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A&E, T&O & ICU > T&O > Flashcards

T&O Flashcards

1
Q

19M pain in R hand after punching a wall.
bruising/swelling on ulna side of hand. unable to make a fist due to pain.
what bone is broken?

A

5th metacarpal

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2
Q

where is lunate

A

articulates with radius centrally

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3
Q

67M painful swollen knee for 24 hours. temp 37.6, hr 104, bp 116/80.
L knee is red, swollen, hot to touch, no weight bearing, reduced range of motion.
raised CRP, raised neutrophils and platelets.
immediate Ix?

A

joint aspiration for microscopy and culture

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4
Q

67M painful swollen knee for 24 hours. temp 37.6, hr 104, bp 116/80.
L knee is red, swollen, hot to touch, no weight bearing, reduced range of motion.
raised CRP, raised neutrophils and platelets.
Dx?

A

septic arthritis

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5
Q

joint types affected by RA

A

multijoint, symmetrical, gradual onset

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6
Q

what does serum uric acid help diagnose

A

gout

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7
Q

what does anti CCP AB test diagnose

A

RA

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8
Q

what is the dermatome nerve of middle finger

A

c7

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9
Q

what is the dermatome nerve of thumb

A

c6

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10
Q

what is the dermatome nerve of little finger

A

c8

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11
Q

7M with sprained ankle, in pain, red, swollen.
what is the mediator causing pain?

A

bradykinin

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12
Q

23F pain and swelling in R ankle after inverting it playing netball. no bony tenderness, able to weight bare but painful.
what ligament is torn?

A

anterior talofibular

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13
Q

88F falls from standing height at home.
afterwards she has ++ pain in R groin, difficulty mobilising.
R leg shortened and externally rotated.
Dx?

A

fractured NOF

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14
Q

88F falls from standing height at home.
afterwards she has ++ pain in R groin, difficulty mobilising.
R leg shortened and externally rotated.
fractured NOF diagnosed. why is the leg shortned?

A

fractured bone is less able to resist forces of pulling from leg muscles so it is pulled up

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15
Q

48M L wrist drop and numbness over L hand.
drank bottle of whisky, fell asleep with arm over back of chair.
reduced power of L wrist extension and numbness of radial aspect of L hand. Dx?

A

radial nerve injury

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16
Q

48M L wrist drop and numbness over L hand.
drank bottle of whisky, fell asleep with arm over back of chair.
reduced power of L wrist extension and numbness of radial aspect of L hand. what is underlying pathophysiological process?

A

neurapraxia

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17
Q

what is neurotmesis

A

most severe nerve injury - cut straight through nerve

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18
Q

what is neuroma

A

tissue develops over damaged area over time

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19
Q

what is mildest type of nerve damage

A

neurapraxia

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20
Q

32M sharp pain at base of thumb having FOOSH off ladder.
pain on moving thumb and when pinching / gripping. no swelling but is tender.
Dx?

A

scaphoid fracture

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21
Q

20F fell from horse, R shoulder pain and anterior shoulder dislocation. what nerve is most likely to be damaged?

A

axillary

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22
Q

20F fell from horse, R shoulder pain and anterior shoulder dislocation. how do you test that the axillary nerve has been damaged?

A

sensation over regimental patch

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23
Q

25M assaulted with beer glass, cut hand/wrist. concern that median nerve is damaged - how is this assessed?

A

abduction of thumb

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24
Q

what nerve controls most of the movement of the hand

A

ulna nerve

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25
Q

what is the bone pneumonic for the function of bone

A

B - biochem, biomech, biomaterial
O - osteoblasts / clasts / cytes
N - number of bones in body (206)
e - extracellular fluid

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26
Q

what is the most common bone cell

A

osteocytes

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27
Q

how many bones are in the body

A

206

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28
Q

how many bones are in the foot / spine / hand

A

26
26
27

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29
Q

what is the make up of bone extracellular fluid with %

A

35% organic - collagen
65% inorganic - Ca, phosphate

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30
Q

what are the phases of gait

A

stance and swing

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31
Q

what is the pattern of normal gait called

A

heel toe

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32
Q

name some abnormal gaits

A

waddling gait
antalgic gait
high stepping gait
foot drop gait
in toring
tip toeing
charlie chaplain

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33
Q

what causes waddling gait

A

dislocation of hip - congenital (DDH) or acquired

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34
Q

define antalgic gait

A

unilateral PAIN causing INABILITY TO WEIGHT BARE on the affected side, thus REDUCED STANCE phase

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35
Q

what causes high stepping gait

A

loss of sensation of the foot

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36
Q

what is foot drop

A

loss of dorsiflexion of the foot

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37
Q

what causes foot drop

A

common perineal nerve damage

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38
Q

how is foot drop gait different to high stepping gait in terms of aetiology

A

foot drop = motor issue
high stepping = sensation issues

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39
Q

is stance phase reduced in short leg gait

A

no

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40
Q

who has in toeing gait

A

children

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41
Q

what causes intoeing gait

A

antiversion of femur

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42
Q

what causes tip toeing gait

A

tight achilles tendon or habit

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43
Q

what is charlie chaplain gait

A

toes pointed out and sitting into hip

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44
Q

what causes charlie chaplin gait

A

retroversion of NOF

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45
Q

what tool measures the angle of the joints

A

goniometre

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46
Q

which joint angle can’t be measured and why? what is done instead?

A

shoulder internal rotation
- tummy gets in the way
- get the pt to reach to their scapula instead

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47
Q

what % of the bodies ca is in the bone

A

95%

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48
Q

what materials can prosthese be made from

A

titanium
hydroxyapetite

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49
Q

what is the precursor of osteoporosis

A

osteopenia

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50
Q

what type of collagen is present in bones

A

type 1

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51
Q

what is a lack of collagen in bones called

A

osteogenesis imperfecta

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52
Q

long bone vs short long bone

A

long = 2 growth plates
short long = 1 growth plate

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53
Q

name the parts of the bone from top to middle

A

epiphysis
physis = growth plate
metaphysis
diaphysis

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54
Q

what is the salter harris classification for

A

fractures of growth plates

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55
Q

what is type 1 salter harris classification

A

fracture straight across growth plate

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56
Q

what is type 2 salter harris classification

A

fracture above the growth plate which is flat then curves up

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57
Q

what is type 3 salter harris classification

A

fracture of the epiphysis

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58
Q

what is type 4 salter harris classification

A

fracture of the epiphysis and metaphysis

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59
Q

what is type 5 salter harris classification

A

fracture of the whole growth plate

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60
Q

which salter harris classification has the best / worst prognosis & why

A

1 and 2 best - growth plate not affected
3-5 worst - grwoth plate affected so might impair growth

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61
Q

what is the healing rate in a child for a fracture

A

<6 months as they have faster growth rate

62
Q

contrast deformity and disability in terms of when you’d intervene with a fracture

A

if deformity only, wait for child to finish growing then intervene
if disability, intervene immediately

63
Q

what is a tumour of the metaphysis called

A

osteogenic sarcoma

64
Q

who gets osteogenic sarcoma

A

adolescents

65
Q

what is a tumour of the physis called

A

giant cell tumour

66
Q

what does a giant cell tumour look like

A

soap bubble

67
Q

when do giant cell tumours occur

A

after growth stops

68
Q

what are the types of joints

A

biochem: synovial, cartilagenous, fibrous
mechanical: hinge, ball and socket

69
Q

what is in a synovial joint and where does it come from

A

synovial fluid from synovium around joint

70
Q

why is synovial fluid important

A

provides nutrition to the articular cartilage which has no blood supply of its own

71
Q

why is the synovial fluid important in septic arthritis

A

it is the only nutrition source for the cartilage, so if its infected, the cartilage may die and you get osteoarthritis of the joint

72
Q

what is another name for cartilagenous joint

A

symphysis

73
Q

give examples of cartilagenous joints

A

pubic symphysis
sternum/xiphisternum

74
Q

where are cartilagenous joints found

A

MIDLINE only

75
Q

what is another name for fibrous joints

A

sindesmosis

76
Q

give an example of a fibrous joint

A

inferior tibia fibula joint

77
Q

what is diastasis

A

seperation of bones joined in a fibrous joint

78
Q

what is the pneumonic for reasons to see an orthopaedic dr

A

PISSOFF

pain
instability
swelling
stiffness
orthotics
function

79
Q

what will the patient say if they have joint instability

A

my leg gives way or locks

80
Q

what is important to remeber / examine when a person comes in with pain of one joint only

A

check related joints for referred pain

81
Q

which joints are most commonly assessed in paces

A

knee > hip > hand > spine > shoulder > feet

82
Q

what is the hip socket called

A

acetabulum

83
Q

what is the ball of the hip joint called

A

head of the femur

84
Q

what is ligamentum terres

A

attaches from flava (dip on NOF) to hip joint

85
Q

what is one way to section up the femur anatomically

A

intra / extracapsular

86
Q

what is the mortality of fractured NOF

A

30%

87
Q

how do you measure leg length

A

ASIS to medial malleolus

88
Q

where is the hip joint

A

midpoint of inguinal ligament NOT asis
very deep

89
Q

what is shentons line and what is key to remember about it

A

line from femur > NOF > across pelvic bone > across top of foramen

it should be SMOOTH

90
Q

physis present on a bone. what does this mean?

A

its immature bone

91
Q

when do physes fuse in boys / girls

A

18 / 16

92
Q

list the 7 stages of a clinical ortho exam

A

look
feel
move
special tests
measure
other joints
NV status

93
Q

what do you look for in a joint exam

A

skin changes
scars
shortening
swelling
stance
gait

94
Q

what do you feel for in a joint exam

A

warmth
tenderness
swelling
bony landmarks

95
Q

what movements do you do in a joint exam

A

flex
ext
abduction
adduction
rotation

96
Q

what do you measure in a joint exam

A

length
circumference

97
Q

name special tests for a hip exam / knee exam

A

hip - thomas, trendelenburg, simmons
knee - drawer’s, lachmanns, MCL/LCL

98
Q

how do you assess NV status in a LL joint exam

A

touch toe and see if they feel it
ask to wiggel toes
ask to flex / ext toes against resistance
feel pulses
feel temp

99
Q

what is simmons test

A

get pt to kneel on one knee and squeeze calf
their foot should plantarflex

100
Q

what does a positive simmons test indicate

A

rupture of achilles

101
Q

what is trendelenburgs test

A

get pt to stand on one leg to observe if they dip their hip or can keep it straight

102
Q

what does a positive trendelenburg test indicate

A

muscle wasting / nerve damage to gluteal

103
Q

what is thomas’ test

A

hand on spine, bring one leg to chest and extend the other - should be flat

104
Q

what does a positive thomas’ test indicate

A

fixed flexion deformity of the hip

105
Q

what type of joint is the knee joint

A

synovial, modified hinge joint

106
Q

how many menisci does the knee have

A

2

107
Q

where else in the body are menisci found

A

TMJ and sternoclavicular joint

108
Q

Mx for tear of medial meniscus? why?

A

removal of torn section - there is no blood supply to this area so won’t heal

109
Q

Mx for tear of peripheral meniscus? why?

A

fixation via keyhole surgery - there is a blood supply so it will heal

110
Q

name the ligaments in the knee

A

ACL
PCL
2 menisci
medial and lateral collateral ligaments

111
Q

what type of bone is the patellar and where else in the body are these found

A

sesamoid bone
under the big toe

112
Q

what is the knee axis

A

straight line from centre of head of femur to condyles of femur/tibia to maleoli of ankle

113
Q

name congenital deformities of the knee

A

discoid meniscus
hyperextension
valgus deformities
varus deformities

114
Q

what sx do patients present with if they have discoid meniscus

A

clunking of kne e

115
Q

how is congenital hyperextension of the knee managed

A

bending it back each day by 10 degrees and strapping it until its backto normal. never do it all in one go though

116
Q

define varus

A

towards midline

117
Q

define valgus

A

away from midline

118
Q

what is physiological knee varus called

A

bow legs

119
Q

what is physiological knee valgus called

A

knock knees

120
Q

list 3 metabolic issues of the knee

A

gout
pseudogout
pagets

121
Q

what is the issue for a gouty knee

A

gout is uric acid crystals which are spikey so can damage cartilage

122
Q

how is a torn ACL Mx

A

reconstructed with hamstring tendon

123
Q

relevant Qs to ask pt in an ortho exam

A

age
pain
stiffness
swelling
referred
operation

124
Q

what is true locking vs pseudolocking of the knee

A

true = won’t be able to move joint
pseudo = small amount of flexion. due to spasm of the hamstring muscle

125
Q

scar on the back of knee. likely cause?

A

vascular surgery

126
Q

what is patellar tracking and what does it indicate

A

wtach patellar move as knee moves - if it goes lateral it means its dislocated recurrently

127
Q

longitudinal scar down midline of knee ?

A

total knee replacement

128
Q

1cm scars either side of patellar tendon ?

A

arthroscopy scars

129
Q

causes of a warm knee

A

infection
inflammation
trauma - haematoma
malignant tumours - osteogenic sarcoma

130
Q

how do you assess for fluid in the knee

A

shift or bulge test

131
Q

what is lachmans test

A

knee at 20 degrees flexion. grab thigh and then tibial tuberosity, then try and push tibia forward

132
Q

what is drawer’s test

A

look for posterior sag of tibia by bringing both heels together and looking at knees. sit on their foot, make sure hamys are relaxed, then put hands round the back of knee and try pull their tibia forward

133
Q

how do you assess the MCL/LCL

A

stabilise the lower leg and move it valgus / varus

134
Q

what is the apprehension test

A

flex knee and try to move knee cap laterally to assess if its dislocatable

135
Q

how do you measure circumference of knee

A

10cm above and below

136
Q

what test assess meniscal issues

A

mcmurrays (not often done as its painful

137
Q

4 features of osteoarthritis

A

LOSS
loss of joint space
osteophytes
subchondral sclerosis
subchondral cysts

138
Q

how can you describe a knee replacement

A

total or compartmental
cemented or not
constrained or not

139
Q

what should you asses prior to doing a hand exam

A

shoulder function - hands on back of head, then reach for scapula
elbow function - supine/prone, flex/ext

140
Q

sensation of the hand (median, ulna, radius)

A

ulna = little finger and half of ring finger, bothsides
median = rest of hand minus base of thumb / backs of palm
radial = thumb and base of thumb

141
Q

dermatomes of hand

A

c6 = thumb
c7 = middle finger
c8 = little finger

142
Q

motor supply of hand muscles

A

all ulna except LLOAF which is median

143
Q

deformities of the hand

A

mallet
swan neck
clawing
thumb in hand
carpal tunnel
arthritis ones

144
Q

name arthritis deformities of the hand

A

boutonnieres
z deformity of thumb
swan neck

145
Q

what is the carpal tunnel

A

osseous-fibrous tunnel with flexor retinaculum on top
at base of wrist

146
Q

what is contained in the carpal tunnel

A

median nerve and 9 other things

147
Q

commonest causes of carpal tunnel

A

pregnancy
myxoedema
RA
osteoarthritis

148
Q

Mx of RA

A

Medical - analgesia, biological agents, DMARDs
Disease aids - OT, PT, splints
Surgery - arthroplasty

149
Q

RA signs on hands

A

Z or swan neck deformity

150
Q

Why would you do a hemiarthroplasty rather than a THR for an intracapsular NOF

A

capsular is very vascular so preserve it in hemi

A&E, T&O & ICU (3 decks)

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