Cortex Flashcards
1
Q
risk factors for type 1/post menopausal osteoporosis
A
early menopause white caucasians smoking alcohol low exercise poor diet
2
Q
risk factors for type 2/ old age osteoporosis
A
vit D / sunshine
inactivity
3
Q
emergency Rx of very high serum Ca2+
A
IV fluids
biphosphonates
calcitonin
4
Q
PTH increases bone ___ and renal ___ of Ca2+
A
resorption
reabsorption
5
Q
CKD => decreased ___ excretion and inactive activation of ___ => _____ => __+__+__
A
phosphate vitamin D 2ndry hyperparathyroidism sclerosis of bone osteomalacia calcification of soft tissues
6
Q
seronegative arthitises
A
ank spond
psoriatic
reactive
enteropathic
7
Q
seropositive arthritises
A
RA lupus scleroderma vasculitis Sjogrens
8
Q
limited type systemic sclerosis is ass with which auto Ig
A
anti centromere
9
Q
diffuse type systemic sclerosis is ass with which auto Ig
A
anti-Scl-70
10
Q
myositis is ass with which auto Ig
A
anti Jo 1
11
Q
typical xray of OA (LOSS)
A
loss of joint space
osteophytes
sclerosis
subchondral cysts
12
Q
sacroiliitis, uveitis, dactylitis and enthesopathies are common features of ___
A
seronegative arthritis
13
Q
v aggressive and destructive form of psoriatic arthritis
A
arthritis mutilans
14
Q
enteropathic arthritis tends to be a __ joint _____ ___arthiritis
A
large
asymmetrical
oligo
15
Q
Reiter’s syndrome =
A
urethritis
uveitis/conjunctivitis
reactive arthritis
16
Q
___ is low in active SLE and especially in ___
A
C3/4
renal disease
17
Q
used to monitor the activity level of SLE
A
C3/4
anti dsDNA Ig
18
Q
auto Igs in Sjogrens
A
anti Ro + La
19
Q
For Sjogrens: ___ can stimulate saliva production but may cause facial flushing
A
pilocarpine
20
Q
3 stages in cutaneous systemic sclerosis
A
oedematous -> indurative > atrophic
21
Q
beaking of the nose skin is a sign of
A
systemic sclerosis
22
Q
MCTD is ass with which auto Ig
A
anti-RNP Ig
23
Q
usual sites of pseudogout
A
knee
wrist
ankle
24
Q
chondrocalcinosis =
A
calcium pyrophashate deposition in cartilage/other soft tissues without acute inflammation
25
antigens specific to myositis
anti-Jo-1
| anti SRP
26
Rx for dermato+polymyositis
prednisolone (initially 40mg)
| IS eg. methotrexate
27
early features of Takayasu arteritis
```
low grade fever
night sweats
wt loss
arthralgia
fatigue
```
28
Takayasu arteritis population?
East Asian 100x the risk
| young F 10-30yo
29
later signs of Takayasu arteritis
claudication in upper and lower limbs
| if untreated = vascular stenosis and aneurysms
30
ass with cANCA and PR3
GPA
31
brittle bone disease =
| defect of __+__
osteogenesis imperfecta
| maturation and organisation of Type 1 collagen
32
commonest skeletal dysplasia
Achondroplasia
33
IQ in achondroplasia is ___
normal
34
double jointed - ness inheritance pattern =
dominant inheritance
35
Ehlers Danlos - abnormal __+__ formation
| inheritance =
elastin and collagen
| autosomal dominant
36
DMD = ___ gene defect involved in __ transport
dystrophin
| Ca2+
37
Diagnosis of DMD is by __+__
increased serum creatinine phosphokinase
| muscle biopsy
38
similar to DMD but able to walk in teens and live til 30-40yo
Beckers muscular dystrophy
39
upper motor system = __+__
brain and spinal cord
40
lower motor system = _+_+_
anterior horn cells
nerve roots
peripheral nerves
41
spastic CP is caused by injury to __/__/___
motor cortex
upper motor neurons
corticospinal tract
42
ataxic CP is caused by injury to __
cerebellum
43
athetoid CP is caused by injury to __+__+__
extrapyramidal motor system, pyramidal tract and basal ganglia
44
spina bifida is caused by __ not fusing
two halves of posterior vertebral arch
45
polio is an infection of the ____ cells in ____ = L/UMN deficit
motor anterior horn cells
spinal cord/brainstem
LMN
46
2 digits fused together congenitally =
syndactyly
47
fibular hemimelia =
| features =
partial/complete abscence of fibula often with abscence of lateral foot rays
shortened limb, tibia bowing + ankle deformity
48
Erb's palsy is caused by __+__ damage
loss of motor innervation to __+__+__+__+__
classic sign =
C5 +6
deltoid, supraspinatus, infraspinatus, biceps and brachialis
Waiters tip posture
49
watiers tip sign of __
Erbs palsy
50
Klumpkes palsy = __+__ injury due to forceful ___ => paralysis of ___ +/- finger and wrist ___
possible ___ syndrome
fingers are in ___ position
```
C8 T1
adduction
intrinsic hand muscles
flexors
Horners
flexed
```
51
Blount's disease =
growth disorder of medial proximal tibial physis => genu varum - also called tibia vara
52
DDH: __/___ of femoral head in perinatal that affects development of the hip
subluxation/dislocation
53
Pavlik harness for ___ keeps in __+__
DDH (dislocated/unstable) - keeps in flexion and abduction
54
most common cause of hip pain in childhood
usually preceded by ___
age:
M:F
Transient synovitis of the hip
URTI (viral)
2-10yo
M>F
55
presentation of transient synovitis of the hip
limp/no wt bearing
motion restriction
low grade fever
56
Ix for transient synovitis of the hip
radiographs (exclude Perthes)
normal CRP (exclude septic arth)
MRI (exclude osteomyelitis)
57
Rx for transient synovitis of the hip
NSAIDs and rest - resolves in a few weeks
58
idiopathic osteochondritis of the femoral head =
Perthes
59
presentation of Perthes
pain and limp
loss of internal rotation
+ve trendelenburg test (loss of abduction + gluteal weakness)
60
Rx for Perthes
regular xray + decrease physical activity
61
mainly affects overweight prepubertal boys
| hypothyroid and renal might predispose
SUFE
62
in SUFE get loss of ___ (movement)
internal rotation
63
Rx for SUFE =
urgent Sx pinning
replacement
osteotomyif chronic
64
jumpers knee =
| Rx:
patellar tendonitis
| rest +/- physio
65
Sinding-Larsen-Johansen =
inferior pole of patella apophysitis of patellar tendon
66
patellofemoral dysfunction =
anterior knee pain in adolescents
67
adolescent with poorly localised knee pain, effusion and locking =
Osteochondritis Dissecans
68
___ technique for splinting talipes equinovarus =
Ponseti
69
tarsal coalition is between ___ or ___
calcaneus-navicular
| talus-calcaneus
70
management of cauda equina syndrome =
urgent PR -> MRI > discectomy
71
cervical disc prolapse is usually __/___ nerve roots that are affected
C7/8
72
Downs and Rheum arth are at risk of _/__ spine subluxation
C1/2
73
rotator cuff muscle that initiates abduction
| attaches to ___
supraspinatus
| greater tuberosity
74
rotator cuff muscle that is external rotator
| attaches to ___
infraspinatus and
| greater tuberosity
75
rotator cuff muscle that is internal rotator
| attaches to ___
subscapularis
| lesser tuberosity
76
in frozen shoulder: initial ___ (subsides in ___ months) as ___ increases (for __ months)
pain
2-9months
stiffness
4-12 months
77
Ca2+ deposition in supraspinatus tendon seen on xray just proximal to greater tuberosity
=> ___
Acute calcific tendonitis
| acute severe shoulder pain
78
Rx of acute calcific tendonitis =
self limiting as Ca2+ resorbs
| injection of subacromial steroid and local anaesthetic
79
carpal tunnel contains -
median nerve
| 9 flexor tendons ( 4x FDS + FDP and 1 FPL) with synovial covering
80
carpal tunnel syndrome => paraesthesia of ____
worse at ___
loss of ___ and ___ of thumb or __ of hand
thumb and radial 2 1/2 fingers
night
sensation and weakness
clumsiness
81
Osborne's fascia
tight band over cubital tunnel roof
82
cubital tunnel syndrome => paraesthesia in ___
ulnar 1 1/2 fingers
83
__+__ supinate forearm
biceps and supinators
84
__+__ pronate forearm
pronator teres and pronator quadratus
85
hyperplasia of myofibroblast cells and production of type 3 not 1 collagen in palmar fascia =
Dupuytrens contracture
86
__+__ contractures occur in Dupuytrens
MCP and PIP
87
deformities of hand and wrist in RA
```
volar MCPJ subluxation
ulnar deviation
swan neck
boutonniere
z-shaped thumb
```
88
hanging rope sign =
AVN of femoral head
89
pain and tender at greater trochanter and pain on ____
troachanteric bursitis
| resisted abduction
90
menisci are made from ___
fibrocartilagenous
91
degenerative meniscal tears are Steinmann's ___
-ve
92
usually extensor mech part that ruptures in < and > 40yos
```
<40yo = patellar
> = quadriceps
```
93
avoid ___ in tendonitis in extensor mechanism as increases rupture risk
steroid injection
94
___ (Abx) that can cause tendonitis
quinolones
95
patellofemoral dysfunction encompasses (3)
chondromalacia patellae
adolescent ant knee pain
lateral patellar compression syndrome
96
quad muscle tends to pull patella medially/laterally
| this is greater in F/M due to ___
laterally
| F - wider hips
97
patella almost always dislocates ___
| and is reduced when __
laterally
| leg is straightened
98
OA of foot and ankle common in __ due to repeated dorsiflexion => osteophytes and impingement
___ Rx is more reliable and has fewer re-op rates
___Rx has a better functional outcome, usually only in elderly
footballers
Arthrodesis
replacements
99
hallux valgus is due to ___ of 1st MT and ___ of toe
medial deviation
| lateral deviation
100
gold standard for hallux rigidis (1st MTPJ OA)
| means F can no longer___
arthrodesis
| wear heels
101
plantar interdigital nerves (from medial and lateral plantar nerves) overlying intermetatarsal ligaments can be subjected to repeated trauma. Become swollen and inflamed =
Morton's neuroma
102
Morton neuroma => ___ pain and ___ into toes
burning
| tingling
103
most common site of Morton's neuroma
3rd interspace nerve > 2nd
104
Med-laterally compressing MT heads reproduces burning pain and toe tingling and produces a click =
test for
Mulder's click test
| Mortons neuroma
105
Rx of Mortons neuroma
US
may => MT pad/offloading insole
Steroid and LA injections
can be excised
106
MT stress # is usually in ___ then ___ next most common
| Rx =
2nd > 3rd
xray might not show til 3rd wk and bone scan may be useful
6-12wk in rigid soled boot
107
```
tibialis posterior distal insertion is predominantly ___
function =
```
medial navicular
| support medial arch (+ plantarflexion + invertor of foot)
108
hyperextension at MTPJ and hyperflex at PIP+DIPJ =
claw toe
109
hyperextension at MTPJ + DIPJ and hyperflex at PIPJ =
hammer toe
110
metal particles in arthroplasty can => ___ => ___
```
inflammatory granuloma (pseudotumour)
bone and muscle necrosis
```
111
polyethylene particles in arthroplasty can => ___ => __+__
inflammation in bone
| osteolysis and loosens joint replacement
112
___ used in arthroplasty can shatter due to being brittle
ceramics
113
arthrodesis = remove __+___ and stabilise bone with __
hyaline cartilage and subchondral bone
| fusion
114
arthrodesis is an option for __+_+_
ankle arthritis
wrist arthritis
hallux rigidis
115
osteotomy =
remove a wedge of bone to redistribute weight, realign and correct deformity
116
osteotomy can be used for __+__
early hip and knee arthritis
117
___ may infect osteocytes intracellularly
S. aureus
118
in neonates some metaphyses are ___ and so osteomyelitis can cause
intra articular
| septic arthritis
119
Brodies abscess =
children's subacute osteomyelitis where abscess is walled by thin sclerotic bone
120
most common site in spine for osteomyelitis
lumbar
121
neonatal organisms of osteomyelitis
S aureus
enterobacter spp
Strep A + B
122
4m -4yo organisms of osteomyelitis
S. aureus
Strep A
H. infu
enterobacter spp
123
4yo - adult orgs of osteomyelitis
S aureus 80%
Strep A
H influ
enterobacter spp
124
adult orgs of osteomyelitis
S aureus
| occasionally Strep/enterobacter spp
125
sickle cell anaemic org.s of osteomyelitis
S. aureus
| salmonella - unique to this group
126
salmonella osteomyelitis is unique to which pop group
Sickle cell anaemics
127
late onset haemotologically spread causative org.s of infection post ortho Sx =
S. aureus
beta strep
enterobacter
128
in primary healing gap fills with
new bone from osteoblasts
129
hypertrophic non-union occurs if ____ => abundant ___ but no bridging
excessive movement
| hard callus
130
cause of transverse # = __ force
bending
131
oblique fractures are caused by a ___ force
shearing (fall/deceleration)
132
transverse #s may ___ and don't ___ unless completely displaced
angulate
| shorten
133
oblique fractures tend to ___ and may ___
| fix with ____
shorten
angulate
interfragmentary screws
134
spiral #s are due to ___ forces
torsional
135
most spiral fractures are unstable to ___ and can ___. Fix with ___
rotation
angulate
interfragmentary screws
136
bone fracture with >=3 parts =
| usually high E / poor bone quality
comminuted
137
2 separate fractures =
| need ___ Rx
segmental
| need stabilisation with rod / plates
138
direct translation of distal fragment =
displacement
139
direction the distal fragment to the degree of deformity
angulation
140
Ix for #s =
```
1st line = AP and lateral xray
perhaps later: tomography (mandibular)
CT complex/Sx plan)
MRI (occult #)
technetium bone scan (stress #)
```
141
compartment syndrome:
| __+__ increase pressure in fascial compartment => compress ___ => ____ as ___ cant supply
```
blood
inflammation
veins
secondary ischaemia
arteries
```
142
if untreated compartment can => necrosis => ____
Volkmann's ischaemic contracture
143
increased pain on passive stretching and more severe pain than expected
compartment syndrome
144
contusion =
bruising
145
blisters are caused by:
inflammatory exudates lift epidermis
146
of tibia take ___ to unite
16wk-1yrs
147
of the femoral shaft take ___ to unite
3-4 months
148
___ heal faster that cortical #
metaphyseal
149
fracture disease symptoms = __+__ usually Rx =
stiffness
weakness
resolve with time
150
sites prone to non-union =
scaphoid waist
distal clavicle
subtrochanteric femoral
Jones # of 5th MT
151
heightened chronic pain response after injury =
CRPS - chronic regional pain syndrome
152
type 1+2 CRPS =
1 - due to peripheral nerve injury
| 2 - no cause
153
Rx for CRPS
```
analgesia
amitriptylline
gabapentin + steroids
TENS
lidocaine patches
symp nerve block injections
```
154
Gustilo classifaction describes the degree of __+__+__ in assessing ____
contamination, wound size, if can be closed, if vascular injury
open #s
155
Rx of open #s =
IV broad spectrum Abx (fluclox, gent + metro if soil contaminants) + sterile dressing =>
debride + int/ext fixation => close wound
156
skin grafts don't take to _+_+_+_
bare tendon, bone, metal or fat
157
most disclocations Rx =
closed manipulation and anaesthesia
158
__+__ tendon tears need repair to restore function
quad and patellar
159
_+_+_+_ tendon tears can be treated conservatively unless reduced function
achilles
rotator cuff
long head of biceps brachii
distal biceps
160
suspect ___ if septic arthritis in multiple joints
endocarditis
161
Organisms of Septic arthritis
```
S aureus (most common)
strep
H influ (kids)
Neisseria gonorrhoea
E coli (IS, elderly, IVDUs)
```
162
Rx in septic arthritis
aspirate
Abx ( after confirmed diagnosis and organism)
Sx washout
163
criteria for a clinically clear (collar can be removed) C spine =
```
no Hx of loss of consciousness
GCS 15 without intoxication
no other sig distracting injuries
no neuro
no midline tenderness
no pain on neck movement
```
164
if C spine not clinically cleared must ___ clear
radiologically
| CT/xray
165
Rx for C spine #
immobilise in halo vest or stabilise
166
flexion distraction # with failure of posterior ligaments of thoracolumbar spine
Chance #
167
spinal shock = physiological response to ___ with complete loss of _+_+_
resolves in __
____ return signals its end
injury
sensory, motor and reflexes
24hrs
Bulbocavernous reflex
168
Bulbocavernous reflex =
| signals end of ___
anal sphincter contracts with squeeze of glans penis/ tap mons pubis / pull urethral catheter
169
neurogenic shock is 2ndry to ____ of ___
temporary shutdown of sympathetic outflow from T1-L2
170
in men neurogenic shock may => ___ due to unopposed
priapism
| parasympathetics
171
neurogenic shock => __+__ resolves in ___
hypotension
bradycardia
24-48hrs
172
corticospinal tract is responsible for __
motor
173
spinothalmic tract is responsible for __+__+_
coarse touch
| pain and temp
174
central cord syndrome more commonly affects __ >___ as corticospinal tracts lie more ___ than __ ones
arms > legs
central
leg
175
anterior cord syndrome = loss of __+__ with __+__+__ preserved
```
corticospinal tract (motor) + lateral spinothalmic tract (coarse touch, pain temp)
proprioception, vibration sense and light touch (dorsal collumns)
```
176
Brown Sequard syndrome:
due to ___ of cord => loss of ___ sensation (proprioception, vibration sense and light touch) and ___ ipsilaterally
an contralateral loss of _+_+_ sensation as ___ nerves cross 1/2 levels above entry into cord + others cross in ___
```
hemisection
dorsal
paralysis
pain, temp and coarse touch
medulla
```
177
lateral compression # of pelvis:
__ impact
1 hemipelvis is displaced ___
#s through __/___ + ___ #/____ disruption
side
medially
pubic rami/ischium
sacral compression #/ SIJ disruption
178
Vertical shear # of the pelvis:
__ force on one hemipelvis where its displaced ___
may cause __+___ injury and major haemorrhage
leg on affected side will look ___
axial
superiorly
sacral nerve root + lumbosacral plexus
shorter
179
anteroposterior compression injury to pelvis => ___ of ___ ("____" #) = substantial bleeding
wide disruption
pubic symphysis
open book #
180
low E pelvic #s in elderly:
| usually __ displaced __ compression injuries with __/___ posteriorly
minimally
lateral
sacral#/ SIJ disruption
181
___ needed for Sx planning of acetabulum #s
CT
182
most common humeral neck # =
surgical neck with medial displacement of humeral shaft due to pull of pectoralis major muscle
183
Rx of humeral neck Rx =
sling
| if repeatedly displaced # = internal fixation
184
Bankart lesion =
anterior glenoid labrum and capsule detach
185
post humeral head impact on ant glenoid causing an impaction # of posterior head =
Hill-Sachs lesion
186
light bulb sign is seen in __ xrays = sign of
AP
| posterior GHJ dislocation
187
__ union rate ; ___ angulation is acceptable in humeral shaft #s as __+__ are mobile
90%
<=30 degrees
elbow and shoulder
188
radial nerve injury => ___ + ___ sensation loss
wrist drop
| first dorsal web space sensation loss
189
humeral shaft # Rx =
functional humeral brace
| internal fixation may => quicker recovery
190
olecranon # is caused by fall onto __ with ___ contraction
| Rx =
elbow point
triceps
ORIF
191
radial head + neck # Rx =
sling and physio
| may need ORIF
192
Rx of Galeazzi and Montegggia # dislocations
ORIF
193
volarly displaced/angulated extra-art # of distal radius usually due to fall on back of flexed wrist =
Smith's #
194
intra art # of distal radius involving dorsal/volar rim and carpal bones sublux with displaced rim # fragment
Barton's #
195
intra-art Smith's # =
volar Barton's #
196
intra-art Colles # =
dorsal Barton's #
197
anatomical snuff box is between __/__ + __ tendons
APB/EPB
| EPL
198
spilt cup sign on xray =
lunate dislocation
199
lateral ankle ligs affected in a sprain=
ant and posterior talofibular and calcaneofibular
200
stable ankle # = ___ without __/___
isolated distal fibular #
| medial#/ deltoid lig rupture
201
suspect deltoid lig rupture if ___
medial tenderness
202
if talar shift then ___ msut be ruptured
deltoid lig
203
Rx of talar # =
reduce and screw fixation
204
prox diaphyseal # of 5th MT
Jones #
205
in paeds ___ angulation is corrected with every year of growth remaining
10 degrees
206
treat #s in kids that are ___ as adults as remodelling potential is less
12-14yo
207
Salter harris I classification of physeal #s
purely physeal separation
| least likely to result in growth arrest
208
Salter harris II classification of physeal #s
most common
| physeal separation + small metaphyseal fragment attached to physis and epiphysis
209
Salter harris III + IV classification of physeal #s
intraarticular + # splits physis
| must reduce and stabilise
210
Salter harris V classification of physeal #s
compression injury to physis => growth arrest
| only detected when angular deformity shows
211
if displaced forearm # in paeds Rx=
flexible IM nail
212
__ are more common than ___ as causes for supracondylar # of elbow in paeds
FOOSH
| flexion #
213
median nerve branch predominantly damaged in supracondylar #s?
=> no __ sign as lose __+__ to index
anterior interosseous
OK
FPL + FDP
214
Rx of femoral shaft # in <2yo
Gallows traction and early hip spica cast
215
Rx of femoral shaft # in 2-6yo
Thomas splint/ hip spica cast
216
Rx of femoral shaft # in 6-12yo
flexible IM nail
217
Rx of femoral shaft# in >12yo
adult IM nail
218
undisplaced spiral tibial shaft # is common in (age groups)
| Rx =
toddlers
| cast
