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Year 6 - Surgery > Passmed: Ortho > Flashcards

Passmed: Ortho Flashcards

1
Q

What are Tinel’s + Phalen’s signs?

A

Both test the MEDIAN nerve

Tinel’s: tapping over the median nerve causes paraesthesia

Phalen’s: downward prayer position results in flexion at the wrist producing sx

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2
Q

What are the Ottawa ankle rules?

A

Ankle x-ray is only required if there’s any pain in the malleolar zone and one of: inability to WB for four steps or bony tenderness over distal tibia or fibula

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3
Q

Outline the Weber classification

A

A: infrasyndesmotic

B1-3: usually starting at level of tibial plafond and extending proximally

C1-3: suprasyndesmotic +/- tibiofibular syndesmosis disruption, medial malleolus #, deltoid ligament injury

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4
Q

Mx of Weber A + C

A

A: remain WB as tolerated in CAM boot for 6wks

C: open reduction + external fixation

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5
Q

What position does ANTerior shoulder dislocation result in?

A

Ext rotation and aBduction

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6
Q

What radiographic signs are a/w ANTerior shoulder dislocation?

A

Bankart Lesion: injuries specifically at the anteroinferior aspect of the glenoid labral complex

Hill-Sachs Defect: posterolateral humeral head depression fracture resulting from the impaction with the anterior glenoid rim

Greater Tuberosity #

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7
Q

What position does POSTerior shoulder/hip dislocation result in?

A

Int rotation and aDduction

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8
Q

What radiographic signs are a/w POSTerior shoulder dislocation?

A

Rim’s: widened glenohumeral joint >6 mm

Light Bulb: fixed internal rotation of the humeral head

Trough Line: dense vertical line in the medial humeral head

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9
Q

Which group of pts typically get posterior shoulder dislocations?

A

Epileptics

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10
Q

Which #s are most commonly a/w compartment syndrome?

A

Supracondylar + Tibial Shaft

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11
Q

What is the most common site of metatarsal stress #s?

A

Second metatarsal shaft as it’s the longest

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12
Q

Fifth Metatarsal #s: Pseudo-Jones vs Jones

A

Pseudo: most common, avulsion # at proximal tuberosity, a/w lateral ankle sprain and often follow inversion injuries

Jones: less common, transverse # at metatarsal base, a/w sig aDduction force to forefoot w ankle in plantar flexion

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13
Q

Outline the Gustilo + Anderson classification

A

Open #s

1 - low energy wound <1cm

2 - >1cm w mod soft tissue damage

3 - high energy wound >1cm w extensive soft tissue damage
A: adequate ST coverage
B: inadequate ST coverage
C: associated arterial injury

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14
Q

How soon should open #s be debrided and lavaged?

A

<6hrs of injury + IV broad spec abx and tetanus prophylaxis

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15
Q

: Trauma v Stress v Patho

A

XS forces, repetitive low velocity injury, abnormal bone w normal use

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16
Q

Pt w snuffbox tenderness but neg x-rays next step?

A

Ideally MRI before discharging w splint/cast plus thumb immobilisation + 2wk review in # clinic to repeat x-ray

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17
Q

What are the scaphoid views?

A

PA
Ziter
Lateral
Oblique

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18
Q

What is the mx of undisplaced scaphoid #s?

A

Immobilisation in below elbow cast for 6-8wks

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19
Q

Which scaphoid #s require surgical fixation?

A

Displaced OR proximal scaphoid pole #s

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20
Q

What are the comps of discitis? (2)

A

Sepsis + Epidural Abscess

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21
Q

What other ix do you need to perform alongside spine MRI for pt w discitis?

A

Assess for signs of infective endocarditis

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22
Q

What is the FRAX score?

A

Estimates the 10yr risk of fragility fracture for pts 40-90yo: low reassure and lifestyle advice, med offer BMD, high offer boje protection tx

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23
Q

Ddx for sx ruptured bakers cyst

A

DVT

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24
Q

What is the most common 1° + 2° cause of iliopsoas abscess?

A

1°: staph aureus + 2°: crohns disease

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25
Q

Iliopsoas abscess ix + mx

A

CT abdomen + IV abx and percutaneous drainage

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26
Q

What is the Garden classification?

A

NOF

I: stable w impaction in valgus

II: complete but undisplaced

III: displaced but still has boney contact

IV: complete boney disruption

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27
Q

Tests for DDH

A

Barlow -> Ortolani

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28
Q

Perthes vs SUFE

A

Perthes: 4-8yo boy, hip pain stiffness red rom, widening of hip joint space due to avasc necrosis w flattening of femoral head on x-ray

SUFE: 10-15yo obese boys, distal thigh or knee pain w loss of int rotation of leg in flexion, displacement of femoral head epiphysis postero-inferiorly on x-ray

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29
Q

Aetiology of Dupuytren’s contracture

A

Manual labour, trauma, alcoholic liver disease, diabetes mellitus, phenytoin

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30
Q

What is Simmond’s triad?

A

Helps to exclude Achilles tendon rupture: palpation of tendon, angle of declination at rest, Thompson test ie calf squeeze test

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31
Q

De Quervain’s tenosynovitis vs Wartenberg’s syndrome

A

De Quervains: inflam of EPB and APL tendon sheath causing radial styloid process pain w no sensory deficit

Wartenbergs: entrapment of superficial branch of radial nerve causing rest pain regardless of position over distal radial forearm w paraesthesia over dorsal radial aspect of the hand

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32
Q

What is Finkelstein’s test?

A

Pulling the thumb in ulnar deviation and longitudinal traction will cause pain over the styloid process and along EPB+APL in pts w tenosynovitis

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33
Q

Tx for NOF

A

Intracapsular - internal fixation, hemi (immobile), total (mobile)

Extracapsular - DHS (intertrochanteric) or intramedullary nail (subtrochanteric)

34
Q

How long should you wait to weight bear following the placement of an intramedullary nail?

A

You don’t need to wait as WB is tolerated and prolonging it would just inc risk of VTE and decline in physical function

35
Q

The red flags for lower back pain (5)

A

Age <20 or >50, night pain, sys unwell, hx of trauma, prev malignancy

36
Q

What does the light bulb sign on x-ray suggest?

A

Posterior dislocation of the shoulder

37
Q

Elbow: Golfers vs Tennis

A

Middle of the fairway vs sides of the court

Golfers: tenderness over MEDIAL epicondyle + medial wrist pain on resisted wrist pronation/flexion

Tennis: tenderness over LATERAL epicondyle + lateral elbow pain on resisted wrist supination/extension

38
Q

Mx of Open #

A

Consrv: examine extent of injury, monitor and document NV status, image, dressing

Med: IV broad spec abx + tetanus prophylaxis

Surg: primary debridement within 6hrs of injury +/- temp external fixation followed by secondary debridement after 24-48hrs to ensure soft tissue recovery before def fixation

39
Q

What is the main NV structure that is compromised in a scaphoid #?

A

Dorsal carpal arch of the radial artery

40
Q

What is long term steroid use a key RF for the development of?

A

Avascular necrosis of the femoral head

41
Q

What are the causes of AVN of the hip? (4)

A

Steroids, chemo, xs alcohol, trauma

42
Q

What causes of lower back pain are worst in the morning?

A

Facet Joint + Ank Spond

43
Q

What causes of lower back pain are relieved by rest?

A

Spinal Stenosis + Peripheral Arterial Disease

44
Q

What does the straight leg raise test?

A

If a pt w lower back pain has an underlying lumbosacral nerve root sensitivity

45
Q

How is the straight leg raise performed?

A

Pt lying supine raise the straight leg, place hand under the lumbar spine to ensure no compensatory lordosis, dorsiflex the foot to exacerbate the signs

46
Q

What are RFs for haematogenous osteomyelitis? (5)

A

Sickle cell anaemia, immunosuppression, HIV, infective endocarditis, IVDU

47
Q

What are RFs for non-haematogenous osteomyelitis? (4)

A

Diabetic foot ulcers, diabetes mellitus, peripheral arterial disease, pressure sores

48
Q

What are the most common causative organisms of osteomyelitis? (2)

A

Staph aureus except in pts w sickle cell where salmonella predominate

49
Q

What are the possible features of cauda equina syndrome? (5)

A

Lower back pain, bilateral sciatica, red perianal sensation, dec anal tone, urinary dysfunction

50
Q

What should you check in pts with new onset back pain?

A

Anal Tone

51
Q

What is the most common cause of cauda equina syndrome?

A

Central disc prolapse

Plus: infection, malignancy, trauma

52
Q

CES: ix + mx

A

Urgent MRI within 6hrs + surg decompression

53
Q

Comps of cauda equina syndrome (2)

A

Paralysis + Incontinence

54
Q

What is the initial imaging modality for suspected Achilles tendon rupture?

A

USS

55
Q

RFs for Achilles tendon disorders (2)

A

Quinolone + Hypercholesterolaemia

56
Q

What is the first line tx for back pain?

A

NSAIDs +/- PPI

57
Q

Typical LCL + MCL injuries

A

LCL: direct blow to MEDIAL aspect w slow developing effusion and lateral joint line tenderness

MCL: direct blow to LATERAL aspect w slow developing effusion and medial joint line tenderness

58
Q

What are meniscal tears a/w? (3)

A

Twisting injuries, delayed knee swelling, joint locking

59
Q

What does the Schatzker system classify?

A

Tibial plateau fractures

60
Q

What is the incidence of different shoulder dislocations?

A

Ant >95%
Post 2-4%
Inf <1%

61
Q

How is acromioclavicular joint injury graded?

A

Based on degree of separation: I+II conv rest w sling and IV-VI surg

62
Q

What is Thessaly’s test?

A

Used to assess meniscal tear: weight bear at 20° knee flexion and pos if pain on twisting knee

63
Q

How does lumbar spinal stenosis px?

A

Back pain, neuropathic pain and sx mimicking claudication however sitting>standing and uphill>downhill

64
Q

Mx of lumbar spinal stenosis

A

MRI + Laminectomy

65
Q

Adhesive Capsulitis vs Subacromial Impingement

A

AC: restriction of both active and passive ROM w ext rotation most marked

SI: pain on overhead activities w painful arc at the top of aBduction o/e and worse when lying on affected side

66
Q

Ddx of Painful Arc

A

45-120°: Glenohumeral

170-180°: Acromioclavicular

67
Q

Osgood-Schlatter Disease vs Chondromalacia Patellae

A

OSD: inflam of insertion into tibial tuberosity worst w activity and better w rest

CMP: inflam of underside of patella typically teenage girl w knee pain on walking down the stairs + o/e wasting of quads and pseudolocking of knee

68
Q

Osteochondritis Dissecans: DISGAPMMSSP

A

Affects subchondral bone w 2° pain, oedema, free bodies, mechanical dysfunctions

Young males
RFs trauma+genetics

Loose piece separates from end of bone

Sx: knee pain and swelling typically after exercise, locking/giving way a/w loose bodies

Signs: effusion, tenderness, Wilson’s sign

Left untx can develop degen arthritis

69
Q

What is Wilson’s sign?

A

Used for detecting medial condyle lesion: knee at 90° flexion and tibia int rotated gradual extension leads to pain at about 30° relieved by tibia ext rotation

70
Q

Mx of Frozen Shoulder

A

Relieve Pain + Restore ROM: consrv physio, meds NSAIDs codeine steroid injections, surg MUA

71
Q

What are the origins + insertions of the rotator cuff muscles?

A

Scapula + Humerus

72
Q

What are the common injuries following a FOOSH?

A

Fractures: scaphoid, colles type, clavicle + ant shoulder dislocation

73
Q

Mx of Radial Head Sublux

A

Analgesia and passive supination in 90° flexion

74
Q

Which nerve is compressed in meralgia paresthetica?

A

Lateral Femoral Cutaneous

75
Q

What are Kanavel’s signs of flexor tendon sheath infection?

A

Fixed flexion, fusiform swelling, tenderness on passive extension

76
Q

Which digits are more responsible for the pincer + power grips?

A

Pincer: index + middle

Power: ring + little

77
Q

Which knee ligament is isolated injury uncommon?

A

LCL

78
Q

What is the sx triad of a fat embolism?

A

Resp, Neuro, Petechial Rash

79
Q

Which biceps tendon rupture requires urgent MRI and often surgical intervention?

A

Distal

80
Q

Achilles Tendon RFs

A

Ciprofloxacin + Hypercholesterolaemia

81
Q

What are the key features of a ACJ dislocation?

A

Loss of shoulder contour and a prominent clavicle

Year 6 - Surgery (27 decks)

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