Orthopaedics Flashcards
(246 cards)
1
Q
What is the management of suspected Cauda Equina?
A
Urgent MRI Spine
The most common cause is herniation of an intervertebral disc compressing the cauda equina. Other causes include primary or metastatic spinal tumours, infections (such as an epidural abscess) or haematomas
2
Q
What is De Quervain’s tenosynovitis ?
A
Idiopathic pain syndrome of the lateral aspect of the wrist, involving the tendons of extensor pollicis brevis and abductor pollicis longus at the radial wrist
3
Q
What is Finkelstein’s test?
A
Getting patient to make a fist but thumb inside fingies and move wrist towards ulna.
4
Q
What is Spinal Stenosis?
A
The central canal is narrowed by tumour, disk prolapse or other similar degenerative changes.
Patients may present with a combination of back pain, neuropathic pain and symptoms mimicking claudication
Can distinguish from ischaemic pain by positional changes e.g bending forward relives, going downhill hurts more
5
Q
What are some Red Flags for Lower Back Pain?
A
History of trauma
Fever
Recent infection
Night pain
Age < 20 years or > 50 years
History of previous malignancy
Systemically unwell e.g. weight loss, fever
Thoracic pain
Saddle Anaesthesia
Urinary Incontinence
Bowel Incompetence
6
Q
What are some differentials for LBP?
A
Ankylosing Spondylitis
Spinal Stenosis
Prolapsed Disc
Peripheral Arterial Disease
Mechanical back pain
Discitis
Cauda Equina
Spinal tumour/ metasases
Osteoarthritis
7
Q
What are the Ottawa Ankle Rules?
A
Bony tenderness over the malleoli zones
OR an inability to walk four weight-bearing steps
8
Q
What is Meralgia Paresthetica?
A
A condition characterised by numbness, tingling and burning pain in the outer part of your thigh. It’s caused by compression of the lateral cutaneous nerve of the thigh
9
Q
What is the treatment for all patients with a displaced hip fracture?
A
Hemiarthroplasty
Total Hip Replacement ( If low risk patient)
10
Q
What is the imaging of choice for an Achilles Tendon rupture?
A
Calf US
11
Q
What are the g Ps of Compartment Syndrome?
A
Pain
Pulseless
Paresthesia
Pallor
Paralysis
Perishingly cold
12
Q
What does a painful passive leg raise indicate?
A
Sciatic nerve compression
13
Q
Subtrochanteric hip fracture treatment?
A
Intramedullary nail
14
Q
Trochanteric hip fracture treatment?
A
Sliding hip screw
15
Q
Intracapsular hip fracture, displaced , not independently mobile?
A
Hemiarthroplasty, cemented implants preferred
16
Q
Intracapsular hip fracture displaced, independently mobile?
A
Total Hip Replacement
17
Q
What are features of a meniscal tear?
A
Pain worse on straightening the knee
knee may ‘give way’
Displaced meniscal tears may cause knee locking
tenderness along the joint line
Thessaly’s test - weight bearing at 20 degrees of knee Flexion, patient supported by doctor, positive if pain on twisting knee
18
Q
How does a Scaphoid Fracture present?
A
Pain over the anatomical snuffbox
Cannot be seen on XRAY
19
Q
What is a Colles Fracture?
A
Following FOOSH
Distal radius fracture with dorsal displacement of fragments
Dinner fork type deformity
20
Q
What are the risk factors for a congenital hip dislocation?
A
Female gender
Breech presentation
Family history
Firstborn
Oligohydramnios
21
Q
What is fat embolism syndrome?
A
Fat embolism due to fat fragments entering the circulatory system and lodging in small vessels further along, often occurs following a long bone fracture.
22
Q
What are the symptoms of a fat embolism?
A
The signs and symptoms of fat embolism are largely determined by the site of embolization:
Pulmonary: Breathlessness, hypoxia, tachycardia, tachypnea, and fever
Neurologic: Altered mental status, seizures, focal deficits, or coma
Dermatologic: Petechial rash predominantly on the upper body
23
Q
What is a burst fracture?
A
Vertebra is crushed in all directions
Following high energy axial loading
24
Q
What is a Maisonneuve injury
A
It’s a complex and severe fracture involving a spiral fracture of the proximal fibula and an associated unstable ankle injury
25
Which type of fracture cannot be seen on xray?
Scaphoid fracture
26
What tendons are affected by De Quervain's tenosynovitis?
Extensor Pollicis Brevis
Abductor Pollicis Longus
My guy Finkelstein De Quervain is flipping pancakes with his thumb in his fingers , hand down
Eat Pancakes Bitch And Put Lemon
27
What is SUFE ( Slipped Upper Femoral Epiphysis )
Common adolescent hip disorder caused by weakness in the proximal femoral growth plate leading to displacement of the capital femoral epiphysis.
28
What do patients with SUFE present with?
Hip pain
Limping
Reduced range of hip movement
Positive Trendelenburg gait
29
What positions exaggerate Tennis Elbow ( Lateral Epicondylitis)?
Gripping
Wrist extension
Supination
30
What organism is Gas Gangrene most commonly caused by?
Clostridium perfringens
31
What is Perthes Disease?
Avascular Necrosis of the femoral head in children
32
What are the symptoms of Perthes Disease?
Gradual onset of limp
Hip pain, which may also be referred to the knee
Lasts over 4 weeks
33
What is a Pathological fracture?
Fracture sustained when patient already has an underlying condition causing bone weakness so they are more prone, e.g even minor trauma can cause it
34
Which conditions can cause a pathological fracture?
Tumours: These can be Primary or Secondary (metastatic, the most common cause of pathological fractures)
Osteoporosis
Hyperparathyroidism
Paget's disease
35
What is a Boxer's Fracture?
Fracture of the neck of the 5th metacarpal and usually occurs due to punching a hard object with a closed fist
36
What is the treatment for a Boxer's fracture?
Ulnar Gutter Splint
If Significant rotation or angulation of the affected fingers.
Articular involvement of the fracture.
Multiple metacarpal fractures.
Open fractures.
Then surgical intervention is recquired
37
How does a Radial nerve injury present?
Weakness or paralysis of the muscles innervated by the radial nerve (e.g., triceps brachii, brachioradialis, and extensor muscles of the forearm)
Numbness, tingling, or pain in the sensory distribution of the radial nerve (posterior forearm, lateral aspect of the dorsum of the hand, and dorsal surface of the lateral 3 1/2 digits)
38
What is the method of action of Bisphosphonates?
Inhibition of osteoclasts
39
What is Osgood-Schlatter's Disease?
Tibial osteochondritis causing inflammation at the point of patella tendon insertion at the tibial tuberosity
40
What tests are useful on examination for Cruciate Ligament Tears?
Anterior Drawer Test , positive = Anterior Cruciate Ligament Tear
Posterior Drawer Test , positive = Posterior Cruciate Ligament tear
41
What is a Primary Trauma Survey?
CABCDE
C= Catastrophic haemorrhage
A= Airway management with C spine assessment
B = Breathing
C = Circulation
D = Disability
42
What is the treatment for Osteomyelitis?
Long-term antibiotic therapy (4-6 weeks)
I.V Flucloxacillin plus fusidic acid/rifampicin, with vancomycin used if MRSA is suspected.
If chronic, antibiotics for 12 weeks and surgical debridement if necessary
43
What is the treatment for Septic Arthritis?
Give High Flow O2
I.V Large bore cannula and fluids
ABG - Lactate
Catheterise - urine output
Send blood cultures
Knee joint fluid cultures
Initiate intravenous flucloxacillin
44
What type of cell is responsible for repairing and maintaining cartilage?
Chondrocyte
45
What name is given to the bulky enlargements of the DIP joints in OA?
Heberden's Nodes
46
What name is given to the bulky enlargements of the PIP joints in OA?
Bouchard's Nodes
47
What is the saddle joint at the base of the thumb?
The Carpometacarpal joint ( CMP )
48
At what age can OA be diagnosed without any investigations with typical symptoms and no red flags?
Over 45
49
What effect do NSAIDs have on BP?
Increase it
50
How do NSAIDs increase BP?
They inhibit COX in the kidneys , which reduces vasodilatory prostaglandins. This leads to vasoconstriction of the afferent nephron arteriole. This causes decreased blood flow and therefore decreased GFR. This activates the RAAS system to cause Aldosterone release which leads to sodium retention, as well as causing an increase in ADH which causes more water reabsorption at the collecting duct.
51
What is the most common indication for elective joint replacement surgery?
OA
52
What are the options for elective joint replacement surgery?
Total joint replacement
Hemiarthroplasty
Partial joint resurfacing
53
What are the options for fitting a prosthesis into the shaft of the femur ?
Cemented
Uncemented
54
What are the options for fitting a prosthetic socket into the pelvic joint?
Cement
Screws
55
The articular surfaces of which bones are replaced in a total knee replacement?
Femur and tibia
56
What is the name of the shoulder socket that articulates with the head of the humerus
Glenoid socket
57
What important process is undertaken before surgery to ensure correct limb is operated on?
Marking the limb
58
What medication may be used during elective joint replacement surgery to minimse blood loss?
Tranexamic Acid
59
What Ix are required shortly after joint replacement surgery?
XRAY
FBC
60
What duration of LMWH is recommended after elective hip replacement?
28 days
61
What duration of LMWH is recommended after elective knee replacement?
14 days
62
What organism is the most common cause of prosthesis infection?
Staph Aureus
63
What is a Colles Fracture?
Transverse fracture of the distal radius causing the distal portion to displace posteriorly
64
What description is used for a Colles Fracture deformity?
Dinner fork deformity
65
What is the usual cause of a Colles Fracture?
FOOSH
66
What is the usual cause of a Scaphoid Fracture?
FOOSH
67
Where do you find tenderness in a Scaphoid Fracture?
Anatomical Snuffbox
68
What is the key complications of Scaphoid Fracture?
Avascular Necrosis
Non union
69
What classification is used for classification of a Lateral Malleolus Fracture?
Weber Classification
70
Which bone is affected in a lateral malleolus fracture?
Fibula
71
What anatomical feature is the Weber classification based on?
A - below the syndesmosis ( doesn't disrupt it)
B - at the level of the syndesmosis ( partial tear or no disruption )
C - above the syndesmosis ( disrupts it )
72
What term describes a fracture associated with an underlying tumour?
Pathological fracture
73
What are bone common cancers that metastasise to bone?
Prostate
Renal
Thyroid
Breast
Lung
PRTBL
74
What term describes a fracture associated with OA?
Fragility fracture
75
What tool is used to describe a patient's likelihood of having a fracture in the next 10 years?
FRAX tool
76
What Ix calculates bone mineral density?
DEXA scan
77
What guidelines recommend management related to a patient's risk of fractures related to OA?
NOGG guidelines
78
What are the first line medical treatments for reducing the likelihood of a fracture related to OA?
Vitamin D Supplements
Calcium
Bisphosphonates
79
What monoclonal antibody can be used to reduce risk of fragility fratures?
Denosumab
79
How does Denosumab work?
Blocking the activity of osteoclasts
80
What term describes a fracture where the bone has shattered into multiple pieces?
Comminuted
81
Which type of fractures occur mainly in children?
Greenstick
Buckle
Salter-harris
82
What is the initial imaging when fracture is suspected?
X Ray with two views
83
What are the options for achieving mechanical alignment of a fracture
Closed reduction
Open reduction
84
What term describes slow healing of a fracture?
Delayed union
85
What term describes misaligned healing of a fracture?
Malunion
86
What term describes the failure of a fracture to heal?
Nonunion
87
What term describes tightening of the soft tissues leading to reduced ROM or deformity of a joint?
Contracture
88
What is the target timeline for operating on a hip fratcue?
Within 48 hours
89
What landmark distinguishes intracapsular and extracapsular fractures?
Intertrochanteric line
90
What classification is used for intracapsular hip fractures?
Garden classification
91
What are the surgical options for managing a displaced intracapsular fracture?
Total hip replacement
Hemiarthroplasty ( if high risk/older)
92
What is the surgical option for managing an intertrochanteric hip fracture?
Dynamic hip screw
93
What is the surgical option for managing a subtrochanteric hip fracture?
Intramedullary nail
94
What is the typical position a patient presents in with a hip fracture?
Shortened leg
Abducted
Externally rotated
95
What is the name for the continous curving line present on an AP x ray of the hip formed by the medial border of the femoral neck and continuing to the inferior border of the superior pubic ramus?
Shenton's line
96
What is the significance of Shenton's line?
Disruption indicates a NOF fracture
97
What are the two most notable types of acute injury that lead to compartment syndrome?
Fracture
Crush injuries
98
What investigation can be used to measure the pressure in a compartment?
Needle manometry
99
What bacteria most commonly cause Osteomyelitis?
Staph Aureus
100
What is the best imaging for establishing a diagnosis of Osteomyelitis?
MRI scan
101
What is the main ABx for treating Osteomyelitis?
Flucloxacillin for 6 weeks
If penicillin allergic - Clindamycin
If MRSA suspected - Vancomycin
102
What is the most common type of bone cancer?
Osteosarcoma
103
What type of cancer originates from the cartilage?
Chondrosarcoma
104
What type of cancer causes raised red/purple skin lesion commonly seen in HIV?
Kaposi's Sarcoma
105
What virus causes Kaposi's Sarcoma?
Human Herpesvirus 8
106
Which investigation is the initial for suspicious bony lumps?
XRAY
107
Which investigation is the initial one for suspicious soft tissue lumps?
US
108
What is Spondylolisthesis?
Anterior displacement of a vertebrae out of line with the one below
109
What condition causes a patient to wake up with a unilateral stiff and painful neck due to muscle spasm?
Torticolis
110
What spinal nerves join to form the sciatic nerve?
L4-S3
111
Where does the Sciatic Nerve exit the pelvis?
The Greater Sciatic Foramen
112
Where is the Greater Sciatic Foramen?
At the posterior part of the pelvis in the buttock area
113
What nerves does the Sciatic nerve divide into at the knee?
The tibial nerve
The common peroneal nerve
114
What areas receive sensory innervation from the Sciatic nerve?
Lateral lower leg and foot
115
What are the most common causes of unilateral sciatica?
Disc herniation
Spondylolisthesis
Spinal stenosis
116
What is Sciatica?
Its a symptom
pain, weakness, numbness, or tingling in the leg
117
What should bilateral sciatica raise concerns about?
Cauda Equina Syndrome
118
What clinical test can be used to diagnose Sciatica?
Straight Leg Raise
Lift leg up and dorsiflex foot , positive test is indicated by exacerbation of pain in buttocks of posterior thigh
119
What investigations are indicated for Cauda Equina Syndrome?
Post void Bladder Scan - indicates retention due to pudendal nerve pathology
Spinal MRI
120
What tool can be used to stratify risk of patient with acute back pain developing chronic back pain?
STarT Back
121
What analgesia is use first line in patients presenting which acute back pain?
NSAIDS
122
What are some examples of NSAIDs
Aspirin
Ibuprofen
Naproxen
Diclofenac
Celecoxib
123
What is the MOA of NSAIDs?
Inhibition of the COX 1 and 2. COX is required to convert arachidonic acid into thromboxanes, prostaglandins, and prostacyclins.
Can be more COX 1 or COX 2 selective but all still inhibit both.
124
What procedure may be indicated in patients with chronic lower back pain originating in the facet joints?
Radiofrequency denervation
125
What medications are available for persistent symptoms of Sciatica?
Amitriptyline
Duloxetine
126
What is the most common cause of CES?
Disc herniation
127
To what does the Cauda Equina provide parasympathetic innervation?
Bladder
Rectum
128
What areas does the Cauda Equina provide sensory innervation?
Perineum
Bladder
Rectum
129
What areas does the Cauda Equina provide motor innervation?
Anal sphincters
Urethral sphincters
130
What are the three types of spinal stenosis and what are they?
Central - narrowing of the central spinal canal
Lateral - narrowing of the nerve root canals
Foraminal - narrowing of intervertebral foramina
131
What is the key presenting feature of lumbar spinal stenosis with narrowing of central canal?
Psuedoclaudication
132
What movements exacerbate the pain felt in lumbar spinal stenosis with narrowing of central canal?
Standing up straight
Walking
133
What movements relieve the pain felt in lumbar spinal stenosis with narrowing of central canal?
Bending forwards
134
What is radiculopathy?
Compression of the nerve roots as they exit the spinal cord leading to motor and sensory problems
135
What nerve is affected in Meralgia Paresthetica?
Compression of the Lateral femoral cutaneous nerve
136
Which movement of the hip exacerbates Meralgia Paresthetica?
Extension of hip on affected side
137
What are bursa
Sac created by synovial membrane filled with synoviL fluid
138
What movements are restricted in Trochanteric Bursitis?
Hip abduction
Internal rotation
External rotation
139
What special test can be used alongside restricted movements to diagnose Trochanteric bursitis?
Trendelenburg Test
140
What are the 4 ligaments in the knee?
Anterior Cruciate Ligament
Posterior Cruciate Ligament
Medial Collateral Ligament
Lateral Collateral Ligament
141
What is the usual first line imaging investigation for a suspected meniscal tear?
MRI scan
142
What is the gold standard for diagnosis of a Meniscal Tear?
Arthroscopy
143
What tool can used to determine if a patient needs an xray for a suspected knee fracture?
Ottawa Knee Rules
144
Where does the ACL originate and insert?
Originates at lateral aspect of intercondylar notch of the femur
Inserts at the anterior intercondylar area of the tibia
145
What is the role of the ACL?
It stops the tibia from sliding forward in relation to the femur
146
What tests can assess for ACL tear?
The anterior drawer test
Lachman Test
147
What can be used as a graft for repair of the ACL?
Hamstring tendon
Quadriceps tendon
148
What is the most common age for presentation of Osgood-Schlatters disease?
10-15
149
Where does the patella ligament insert?
The tibial tiberosity
150
Where are Baker's Cysts located?
The popliteal fossa
151
What is Foucher's Sign
The patient stand and extend the knee full; this is when the mass should be most prominent. When the knee is flexed to 45 degrees, the mass often either softens or fully disappears
152
What is the usual first line investigation for a Baker's Cyst?
US
153
What are the two types of achilles tendinopathy?
Insertion tendinopathy
Mid section tendinopathy
154
What test is used to assess for Achilles Rupture?
The Simmon's Calf Squeeze Test
155
Why are steroid injection avoided in Achilles Tendinopathy?
There is a risk of rupture
156
What key class of medicine is associated with Achilles Tendinopathy and Rupture?
Fluoroquinolone
157
What are two examples of Fluoroquinolones?
Ciprofloxacin
Levofloxacin
158
Where does the plantar fascia insert at the heel of the foot ?
Calcaneous
159
What condition is caused by an abnormal nerve between the 3rd and 4th metatarsal?
Morton's Neuroma
160
What is the medical term for a bunion?
Hallux Valgus
161
What investigation can be used to determine the extent of the deformity in Hallux Valgus?
Weight-bearing Xray
162
What joint in the foot is most commonly affected by gout?
MTP at the base of the big toe
163
What will be seen in aspirate fluid of a joint affected by Gout?
Needle shaped crystals that are negatively birefringent to polarised light
Monosodium Urate crystals
164
What is the first line treatment for an acute flare of Gout?
NSAIDs
165
What medication might be used in a patient with kidney disease that has an acute flare of Gout?
Colchicine
166
What are side effects of Colchicine?
Nausea
Diarrhoea
167
What medication is used for the prophylaxis of Gout?
Allopurinol
168
WHat is the MOA of Allopurinol?
Xanthine oxidase inhibitor that reduces urate levels
169
What is Frozen Shoulder?
Adhesive Capsulitis
170
What existing condition is the most notable risk factor for Frozen Shoulder?
Diabetes
171
What are the three phases of Frozen Shoulder?
Painful phase
Stiff phase
Thawing phase
172
How long does each phase of Frozen Shoulder last?
6 months
173
Which joints in the shoulder can be affected by OA?
Acromioclavicular joint
Glenohumeral joint
174
What clinical test is used to assess for Supraspinatus Tendinopathy?
The empty can test ( Jobe Test)
175
What are the 4 rotator cuff muscles and what actions do they perform?
Supraspinatus - abducts arm
Infraspinatus - externally rotates arm
Teres minor - externally rotates arm
Subscapularis - internally rotates arm
SITS mnemonic
176
What imaging is used to assess for a Rotator Tear Cuff Tear?
US or MRI
177
What is the name of a partial dislocation of the shoulder?
Sublaxation
178
What are they key causes of a posterior shoulder dislocation?
Electric shocks
Seizures
179
What are Bankart lesions?
Tear of the anteroinferior aspect of the glenoid labral complex. Usually due to anterior dislocation of the shoulder.
180
What is a Hill-Sachs lesion?
A compression fracture of the posterolateral part of the head of the humerus. Usually due to anterior dislocation of the shoulder.
181
What nerve is most commonly damaged by an anterior shoulder dislocation?
Axillary Nerve
182
What sensory distribution is lost when there is damage to the axillary nerve?
Regimental Badge area
183
Motor weakness can occur in which muscles when there is damage to the axillary nerve?
Deltoid
Teres Minor
184
What test is used to assess for shoulder instability in the anterior direction?
The Apprehension Test
185
What imaging investigation is most helpful in assessing the shoulder for damage in someone with a previous shoulder dislocation?
Magnetic Resonance Arthrography
186
What would the aspirate look like from the Olecranon Bursa in someone with Gout or Pseudogout?
A milky fluid
187
What is the medical term for Tennis Elbow?
Lateral Epicondylitis
188
Where is the tenderness in a patient with lateral epicondylitis?
At the lateral epicondyle
189
What movement at the wrist do the muscles that insert at the lateral epicondyle perform?
Extend the wrist
190
What two clinical tests can be used to assess for Tennis Elbow?
Mill's Test
Cosen's Test
191
What is the medical term for Golfer's Elbow?
Medial Epicondylitis
192
Where is the tenderness in a patient with medial epicondylitis?
Medial Epicondyle
193
What movement at the wrist do the muscles that insert at the medial epicondyle perform?
Flexion of the wrist
194
What tendons are affected in De Quervain's Tenosynovitis?
Abductor Pollicis Longus
Extensor Pollicis Brevis
195
What test can be used to assess for De Quervain's Tenosynovitis?
Finkelstein's Test
196
What is the most commonly affected tendon sheath in trigger finger?
A1 at the MCP joint
197
What finger is most often affected by Dupuytren's Contracture?
Ring finger
198
What test is used to assess for Dupuytren's Contracture?
The tabletop test
199
What are the three surgical options for treating Dupuytren's Contracture?
Needle fasciotomy
Limited fasciectomy
Dermofasciectomy
200
What nerve is affected in Carpal Tunnel Syndrome?
Median nerve
201
What areas are affected by sensory symptoms in Carpal Tunnel Syndrome?
The palmar aspects and full finger tips of thumb, index and middle finger and the lateral half of the ring finger
202
What are the muscles of the thenar eminece?
Abductor Pollicis Brevis
Opponens Pollicis
Flexor Pollicis Brevis
203
What are the special tests for Carpal Tunnel Syndrome?
Phalen's Test
Tinel's test
204
What is the primary investigation for establishing a diagnosis of Carpal Tunnel Syndrome?
Nerve conduction studies
205
What is the usual initial intervention in someone with Carpal Tunnel Syndrome?
Wrist splints that maintain a neutral position of the wrists at nightime
206
What structure is cut during surgery for Carpal Tunnel Syndrome?
Flexor Retinaculum
207
What does osteomyelitis show on X-ray?
Periosteal reaction, focal cortical loss and regional osteopenia
208
What is the guidance for VTE prophylaxis following an elective total hip replacement?
Starting 6-12 hours following surgery
LMHW Heparin for 10 days followed by Aspirin 75/150mg for 28 days
209
What is the guidance for VTE prophylaxis following a knee replacement?
Aspirin (75 or 150 mg) for 14 days
210
What is the guidance for VTE prophylaxis following a Fragility fractures of the pelvis, hip and proximal femur?
LMWH starting 6-12 hours after surgery
211
What does a femoral nerve injury present like?
Weakness in knee extension, loss of the patella reflex, numbness of the thigh
212
What does a Sciatic nerve injury present like?
Weakness in knee flexion and foot movements, pain and numbness from gluteal region to ankle
213
What does an obturator nerve injury present like?
Weakness in hip adduction, numbness over the medial thigh
214
How would a L2 nerve root compression present?
Weakness in hip flexion
Pain or numbness in the anterior thigh region
215
How would a L3 nerve root compression present?
Weakness in knee extension and difficulty walking up stairs or inclines
Sensory changes would be expected over the medial aspect of the knee
216
How would a L4 nerve root compression present?
Weakness in ankle dorsiflexion
Sensory changes overlying the medial malleolus or medial calf area
Decreased patellar reflexes
217
How would a L5 nerve root compression present?
Loss of foot dorsiflexion
Sensory loss dorsum of the foot
218
How would a S1 nerve root compression present?
Weakness in plantar flexion of the foot
Pain radiating down to the posterior thigh and calf region
Loss of Achilles tendon reflex
Sensory changes overlying the lateral foot or heel area
219
What nerve is most likely to be damaged during a knee arthroplasty?
Common peroneal nerve
220
How do you differentiate between Chondrosarcoma of the pelvis and a metastatic bone cancer?
Increasing pain at rest, together with increased serum calcium and alkaline phosphatase are most likely to represent metastatic tumour to bone.
Chondrosarcomas do occur in the pelvis but are not associated with increased serum calcium and typically have a longer history.
221
How does Paget's disease appear on investigation?
X-ray is thickened and sclerotic
Serum ALP is elevated
Calcium is within normal limits
222
How does neurogenic shock happen due to spinal cord transection?
Loss of sympathetic innervation or increased parasympathetic innervation leads to widespread vasodilation, leading to hypotension
Presents flushed with warm peripheries (Distributive shock)
223
224
What is Osgood-Schlatters disease?
The primary cause is mechanical stress due to repetitive traction on the tibial tubercle from the patellar tendon during rapid growth periods in adolescenc
225
What is Erb's palsy caused by?
Damage to C5 and C6 myotomes
Presents with waiter's tip
flexed wrist, extended forearm and internally rotated, adducted arm.
226
What are the myotomes?
C5 - shoulder abduction
C6 - elbow flexion
C7 - elbow extension
C8 - finger flexion
T1 - finger abduction
L2 - hip flexion
L3 - knee extension
L4 - ankle dorsiflexion
L5 - great toe extension
S1 - ankle plantarflexion
227
What is the Nexus criteria to exclude a C-Spine injury?
Normal level of alertness
No evidence of intoxication
No painful distracting injuries
No focal neurological deficit
Absence of midline cervical tenderness
228
What is a better way to maintain a patient's airway in a patient with suspected C-Spine injury?
Jaw thrust rather than head tilt and chin lift
229
How should Bisphosphonates be taken?
Empty stomach
Sit upright for 30 minutes
230
What is the treatment for Plantar Fasciitis?
Weight loss
Resting foot
Simple stretch exercises
231
What is a Monteggia fracture?
Dislocation of the proximal radioulnar joint in association with an ulnar fracture
232
What is a Galeazzi fracture?
Fracture of the distal radius with an associated dislocation of the distal radioulnar joint
233
What is the management for a non-displaced Scaphoid fracture?
Cast for 6-8 weeks
234
What is the immediate management for septic arthritis?
Analgesia
Take cultures ( aspirate and blood) before antibiotics
235
What organism is more likely in SA if you have a prosthetic joint?
Staph Epidermis
236
What muscle takes over abduction after 15 degrees ( After SUpraspinatus)?
Deltoid
237
What muscles are supplied by the axillary nerve?
Teres Minor
Deltoid
238
What might you suspect is there is dullness to percussion in a tension pneumothorax?
Massive haemothorax - wanna to a thoracostomy with chest drain
239
What tendon can be used to graft an ACL tear?
Patella
Quadriceps
Hamstring
240
What is the blood supply to the NOF?
Retinacular arteries
Artery of the Ligamentum Teres
Intramedullary vessels
241
What is a Bier's Block?
A tourniquet is applied to the proximal part of the limb and local anesthetic is injected IV, the procedure can be done and the tourniquet released after 20-30 mins
242
How long does a Colles Fracture take to heal?
6-8 weeks
243
What is the treatment for compartment syndrome?
Urgent decompression via open fasciotomy
244
What are complications of open fractures?
Wound infection
Tetanus infection
Osteomyelitis
Vascular damage
Malunion
Sepsis
DVT
Death
245
What are indications for joint arthroplasty in OA?
Not responding to conservative or medical management
Reduced QOL
