MDEMO Flashcards
(108 cards)
1
Q
chemical burns - neutralise?
A
No, it worsens thermal damage
2
Q
age of wound
<6hrs
>6hrs
on face and <24hrs
A
close
delayed primary closure (leave and close after 48 hours
close
3
Q
tetanus prone injuries
A
anything within 6 hours of surgery puncture wound significant devitalised tissue evidence of sepsis contamination with soil burns/frostbite high velocity missile injuries
4
Q
moderate risk tetanus
high risk tetanus
A
tetanus diphtheria vaccine or tetanus toxoid vaccine
tetanus immunoglobulin
5
Q
nutrient artery
A
supplies diaphysis
6
Q
fracture healing process
A
haematoma granulation tissue osteoid soft callus hard callus/woven bone remodelling
7
Q
Perren’s law
A
the degree of strain at the fracture site determines the type of tissue that forms between the fracture fragments
8
Q
composition of a Haversian system
A
3 concentric rings of collagen fibres in opposite directions
9
Q
types of non-union
A
hypertrophic (Perren’s law)
atrophic (host factors means it doesn’t heal - heavy drinker, smoker, diabetic, NSAID user)
10
Q
Wolff’s law
A
bone will be deposited along lines of stress due to piezoelectric forces
11
Q
Heuter-Volkman law
A
overload causes too much negative charge in early walkers or overweight children so the medial part of the physis shuts down causing severe genu varum
12
Q
rugby jersey stripe on vertebrae on xray
A
osteopetrosis
13
Q
most common form of rickets in developed world
A
familial hypophosphataemic rickets
14
Q
deformities in rickets
A
erlenmeyer flask deformity in femur
tibial bowing
15
Q
genu varu, or valgum in children
A
<1yo = genu varum 1-2 = 3-5degrees of genu valgum
16
Q
McMurrays test
A
internally rotate for lateral meniscus
Externally rotate for medial meniscus
17
Q
blood supply in ligamentum teres
A
obturator artery –> foveal artery –> small medial part of epiphysis
18
Q
treatment of perthes
A
self limiting. the younger the patient the better the result (Expect in a 2-4 year old)
19
Q
what affects 50% of eskimos
A
spondylithesis (affects 5% of general population)
20
Q
spondylosis
A
stress fracture in the pars interarticularis of the vertebral arch. can lead to spondylolithesis when the whole thing slips on the sacrum
21
Q
congenial spinal stenosis
A
dwarves
22
Q
shopping trolley sign
A
spinal stenosis (like how cycling is good for it)
23
Q
bones that form the floor of the carpal tunnel
A
hamate capitate
24
Q
contents of the carpal tunnel
A
4 flexor digitorum superficialis
4 flexor digitorum profundum
1 flexor hallucis longus
median nerve
25
steroid injections in carpal tunnel
cure 80% of symptoms but 100% recur within 12 months
26
ulnar paradox
closer to the paw the worse the claw
27
treatment of ganglions
conservative
28
treatment of tenosynovitis (e.g. trigger finger)
immobilise + NSAIDs
| steroids
29
collagen type in Dupuytrens contracture
3 (instead of 1)
30
indications for surgery in Dupuytrens contracture
progressive symptoms
greater than 30 degrees contracture
functional loss
31
mechanism of:
transverse fracture
spiral fracture
oblique fracture
direct blow
rotation/torsion
anchored limb
32
gold standard for joint replacemrnt
cemented bone and uncemented cup
33
DMARDs and biologics in surgery
DMARDs increase risk of infection but are not stopped
| biologics are stopped
34
Dorr A B C
narrow, medium, wide marrow in long bones
35
fromen's test
tests adductor pollucis, suppled by the deep branch of the ulnar nerve
36
Colles
dorsal angulation radius fracture
37
Smith
volar angulation radial fracture
38
Barton
intra-articular radial head fracture (dorsal or ventral)
39
Galleazi
radius broken, ulna dislocated
40
Montegia
ulna broken, radius dislocated
41
Bennet
base of the first metacarpal bone with associated CMC joint disruption
42
Mallet finger
extensor tendon broken so DIP is flexed
splint for 6-8 weeks in extension
mechanism = ball hitting outstretched finger and forcing DIP to over flex, breaking extensor tendon
43
Jersey finger
Flexor tendon is broken so can't curl that finger
surgery and rehab
grabbing onto jersey and forcing extension when trying to flex
44
felon
infected anterior facial compartment of fingertip
45
paronychia
infection of nail bed
46
causes of dupuytrens
manual labour
phenytoin
alcoholic liver disease
trauma
47
contraindication to uncememented joint replacement
osteoporosis
48
LMWH after hip replacement
6 hours after
49
most common cause of THR revision
aseptic loosening
50
Bankart lesion
| Hill-Sachs lesion
from glenohumeral dislocation
bankart is of the labrum on the glenoid fossa
hill-sacks is on the humerus
51
sulcus sign
shoulder instability
52
apprehension test/Fowler test/Jobe relocation test/crank test
supine and external rotation of elbow for shoulder instability and anterior dislocation
53
pressures in compartment syndrome
>40 is diagnostic
| >20 is high
54
Kanavel's signs
```
4 signs for flexor tendon sheath infection:
fixed flexion
fusiform swelling
tenderness
pain on passive extension
```
surgical emergency.
55
when to not use FRAX and go straight to DEXA scan
<40yo with a risk factor:
history of fragility fracture
use of high-dose steroids for >3months
56
Pott's fracture
bimalleolar fracture
torn deltoid ligament but in tact syndesmosis
lateral talar subluxation
occurs in forced foot eversion
57
leriche syndrome
Atherosclerotic occlusive disease of the aorta and/or both iliac arteries
claudication of buttocks and thigh
atrophy of leg muscles
impotence (paralysis of L1 nerve)
58
```
rotator cuff actions
supraspinatus
infraspinatus
teres minor
subscalpularis
```
abduction first 20 degrees
external rotation
external rotation
internal rotation
59
```
rotator cuff innervations
supraspinatus
infraspinatus
teres minor
subscalpularis
```
supra scapular nerve
suprascapular nerve
axillary
subscapular nerve
60
signs for posterior dislocation
Rim's sign
| lightbulb sign
61
when to use the FRAX tool
Any woman >65 or any man >75 unless:
basically any risk factor is present (family history, smoking, alcohol, falls, low BMI,)
62
Abx causing awhiles tendon rupture
CIPROFLOXACIN
63
what side is congenital hip dislocation more common
left
```
also more common in:
girls
breech
family history
firstborn
oligohydraminos
```
64
rotator cuff tear vs impingmenet
both have painful arcs
cuff tear --> weakness compared to other side and pain on palpation over anterior acromion
impingement --> no weakness or pain on palpation
65
positive scarf test
acromioclavicular degenration
66
Lloyd-Davies position nerve damage risk
peroneal nerve
67
Hip replacement nerve damage risk
sciatic (posterior approach)
68
groin pain following inguinal hernia repair
Ilioinguinal nerve may have been entrapped in the mesh causing a neuroma
69
management of osteomyelitis
Flucloxacillin for 6 weeks
| Clindamycin if penicillin allergic
70
features of osteopetrosis
recurrent infections and lethargy
| brittle bones with no differentiation between cortex and medulla (marble bone)
71
features of osteogenesis imperfecta
hypermobility
multiple fractures of long bones with irregular patches of ossification (wormian bones)
trefoil pelvis
72
supracondylar fracture worry
brachial artery and median nerve
73
types of osteogenesis imperfecta
```
quality + quantity
1 + -
2 - -
3 - +
4 - +
```
74
Anti-Jo antibodies in polymyositis meaning
found in 20%
worse prognosis
more likely to get interstitial lung disease, Raynaud's and fever
75
treatment for first venous/arterial thromboembolic event in anti-phospholipid syndrome
6 months of warfarin INR 2.5
If arterial, lifelong warfarin INR 2.5
76
treatment for second venous thromboembolic event in anti-phospholipid syndrome
lifelong warfarin INR 2.5
77
treatment for any thromboembolic event whilst on warfarin with a target fo 2.5 in anti-phospholipid syndrome
increase warfarin with INR 3.5
78
score for hypermobility
Beighton score. positive if 5/9 in adults and 6/9 in children
79
% of patients with polymyositis with Anti-Jo
20%
80
Complications of Paget's
```
deafness
bone sarcoma (1% >10 years)
fractures
skull thickenning
high output cardiac failure
```
81
stills disease and treatment
Triad of:
spiking fevers before bed
salmon coloured rash
polyarthalgia
NSAIDs
82
acute attack of gout
high dose NSAID (Aspirin or coxib)
| if NSAID CI, colchicine.
83
If allopurinol is CI or not tolerated
Febuxostat (also a XOi)
84
CIs of using NSAIDs in acute flare of gout
Peptic ulcer
| Elderly and taking warfarin
85
SLE is what type of hypersensitivity
3 (antigen/antibody complexes)
86
Aspirin and gout
Fine at prophylactic doses 75-150mg
| Interferes with uric acid excretion in analgesic doses (600-2400mg)
87
Causes of drug induced lupus
Procainamide
Hydralazine
Less common:
Isoniazid
Minocycline
Phenytoin
88
inheritance of Marfan's
AD of fibrillin gene
89
Luflunomide SEs
liver impariemnt
lung disease
hypertension
90
when to offer allopurinol
4 weeks after the first attack of gout has settled.
| start at 100mg OD and titrate for a serum uric acid of <300umol/l
91
Lifestyle modifications for gout
reduce alcohol
lose weight if obese
avoid food high in purines (liver, kidney, seafood, oily fish)
92
serotypes A-C of chhlamydia
Trachoma
93
Serotypes D-K chylamydia
adult inclusion conjunctivitis
94
Mx of inclusion conjunctivitis
topical erythromycin
95
Mx of allergic conjunctivitis
Levocabastine (topical antihistamine)
Sodium cromoglycate (topical mast cell stabiliser)
Olopatadine (combination of above)
96
Mx episcleritis
Observation + lubricants
| topical steroids only used in persistent cases
97
Mx of scleritis
Oral prednisolone
| Immunosuppression (mycophenolate/azathioprine)
98
Mx bacterial keratitis
Broad spectrum topical ofloxacin (every hour)
99
Mx viral keratitis
dendritic ulcer HSV one
| Topical acyclovir
100
Mx adenospots
Adenoviral conjunctivitis is self limiting but topical steroids can be used to speed up resolution
101
Mx fungal keratitis
Topical anti-fungals
Natamcin
Amphotericin
Corneal graft in unresponsive cases
102
Disproportionate pain compared to ocular signs (red eye, dendritiform epithelial lesions) in someone who has been swimming with contact lenses
Acanthamoeba keratitis
103
Mx Anterior uveitis
Topical prednisolone
| Dilating cyclopentolate
104
Mx AACG
Medical
Acetazolamide
Beta blockers (topical)
Pilocarpine constrictor
Surgical
Iridotomy
Trabeculectomy
105
Mx Orbital cellulitis
CT scan and IV Abx
106
Mx Preseptal cellulitis
Borad spectrum oral antibiotics
107
Mx of rentinal vein occlusion
1. reverse underlying cause (smoking, pill, tumours, hypertension etc)
2. laser treatment for macular oedema or neovascularisation
108
Mx of rental artery occlusion
Low dose aspirin
Send for carotid ultrasound
?drop intraocular pressure to restore vision using ocular massage, paracentesis or acetazolamide
