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Yr 6 PACES knowledge COPY RJ Challenger > Ortho, just ortho (MSK) > Flashcards

Ortho, just ortho (MSK) Flashcards

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1
Q

Osteoarthritis- definition

A

Degenerative disease –> loss of hyaline cartilage + new bone formation at joint surface

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2
Q

Symptoms of osteoarthritis

A

Pain - worse at night + after movement
- Commonly affects knees, hip, PIP, DIP, base of thumb

Reduced ROM: ‘gelling’ after rest for -30min

Deformity (mild)

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3
Q

Investigations for suspected osteoarthritis

A

Bloods:
U+Es (renal function before giving NSAIDs)
Autoantibodies (exclude inflammatory arthritis)

X-Ray

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4
Q

Mx of osteoarthritis

A

Conservative: weight loss, PTOT
Medical: paracetamol, NSAIDs (+PPI), joint injection
Surgical: Hip/knee replacement, osteotomy for younger pt w medial knee OA + thumb OA,

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5
Q

2 types of bone

A

Woven bone - disorganised bone (embryonic skeleton + fracture callus)

Lamellar bone - mature bone. can be either CORTICAL (dense, outer layer) or CANCELLOUS (porous, central)

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6
Q

Fracture healing - 3 phases

A 
Reactive phase (-48hrs)
- Haematoma + inflammatory cell recruitment

Reparative phase (-2 weeks)

  • Callus formation (osteoblasts + fibroblasts proliferate)
  • Endochondral ossification (formation of lamellar bone)
Remodelling phase (- years)
- Remodelling of lamellar bone to cope w mechanical stresses (Wolff's law)
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7
Q

Fracture classification

A

Traumatic
Stress (repeated strain –> bone fatigue)
Pathological (due to diseased bone)

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8
Q

Greenstick fracture

A

Young soft bone which bends + breaks

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9
Q

Comminuted fracture

A

> 2 fragments

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10
Q

Angulation - how is it described

A

the direction of the distal portion of the distal fragment

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11
Q

Fracture in the growth plate?

What types are there

A 
Salter Harris fracture
(Straight, Above, Lower, Through, crush)
Type 1: growth plate fracture
2: growth plate + metaphysis
3: growth plate + epiphysis
4: growth plate + meta + epiphysis
5: crush fracture
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12
Q

Garden classification

A

Intracapsular NOF#

1: incomplete
2: complete, undisplaced
3: complete, partially displaced
4: complete, totally displaced

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13
Q

Distal radius articulates with

A

Scaphoid, lunate, ulna

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14
Q

Distal radial fracture with dorsal angulation

A

Colles fracture

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15
Q

Distal radial fracture with volar angulation

A

Smith fracture

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16
Q

Distal radial fracture involving the joint (intraarticular)

A

Barton fracture

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17
Q

Distal radial fracture + distal radioulnar dislocation

A

Galeazzi fracture

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18
Q

ulnar fracture + proximal radial head dislocation

A

Monteggia fracture

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19
Q

Mx of an open fracture

A 
Analgesia
Asses: N+V status, photograph
Alignment: splint
Antisepsis: wound swab, irrigation, Abx
Anti-tetanus
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20
Q

4 pillars of fracture management

A

Resus (ABC)
Reduction (closed or open)
Restriction (slings, plaster, bracing, internal)
Rehabilitation (PTOT)

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21
Q

Methods of fracture reduction

A

Open (i.e. surgical incision)

or closed

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22
Q

Methods of fracture restriction

A

Hold = sling, plaster

Fixation = either external or internal

  • External = monoplane or multiplanar
  • Internal = inter medullary or extramedullary
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23
Q

Indications for external fixation device

A

Open #s
Burns
Tissue loss

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24
Q

Rehabilitation for fracture management

A

Physiotherapy - strengthen muscles
OT - mobility aids, splints
Social services - home help

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25
Common palsies from the following #s: - Shoulder dislocation - Humeral shaft - Elbow - Hip dislocation - Neck of fibula
-Shoulder dislocation = AXILLARY (weak shoulder abduc) - Humeral shaft = RADIAL (wrist drop) - Elbow = ULNAR (ulnar claw) - Hip dislocation = SCIATIC (foot drop) - Neck of fibula = COMMON PERONEAL (Foot drop)
26
Pathophysiology of compartment syndrome
Oedema from fracture --> increased compartment pressure -->reduced venous drainage As compartment pressure > capillary pressure --> ischemia!
27
Post-op patient w extreme pain *Pain on passive muscle stretching* Reduced pulses
COMPARTMENT SYNDROME
28
Causes of malunion
Infection Ischemia - AVN Interposition of tissue between fragments Disease - malignancy, malnutrition
29
Cause of cubitus varus
Gunstock deformity from malunion of a supracondylar #
30
AVN - what is the consequence
Soft + deformed bone --> pain + stiffness + OA
31
Scaphoid fracture - common method of injury? | O/E?
FOOSH tenderness in anatomical snuffbox Tenderness on scaphoid tubercle (volar surface)
32
Scaphoid fracture - how long until visible on XR?
10 days after injury Therefore, return to # clinic 10 days later for re-XR
33
Mx of scaphoid fracture? Main complication?
Plaster Risk of scaphoid AVN --> pain + stiffness
34
2 types of shoulder dislocation? | Common causes of both?
Anterior: trauma, falling on hand Posterior: epileptics
35
Bankart lesion
Associated w should dislocation Damage to anteroinferior glenoid labrum
36
Hill Sach lesion
Associated w anterior shoulder dislocation Cortical depression of posterolateral humeral head
37
Presentation of shoulder dislocation
Severe pain Shoulder appears square Bulge in subclavicular fossa Arm supported by other hand
38
Ix + Mx of shoulder dislocation
NEUROVASCULAR ASSESSMENT - Regimental badge area for axillary nerve damage XR: AP and lateral view Reduction: under sedation (propofol) Restriction: Sling for 3-4 weeks Rehab: Physio
39
2 complications of shoulder dislocation
Recurrent dislocation Axillary nerve palsy
40
Impingement syndrome - pathology?
Entrapment of supraspinatus tendon + subacromial bursa Trapped btw ACROMION + GREATER TUBEROSITY of humerus
41
Presentation of impingement syndrome
Painful arc 60-120 | +ve Hawkins test
42
Mx of impingement syndrome
Conservative: rest + physio Medical: NSAIDs, steroid injection Surgical: Arthroscopic acromioplasty
43
Differential of painful arc
Impingement syndrome Partial rotator cuff tear OA of acriomoclavicular joint
44
Findings on examination of frozen shoulder
reduced ROM, esp EXTERNAL ROTATION and shoulder abudction
45
Rotator cuff tear: O/E
Partial: painful arc Full tear: Active abudction possible after passive abduction up to 90 degrees
46
Commonest type of supracondylar fracture
Extension i.e. distal fragment is posteriorly displaced
47
Complication of supracondylar fracture
1) Neuromuscular damage: -Brachial artery, Radial nerve, Median nerve 2) COMPARTMENT SYNDROME: pain on passive extension of fingers 3) Gunstock deformity (cubitus varus)
48
Mx of ruptured ACL
autograft from SEMITENDINOSUS Tendon threaded through heads of tibia + femur, held using screws
49
Definition of disc prolapse
Herniation of nucleus pulposus through annulus fibrosis
50
- Loss of sensation on inner dorsum of foot - Foot drop and weak inversion Intact reflexes
L5 root compression
51
Aching buttock on walking Rapid onset Pain on spine extension (leaning back\0
Spinal stenosis
52
Spinal stenosis - presentation
Pain on spine extension | Heavy, aching buttock on walking (spinal claudication)
53
Sx of acute cord compression
Pain - bilaterally at back + radicular UMN signs below lesion LMN signs at compression level
54
Sx of cauda equina syndrome
Asymmetrical symptoms - radicular pain - Saddle anaesthesia - Faecal/urinary incontinence
55
Colour changes in Raynaud's phenomenon
White --> blue --> crimson
56
Secondary causes of Raynaud's
- Systemic disease: SLE, SS, RA - Atherosclerosis - Blood: polycythemia - Trauma: vibration injury
57
Mx of Raynaud's
Conservative: avoid cold, wear gloves, stop smoking Medical: nifedipine
58
Technical term for bunions
Hallux valgus
59
Hallux valgus - how to examine?
``` Look: Degree of valgus Unilateral/bilateral Swelling Calluses on heel ``` Feel: Swelling? - active bursitis Move: Toe joint ROM Extras: look at shoes, assess gait
60
Hallux valgus - aetiology? Ix? Mx?
Aetiology: tight fitting shoes, familial, assoc with RA Ix: Weight bearing x ray w orthogonal views - Assess degree of valgus + OA at MTP joint Mx: conservative: footwear, physic surgical: bunionectomy, 1st metatarsal realignment osteotomy
61
Flattened medial arch of foot + ulcer on medial foot
Charcot joint
62
Features O/E of charcot joint
Painless deformed joint Ulcers/necrosis Swelling
63
Causes of charcot joints
Due to sensory loss - DM - peripheral neuropathy: B12, folate, alcohol
64
Carpal bones
Scaphoid Lunate Triquetrum Pisiform | Trapezium Trapezoid Capitate Hamate
65
Septic arthritis: | which abx for elderly/recurrent UTI/recent abdo surgery?
Ceftriaxone
66
Which Abx for IVDU w septic arthritis?
?Pseudomonas Ceftazidime!!

Yr 6 PACES knowledge COPY RJ Challenger (16 decks)

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