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Finals - Systems Paper > Orthopaedics/Rheumatology > Flashcards

Orthopaedics/Rheumatology Flashcards

1
Q

Compartment syndrome diagnose

A

Measure intracompartment pressure

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2
Q

Treatment compartment syndrome

A

Fasciotomy and aggressive IV fluid resus

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3
Q

Septic arthritis cause

A

Overall - staph aureus

Young sexually active - neisseria gonorrhoea

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4
Q

Septic arthritis diagnose

A

Synovial fluid sampling

Joint imaging

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5
Q

Septic arthritis treatment

A

Flucloxacillin

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6
Q

OA signs in hands

A 
Heberdens node (DIP joint)
Bouchard node (PIP joint)
Squaring base thumb
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7
Q

OA xray features

A

LOSS:

  • loss of joint space
  • osteophytes
  • subchondral sclerosis
  • subchondral cysts
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8
Q

OA treatment

A

1) Paracetamol and topical NSAID
2) NSAIC/opiods/corticosteroid injections
3) Joint replacement

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9
Q

Osteomyelitis cause

A

Overall - staph aureus

Sickle cell - salmonella

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10
Q

Osteomyelitis diagnosis

A

MRI scan

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11
Q

Osteomyelitis treatment

A

Surgical debridement and fluxlocacillin

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12
Q

Open fracture grading

A

Gustile and anderson:

1) <1cm
2) >1cm and moderate soft tissue damage
3) >1cm and extensive soft tissue damage

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13
Q

Open fracture treatment

A

ABCDE
Imaging
Cover with dressing
Early debridement

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14
Q

Common causes pathological fracture

A 
Prostate
Breast
Lung
Renal
Thyroid
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15
Q

Common location pathological fracture

A

Femur

Vertebral bodies

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16
Q

Treatment olecranon bursitis

A

RICE
Analgesia
Aspiration fluid
Antibiotics if infection

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17
Q

Identify osteosarcoma

A

Children/teens

Metaphyseal region long bones

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18
Q

Identify Ewing sarcoma

A

Children/teens
Pelvis and long bones
“onion skin”

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19
Q

Identify chrondosarcoma

A

Middle aged

Axial

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20
Q

Most common malignant bone tumour

A

Osteosarcoma

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21
Q

Most common benign bone tumour

A

Oseochrondroma

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22
Q

Treatment carpal tunnel

A

1) 6w conservative - wrist splint at night and joint injection
2) Flexor retiniculum division

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23
Q

Most common shoulder dislocation

A

Anterior

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24
Q

Identify anterior shoulder dislocation

A

External rotation and abduction

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25
Q

Identify posterior shoulder dislocation

A

Electric shock/seizure

Light bulb sign

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26
Q

Treatment shoulder dislocation acute

A

Open/closed reduction
Analgesia
Sling for immobilisation

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27
Q

Identify de quervain tenosynovitis

A

Pain radial side wrist
Pain over styloid process
Positive finkelstein test

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28
Q

What is de quervains tenosynovitis

A

Inflammation of sheath containing extensor pollicis brevis and abductor pollicis

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29
Q

Commonly affected by dupuytrens contracture

A

Ring and little finger

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30
Q

Identify subluxation radial head

A

Elbow pain

Limited supination and extension elbow

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31
Q

Identify adhesive capsulitis (AKA frozen shoulder)

A

Associated diabetes

Develops over few days:

  • external rotation affected most
  • active and passive movement affected

Phases:
- painful freezing phase then adhesive phase then recovery

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32
Q

Rotator cuff injuries - action each muscle

A

Supraspinatus (most common) - abduction
Infraspinatus - external rotation
Tere minor - external rotation and adduction
Subscapularis - adduction

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33
Q

Identify rotator cuff injuries

A

Symptoms worse when shoulder in abduction

Painful arc

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34
Q

Identify trigger finger

A

Initial stiffness, snapping when extending

Palpable nodule

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35
Q

Features malignant soft tissue tumour

A

Size >5cm
Pain
Deep

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36
Q

Colles fracture

A

Fall onto outstretched hand

Transverse fracture of distal radius - dorsally displaced distal fragment (dinner fork deformity)

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37
Q

Smiths fracture

A

Fall onto outstretched hand

Transverse fracture of distal radius - volar displacement distal fragement (garden spade deformity)

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38
Q

Bartons fracture

A

Fall onto extended and pronated wrist

Colles or smith with radiocarpal dislocation

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39
Q

Montagia fracture

A

Fall onto outstetched hand with forced pronation

Ulna fracture with dislocation of proximal radioulna joint

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40
Q

Galleizi fracture

A

Fall onto outstretched hand with rotational force

Radial shaft fracture with dislocated radioulnar joint

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41
Q

Bennets fracture

A

Fist fight

Base on thumb metacarpal

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42
Q

Identify scaphoid fracture

A

Fall onto outstretched hand

Pain along radial aspect wrist
Pain pushing pulling thumb
Tenderness anatomical snuffbox

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43
Q

Treatment scaphoid fracture

A

Immobilisation with futuro splint and refer
Undisplaced - cast 6-8w
Displaced or proximal - surgical fixation

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44
Q

Identify achilles tendinopathy

A

Posterior heal pain, gradual onset, worse with activity

Morning stiffness

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45
Q

Simmonds triad for achilles tendon rupture

A

> dorsiflexion of foot
Gap in tendon
Calf squeeze causes no movement

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46
Q

Diagnose achilles tendon rupture

A

US to diagnose

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47
Q

Identify lateral ankle ligament sprain

A

Inversion injury
Pain and swelling over ligament
Able to weight bear

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48
Q

Treatment lateral ankle ligament sprain

A

RICE

Maybe orthososis

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49
Q

Identify medial ankle ligament sprain

A

Eversion injury
Weight bearing painful
Hopkins squeeze test positive (pain when tibia and fibula pushed together)

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50
Q

Treatment medial ankle ligament sprain

A

No diastasis - non weight bearing orthostasis

Diastasis - Operative fixation

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51
Q

Most common injured knee ligament

A

Ruptured anterior cruciate

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52
Q

Identify anterior cruciate rupture

A

Sudden twisting or lateral blow

Sudden popping sound

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53
Q

Identify posterior cruciate rupture

A

Hyperextension injuries - dashboard

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54
Q

Investigation knee ligament rupture

A

MRI

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55
Q

Identify meniscal tear

A

Twisting injury
Pain worse on straightening knee
Tender over joint line

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56
Q

Identify chrondomalacia patellae

A

Teenage girls following injury

Pain on going downwards

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57
Q

Identify posterior and anterior hip dislocation

A

Posterior (most common) - shortenned, adducted and internally rotated
Anterior - abducted and externally rotated, no shortening

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58
Q

Treatment hip dislocation

A

ABCDE
Analgesia
Reduction under GA
Physiotherapy

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59
Q

Identify plantar fasciitis

A

Heel pain

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60
Q

Identify mortons neuroma

A

Forefoot pain - most common third intertarsalphalangeal space

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61
Q

Identify hallux valgus

A

Progressive foot deformity - subluxation 1st metatarsophalangeal joint
Abduction first metatarsal, adduction phalanges

62
Q

Leg in hip fracture

A

Shortened, abducted and externally rotated

Not able to weight bear

63
Q

Diagnosis hip fracture

A

1) Xray - disrupted shellon line

2) MRI - CT

64
Q

Intracapsular hip fracture treatment

A

Undisplaced - internal fixation

Displaced - hip replacement

65
Q

Extracapsular hip fracture treatment

A

Stable intertrochanteric - dynamic hip screw

Unstable/subtrochanteric - intramedullary nail

66
Q

Classification hip fracture

A

Gardens:

1) Stable
2) Complete but undisplaced
3) Displaced but still bone contact
4) Complete bony disruption

67
Q

Ankle facture classification

A

Webers:
A) below ankle joint, syndesmosis in tact
B) level ankle joint, syndesmosis in tact or partially disrupted
C) above ankle joint, syndesmosis disrupted

68
Q

Ottowa rules

A

For ankle xray:

  • pain malleolus region and one of
    • bony tenderness lateral or medial malleolus to 6cm superior
      - cannot walk >4 weight beared steps
69
Q

Weber A treatment

A

CAM boot

70
Q

Weber B treatment

A

Displaced - surgery

Stable - CAM boot

71
Q

Weber C treatment

A

Surgery

72
Q

Most common site stress fracture

A

2nd metatarsal

73
Q

Most common metatarsal fracture

A

5th metatarsal - assocaied with lateral ankle sprain

74
Q

Cauda equina diagnosis

A

MRI

75
Q

Identify lumbar spinal stenosis

A

Back pain relieved by sitting/learning forwards

76
Q

Diagnose lumbar spinal stenosis

A

MRI

77
Q

Treatment lumbar spinal stensosis

A

Laminectomy

78
Q

Identify Erb palsy

A

C5/6 damage
Winged scapula
Waiter tip

79
Q

Identify klumpkes palsy

A

T1 damage

Loss intrinsic hand muscles

80
Q

Diagnose iliopsoas abscess

A

CT abdomen

81
Q

Froments sign of

A

Ulner nerve palsy

82
Q

Identify osteochondritis dissecans

A

Usually children/young adults

Knee pain and swelling typically after exercise
Knee locking

83
Q

Mechanism axillary nerve damage

A

Humeral neck fracture/dislocation

84
Q

Radial nerve damage mechanism

A

Humeral midshaft fracture

85
Q

Ulner nerve damage mechanism

A

Medial epicondyle fracture

86
Q

Toddlers fracture

A

Oblique tibial in infants

87
Q

Plastic deformity

A

Stress on bone causing deformity without cortical disruption

88
Q

Greenstick fracture

A

Unilateral cortical breech

89
Q

Buckle fracture

A

Incomplete cortical disruption

90
Q

Identify talipes equinovarus

A

AKA clubfoot - inverted and plantar flexed foot

91
Q

Treatment clubfoot

A

Manipulation and progressive casting from birth

92
Q

Action and mechanism injury femoral nerve

A

Action - knee extension and hip flexion

Mechanism - hip fracture

93
Q

Action and mechanism injury obturator nerve

A

Action - thigh adduction

Mechanism - anterior hip dislocation

94
Q

Action and mechanism injury common peroneal nerve

A

Action - foot dorsiflexion and eversion

Mechanism - injury neck fibul

95
Q

Action and mechanism injury tibial nerve

A

Action - plantarflexion and inversion

Mechanism - posterior knee dislocation

96
Q

Action and mechanism superior gluteal nerve injury

A

Action - hip abduction

Mechanism - Pelvic fracture

97
Q

Deposition in gout

A

Monosodium urate

98
Q

Diagnosis gout

A

Synovial fluid - needle shaped negative monosodium urate crystals

99
Q

Treatment acute gout

A

1) NSAID or colchine

2) Prednisolone

100
Q

Prophylaxis gout

A

Allopurinol - add NSAID/colchine for first 6m

101
Q

Pseudogout deposition

A

Calcium pyrophosphate crystals

102
Q

Diagnosis pseudogout

A

Joint aspiration - weakly positive rhomboid crystals

Xray - chondrocalcinosis

103
Q

Seronegative arthritis gene

A

HLA B27

104
Q

Systemic features ankylosing spondylitis

A

The As:

  • anterior uveritis
  • apical fibrosis
  • aortic regurgitation
  • achilles tendonitis
  • AV node block
105
Q

Diagnosis ankylosing spondylitis

A

1) xray

2) MRI

106
Q

Xray features ankylosing spondylitis

A

Squaring lumbar vertebra
Sacroiliatis
Syndesmophytes

107
Q

Treatment ankylosing spondylitis

A

1) NSAID, regular exercise and physio
2) Different NSAID
3) Anti-TNF therapy

108
Q

Identify psoriatic arthritis

A

Onycholysis (seperation nail from bed)
Dactylitis (inflammation full finger)
Nail pitting
Plaque psoriasis

109
Q

Xray features psoriatic arthritis

A

“Pencil in cup”

Osteolysis

110
Q

Treatment psoratic arthritis

A

Similar RA

111
Q

Treatment reactive arthritis

A

1) NSAID
2) Joint injection
3) Sulfasalazine and methotrexate

112
Q

RA genes

A

HLA DR4

HLA DR1

113
Q

Antibodies RA

A 
Cyclic citrullinated peptide (anti-CCP) - most sensitive and specific
Rheumatoid factor (RF)
114
Q

Identify RA

A

Never affects DIP

Symetrical

115
Q

RA signs in hands

A 
Z shaped deformity
Ulnar deviation MCP (knuckle)
Swan neck ( extension PIP, flexed DIP) and boutenniers deformity (flexed PIP, extended DIP) late
116
Q

Diagnosis RA

A

Clinical but:

  • RF if CCP negative
  • xray
  • joint aspiration
  • inflammatory markers
117
Q

RA xray changes

A

Early:
- juxtraarticular osteoporosis

Late:

  • periarticular erosion
  • subluxation
118
Q

RA check response to treatment

A

DAS28 score

HAQ

119
Q

Treatment flares RA

A

Corticosteroids

120
Q

Treatment long term RA

A

DMARDs:

1) Methotrexate, leftunonide or sulfasalazine
2) 2 in combination
3) Methotrexate + biologic therapy (usually TNF)
4) Plus rituximab

121
Q

Identify felty syndrome

A

RA + splenomegaly + decreased WCC

122
Q

Cancer linked to Sjorens

A

Lymphoid malignancy

123
Q

Antibodies Sjorens

A

anti-Ro/anti-La

RF/ANA

124
Q

Treatment Sjorens

A

Artificial tears

Pilocarpine - saliva production

125
Q

SLE antibody

A

Anti-nuclear most sensitive but not specific

Anti-dsDNA most specific

126
Q

Monitoring SLE

A

ESR used, CRP may be normal

Complement C3,C4

127
Q

Treatment acute flare SLE

A

1) NSAID

2) Consider prednisolone/cyclophosphamide if internal organ involvement

128
Q

Treatment long term SLE

A

Hydroxychloroquine

129
Q

Identify polymyositis

A

Symetrical proximal weakness
Raynauds
Lung disease

130
Q

Identify dermatomyositis

A

Polymyositis + gottron lesions and skin involvement

131
Q

Identify CREST syndrome

A

Oesophageal problems and sclerosis features - Limited systemic sclerosis

Calcinosis
Raynaud’s
Oesophageal dysmotility 
Sclerodactyly 
Telangiectasia
132
Q

Antibodies systemic sclerosis

A

Diffuse - anti-scl-70

Limited - anti-centromere

133
Q

Identify polymyalgia rheumatica from investigation

A

Diagnosis of exclusion

CK normal, ESR raised

134
Q

Treatment polymyalgia rheumatica

A

Prednisolone - if no effect consider other diagnosis

135
Q

Treatment fibromyalgia

A

CBT and neuropathic analgesia

136
Q

Osteomalacia bloods

A

Decreased vit D
Decreased calcium
Decreased phosphate
Increased ALP

137
Q

Pagets blood

A

isolated rise ALP

138
Q

Pagets most common bones

A

Skull
Spine/pelvis
Long bones

139
Q

Treatment pagets

A

Bisphosphonates

140
Q

Treatment osteoporosis

A

1) Bisphosphonates
2) Denosumab, strantium randate, raloxifene, HRT

Everyone lifestyle, vit D and calcium

141
Q

Antiphospholipid syndrome bloods

A

Thrombocytopenia

Prolonged APTT

142
Q

Treatment antiphospholipid syndrome

A

Primary - low dose aspirin

Secondary - warfarin

143
Q

Osteopetrosis bone profile

A

All normal

144
Q

CKD bone profile

A

Ca decreased
PTH increased
Phosphate increased
ALP increased

145
Q

Primary hyperparathyroidism bone profile

A

Ca increased
PTH increased
ALP increased
PTH increased

146
Q

Time to diagnose chronic fatigue syndrome

A

4m

147
Q

Ig to pass to foetal circulation

A

IgG

148
Q

First Ig to be made in response

A

IgM

149
Q

Predominent Ig in breast milk

A

IgA

150
Q

Identify osteogenesis imperfecta

A

Childhood
Following trauma, blue sclera
Bone profile normal

AKA brittle bone disease

Finals - Systems Paper (20 decks)

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