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4 - Med > Trauma and Orthopaedics > Flashcards

Trauma and Orthopaedics Flashcards

1
Q

name all the different vertebral bodies in the spine - how many of each are there? how many cervical roots are there ?

A

C7, T12, L5, S5
but there are 8 Cervical roots

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2
Q

what is the highest and the Lowest score for the UK MRX strength scale ? which is best ?

A
  • 0 (mo muscle contraction)
  • 5 (normal power)
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3
Q

what is a radiculopathy ?

A

compression of nerve roots as they exit spinal cord

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4
Q

what is frozen shoulder ? and what is another name for it ?

A

adhesive capsulitis
- inflammation + fibrosis of joint capsule => adhesions (scar tissue) => tighten joint + restrict motion

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5
Q

frozen shoulder RF ? (1)

A

DM
usually affects those in middle age

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6
Q

describe the different phases to frozen shoulder ? how many phases ? how long does each phase last ?

A
  • painful phase (shoulder pain worse at night)
  • stiff phase
  • thawing phase
    (each phase is 6-12 months)
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7
Q

frozen shoulder Mx ? (2)

A
  • clinical Dx (don’t usually need scans)
  • early physio + NSAIDs
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8
Q

would could shoulder pain preceded by trauma indicate ? (3)

A
  • shoulder dislocation
  • fractures
  • rotator cuff tear
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9
Q

what does the empty can test test for ?

A

tests for supra spinatus tendinopathy

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10
Q

what is a rotator cuff tear ?

A

refers to injury (partially or fully torn) to tendons of the rotator cuff muscles

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11
Q

what are the muscles in the rotator cuff ? (4)

A

SITS
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis

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12
Q

rotator cuff tear px ?

A

typically acute (after injury)
- shoulder pain + specific weakness

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13
Q

what imaging would you do for rotator cuff tear ?

A
  • US (cheaper and quicker)
  • MRI (more info)

no point doing XR as don’t show soft tissue injury

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14
Q

rotator cuff tear Mx ? when surgical Mx ?

A
  • NSAIDs + physio
  • if fails, then surgery (if young and complete tear)
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15
Q

what is another name for students elbow ? what is it ?

A

olecranon bursitis (bony lump at elbow - ulnar)
- traumatic bursitis following pressure on elbows => pain + swelling behind the olecranon, fluctuant (fluid filled)

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16
Q

what are bursae ? bursitis ?

A

sacs created by synovial membrane filled with small about of synovial fluid
- bursitis is inflame of a bursa

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17
Q

what do you do if infection suspected in bursitis px ?

A

aspirate

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18
Q

aspirate shows pus, what could this indicate ?

A

infection

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19
Q

aspirate shows straw-coloured fluid, what could this indicate ?

A

infection less likely

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20
Q

aspirate shows blood stained fluid , what could this indicate ?

A
  • trauma
  • infection
  • inflammation
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21
Q

aspirate shows milky fluid, what could this indicate ?

A
  • crystal arthopathy
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22
Q

students elbow mx ?

A
  • rest
  • ice
  • compression
  • NSAIDs
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23
Q

what is epicondylitis ?

A

inflammation at the point where tendons of forearm insert into epicondyles (as a result of repeitic strain - RSI)

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24
Q

what examination tests can be used to assess for lateral epicondylitis (tennis elbow) (2)

A
  • mills + cozens test (pain indicates +ve)
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25
epicondylitis mx ? (3)
- self limiting + will resolve with time, but can take urs to resolve - rest, physio, NSAIDs
26
what is dupuytren's contracture ?
progressive, painless fibrotic thickening of the palmar fascia with skin puckering + tethering (often bilateral + symmetrical)
27
dupuytren's contracture inheritance pattern ?
autosomal dominant pattern
28
dupuytren's contracture mx ? what examination test ?
if patient can't place palm flat on flat surface (Hestons table top test) => refer for surgery
29
what is the most frequent cause of hand pain at night ?
carpal tunnel syndrome (also most common nerve compression syndrome)
30
what is carpal tunnel syndrome ? what nerve involved ?
caused by compression of median nerve as travels through carpal tunnel => pain + numbness in median distribution (usually due to RSI => swelling of contents of carpal tunnel)
31
what is bilateral carpal tunnel syndrome linked to ?
acromegaly (strange huh)
32
carpal tunnel syndrome px ?
gradual onset, intermittent, worse at night - sensory sx: numbess, parestesia, burning, pain - motor: sx affect that muscles
33
what is median distribution of hand ?
palmar aspects + full fingertips of thumb, inside and lateral half of ring finer
34
carpal tunnel syndrome mx ? (4)
- rest - splints - steroid infection - surgery
35
what conditions could red flags for sinister back pain indicate ? (5)
- spinal fracture - cauda equina - spinal stenosis - ankylosing spondylitis - spinal infection
36
what imagine does red flag for sinister back pain require ?
refer at once to - needs MRI < 4 hrs
37
what is spondylolisthesis ? cause of it ?
anterior displacement of vertebra out online with one below - causes: spondylosis (age related degeneration)
38
what is spinal stenosis ?
narrowing of part of spinal canal => compression of spinal cord or nerve roots => can cause nerve ischaemia
39
spinal stenosis px ?
- gradual onset lower back pain, buttock + leg pain - leg weakness
40
spinal stenosis Ix ?
- MRI - Ix to exclude PAD (ABPI) when sx of intermittent claudication
41
spinal stenosis mx ? (4)
- exercise and weight loss - analgesia - physio - decompression surgery
42
what nerve roots form the sciatic nerve ?
L4 - S3
43
where does the sciatic nerve supply ? sensation ? motor ?
- sensation to lateral lower leg + foot - motor to posterior thigh, lower leg + foot
44
sciatica px ?
unilateral pain from buttock radiating down thigh to below knee or feet - parasthesia, numbness motor weakness
45
sciatica aetiology - what can lead to it ? (3)
- herniated disc - spondylolithesis - spinal stenosis
46
what is the overall mx to chronic back pain ? what risk tool ?
- online star back tool to stratify risk of chronic pack pain - physio - CBT - NSAID - amitriptyline
47
what is spinal cord compression ? usually due to what ?
oncological emergency - usually due to vertebral mets
48
what cancers usually metastasise to bone ?
PoRTaBLE - Porstate - Renal - Thyroid - Breast - Lung
49
spinal cord compression px ? what makes it worse (2)
back pain (most common) worse online down and coughing - lower limb weakness - sensory changes (can be first px of met cancer)
50
spinal cord compression ix ?
Urgery contrast MRI (whole MRI spine within 24 hrs)
51
spinal cord compression mx ? (2)
high dose oral dex urgent oncological assessment
52
What is the most common swelling of popliteal fossa ?
bakers cyst (popliteal cyst)
53
bakers cyst pathophys ?
secondary to degernative changes => synovial fluid squeezed out of knee + collects in the popliteal fossa
54
bakers cyst ix ? rule out what ?
US usual first line (+ rule out DVT)
55
bakers cyst mx ?
no treatment if asymptomatic - non-surgical: physio, analgesia, US guided aspiration - surgical
56
what is the most common primary malignant bone tumour ?
multiple myeloma
57
most common form of bone cancer ?
osteosarcoma
58
what is Ewing sarcoma ?
a bone + soft tissue cancer most often affecting children + young adults
59
XR features of Ewing sarcoma ?
- Bone destruction - new bone formation (onion ring sign) (eWING, onion WING)
60
what is a compound fracture ?
skin is broken + broken bone exposed to air
61
which fractures typically occur in children ? (3)
- greenstick - buckle - Salter Harris (only in kids as involve growth plate)
62
what are pathological fractures ?
fractures secondary to underlying disease of the bone
63
give some examples of causes of pathological fractures (4)
- tumour (metastatic or primary) - pagets - oseoporosis - osteogenesis imperfecta
64
what is fat embolism ? when does it typically occur ?
occurs following fracture of long bone - globules of fat from bone marrow enter circulation => become lodged in blood vessels (pulm arteries) + systemic inflammation response
65
what is done to reduce risk of fat embolism ?
operating early to reduce fracture which reduces risk of this
66
fat embolism mx ?
supportive while condition improvoes - mortality 10%
67
what is a colles fracture ?
distal radius fracture with dorsal displacement
68
what is dinner fork deformity associated with ?
colles fracture
69
what nerve injury may coleus fracture result in ? how does this present
median nerve injury - weakness or loss of thumb/index finger flexion
70
what is a smiths fracture ?
reverse colles - distal radius fracture with volar displacement
71
farden spade deformity associated with what ?
smiths fracture
72
what is monteggia fracture ?
Manchester United - ulnar fracture + dislocation of proximal radioulnar joint
73
what is galeazzi fracture ?
Galaxy Rangers - Distal radius fracture + dislocation of distal radioulnar joint
74
Explain the blood supply to the hip - name the arteries ? where do they run along ?
the medial + lateral circumflex femoral arteries run along intertrochanteric line + provide only blood supply to femoral head
75
what hip fracture has AVN risk ?
intracapsular fracture
76
what classification categorises NOF fractures ? explain the levels ?
garden classification (I - IV) - I/II: non-displaced: may have intact blood supply - III/IV: disrupt blood supply to head of femur
77
Mx of non-displaced NOF fracture ?
garden I/II - internal fixation (screws): hold fewer head in place while heals
78
Mx of displaced NOF fracture ?
garden III/IV - hemi or total hip replacement (total offer if pt is fit)
79
intertrochanteric NOF fracture mx ?
dynamic hip screw
80
NOF fracture O/E ?
shortened abducted externally rooted
81
NOF fracture Ix ?
XR two views (AP, lateral)
82
What is compartment syndrome ?
pressure within fascial compartment is abnormally elevated => cuts of blood supply (can be acute or chronic. acute is med emergency)
83
compartment syndrome px ? (5) what is a worry sign ?
(usually after bone fracture or crush injury) 5Ps - pain (disproportionate) - parasthesia - pale - pressure - paralysis (late + worry sign)
84
compartment syndrome mx ?
medical emergency - escalate to ortho reg - remove external dressings/bandages - elevate limb to heart - definitive: emergency fasciotomy

4 - Med (21 decks)

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