- Damaged medial meniscus

137
Q

Describe the typical presentation of ACL rupture

A

Rotational sports injury
Loud crack with pain
Rapid swelling due to haemarthrosis

138
Q

Recall 2 signs of PCL rupture

A
  1. Tibial lies posterior to femur
  2. Paradoxical anterior draw test
139
Q

What is the key sign of MCL rupture

A

Knee unstable in valgus stress test

140
Q

What are the signs and symptoms of a torn meniscus in the knee?

A
  • DELAYED knee swelling (immediate more likely to be ACL rupture)
  • Joint locking
  • Recurrent pain/ effusions
  • McMurray’s test positive
141
Q

What cause of knee pain typically affects teenage girls?

A

Chondromalacia patellae

142
Q

Why would a visible fluid level in the knee (lipohaemarthrosis) on X ray lead you to perform an MRI?

A

It is either a # or a cruciate ligament tear

143
Q

What is the most obvious sign on examination of a medial/ lateral cruciate ligament tear

A

Extreme valgus/ varus

144
Q

What movement produces the most pain in a meniscal tear?

A

When loading knee in flexion (going downstairs)

145
Q

How can meniscal tears be managed?

A

Arthroscopic debridement or repair (depends on site)

146
Q

How does site of meniscal tear affect management?

A

Lateral 1/3 tears might be able to be managed conservatively as they have a very rich blood supply

Medial tears 2/3 tears may need a meniscectomy as poor supply of blood

147
Q

What is Osgood-Schlatter’s disease?

A

Tibial tuberosty apophysitis and patellar tendonitis

148
Q

Can Osgood-Schlatter’s disease be bilateral?

A

Yes, it is in 25-50%

149
Q

How is Osgood-Schlatter’s disease diagnosed?

A

Clinical diagnosis + XR

150
Q

What would an X ray show in Osgood-Schlatter’s disease?

A

Fragmentation of tibial tubercle and overlying soft tissue swelling

151
Q

What are the signs and symptoms of osgood schlatter’s?

A

Knee pain after exercise with gradual onset
Localised tenderness and swelling over the tibial tuberosity
Hamstring tightness

152
Q

How should Osgood-Schlatter’s disease be managed?

A

Analgesia, ice packs
Reassure –> should resolve at end of growth spurt

153
Q

What is meralgia paraesthetica?

A

Syndrome of paraesthesia/ anaesthesia in distribution of the lateral femoral cutaneous nerve

154
Q

In what age group does meralgia paraesthetica typically develop?

A

30-40y

155
Q

What are the signs and symptoms of meralgia paraesthetica?

A

Upper lateral thigh burning, tingling, coldness or shooting pain
NO MOTOR WEAKNESS
Symptoms usually aggravated by standing and relieved by sitting

156
Q

How can you reproduce symptoms of meralgia paraesthetica on examination?

A

Deep palpation beneath ASIS

157
Q

What is the main symptom of chondromalacia patellae?

A

Patellar aching after prolonged sitting or climing stairs

158
Q

How can you investigate for chondromalacia patellae?

A

Clarke’s test
Pain on patellofemoral compression

159
Q

What would be seen on XR in chondromalacia patellae?

A

Normal film

160
Q

How can symptoms of chondromalacia patellae be improved?

A

Vastus medialis strengthening

161
Q

What is a ‘Baker’s cyst’?

A

Popliteal extensions of the gastrocnemius-semimembranosus bursa (not a true ‘cyst’)

162
Q

If Baker’s cysts are secondary, what are they likely to be secondary to?

A

Osteoarthritis

163
Q

What are the signs and symptoms of Baker’s cysts?

A

Swelling in popliteal fossa

164
Q

What is the mainstay of management for low ankle sprain?

A

RICE (rest, ice, compression, elevation)

165
Q

Which prescription drug is highly associated with achilles tendon rupture?

A

Quinolones (eg ciprofloxacin)

166
Q

What is Simmond’s triad?

A

100% sensitive in combination for picking up an Achilles’ tendon rupture
- Thomas test does not elicit plantarflexion
- Angle of declination (greater dorsiflexion of injured foot)
- Gap in tendon path

167
Q

Which type of imaging is diagnostic of Achiles tendon rupture?

A

USS

168
Q

What are the signs and symptoms of Morton’s neuroma?

A

‘Walking on a marble’
Shooting pain in the ball of the foot
Numb toes

169
Q

Where is the most common site of Morton’s neuroma?

A

Between 3rd and 4th tarsal bones

170
Q

What form of imaging can confirm a diagnosis of Morton’s neuroma?

A

USS

171
Q

What is the management of Morton’s neuroma?

A

Orthotics –> steroid injections –> surgical resection

172
Q

What is plantar fasciitis?

A

Inflammation of the plantar aponeurosis

173
Q

What would make plantar fasciitis better or worse?

A

Exercise makes it better
Inactivity makes it worse

174
Q

What is the management for plantar fasciitis?

A

Orthotics
Physiotherapy
Analgesia
Steroid injection
Refer to orthopaedics

175
Q

What is the proper name for a bunion?

A

Halux valgus

176
Q

How can bunions be managed conservatively?

A

Bunion pads
Plastic wedge between great and 2nd toes

177
Q

What surgery can be used to fix bunions?

A

Metatarsal osteotomy

178
Q

What are the signs and symptoms of charcot foot?

A

Deformity
Debris
Density change
Destruction
Dislocation

179
Q

What are the signs and symptoms of cervical spondylosis?

A

Neck pain and headaches

180
Q

What are the signs and symptoms of lumbar spine stenosis?

A

Back pain that is worse when standing
Leaning forward relieves it
Neuropathic pain
Neurogenic claudication
Preserved distal pulses

181
Q

What is the most common pathogen implicated in discitis?

A

Staph aureus

182
Q

What is the most common pathogen implicated in iliopsoas abscess?

A

Staph aureus

183
Q

What is the difference between the investigation of choice for discitis vs iliopsoas abscess?

A

Discitis: MRI (if S aureus –> echo)
Iliopsoas abscess: CT

184
Q

What is the difference between the management of choice for discitis vs iliopsoas abscess?

A

Discitis: IV Abx
Iliopsoas abscess: Abx and percutaneous drain

185
Q

What is Brown-Sequard syndrome?

A

Hemisected spinal cord

186
Q

What are the signs and symptoms of Brown-Sequard syndrome?

A

Ipsilateral paralysis
Ipsilateral loss of proprioception & fine touch
Contralateral loss of pain & temperature

187
Q

What is the management of developmental dysplasia of the hip in a child <6 months old?

A

Pavlik harness for 6 months

188
Q

What is Perthes’ disease?

A

Avascular necrosis of the proximal femoral epiphysis from interruption of supply –> revascularisation and reossification over 18-36 months

189
Q

What test can you perform on examination to test for Perthes?

A

Roll test
Roll affected hip internally and externally –> guarding or spasm

190
Q

Recall the management protocol for Perthes disease

A

If <6 years: analgesia, traction, crutches, physio to improve ROM

If >6 years: pelvic/ femoral osteotomy

191
Q

What is SCFE?

A

Slipped Capital Femoral Epiphysis
Displaced of epiphysis of femoral head postero-inferiorly

192
Q

What are the 2 main key examination findings in SCFE?

A

Loss of internal rotation of a flexed hip
Trendelenburg gait positive

193
Q

How is SCFE managed?

A

Percutaneous internal fixation at growth plate

194
Q

Which prognostic scoring systems are useful in osteoporosis?

A

FRAX
QFracture
Estimate a patient’s 10 year risk of developing a fragility fracture

195
Q

Recall the treatment indications for bisphosphonates

A
  • Fragility fracture + age >75
  • Fragility fracture + T score 65y and on/ about to start longterm steroids
196
Q

When should you give immediate bisphosophonates to patients who are on or about to start longterm steroids?

A
  • If they are over 65
  • If under 65 then do a DEXA - give bisphosphonates if score -1 or less
197
Q

What treatments should you give alongside bisphosphonates?

A

Always vitamin D
Calcium supplements IF low levels

198
Q

What are some contraindications to bisphosphonates?

A

eGFR <30
Severe GORD
Recurrent gastric ulcer

199
Q

Recall the instructions for administration of PO bisphosphonates

A

Take on empty stomach in the morning
Full glass of water
Stay upright for 30 minutes

200
Q

If PO bisphosphonates are not tolerated, what alternative is there?

A

Annual IV zoledronate

201
Q

What is the 2nd line for bisphosphonates if they are not contra-indicated?

A

SC denosumab

202
Q

Recall some abnormalities that might be seen in the hands in osteoarthritis?

A

Heberden’s nodes (DIPJ)
Bouchard’s nodes (PIPJ)

203
Q

What are the 4 indications of osteoarthritis on X ray?

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

204
Q

Recall some options for managing osteoarthritis

A

Wt loss
Physiotherapy
1st line: PO paracetamol w/ topical NSAID
2nd line: PO NSAIDs + PPI or weak opioids or capsaicin cream
3rd line: intra-articular corticosteroids
Surgical: joint replacement

205
Q

Recall some immediate, early and late complications of T knee replacements

A

Immediate: vascular/ nerve injury
Early: DVT, prosthesis infection
Late: Loosening, instability from los ACL

206
Q

What is osteochondritis?

A

Idiopathic condition in which bony centres of paediatric bones become temporarily softened due to osteonecrosis

207
Q

What would be seen on X ray in osteochondritis?

A

Increased density/ sclerosis –> patchy appearance

208
Q

What is the management for osteochondritis dissecans?

A

Arthroscopic removal

209
Q

What is pre-patellar bursitis?

A

It’s an infection of the potential space in front of the patella

210
Q

What should you ask about in the history if you are querying pre-patellar bursitis?

A

History of kneeling (eg builders)

211
Q

How should pre-patelllar bursitis be managed?

A

Analgesia, compression, aspiration

212
Q

Recall the risk factors for septic arthritis, and split them into modifiable and non-modifiable

A

Modifiable:
crystal arthropathies
Non-modifiable:
Age >90, rheumatoid arthritis, chronic renal failure, prosthetic joints

213
Q

What investigations should be done to investigate septic arthritis?

A

XR
USS and MC&S joint aspirate
Bloods
Blood cultures

214
Q

How should septic arthritis be managed?

A

IV antibiotics
Joint washout

215
Q

What is the investigation of choice in suspected osteomyelitis?

A

MRI

216
Q

What is the management for osteomyelitis?

A

IV antibiotics and radical debridement to living bone

217
Q

What is the most likely pathogen in a prosthetic joint infection within 6 weeks of infection and after that?

A

<6 weeks: S. aureus
>6 weeks: S. epidermidis

218
Q

What are the 2 main types of non-neoplastic bone tumours?

A

Fibrous dysplasia
Simple bone cyst

219
Q

Which bone tumour produces a ‘shepherd’s crook deformity’ on X ray?

A

Fibrous dysplasia

220
Q

Recall the names of 3 types of benign cartilaginous neoplasms

A

Osteochondroma
Endochondroma
Chondroblastoma

221
Q

What is the most common benign bone tumour?

A

Osteochondroma

222
Q

What is the most likely location of an osteochondroma?

A

Knee

223
Q

What is a chondrosarcoma?

A

A malignant cartilaginous neoplasm

224
Q

What are the most common sites of chondrosarcomas?

A

Pelvis
Axial skeleton

225
Q

Which form of tumour produces the appearance of ‘popcorn calcification’ on x ray?

A

Chondrosarcoma

226
Q

Recall the 4 main different types of benign bone-forming neoplasms

A

Osteoma
Osteoid osteoma
Osteoblastoma
Osteoclastoma (giant cell tumour)

227
Q

Which bone tumour typically produces severe nocturnal pain in young adults?

A

Osteoid osteoma

228
Q

Which bone tumour produces a ‘soap bubble’ appearance on X ray?

A

Giant cell tumour/ osteoclastoma

229
Q

What are the 2 main forms of malignant bone-forming neoplasms?

A

Osteosarcoma
Ewing’s sarcoma

230
Q

What is the most common malignant primary bone tumour?

A

Osteosarcoma

231
Q

Which bone tumour is associated with onion-skinning of the periosteum on X ray?

A

Ewing’s sarcoma

232
Q

In which dermatomes is sensation lost in Erb’s palsy?

A

C5 C6

233
Q

In which dermatomes is sensation lost in Klumpke’s?

A

C8 T1

234
Q

What muscle groups would be paralysed in Erb’s palsy?

A

Abductors and external rotators –> waiter’s tip

235
Q

What muscle groups would be paralysed in Klumpke’s?

A

Small muscles of hand –> claw hand

236
Q

What are the symptoms of trochanteric bursitis?

A

Isolated lateral hip/thigh pain with tenderness over the greater trochanter

237
Q

How should Reiter’s syndrome/ reactive arthritis be managed?

A

Acutely: NSAIDs and possible intra-articular steroids
Chronic: sulfasalazine/ methotrexate

ICSM Year 6 COPY Helen Lashwood (20 decks)

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