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Medicine Finals > MSK > Flashcards

MSK Flashcards

1
Q

Define Major Trauma

A

any injury that has the potential to cause prolonged disability or death. injury severity score >15.

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2
Q

Define Polytrauma

A

A syndrome of multiple injuries exceeding a defined severity with sequential systemic reactions that may lead to dysfunction or failure of remote organs and vital systems which have themselves been directly injured.

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3
Q

Initial management of major trauma.

A

Primary Survey - ABCDE approach.

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4
Q

What are the main sources of internal bleeding?

A 
Head
Chest
Abdomen
Retroperitoneum
Pelvis
Long Bones 
(+ on the floor)
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5
Q

GCS scoring system.

A 
Eyes: 1-4.
Verbal: 1-5.
Motor: 1-6.
Minor brain injury - 13-15.
Moderate - 9-12.
Severe - 3-8.
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6
Q

Define shock.

A

A life-threatening condition of circulatory failure resulting in cellular injury and inadequate tissue function.

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7
Q

Define compartment syndrome.

A

Where an osseo-fascial compartment pressure rises to a level that decreases perfusion.

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8
Q

Management of compartment syndrome.

A

Fasciotomy.

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9
Q

Define dislocation.

A

Displacement of bones at a joint from their normal position, resulting in complete loss of congruity.

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10
Q

Define subluxation.

A

Partial displacement, some congruity maintained.

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11
Q

Management of dislocation.

A

Urgent reduction of joint using appropriate analgesia/sedation/anaesthesia.
Document neurovascular status before and after.

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12
Q

Define open fracture.

A

When the skin overlying a fracture is broken, allowing communication between the fracture and the external environment.

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13
Q

Define compound (from within) fracture.

A

the broken end of the bone breaks through/pierces the skin.

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14
Q

Define compound (from without) fracture.

A

External violence causes laceration or tissue damage, higher likelihood of contamination.

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15
Q

Classification of open fractures.

A

Gustillo-Anderson Classification.
Type 1 <1cm
Type 2 1-10cm
Type 3 >10cm or high energy
A – adequate tissue for coverage.
B – extensive periosteal stripping and requires flap.
C – vascular injury requiring vascular repair.

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16
Q

Complications of open fractures.

A
  • Soft tissue infection.
  • Osteomyelitis.
  • Tetanus.
  • Crush syndrome.
  • Skin loss.
  • Non-union.
  • Amputation.
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17
Q

Initial Management of open fractures.

A
  • Control bleeding.
  • Cover with sterile dressing.
  • Splint.
  • IV antibiotics.
  • Tetanus prophylaxis.
  • Assume any open wound over or near a joint extends to the joint until proven otherwise.
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18
Q

Definitive management of open fractures.

A

Stabilise bone to protect soft tissues.

May require multiple surgical procedures if severe soft tissue management.

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19
Q

Management of septic arthritis.

A

Aspiration of joint
IV antibiotics.
Washout of joint.

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20
Q

Clinical Features of septic arthritis.

A
  • Rapid onset.
  • Joint pain, swelling, warmth and erythema.
  • Fever.
  • Decreased range of motion.
  • Pain with active and passive ROM.
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21
Q

Complications of septic arthritis.

A
  • Rapid destruction of joint with delayed treatment (>24 hours).
  • Degenerative joint disease.
  • Soft tissue injury.
  • Osteomyelitis.
  • Joint fibrosis.
  • Sepsis.
  • Death.
22
Q

Clinical features of compartment syndrome.

A 
Pain.
paraesthesia. 
pallor.
pulselessness.
paralysis.
pressure.
23
Q

Define necrotising fasciitis.

A

A life-threatening bacterial infection of the subcutaneous fascia.

24
Q

Management of necrotising fasciitis.

A

Urgent surgical debridement.

High dose broad spectrum abx.

25
Q

Define cauda equina syndrome.

A

A syndrome where a space occupying lesion within the lumbosacral canal puts pressure on the nerves of the cauda equina.

26
Q

Clinical features of cauda equina syndrome.

A

Bowel/bladder dysfunction.
Saddle anaesthesia.
Lower sensorimotor changes.

27
Q

Investigations into cauda equina syndrome.

A

Pre and post voiding bladder scan.
MRI scan.
PR exam recording sensation and anal tone.

28
Q

Treatment of cauda equina syndrome.

A

Urgent spinal decompression within 24 hours.

If due to malignant, may treat with radiotherapy.

29
Q

Complications of missed cauda equina syndrome.

A

Urinary dysfunction requiring catheterisation.
Sexual dysfunction.
Chronic pain.
Persistent leg weakness/altered sensation.

30
Q

Define intra-articular fracture.

A

Any fracture which involves a joint.

31
Q

3 principles of fracture management.

A

Reduce - realign the fragments.
Retain - immobilise the fragments.
Rehabilitate - restore function to the limb.

32
Q

Complications of fractures.

A

Compartment syndrome.
Infection.
Malunion.
Non-union - atrophic or hypermetrophic.

33
Q

Management of mechanical back pain.

A

Patient education.
Good early symptomatic control with simple analgesia.
Early return to normal activities and work.
Self referral to physio

34
Q

Diagnosis of nerve root impingement.

A

MRI indications:

  • initially radicular pain >6 weeks with no improvement with conservative treatment.
  • neurological deficit.
  • bilateral lower limb deficit/peroneal symptoms - urgent referral for assessment of CES
35
Q

Management of nerve root impingement.

A 
Majority non-surgical:
- physio.
- analgesia.
- muscle relaxants.
- alternative therapies (acupuncture). 
Surgery if no improvement.
36
Q

Indications for surgery in nerve root impingement.

A

Absolute:
- cauda equina syndrome.
- progressive neurological deficit.
Relative:
-intractable radicular pain.
- neurological deficit with no improvement.
- recurrent sciatica with no improvement.

37
Q

Red flags of serious spinal pathology.

A

Age <18 or >50 at onset of non-mechanical pain.
Bilateral radicular leg pain.
Limb weakness.
Alternation of bladder and/or bowel function.
Perianal numbness.
PMH cancer.
Constitutional symptoms/weight loss.
Trauma.
Thoracic pain.
PMH immunocompromise/prolonged steroid use.

38
Q

Common organisms of discitis and vertebral osteomyelitis.

A

Staph and strep most common.
Strep and haemophilus in children.
Consider TB.

39
Q

Clinical features of discitis/vertebral osteomyelitis.

A

Fever.
Generally unwell.
Unrelenting back pain.
Late cases may present with spinal deformity - kyphosis, scoliosis.

40
Q

Management of discitis/vertebral osteomyelitis.

A 
Biopsy with CT guidance.
IV abx (minimum 6 weeks). 
surgery may be required:
- stabilisation.
- drainage of large abscess.
41
Q

Investigation of spinal tumours.

A

MRI whole spine.
Bone scans.
Serum calcium - hypercalcaemia.

42
Q

Clinical exam findings of spinal injury.

A

Bony midline tenderness.
Clinical deformity or palpable step.
Boggy swelling or bruising.
Neurological compromise.

43
Q

Features of spinal shock.

A

Bradycardia.

Hypotension.

44
Q

Complications of shoulder dislocation

A

Neuro/plexus injuries.
Bankhart/Hill-Sachs lesions.
Recurrent rates higher in younger patients.
Cuff tears in older patients.

45
Q

Classification of acromioclavicular dislocation.

A

Rockwood types 1-6.
Grade 1-3: conservative (physio)
Grades 4-6: reconstruction or ORIF with hook plate.

46
Q

Classification of proximal humerus fracture.

A

Neer system.

4 parts based upon displacement and angulation.

47
Q

Classification of radial head fracture.

A

Mason types 1-4.
1 - conservative management.
2 - conservative unless unable to rotate.
3 and 4 - ORIF, excision or replacement.

48
Q

Monteggia fracture.

A

Proximal 1/3 ulnar fracture with radial head dislocation/instability.
Types 1-4.

49
Q

Galeazzi fracture.

A

Distal 1/3 radius shaft fracture and associated DRUJ injury.

50
Q

Colle’s fracture.

A
  • Transverse fracture of the radius.
  • 2.5 cm (0.98 inches) proximal to the radio-carpal joint.
  • dorsal displacement and dorsal angulation, together with radial tilt.

Medicine Finals (8 decks)

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