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MBBS Y5 > Surgery - Orthopaedics > Flashcards

Surgery - Orthopaedics Flashcards

1
Q

risk factors for OA?

A

NAME?

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2
Q

which joints are commonly affected in OA?

A

NAME?

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3
Q

LOSS: X-ray changes seen in OA?

A

NAME?

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4
Q

presentation of OA?

A

NAME?

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5
Q

hand signs seen in OA?

A
  • bouchard’s nodes (PIPs)- heberden’s nodes (DIPs)- squaring of base of thumb- weak grip- reduced ROM
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6
Q

how is OA diagnosed?

A

does not require investigations if:- age >45- typical pain w/ activity- no morning stiffness (or <30 mins of morning stiffness)

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7
Q

management of OA?

A

NAME?

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8
Q

analgesic ladder in OA?

A
  1. PO paracetamol + topical NSAIDs2. add PO NSAIDs (+PPI)3. weak opioids (codeine)other options:- topical capsaicin - intra-articular steroids
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9
Q

what is a compound fracture?

A

when skin is broken and the broken bone is exposed to air

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10
Q

what is a stable fracture?

A

when sections of the bone remain in alignment at the fracture

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11
Q

what is a pathological fracture?

A

when a bone breaks due to underlying bone abnormalities

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12
Q

give some causes of pathological fractures

A
  • bony mets- osteoporosis- paget’s disease of the bone
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13
Q

which cancers commonly metastasise to the bone?

A

NAME?

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14
Q

what is a colle’s fracture?

A

transverse fracture of the distal radius

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15
Q

which fractures are commonly caused by falling onto an outstretched hand (FOOSH)?

A
  • colle’s fracture| - scaphoid fracture
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16
Q

main complication of a pelvic fracture?

A

intra-abdominal bleeding, which can then cause shock / death

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17
Q

common sites for pathological fractures?

A
  • femur| - vertebral bodies
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18
Q

what is a fragility fracture? commonest cause?

A
  • fracture due to weakness of bone| - osteoporosis
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19
Q

what is the FRAX score?

A

risk of fragility fracture within the next 10 years

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20
Q

how can bone mineral density be calculated?

A

using a DEXA scan

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21
Q

which T-score range means there is osteopenia?

A

-1 to -2.5

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22
Q

which T-score range means BMD is normal?

A

more than -1

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23
Q

T-score range indicating osteoporosis?

A

less than -2.5

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24
Q

WHO criteria for severe osteoporosis?

A

T-score < -2.5 AND a fracture

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25
Q

prophylaxis of fragility fractures in osteoporotic pts?

A

NAME?

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26
Q

key side effects of bisphosphonates?

A

NAME?

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27
Q

what are the 3 key goals of fracture management?

A

NAME?

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28
Q

2 methods of achieving mechanical alignment in fracture management?

A
  • closed reduction (manipulating the limb)| - open reduction (surgery)
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29
Q

complications of a fracture?

A

NAME?

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30
Q

presentation of fat embolism syndrome?

A
  • onset is typically 24-72h after a fracture- respiratory distress- petechial rash- cerebral involvement
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31
Q

how can fat embolism syndrome be prevented?

A

by operating early on the fracture

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32
Q

RFs for hip fracture?

A
  • ageing| - osteoporosis
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33
Q

how can hip fractures be classified?

A
  • intra-capsular| - extra-capsular
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34
Q

describe the capsule of the hip joint

A

NAME?

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35
Q

describe the blood supply to the hip joint

A
  • retrograde blood supply| - supplied by medial and lateral circumflex femoral arteries
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36
Q

when is a hip fracture classed as intra-capsular?

A
  • when there is a break in the femoral neck| - this is proximal to the intertrochanteric line
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37
Q

how can intra-capsular hip fractures be classified?

A

using Garden classification: - grade I = incomplete- grade IV = fully displaced

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38
Q

main complication of an intra-capsular hip fracture?

A

avascular necrosis

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39
Q

how can non-displaced intra-capsular hip fractures be treated?

A

interval fixation with screws

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40
Q

describe a hemiarthroplasty. which pts get offered this?

A

NAME?

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41
Q

describe a total hip replacement. which pts get offered this?

A
  • replacing both head of femur and acetabulum| - pts who are independently mobile and fit for surgery
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42
Q

which is worse: extra-capsular or intra-capsular hip fracture?

A
  • intra-capsular| - in an extra-capsular fracture, the blood supply is left intact, so the head of femur doesn’t need to be replaced
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43
Q

types of extra-capsular hip fracture?

A
  • intertrochanteric| - subtrochanteric
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44
Q

how are intertrochanteric (extra-capsular) hip fractures treated?

A

dynamic sliding hip screw

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45
Q

how are subtrochanteric (extra-capsular) hip fractures treated?

A

intramedullary nail

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46
Q

presentation of a hip fracture?

A

NAME?

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47
Q

investigations for a hip fracture?

A
  • initially: X-ray in 2 views (AP and lateral)| - MRI / CT where X-ray is -ve but fracture still strongly suspected
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48
Q

what might be seen on an AP view X-ray in a hip injury? what does this indicate?

A
  • shenton’s line| - indicates #NOF
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49
Q

management of a hip fracture?

A
  • analgesia- X-ray in 2 views- VTE risk assessment - bloods, ECG for pre-op assessment - operate within 48h (improves prognosis)- orthogeriatrics input
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50
Q

recovery time following a hip replacement surgery?

A

pt should be able to bear weight immediately!

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51
Q

what is compartment syndrome?

A

when the pressure in a fascial compartment is too high

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52
Q

what is acute compartment syndrome? how is it treated?

A

NAME?

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53
Q

5Ps: presentation of acute compartment syndrome?

A

NAME?

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54
Q

describe the pain felt in acute compartment syndrome. which areas might be affected?

A
  • disproportionate to initial injury (fracture / crush)- unresponsive to analgesia- worse on passive stretching of muscles- legs are most common, but also: forearms, feet, thighs
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55
Q

how can acute compartment syndrome be differentiated from acute limb ischaemia?

A

in compartment syndrome, pulses remain present (whereas there’s pulselessness in ALI)

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56
Q

investigation for acute compartment syndrome?

A

needle manometry (measures pressure in compartment)

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57
Q

initial management of acute compartment syndrome?

A

NAME?

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58
Q

definitive management of acute compartment syndrome?

A

emergency fasciotomy

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59
Q

what is chronic compartment syndrome typically associated with?

A

exertion

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60
Q

presentation of chronic compartment syndrome?

61
Q

investigation and management of chronic compartment syndrome?

A
  • needle manometry| - may offer fasciotomy
62
Q

what is osteomyelitis?

A

bacterial infection of the bone and bone marrow

63
Q

how can ostemyelitis occur?

A
  • haematogenous spread of a bacterium| - direct contamination (e.g. from a fracture / surgery)
64
Q

commonest causative organism of osteomyelitis?

A

staph aureus

65
Q

RFs for osteomyelitis?

66
Q

presentation of osteomyelitis?

67
Q

investigations for osteomyelitis?

68
Q

signs on X-ray in osteomyelitis?

69
Q

which bloods are relevant in osteomyelitis?

A
  • WCC| - inflamm markers (CRP, ESR)
70
Q

management of osteomyelitis?

A
  • surgical debridement of infected bone / tissue| - ABx
71
Q

ABx of choice in acute osteomyelitis? how long is the course of these?

A
  • flucloxacillin for 6w- may add on rifampicin / fusidic acid after week 2 - clindamycin if pen allergic
72
Q

ABx of choice in osteomyelitis caused by MRSA?

A

either: vancomycin or teicoplanin

73
Q

how long are ABx taken for in chronic osteomyelitis?

74
Q

management of osteomyelitis caused by an infected prosthetic joint?

A

complete revision surgery (replacing the joint again)

75
Q

what are the 3 types of bone sarcoma?

76
Q

which organism causes kaposi’s sarcoma? which condition is this associated with?

A
  • HHV 8| - end-stage HIV (it is an AIDS-defining illness)
77
Q

commonest type of bone Ca?

A

osteosarcoma

78
Q

presentation of sarcoma?

79
Q

investigations for sarcoma?

80
Q

which CT scan is particularly important in sarcoma? why?

A
  • CT thorax| - lungs are most common place for it to spread to
81
Q

management of sarcoma?

82
Q

what is sciatica?

A

irritation of the sciatic nerve

83
Q

how long does acute lower back pain last?

A

should improve within 1-2 weeks

84
Q

average recovery time after sciatica?

85
Q

causes of mechanical back pain?

86
Q

causes of neck pain?

87
Q

describe torticollis

A
  • waking up with unilateral neck stiffness| - caused by muscle spasm
88
Q

red flag causes of back pain?

89
Q

causes of back pain not directly related to the spine?

90
Q

which nerves make up the sciatic nerve?

91
Q

presentation of sciatica?

A
  • unilateral buttock pain- shoots down the leg, “electric shock” like- pins and needles- numbness- motor weakness- loss of reflexes
92
Q

main causes of sciatica?

A

things that compress the lumbosacral nerve:- herniated disc- spondylolisthesis- spinal stenosis

93
Q

what is spondylolisthesis?

A

when one vertebra is out of alignment with the rest

94
Q

why is bilateral sciatica a red flag?

A

could indicate cauda equina syndrome

95
Q

findings O/E in back pain? what could each of these indicate?

96
Q

what test can be performed to diagnose sciatica?

A

sciatic stretch test

97
Q

describe the sciatic stretch test

A
  • pt lies on their back with leg straight- lift one leg from ankle to 90 degs- then dorsiflex ankle - if sciatic pain felt, then there’s sciatica- symptoms improve on flexing knee
98
Q

main cancers that metastasise to bone?

99
Q

investigations for spinal fractures?

A

X-ray / CT spine

100
Q

investigation for suspected cauda equina?

A

emergency MRI (within hrs of presentaion)

101
Q

investigations for suspected ankylosing spondylitis?

102
Q

key finding on X-ray in late-stage ankylosing spondylitis?

A
  • “bamboo spine”| - everything is fused together
103
Q

finding on MRI spine in early stages of ankylosing spondylitis?

A

bone marrow oedema

104
Q

analgesic ladder for lower back pain?

105
Q

management of sciatica?

106
Q

pathophysiology of cauda equina syndrome?

A

compression of nerve roots at L2 - L3

107
Q

causes of cauda equina syndrome?

108
Q

red flags for cauda equina syndrome?

A

LMN signs: - saddle anaesthesia- loss of sensation in bladder and rectum- urinary retention / incontinence - faecal incontinence- bilateral sciatica - bilateral / severe motor weakness- reduced anal tone on PR

109
Q

management of cauda equina syndrome?

110
Q

key features of metastatic spinal cord compression to differentiate it from cauda equina syndrome?

A
  • UMN signs instead of LMN| - back pain that is worse on coughing or straining
111
Q

management of metastatic spinal cord compression?

112
Q

pathophysiology of spinal stenosis?

A

narrowing of spinal canal causing compression on spinal cord and nerve roots

113
Q

typical age group affected by spinal stenosis?

A

pts aged 60+

114
Q

causes of spinal stenosis?

115
Q

presentation of spinal stenosis?

116
Q

investigations for spinal stenosis?

A
  • MRI = first line| - ABI to r/o PAD
117
Q

management of spinal stenosis?

118
Q

which nerve is affected in meralgia paraesthetica?

A

lateral femoral cutaneous nerve

119
Q

presentation of meralgia paraesthetica?

A
  • NO motor symptoms!!!- burning - numbness- pins and needles- cold sensations - localised hair loss… all on upper outer thigh region
120
Q

which action worsens the pain felt in meralgia paraesthetica?

A

hip extension

121
Q

presentation of trochanteric bursitis? (incl. O/E)

122
Q

what are the 4 ligaments of the knee?

123
Q

presentation of a meniscal tear?

A
  • young pt who heard a “pop” after doing a twisty movement - pain, referred to hip / back- swelling- stiffness, reduced ROM- knee locking - knee “gives way”
124
Q

tests done O/E for suspected meniscal tear?

A
  • mcmurray’s test| - apley grind test
125
Q

according to the ottawa rules, which pts require a knee x-ray (after a knee injury)?

A

high suspicion of bony fracture in these cases:- aged 55+- patellar tenderness- fibular head tenderness- can’t flex past 90 degs- can’t weigh bear

126
Q

investigation for meniscal tear?

A
  • MRI knee| - arthroscopy of knee = gold standard
127
Q

management of meniscal tear?

128
Q

RICE: conservative management of meniscal tears?

129
Q

demographic affected by osgood-schlatter disease?

A

pts aged 10-15 years old

130
Q

pathophysiology of osgood-schlatter disease?

A

inflamed tibial tuberosity, where patellar tendon goes in

131
Q

presentation of osgood-schlatter disease?

A
  • unilateral, gradual onset knee pain| - visible / palpable lump at tibial tuberosity (permanent!)
132
Q

management of osgood-schlatter disease?

133
Q

where do baker’s cysts present?

A

popliteal fossa

134
Q

conditions associated with baker’s cysts?

135
Q

presentation of baker’s cyst?

136
Q

differentials for a lump in the popliteal fossa?

A
  • baker’s cyst- DVT- abscess- popliteal artery aneurysm- ganglion cyst- lipoma - varicose vein- tumour
137
Q

investigation for baker’s cyst?

138
Q

which bone does the achilles tendon attach to?

A

calcaneus bone

139
Q

RFs for achilles tendinopathy?

140
Q

presentation of achilles tendinopathy?

141
Q

management of achilles tendinopathy?

142
Q

presentation of achilles tendon rupture?

A
  • sudden onset achilles / calf pain- snapping sound / sensation- feeling like someone hit them in the back of the leg :(- positive simmonds calf squeeze test (no plantar flexion)
143
Q

how is achilles tendon rupture diagnosed?

144
Q

management of achilles tendon rupture?

145
Q

presentation of plantar fasciitis?

146
Q

management of plantar fasciitis?

147
Q

how can the extent of deformity in a bunion be assessed?

A

weight-bearing X-ray

148
Q

commonest cause of shoulder pain and stiffness?

A

adhesive capsulitis

MBBS Y5 (27 decks)

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