Monday [17/4/23] Flashcards
(36 cards)
what are U waves?
U wave is the deflection that follows the waves of depolarization (QRS) and repolarization (T) of the heart chambers. Its polarity is normally the same as that of the T wave.
how to assess the image quality before interpreting CXR
Rotation
The medial aspect of each clavicle should be equidistant from the spinous processes.
The spinous processes should also be in vertically orientated against the vertebral bodies.
Inspiration
The 5-6 anterior ribs, lung apices, both costophrenic angles and the lateral rib edges should be visible.
Projection
Note if the film is AP or PA: if there is no label, then assume it’s a PA film (if the scapulae are not projected within the chest, it’s PA).
Exposure
The left hemidiaphragm should be visible to the spine and the vertebrae should be visible behind the heart.
which Abx is given before a THR? [2]
Cephalexin or amoxicillin 2 grams orally one hour prior to procedure. Patients allergic to penicillin: Vancomycin 1 gram intravenously slowly over 1 hour beginning 1 hour before the procedure. PLUS gentamycin 1.5 mg/KG IM or IV 30 minutes before the procedure
why might NSAIDS not be the best for fracture healing after surgery
Prostaglandins play an important role in the regulation of osteoblast and osteoclast functions, and, based on animal models, the inhibition of prostaglandin production by NSAIDs or COX-2 inhibitors retards bone formation.29 However, further investigation is needed to characterize patients at greatest risk for NSAID-induced delayed fracture healing
pharmacological Mx of vascular dementia
There is no specific pharmacological treatment approved for cognitive symptoms
Only consider AChE inhibitors or memantine for people with vascular dementia if they have suspected comorbid Alzheimer’s disease, Parkinson’s disease dementia or dementia with Lewy bodies.
There is no evidence that aspirin is effective in treating patients with a diagnosis of vascular dementia.
No randomized trials found evaluating statins for vascular dementia
generally, what is best for mx of vascular dementia? [1]
tight control of RF
antipsychotic in dementia patients [1]
antipsychotics should only be used for patients at risk of harming themselves or others, or when the agitation, hallucinations or delusions are causing them severe distress
they are associated with a signifcant increase in mortality in dementia patients
Dx for LBD
usually clinical
single-photon emission computed tomography (SPECT) is increasingly used. It is currently commercially known as a DaTscan. Dopaminergic iodine-123-radiolabelled 2-carbomethoxy-3-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123-I FP-CIT) is used as the radioisotope. The sensitivity of SPECT in diagnosing Lewy body dementia is around 90% with a specificity of 100%
when to give haloperidol?
Acute confusional state: if treating the underlying cause and environmental modification not working then haloperidol sometimes used
which material is most likely to be used hip replacement
for hips the most common type of operation is a cemented hip replacement. A metal femoral component is cemented into the femoral shaft. This is accompanied by a cemented acetabular polyethylene cup
which material is becoming more popular hip replacements
uncemented hip replacements are becoming increasingly popular, particularly in younger more active patients. They are more expensive than conventional cemented hip replacements
what is hip resurfacing?
hip resurfacing is also sometimes used where a metal cap is attached over the femoral head. This is often used in younger patients and has the advantage that the femoral neck is preserved which may be useful if conventional arthroplasty is needed later in life
THR vs hemiarthroplasty [2]
THR is replaciong both th e acetabulum and femoral head, whilst the hemiarthroplasty generally only replaces the femoral head
reasons to have THR
Total hip replacement is most commonly used to treat joint failure caused by osteoarthritis. Other indications include rheumatoid arthritis, avascular necrosis, traumatic arthritis, protrusio acetabuli, certain hip fractures, benign and malignant bone tumors, arthritis associated with Paget’s disease, ankylosing spondylitis and juvenile rheumatoid arthritis.
follow-up assessments for revision of hip surgery
Follow-up assessments are conducted to examine the need for revision surgery. However, a UK study showed that only 3-6% of hip replacements needed a revision. Researchers recommended that routine follow-up may not be needed for up to 10 years. At this point, x-rays should be used to assess the joint, and there should be a clinical assessment of pain and mobility
what is the most common Cx of hip surgery? [1]
dislocation
what are hip replacements commonly mad eout of?
Most hip replacements consist of cobalt and chromium alloys, or titanium. Stainless steel is no longer used
what is ORIF? [2]
implementation of implantw to guide healing process of bone, as well as open reduction, or setting of bone
when is ORIF used? [2]
ORIF techniques often are used in cases involving serious fractures such as comminuted or displaced fractures or, in cases where the bone otherwise would not heal correctly with casting or splinting alone.
vancouver classification
Type Description Treatment
A Fracture in the trochanteric region ORIF if displaced
B1 Fracture around stem or just below, with well fixed stem ORIF with cables and plate
B2 Fracture around stem or just below, with loose stem but good proximal bone Revision of femoral component
B3 Fracture around stem or just below, with poor quality or severely comminuted proximal bone Revision of femoral component with proximal femoral replacement
C Fracture below the prosthesis ORIF with plate
when is the vancouver classification used? [2]
The Vancouver classification is a grading system used in orthopaedics to determine management of post-operative periprosthetic femoral fractures following a hip arthroplasty. It is named for the city Vancouver, home to the University of British Columbia where the authors of the 1995 paper worked.
what is the Weber classification? [2]
The Danis–Weber classification (often known just as the Weber classification) is a method of describing ankle fractures.
type a weber fractures
Fracture of the fibula distal to the syndesmosis (the connection between the distal ends of the tibia and fibula). Typical features:
below level of the ankle joint
tibiofibular syndesmosis intact
deltoid ligament intact
medial malleolus occasionally fractured
usually stable: occasionally nonetheless requires an open reduction and internal fixation (ORIF) particularly if medial malleolus fractured
type b weber fractures
Fracture of the fibula at the level of the syndesmosis. Typical features:
at the level of the ankle joint, extending superiorly and laterally up the fibula
tibiofibular syndesmosis intact or only partially torn, but no widening of the distal tibiofibular articulation
medial malleolus may be fractured or deltoid ligament may be torn
variable stability
