Trauma and ortho Flashcards by Georgina Mitchell

Q

What is achillies tendonitis ?

A

Inflammation of the achillies tendon sheath

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Q

What are the RF for achillies tendonitis ?

A

Sports (running)
Medications like ciprofloxacin (patient with regular antibiotic use)

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Q

What medication increases the risk of achilies tendonitis ?

A

Ciprofloxacin

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Q

What are the features on examination of achillies tendonitis ?

A

Posterior ankle pain
Pain on palpation of tendon
Swelling and thickening of the tendon
May be ankle crepitus

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Q

How is achillies tendonitis managed ?

A

Conservative

Rest

Analgesia (NSAIDS)

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Q

What are the signs and symptoms of an ACL injury ?

A

In history (sudden deceleration)
Sudden painful popping sensation with rapid swelling
inability to return to activity
Lateral knee and joint line tenderness
Positive lachman test
Anterior drawer test is positive (pull the tibia anterior)

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Q

What are the signs and symptoms PCL rupture?

A

Direct blow to the proximal tibia when the knee is flexed
Asymptomatic, posterior or anterior knee pain
Posterior sag test may be positive
Posterior drawer test may be positive

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Q

How are cruciate tears managed ?

A

Conservative
Physiotherapy
Surgery

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Q

What mechanism commonly causes menisci tears ?

A

Twisting injuries

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Q

How do menisci tears commonly present ?

A

Meniscal tears typically present with pain and swelling of the knee, and patients may complain of ‘locking’ or ‘buckling’ of the knee. Meniscal tears are best seen on MRI, and can be treated conservatively or surgically.

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Q

What test can be used to detect meniscal tears ?

A

Mcmurray test

Varus - medial
Valgus - Lateral

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Q

What is patellar tendinitis ?

A

Patellar tendinitis or ‘jumper’s knee’ is an inflammation of the patella tendon at the tibial tuberocity which commonly occurs in adults participating in sports which involve jumping.

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Q

How does patellar tendinitis present ?

A

Anterior knee pain that is made worse by activity. Pain at the tibial tuberosity

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Q

How is patellar tendinitis treated ?

A

Diagnosis is primarily clinical and management strategies typically involve analgesia, rest, and modification of activities.

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Q

What is plantar fasciitis ?

A

inflammation of the plantar fascia associated with repeated microtrauma to the sole of the foot which manifests as pain in the plantar and heel areas of the foot.

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Q

What causes plantar fasciitis ?

A

Repeat overuse without rest

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Q

How does plantar fasciitis present and how is it managed ?

A

Pain across the heel and sole of the foot

Diagnosis is clinical and most people recover within a year with conservative management with analgesia, rest and supportive footwear

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Q

What time is transient synovitis ?

A

Benign cause of limp in children due to inflammation of the synovial lining of the hip joint.

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Q

What are the causes of transient synovitis ?

A

Normally preceded by a viral infection (usually an upper resp tract infection) 1-2 weeks before the onset of pain and limp.

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Q

How does transient synovitis present ?

A

Can present similarly to early septic arthritis as both present with avoidance of weight bearing exercise and fever.
Limitation of internal/external rotation
The symptoms are generally milder than that of septic arthritis

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Q

How does transient synovitis present ?

A

Raised white cell counts and raised inflammatory markers may point to a more septic picture but may be normal in other conditions.
USS may show effusion and x-ray normal
If there is a high index of suspicion for septic arthritis - joint aspiration
Microscopy, culture and sensitivity of the joint aspirate will distinguish between the two, as bacteria within the joint space confirms septic arthritis.

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Q

How does transient synovitis present ?

A

Usually resolves in around 7 days with minimal risk for further damage.

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Q

What are the symptoms of osteoarthritis ?

A

Joint pain and stiffness. Often unilateral symptoms. Symptoms improve with rest and are worse with activity.

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Q

What are the signs on X-ray of OA ?

A

Loss of joint space, osteophyte formation at the joint margins, subchondral sclerosis and subchondral cysts.

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What are the signs on the hands of OA ?

Heberdens nodes at the DIP and bouchardes nodes at the PIP.

What criteria can make a diagnosis of OA ?

NICE (2014) suggest that a diagnosis can be made without any investigations if the patient is over 45, has typical activity related pain and has no morning stiffness or stiffness lasting less than 30 minutes.

Describe the stepwise management of OA

First part of management is patient education and management of risk factors like weight loss, physiotherapy and OT. Orthotics ref-feral to support activities and function. Stepwise use of **analgesia** to control symptoms: 1. Oral ***paracetamol*** and topical ***NSAIDs*** or topical ***capsaicin*** (chilli pepper extract). 2. Add oral ***NSAIDs*** and consider also prescribing a ***proton pump inhibitor*** (PPI) to protect their stomach such as ***omeprazole***. They are better used intermittently rather than continuously. 3. Consider ***opiates*** such as ***codeine*** and ***morphine***. These should be used cautiously as they can have significant side effects and patients can develop dependence and withdrawal. They also don’t work for chronic pain and result in patients becoming depending without benefitting from pain relief. **Intra-articular steroid injections** provide a temporary reduction in inflammation and improve symptoms. **Joint replacement** can be used in severe cases. The hip and knee are the most commonly replaced joints.

How do acetabular labral tears present ?

- Hip and groin pain - Snapping sensation - Pain on external rotation - Able to weight bear

What is De quervains tenosynovitis ?

Common condition which the sheath containing the extensor pollicis brevis and the abductor pollicis longus tendons are inflammed. Usually affects females age 30-50 years old.

Symptoms of De Quervains tenosynovitis ?

Pain on the radial side of the wrist tenderness over the radial styloid process

How does inflammatory arthritis pain (like psoratic arthritis) tend to present ?

Pain better with activity and worse in the morning - Boggy pain rather than bony

How to differentiate between OA and psueudogout on x-ray ?

Psudogout will chow chondrocalcinosis.

What does subchondral sclerosis look like on x-ray ?

White(dense) on the joint borders of bones

What does dactylitis indicate (swelling of the whole digit) ?

Psoratic arthritus/AS

Is OA usually in one joint ?

Yes but can be across multiple joints.

Squaring of the thumbs is a characteristic feature of ????

Osteoarthritis

What is one of the ECG patterns that can be seen in an AKI ?

Hyperkalemia (AKI)

What is the most common cause of osteomyelitis ?

Staphylococcus aureus

What is the first line of treatment for osteomyelitis ?

IV flucloxacillin for 4 weeks

What is the first line treatment of Raynauds (after conservative measures) ?

Calcium channel blockers like Nifedipine

Haemochromatosis is strongly associated with ....

Pseudogout

Why do patients with a displaced NOF need hip replacement ?

Due to retrograde blood supply. risk of Avascular necrosis.

What is the garden classification ?

Used to grade intracapsular fractures - ***Grade I*** – incomplete fracture and ***non-displaced*** - ***Grade II*** – complete fracture and ***non-displaced*** - ***Grade III*** – partial ***displacement*** (trabeculae are at an angle) - ***Grade IV*** – full ***displacement*** (trabeculae are parallel)

How are grade 1 and 2 intracapsular fractures managed ?

Internal fixation with screws DHS.

How are grade 1 and 2 intracapsular fractures managed ?

Internal fixation with screws DHS.

How are grade 1 and 2 intracapsular fractures managed ?

Internal fixation with screws DHS.

How are grade 1 and 2 intracapsular fractures managed ?

Internal fixation with screws DHS.

How are grade 1 and 2 intracapsular fractures managed ?

Internal fixation with screws DHS.

How are grade 1 and 2 intracapsular fractures managed ?

Internal fixation with screws DHS.

How are grade 3/4 intracapsular fractures treated ?

- Hemiarthroplasty - Replacing head of femur but leaving the acetabulum in place. Offered to patients that have limited mobility or significant co-morbidities. - Total hip replacement - HOF and acetabulum and offered to patients who can walk and are fit for surgery.

How are inter-trochanteric fractures managed ?

DHS

How are subtrochanteric fraactures managed ?

IM nail.

How does a posterior hip dislocation present ?

Typical dashboard injury. Leg is internally rotated and flexed. Unable to weight bare

How does a posterior hip dislocation present ?

Typical dashboard injury. Leg is internally rotated and flexed. Unable to weight bare

How does a posterior hip dislocation present ?

Typical dashboard injury. Leg is internally rotated and flexed. Unable to weight bare if in doubt its more common

How does a posterior hip dislocation present ?

Typical dashboard injury. Leg is internally rotated and flexed. Unable to weight bare if in doubt its more common

How does a anterior hip dislocation present ?

Externally rotates and slightly flexed.

What is the initial investigation in cauda equina syndrome ?

Whole spine MRI

What can cause spinal cord compression/cauda equina ?

- Disk herniation, neoplasms, abscess

What is the management of cauda equina/acute spinal cord compression ?

Dexamethasone 16mg then compression within 48 hours

What is the typical history of a patient with a colles fracture ?

Falling on an outstretched hand (typically osteoporosis)

What is found on examination in a patient with a colles fracture ?

Distal radial fracture and dorsal displacement of the distal fragment. Dinner fork malformation

How is a colles fracture managed ?

- Manipulation to reduce the fracture - Open reduction and internal fixation if reduction can not be achieved if precise alignment is needed.

How does median nerve palsy present ?

weakness of thumb abduction and opposition and difficulty with daily tasks.

How does a Scaphoid fracture typically present ?

Occur after a fall onto an outstretched hand and pain on palpation of the anatomical snuffbox.

What imaging is carried out in suspected scaphoid fracture. What if this is negative ?

Scaphoid series. If no sign on x-ray but high clinical suspicion, the hand should still be put in a cast and repeat MRI/X-ray in 10 days.

How is a scaphoid fracture managed ?

Wrist is placed in a beer glass position and casted.

What is one of the complications of scaphoid fractures and how does this present ?

Avascular necrosis (pain and stiffness at the wrist)

What are the common malignancies that spread to bone ?

Prostate loves (liver) to (thyroid) Kill (kidney) bone (breast)

What are the risk factors for developing osteoporosis ?

- Age over 50 in women and over 65 in men - female sex - Steroid use/carbmezapine (epilepsy) - Hyperthyroidism/hyperparathyroidism - Alcohol and smoking - Thin - Testosterone deficiency - Early menopause - Renal/liver failure - Erosive/inflammatory bone disease - Diabetes - FHx

When is FRAX screening commenced ?

- All men over 75 - All women over 65 - All men and women over 50 with rf

Gold standard imaging in OP ?

Gold standard - DEXA scan

What are some of the treatment options for OP ?

1. Reduce risk factors (stop smoking/diebeties control) and diet. Regular weight bearing excersises and hip protectors in nursing home patients. 2. Biphosphonates (1st line) - Inhibition of osteoclasts →Pts need to sit up for 30 mins after dose and drink a full glass of water to reduce the risk of oesophageal ulcers (other SE = AF, osteonecrosis of the jaw and a-typical stress fractures). Should be taken on an empty stomach.Commenced if T score is less than -2.5. 3. Denosumab (inhibits RANK-L) - Monoclonal antibody 4. Raloxifene - In post menopausal women 5. HRT in post menopausal women 6. Teriparatide (PTH)

How does De Quervains tenosynovitis present ?

Pain on the radial side of the wrist and tenderness over the radial styloid process.

What medication is likely to cause new onset Achilles tendinitis ?

Ciprofloxacin

The patient presents with a visibly deformed ankle joint. What is the management

Reduction in theater 1st !

How does Trochanteric bursitis present ?

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

What does an ulnar nerve lesion at the site of the elbow indicate ?

Clawing of the digits. Weak finger abduction and adduction