Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 6 - Surgery > Firms: T&O > Flashcards

Firms: T&O Flashcards

1
Q

Bone growth in width and length?

A

Width - intramembranous ossification

Length - endochondral ossification

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

What are the two types of bone healing?

A

Primary/Direct - by direct union and cutting cone where haematoma has been disturbed - slow

Secondary/Indirect - by callus formation where haematoma has NOT been disturbed - fast

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

Which cells make up the cutting cone?

A

The osteoClasts lead + osteoBlasts follow that lay osteoids

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

Which type of bone healing can the union be evaluated by xray?

A

Secondary

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

Which type of bone healing is fastest?

A

Secondary

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

The prerequisites for bone healing

A

Blood supply and periosteum, minimal fracture gap and movement, optimum pH/nutrients/growth factors

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

How do you dx a fracture?

A

Hx, o/e (tenderness + swelling), xray

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

How many planes must you ensure you xray a fracture in?

A

Two

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

What are the biggest RFs for poor bone healing that you should always elicit from the hx?

A

Diabetes

Smoking

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

How does movement affect bone healing?

A

If direct bony contact there shouldn’t be any movement vs if indirect up to 10% can be helpful

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

What should you avoid when using k wires in children?

A

The physis i.e. growth plate

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

The principles of fracture mx

A

Save Life -Then- Save Limb

Resus, Reduce, Restrict, Rehabilitate

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

What are the benefits of reducing the fracture?

A

Helps to prevent malunion

Places the soft tissues under less direct stress, inc blood flow to skin, red secondary damage

Red pain and risk of carpal tunnel syndrome etc

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

PWB vs TWB

A

Partial - a % of BW is placed on the injured limb

Touch - the injured limb is used only for balance

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

Methods of restriction

A

Non-Op: casts (backslab or full POP/fibreglass), splints, traction

Operative: external/percutaneous/internal fixation + replacement

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

When would you immobilise just that joint or both above/below?

A

If near epiphysis then below vs midshaft above

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

The ALTS principles

A 
Primary Survey
A - C spine control w manual inline stabilisation
B - ?pneumothorax
C - ?haemorrhage
D - GCS, spine, log roll
Secondary Survey
E - top to toe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a pathological fracture?

A

When there was no trauma, assess fragility, ask FLAWS/hx of cancer

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

What is the most sensitive marker of blood loss?

RR, UO, HR, BP

A

Clinically RR>HR>BP + objectively fall in urine output but not immediate

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

What is the least sensitive marker of blood loss?

RR, UO, HR, BP

A

Fall in BP

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

What is the most important marker of resus?

A

Lactate

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

Classification for open fractures

A

Gustillo Anderson:

I - puncture wound <1cm

II - 1-10cm w mod soft tissue injury

IIIa - >10cm but able to close skin

IIIb - either extensive tissue injury or needs flap/graft to close overlying skin

IIIc - vascular injury

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

Def of compartment syndrome

A

Sustained inc pressure within a myofascial compartment leading to reduced perfusion which if left untreated may lead to permanent tissue necrosis

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

What is the main give away for compartment syndrome?

A

Pain out of proportion w clinical picture and worse on passive stretching eg wriggling toes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which blood supply is occluded first in compartment syndrome?

A

Venous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Mx of suspected compartment syndrome

A

Take everything off the limb dressings/casts and give analgesia, go back and see them in ~15mins, emerg fasciotomy if lower leg two incision four compartment decomp, excise necrotic tissue, re-exploration <48hrs, early involvement of plastics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What should you do w any erythema you see?

A

Mark the outline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How long does nec fas take to spread?

A

Hrs NOT days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What should you always do before sticking a needle into a joint w septic arthritis?

A

Xray before aspirating before abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are vital parts of an ortho examination?

A

Neurovascular status on both sides + examine the joint above/below

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which blood supply to the bone inc if the nutrient artery is impaired?

A

The periosteum therefore important not to take too much away during surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is Wolff’s law?

A

The bone density changes in response to functional force

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

The two broad categories of a fracture

A

Simple and comminuted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Why do you straighten and apply pressure to a break before op?

A

Pain relief, better for the surrounding soft tissue, makes the op easier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When would you measure the compartment pressure?

A

If the pt is unconscious

NB: compartment syndrome is otherwise a clinical dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the four compartments of the lower leg?

A

Anterior, lateral and deep/superficial posteriors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What inserts onto the greater trochanter?

A

Gluteus medius and minimus - hip aBductors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What inserts onto the lesser trochanter?

A

Psoas - hip flexor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How do you categorise NOF fractures?

A

Intracapsular - undisplaced (Garden I+II) and displaced (Garden III+IV)

Extracapsular - intertrochanteric and subtrochanteric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

The blood supply to the NOF

A

Major supply - medial and lateral circumflex femoral arteries from profunda femoris and subsequent trochanteric anastomosis w branches of gluteal arteries

Minor supply - ligamentum teres from obturator artery/internal iliac + intramedullary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the NOF# give away on inspection?

A

Shortened + externally rotated leg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What do you do if clinically it suggests NOF# but not present on xray?

A

MRI>CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is malunion?

A

The bone heals but outside normal parameters of alignment: limp, gait, arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is non union?

A

Failure of bone healing within an expected timeframe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

The two types of non union

A

Atrophic - infection, gap, too stiff

Hypertrophic - too much movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

When would you favour external > internal fixation?

A

Poor soft tissues and quicker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Why are some fractures not fixed?

A 
Infection
Bleeding
VTE
NV Injury
Nonunion
Malunion
Stiffness
CRPS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Outline the mx of open fractures

A 
Save life first w ATLS
Document NV status
Photo of soft tissue
Cover w gauze and saline
IV abx co-amoxiclav and tetanus
Splint w backslab POP cast
Xrays and plan for theatre
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

How do you describe a fracture? (3)

A

Type
Location
Displacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How do you describe displacement? (3)

A

In relation of the distal to the proximal: translation, angulation, rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How do you describe translation?

A

The fixed point is your proximal bone and it’s the lateral bone that’s described

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How do you describe angulation?

A

Coronal - varus (apex lateral) or valgus (apex medial)

Sagittal - recurvartum (apex posterior) or procurvatum (apex anterior)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the general approach to interpreting a MSK radiograph?

A

The usual details + whether the pt is skeletally mature/immature

The ABCS Approach

Alignment: sublux or discl

Bones: cortex, fragments, quality

Cartilage: joint spaces, contour, arthritic/gout changes

Soft Tissues: disruption, swelling, foreign bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What does a fat pad on x-ray indicate?

A

An occult fracture that has caused swelling: ant can be normal but post is abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is a Jefferson #?

A

Multiple fractures at different points in C1 ring due to compressing vertical force

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is a Hangman’s #?

A

Fractures of both pedicles of C2 due to hyperextension injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Colles v Smiths v Bartons

A

Colles Type - extension # of distal radius w dorsal angulation

Smiths Type - flexion # of distal radius w volar angulation

Bartons Type - intra articular distal radius #

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Monteggia v Galeazzi

A

MUgGeR

Monteggia - ulna # w dislocation of radial head

Galeazzi - radius # w dislocation of distal radioulnar joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What are the clinical signs of a scaphoid #?

A

Any tenderness in the anatomical snuffbox, scaphoid tubercle, thumb telescoping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What if there’s no visible fracture on xray but there’s clinical suspicion of a scaphoid #?

A

Treat and repeat xray in 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Why is it important not to miss scaphoid fractures?

A

Retrograde blood supply and avasc necrosis risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is the Weber classification of lateral malleolus fractures?

A

A - below ankle joint

B - at ankle joint

C - above ankle joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Mx of OA

A

Confirm dx w hx, exam, ix

Take an MDT approach w PT, OT, podiatrist

Consrv: manage RFs ie optimise weight, diet, low impact exercise, ensure other medical conditions are well controlled + consider applying warm/ice packs and use of arthritis gloves if the hands are affected

Med: analgesia up WHO pain ladder + intra-articular steroid injections

Surg: referral to ortho for osteotomy, arthrodesis and more likely arthroplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

OA: DISGAPMMSSP

A

A multifactorial degenerative disease process involving degradation of articular cartilage, cellular changes and biomechanical stresses

It’s the sixth most prevalent cause of disability globally affecting predominantly elderly females esp from low income countries

Usually 1° but can be 2° to infection, inflam RA, trauma #/meniscal tear

Sx: pain, stiffness, swelling; Signs: tenderness, crepitus, dec ROM, Heberden’s, Bouchard’s; Ix: x-ray

The prognosis depends on the joints affected and disease severity and surgical mx appears to yield the best long term outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What are the features of OA on an x-ray?

A

LOSS: loss of joint space (trendelenburg), osteophytes, subchondral sclerosis, subchondral cysts (late sign)

If it’s a WB joint take the x-ray standing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What are the two causes of a trendelenburg gait in OA?

A

Loss of joint space + pain inhibition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is the unhappy triad?

A

ACL, MCL, medial meniscus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Which nerve innervates the gluteus medius/minimus and tensor fascia lata?

A

Superior Gluteal Nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Which nerve innervates the gluteus maximus?

A

Inferior Gluteal Nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is a crude way of assessing A-E in ATLS?

A

Ask for their name + to wiggle their fingers/toes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Which clinical situation would 2° bone healing be problematic?

A

Intra-Articular + Displaced #: operate to promote 1° bone healing and minimise the joint surface becoming uneven

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

When do you try and operate on a #?

A

Within 2wks before callus formation makes the procedure more difficult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What are the types of lamellar bone?

A

Cortical: hard concentric Haversian systems that communicates w medullar canal

Cancellous: soft trabecular honeycomb structure around metaphysis oriented in direction of most stress which allows for meta/epiphyseal vessels

74
Q

What happens to the blood supply to a bone after fracture?

A

The nutrient artery is disrupted and inc supply to periosteum unless open

75
Q

What are the stages of secondary bone healing?

A
  1. Haematoma 0-2w
  2. Soft Callus 2-3w
  3. Hard Callus 3-6w
  4. Remodelling <2yr
76
Q

Why might a fracture displacement in a cast?

A

As the swelling reduces therefore we take xrays to ensure it remains in place

77
Q

How long do you have if there’s damage to the blood supply?

A

Check pulses, cap refill, doppler -> limited 3-6hrs to revascularise

78
Q

: Replace>Fix

A

Comminuted
Intra-Articular
Avasc Necrosis

79
Q

: Backslab>Full Cast

A

Allow for swelling therefore red risk of compartment syndrome

80
Q

: ExFix>Cast

A

If you’re worried about infection

81
Q

: Full Cast>Backslab

A

When seen in 2wk # clinic, more stable, if fibreglass also lighter weight

82
Q

When would traction be used?

A

Midshaft femur # before operating where a cast would be inappropriate

83
Q

What needs immobilising in a midshaft fracture?

A

The joint either side so above knee/elbow casts required

84
Q

Why do pts die following a RTA?

A

Immediate: brain injury + catastrophic bleeding

Early: bleeding, DIC, ARDS

Late: comps from surgery

85
Q

Mx of Open Fracture

A 
ATLS
NV Status
Photograph
Soaked Gauze
Abx + Tetanus
Restrict
Xrays
Theatre
Rehab
86
Q

What muscles sit in the anterior compartment of the lower leg? (4)

A

Tibialis anterior, fibularis tertius, extensor hallucis longus, extensor digitorum longus

87
Q

What muscles sit in the lateral compartment of the lower leg? (2)

A

Peroneal Longus + Brevis

88
Q

What are the 6P’s of compartment syndrome?

A

Pain x6

89
Q

Dx of Compartment Syn

A

Clinical

90
Q

When would you measure the pressure of a compartment?

A

Unconscious or pt w severe learning disabilities to see if delta p >30 (within 30mmHg of diastolic pressure or absolute pressure above 40mmHg)

91
Q

What muscles sit in the posterior compartments of the lower leg?

A

Deep: tibialis posterior, popliteus, flexor hallucis longus, flexor digitorum longus

Superficial: gastrocnemius, soleus, plantaris

92
Q

Why do pts die following a NOF#?

A

Mechanical fall due to slow decline and degeneration of reflex pathways

Plus stroke, MI, UTI

93
Q

Workup for NOF#

A

Full/collateral hx to identify cause inc pre-injury mobility, DHx, SHx

Examination inc NV status, cvs, resp

Special tests inc bloods, G+S, ECG, CXR, AP pelvis and lateral hip

94
Q

What bones make up the acetabulum?

A

Ileum, Ischium, Pubis

95
Q

Mx of NOF#

A

Upon admission MMSE, seen by orthogeris, operate within 36hrs

Intracapsular: 1,2,Screw + 3,4,Austin-Moore

Extracapsular: inter DHS + sub nail

Mobilise early w physio and minimise risk of future falls and osteoporosis

96
Q

Why don’t we mx NOF# non-operatively?

A

Dec Pain, VTE, Pneumonia, UTI, Sepsis

97
Q

Which group of elderly pts would you worry about giving a THR to?

A

Alcoholics or demented pts who forget to follow the restrictions and result in dislocation

98
Q

Hemi vs Total

A

The risk of dislocation is less for a hemi because of the larger head but initial immobilisation isn’t as good and it won’t last as long due to wearing of the acetabulum

99
Q

Which OA is most common in the hip, knee, ankle?

A

Hip 1°, Knee 1°, Ankle 2°

100
Q

Which pts classically get valgus knee OA?

A

RA

101
Q

Why would you perform a unicondylar knee replacement > TKR?

A

Operatively: quicker op + preserve as much native bone making future revisions easier w less comps

Postop: faster recovery, less pain, feels more like a real knee

102
Q

What are the main comps specific to a THR?

A

Immediate - bleeding + nerve injury

Early - infection + VTE

Late - leg length discrepancy, dislocation, loosening

103
Q

What is a potential cause for a trendelenburg gait?

A

An anterolateral approach to hip surgery resulting in superior gluteal nerve injury

104
Q

What are the hip approaches? (3)

A

Anterior, Anterolateral (hemi), Posterior (total)

105
Q

Where does AVN typically occur? (3)

A

Scaphoid, Navicular, NOF

106
Q

What are the most common causes or AVN? (5)

A 
Idiopathic
Trauma
Alcohol
Steroids
Sickle Cell
107
Q

Mx of AVN

A

Dx: exclude other causes and xray/MRI

Tx: remove cause, revascularise, arthroplasty

108
Q

Where does the spinal cord end? And what is a useful landmark?

A

L1 @ bottom of ribcage

109
Q

Cord Compression vs Cauda Equina Syndrome

A

CC: presynaptic, inc tone, red power, brisk reflexes, clonus, upgoing plantars, reduced PR tone, incontinence, sensory level loss of sensation

CES: postsynaptic, dec tone, red power, red reflexes, no clonus, downgoing plantars, reduced PR tone, incontinence, patchy loss of sensation

110
Q

Why is it so important to clinically distinguish b/w CC + CES?

A

To MRI the correct part of the spine to confirm dx vs the wrong part of the spine and falsely reassure

111
Q

Myelopathy vs Radiculopathy

A

Compression of cord + root

112
Q

What happens if CES is left untreated?

A

Lower limb weakness and paralysis + long term incontinence

113
Q

Where is the T4 sensory level?

A

Nipples

114
Q

Where is the T10 sensory level?

A

Umbilicus

115
Q

What are the causes of cord compression?

A

Tumour (Mets)

Trauma

Infection (Epidural Abscess + Discitis)

Disc Prolapse

Degeneration (Spondylolisthesis)

Congenital (Scoliosis + Syringomyelia)

116
Q

What are the causes of CES?

A

The same pathology as for cord compression however it’s the level where it occurs that’s differs as does the order of most common causes: disc prolapse, degeneration, infection, tumour

117
Q

What is the most common cause of CC + CES?

A

CC: Tumour + CES: Central Disc Prolapse

118
Q

What are the red flags for impending CES?

A

Bilateral sciatica, progressive evolving neurology, saddle anaesthesia, urinary/bowel sx, sexual dysfunction

119
Q

Mx of CES

A

Confirm dx w urgent MRI + emerg discectomy/laminectomy within 48hrs of onset of sx

120
Q

How does conus medullaris syndrome differ to CC + CES?

A

It presents w a mixture of UMN + LMN signs

121
Q

What joins the lamina to the vertebral body?

A

Pedicle

122
Q

How do you reduce a patella that’s dislocated laterally?

A

Extend the knee

123
Q

What is the typical cause of a supracondylar fracture?

A

Child falling on an outstretched elbow fracturing the narrowest part of the humerus

124
Q

How are supracondylar fractures classified?

A

Gartland:

I - undisplaced

II - displaced w intact posterior cortex

IIIa - completely displaced posteromedially

IIIb - completely displaced posterolaterally

125
Q

What NV can be damaged following a supracondylar fracture?

A

Median Nerve + Brachial Artery

126
Q

What is the indication for urgent surg tx of a supracondylar fracture?

A

Absent radial pulse, clin signs of impaired perfusion, evidence of threatened skin viability

127
Q

What is the surg tx of a supracondylar fracture according to BOAST?

A

Stabilise w bicortical wire fixation: crossed wires lower risk of loss of fracture reduction + divergent lateral wires lower risk of ulnar nerve injury

Postop radiographs @ 4-10d + wire removal and mobilisation @ 3-4w

128
Q

What is the Salter-Harris grading for growth plate fractures?

A 
I - Separated
II - Above
III - beLow
IV - Through
V - Rammed
129
Q

Paeds: Septic Arthritis vs Transient Synovitis

A

The hx and symptomatology are similar: not moving, ?temp/tachy, ?recent viral illness, use Kocher criteria

130
Q

Why do children w an inflam hip find externally rotating their hip and flexing the knee more comfortable?

A

It puts the least amount of tension on the capsule

131
Q

What are the Kocher criteria for a child w an inflamed hip?

A

NWB
Temp >38.5°
ESR >40mm/hr
WBC >12,000cells/mm^3

It’s a point for each w more points making septic arthritis and need for aspiration/surg drainage more likely: 1=3%, 2=40%, 3=93%, 4=99%

132
Q

What would you do if a child’s limping and only has one of the Kocher criteria?

A

Start NSAIDs to see if it settles down as an irritable hip is self limiting

If there’s no improvement consider US looking for an effusion +/- aspiration

133
Q

What is Perthes disease?

A

Idiopathic transient AVN of the hip usually 4-8yo w the older they px the worst the prognosis as less potential for remodelling

134
Q

What should you consider if a suspected transient synovitis is not improving after a few days?

A

Perthes

135
Q

What are the stages of Perthes disease? (3)

A

Precollapsed, Collapsed, Remodelling

136
Q

Mx of Perthes

A

Dx: initially w MRI and may be found later on xray

Tx: aim to preserve shape of femoral head until revascularisation to red future arthritis

Consrv: avoid contact sports and consider crutches during painful stages

Surg: when older osteotomy/THR left as late as possible

137
Q

What is a SUFE?

A

Idiopathic head of femur slips backwards usually 9-15yo undergoing puberty px w groin or referred knee pain

138
Q

What should you consider as a potential cause of a pre-pubertal boy px w SUFE?

A

Likely to be due to hormonal changes: obesity, hypogonadal, thyroid disease

Also more likely to end up w bilateral disease and could be a ~yr b/w each px

139
Q

Mx of SUFE

A

Dx: have a low threshold to ask for AP pelvis and frog lateral xrays

Tx: aim to fix epiphysis in current position w a screw to prevent further slippage and development of 2° AVN, nonunion, arthritis +/- prophylactically tx other side in young pts

140
Q

What are the DDH screening tests for all children?

A

Barlow -> Ortolani

141
Q

Which children are at a high risk of DDH? (3)

A

FHx
Breech
Oligohydramnios

142
Q

Mx of DDH

A

Dx: initially w US if RF/pos screening and may be found later on xray

Tx: aim to keep the hip joint in place

Consrv: Pavlick harness + serial USS

Surg: MUA, spica cast, open reduction, when older osteotomy/THR

143
Q

What results in a break in shentons line?

A

DDH

NOF#

144
Q

Which rotator cuff muscle does the axillary nerve innervate?

A

Teres Minor

145
Q

What is a crude way to examine the peripheral nerves of the upper limb in a child?

A

Play rock (median), paper (radial), scissors (ulnar)

146
Q

What is Sir Herbert Seddon’s classification of peripheral nerve injury?

A

Mild-Sev: neurapraxia, axonotmesis, neurotmesis

147
Q

What are the comps of a distal radius fracture?

A

Immediate: soft tissues, haemorrhage, shock

Early: infection, compartment syn, VTE, ARDS

Late: malunion, nonunion, scarring, stiffness, CRPS

148
Q

Fat Embolism vs PE

A

You have a petechial rash w fat embolism

149
Q

Where is true hip pain?

A

Groin

150
Q

What are the three compartments of the knee joint?

A

Patellofemoral
Medial Femorotibial
Lateral Femorotibial

151
Q

What is the ASIA score?

A

The minimal elements of neurological assessment for all pts w spinal injury: strength of 10 muscle groups each side + pin prick discrimination at 28 sensory locations each side

152
Q

Mnemonic to remember the carpus: thumb + pinky

A

Here Comes The Thumb: Hamate Capitate Trapezoid Trapezium

Straight Line To Pinky: Scaphoid Lunate Triquetrum Pisiform

153
Q

What are the boundaries of the anatomical snuffbox? (3)

A

EPL + EPB/APL

154
Q

What passes through the anatomical snuffbox? (3)

A

Radial artery, cephalic vein, superficial branch of the radial nerve

155
Q

What are the boundaries of the carpal tunnel? (2)

A

Superficial flexor retinaculum + deep carpal arch

156
Q

What passes through the carpal tunnel? (4)

A

FDSx4, FDPx4, FPL, Median Nerve

157
Q

What are the boundaries of Guyon’s canal? (4)

A

Volar and transverse carpal ligaments, pisiform, hook of hamate

158
Q

What passes through Guyon’s canal? (3)

A

Ulnar artery, vein, nerve

159
Q

What is the sensory distribution of the median + ulnar nerves?

A

Median: lateral three 1/2 digits inc nail beds + palmar cutaneous

Ulnar: medial one 1/2 digits, palmar cutaneous, dorsal branch

160
Q

What does the anterior interosseous branch of the median nerve supply?

A

FDP, FPL, Pronator Quadratus

161
Q

What is the Kapandji score?

A

Assessment of thumb opposition: 1 (radial side of proximal phalanx of index finger) to 10 (distal palmar crease)

162
Q

What is the vertebral level of the inferior angle of scapula?

A

T7

163
Q

What are the borders of the femoral triangle? (3)

A

Inguinal ligament, adductor longus, sartorius

164
Q

Where in the ankle do the long + short saphenous veins pass?

A

Long: in front of the medial malleolus

Short: behind the lateral malleolus

165
Q

Ddx for a hot swollen knee

A 
Trauma
Septic
Gout
Bursitis
Reactive
Haemarthrosis
Flare up of RA
166
Q

What are hints that the joint could be septic?

A

RIG: recent replacement, infection risk (elderly, diabetic, immunocomp), gonococcal

167
Q

Septic Arthritis vs Bursitis

A

ROM

168
Q

Where are the diff eponymous bursitis in the knee?

A

Housemaids - Prepatella

Clergymans - Infrapatella

Bakers Cyst - Semimembranous

169
Q

What are the potential consequences of septic arthritis? (2)

A

Septic Shock + OA

170
Q

What’s the most common culprit for septic arthritis?

A

Staph Aureus

Plus ivdu mrsa, sickle cell salmonella, sexually active gonococcal

171
Q

What is a red hot swollen joint until proven otherwise?

A

Septic Arthritis

172
Q

What is a bakers cyst usually on the background of?

A

OA or RA

173
Q

Workup for a hot swollen knee

A

Full hx inc recent surg/diabetic/sexual, examination inc mcmurrays/hands/obs, special tests inc bloods (wcc crp esr urate clotting) + aspiration (MCS and crystals) only if native joint

174
Q

Tx of Septic Arthritis

A

Washout + IV Empirical Abx

175
Q

What can result in ulnar nerve palsy? (3)

A

Dysfunction at cervical spine, cubital tunnel syndrome at elbow, guyons canal syndrome at wrist

176
Q

Which muscles in the forearm does the ulnar nerve supply?

A

Flexor capri ulnaris + the medial half of flexor digitorum profundus

177
Q

What are the subtypes of osteomyelitis?

A

Acute: initially nidus of infection which can spread under the periosteum

Subacute: brodies abscess in children

Chronic: walled off abscess w sequestrum (necrotic bone) inside and involucrum (reactive bone) outside +/- sinus

178
Q

What are the majority of osteomyelitis you see in the community?

A

Chronic: young/old, immunocomp, diabetic

179
Q

Tx of Osteomyelitis

A

Aggressive IV abx if acute + surgical drilling if sequestrum

180
Q

CIs of FIB

A

Absolute: clinical suspicion of compartment syndrome + local anaesthetic allergy

Relative: associated crush injury, infection/burn of overlying skin at injection site, easy bruising

181
Q

What is the vertebral level of the iliac crest?

A

L4

Year 6 - Surgery (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions