Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 3 Surgery > 11 - Orthopaedic Assessment > Flashcards

11 - Orthopaedic Assessment Flashcards

(105 cards)

Start Studying
1
Q

What is infection of bone + inflammatory destruction and apposite of new bone?

A

Osteomyelitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the usual cause of osteomyelitis?

A

Bacterial infection
Commonest = staph aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are RF for osteomyelitis?

A

<20 or >50
Chronic health conditions
IVDU
DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How can osteomyelitis arise?

A

Haematogenous spread (children)
Wound / surgery
Diabetic foot infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What bones are affected predominantly by osteomyelitis in children?

A

Long bones (have a lack of macrophages - and blood flow slows down around the metaphysis = good place for infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What bones are affected most by osteomyelitis in dialysis Ps?

A

Spine
Ribs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which bone is most commonly affected by osteomyelitis in IVDU?

A

Clavicle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which bones are most commonly affected in diabetic Ps?

A

Foot bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the risk if a P has had osteomyelitis as a child and then in later life needs bone surgery?

A

That a biofilm of bacteria remains which can be reactivated in the joint space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a biofilm?

A

Where bacteria lie dormant (therefore not susceptible to Abx) in a matrix attached to an inert substance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is osteomyelitis classified?

A

Acute (within 2w)
Subacute (1-several months)
Chronic (after several months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the S&S of osteomyelitis?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the DDs for osteomyelitis?
What should you always do when diagnosing osteomyelitis?

A

Tumor
Healing fracture

If suspect osteomyelitis - Send tissue to histology.

Similarly - if tumour suspected - send send tissue for culture.

ALWAYS rule out both - look VERY similar. Impossible to tell for sure from XRAY.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What would bloods show in osteomyelitis?

A

Elevated ESR and CRP - esp in chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What will histology show in osteomyelitis?

A

Acute = Ns and live osteocytes

Chronic = fibrosis, osteocytes without nuclei, lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How long can it take for acute osteomyelitis to show on XR?

A

Up to 2 weeks - takes that long for cell turnover and change in calcified bone to be seen.
Bone loss has to be 50% loss before it is seen!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is it called when you get new bone around necrotic bone?

A

Involucrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does chronic osteomyelitis look like on XR?

A

Lucency
Sclerotic rim
Osteopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which investigation is good for bone?

A

CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which investigation is good at looking at soft tissue surrounding bone?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which scan is good for diabetic feet or if MRI is not an option for bone?

A

Gallium scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is Rx for osteomyelitis?

A

Depends when the infection is identified.

Want Abx spruce to identified organism - high dose asap.

Can also give hyperbaric oxygen therapy
Surgery also an option - irrigation, debridement, poss amputation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is a piece of dead bone that has become separated from the surrounding living bone as a result of an infection called?

A

Sequestrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What does Rx of osteomyelitis depend on?

A

Patient status - IC? nutritional status?
Severity of injury
Location
Implant
Ischaemic tissue / Necrotic tissue?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Which part of the bone responds better to infection Rx?
Metaphysis better than diaphysis
26
How is osteomyelitis managed surgically?
27
What is the prognosis of both acute and chronic osteomyelitis?
Acute - good outcome if caught early Chronic = 1% can turn malignant 30% can recur
28
What are the RF for OA?
F Older age Occupation Muscle weakness Inflammatory joint disease Lack of osteoporosis
29
What percentage of Ps over 65 will have XR evidence of OA?
at least 50% - but many will be asymptomatic
30
What do you base need for surgery on when looking at OA?
The P's symptoms and their QOL - if severe effect on ADL then stronger case for surgery. Dont make decision on radiological extent of disease alone.
31
What is the pathophysiology of OA?
Get articular damage in a synovial joint Osteophytes -> formation of new bone -> Secondary joint inflammation Get changes to the chondral surface
32
Which 4 joints are particularly susceptible to OA?
hip, knee, shoulder, elbow - because they have capsules
33
What are the symptoms of OA?
Pain! Swelling Stiffness - loss of range of movement Clicking joints Functional impairment
34
What are the signs of OA?
Deformity Muscle wasting Effusion Fixed flexion Crepitus Pain in active and passive motion
35
What investigations can be done for OA?
XR CT if specific cause
36
How does OA appear on XR?
Narrow joint space Subchondral sclerosis Osteophyte formation Cyst formation
37
How is OA managed in primary care?
Analgesia Supports / footwear Modification of activity Exercise Steroid injection - e.g. interarticular injections Reduction of load
38
What is surgery to realign the joint and alter the forces within that joint called?
Osteotomy
39
What is surgery to fuse the joint to eliminate painful movement called?
Arthrodesis
40
What is surgery to restore function of the joint called?
Arthroplasty
41
What is surgery to excise and debride a joint space called?
Excision arthroplasty
42
What is surgery to partially replace a joint surface called?
Hemi-arthroplasty
43
What is surgery to replace a joint called?
Total arthroplasty
44
What hip surgery can be done for younger Ps with active lifestyles?
Hip resurfacing - no acetabular replacement done.
45
What surgery is often done for NOF#?
Hemi-arthroplasty - no acetabular replacement done
46
How is a hip arthroplasty done?
Acetabulum and femoral shaft are both replaced
47
What are the general complications of a total joint replacement?
Largely depends on health of P prior to surgery Acute = MI, CCF Fat embolism Pulmonary embolism DVT (esp following knee replacement) Neurovascular injury Dislocation Fracture Infection Bleeding Long Term = Implant failure / loosening of implant Metallosis Infection Discloation Failure to achieve desired outcome
48
What is it called when the P has a reaction to the implant, causing tissues to become extremely inflamed with metal distribution in the tissue?
Metallosis
49
What is infection of a joint called?
Septic arthritis
50
What is the most common cause of septic arthritis?
Strep aureus (Group B strep in neonates)
51
What is the commonest joint in a child to be affected by septic arthritis?
Hip & knee
52
What is the commonest joint in an adult to be affected by septic arthritis?
Knee
53
What are the RF for septic arthritis?
>80 RA DM Cirrhosis HIV Endocarditis IVDU Recent joint surgery
54
How does septic arthritis spread?
Haematogenous spread Penetrating wound Adjacent osteomyelitis (rare)
55
What happens in septic arthritis?
Articular cartilage is destroyed rapidly -> ankylosis Is SURGICAL EMERGENCY
56
What is ankylosis?
Ankylosis, in medicine, stiffness of a joint as the result of injury or disease. The rigidity may be complete or partial and may be due to inflammation of the tendinous or muscular structures outside the joint or of the tissues of the joint itself.
57
How long can it take for damage to occur in septic arthritis?
Within 8 hours
58
What are the S&S of septic arthritis?
59
What are the differentials for septic arthritis?
More reduced range of motion with septic arthritis rather than bursitis - because the SA is in the joint - and the bursitis is more restricted to an area. SA is painful movement throughout the whole range of motion of the joint. Bursitis should respond to NSAIDs better than SA.
60
When can you give Abx in septic arthritis?
Need to remove and culture the swelling before you start Abx.
61
How can you differentiate between gout and pseudogout?
Gout = sodium urate, needle shaped, negatively bifringent Psuedogout = calcium pyrophosphate, rectangular, positively bifringent crystals
62
What investigations can you do for septic arthritis?
Bloods - WCC, ESR, CRP raised? Aspirate synovial fluid - MC&S XR / MRI not usually needed - clinical diagnosis
63
How is septic arthritis managed?
IV Abx Surgical irrigation and drainage + debridement if needed
64
What complications can arise from septic arthritis?
Arthritis Fibrous ankylosis Osteomyelitis
65
Which bursae most commonly get bursitis in M and F?
F = Pes anserinus and trochanteric bursae M = Olecranon
66
Septic bursitis is more common in which Ps?
IC DM RA Alcoholics
67
Which AI conditions can make you susceptible to bursitis?
SLE RA Scleroderma
68
What is the pathophysiology of bursitis?
Inflammation of synovial lining of bursae -> inc inflammatory markers inc TNF, cyclooxygenases, ILs.
69
What are the S&S of bursitis?
70
What are the two forms of bursitis?
Acute and chronic
71
What are the DDs for bursitis?
Think - where is the region - what structures are next to there.
72
What investigations can you do for bursitis/
XR if foreign body /trauma suspected USS MRI for deep bursae Aspiration - if thinking septic joint or gout
73
What are the risks of aspirating inflammatory bursitis?
Can turn it into infective bursitis if not entirely asceptic.
74
How is bursitis managed?
Most resolve on their own - rest, ice, compression, avoid aggrevating Can give anti-inflammatories Abx only if infection Rarely - steroid injection
75
How can you differentiate between acute, sub-acute and chronic back pain?
Acute = sudden onset, days - weeks Sub-acute = sudden or slow onset = 4-12w Chronic = sudden or slow onset - 12w+
76
What is the commonest cause of back pain in middle age?
OA of the spine
77
What non-spinal causes of back pain are there?
78
What infective causes of back pain are there?
Discitis Vertebral osteomyelitis
79
What Qs do you need to ask about back pain?
80
What are yellow flags for back pain?
Signs that it might be difficult to eliminate or manage the P's pain
81
What tests should you do for back pain?
DRE - check anal tone!
82
What are spinal causes of back pain?
83
What investigations can you do for back pain?
84
How should back pain be managed?
Avoid bed rest, modify activities NSAIDS Phsyio Ice packs Keep moving Surgery rarely indicated
85
What are complications of back surgery?
86
What are the Red Flags for back pain?
<20 or >55 Weight loss Fevers Persistent pain NOT affected by movement Night pain Hx of malignancy Progressive neurology - bowel/bladder dysfunction - saddle anaesthesia = poss cauda equina syndrome
87
What does red dot mean on XR?
The 'red dot' is the name given to a system whereby the radiographer marks a radiograph that he or she believes shows an acute abnormality.
88
What does AABCSS stand for?
Adequacy Alignment Bones Cartilage/Joints Soft tissue Satisfaction of search
89
When looking at alignment - what should you check for?
90
When looking at bones - what should you check for?
91
How do lytic and sclerotic areas look on XR?
Lytic = darker areas Sclerotic = brighter areas
92
When looking at cartilage on XR - what should you look for?
93
When looking at soft tissue on imaging - what should you look for?
94
What should you check at the end when looking at imaging?
95
What type of fracture: 1 - goes across the bone 2 - goes in a corkscrew through the bone 3 - goes diagonally across the bone 4 - follows the long axis of the bone 5 - is broken into multiple pieces 6 - extends out of the skin?
1 - transverse 2 - spiral 3 - oblique 4 - longitudinal 5 - comminuted 6 - compound
96
What is it called when you get bulging of the cortex (children's fracture?
Torus or buckle fracture
97
What is it called when you get a bulge in the cortex on one side and a break in the cortex on the other side?
Greenstick fracture A greenstick fracture is a partial thickness fracture where only the cortex and periosteum are interrupted on one side of the bone but remain uninterrupted on the other
98
What is it called when you get partial loss of articulation of a joint?
Subluxation
99
What is it called when you have complete loss of articulation at a joint?
Dislocation
100
How can you differentiate between paediatric and adult XR?
Paeds - apophysis is not yet fused
101
What are the following called? - anterior margin of the vertebral bodies - posterior margin of the vertebral bodies - posterior margin of the spinal canal - tips of the spinous processes
Anterior vertebral line Posterior vertebral line Spinolaminar line Posterior spinous line
102
How many columns is the spine divided into?
103
When is a spinal fracture deemed to be unstable?
If 2 or more spinal columns are affected
104
What is a common fracture of the wrist?
Colles fracture
105
What often causes a wedge/anterior compression of the T or L spine?
Osteoporosis

Year 3 Surgery (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions