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Year 2: Joint Pain > Orthopedic Investigations > Flashcards

Orthopedic Investigations Flashcards

1
Q

What is dactylitis suggestive of (3)

A

psoriatic arthritis
spondyloarthritis
gout

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2
Q

4 hand signs of rheumatoid arthritis

A

Boutonniere deformity of thumb
ulnar deviation of MCP
swan neck deformity of fingers
Hebenden and Bouchard’s nodes

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3
Q

subcutaneous tophi is a sign of what

A

gout

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4
Q

splinter haemorrhages and janeway lesions are a sign of what

A

subacute bacterial endocarditis

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5
Q

malar rash, alopecia and oro-nasal ulcers signs of what

A

SLE

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6
Q

4 (XRay) signs of osteoarthritis

A 
joint space narrowing 
osteophytes 
subchondral cysts 
bony sclerosis 
(and loss of shape of femoral head from AVN)
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7
Q

4 options for operative management of osteoarthritis

A
  1. osteotomy (re-align the joint/limb)
  2. arthrodesis (make a stiff, painless joint)
  3. excision arthroplasty (remove arthritis)
  4. replacement arthroplasty (large joints mostly)
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8
Q

4 indications for joint replacement

A
  • disabling pain (despite analgesia)
  • functional restrictions (walking distance)
  • quality of life (night pain)
  • radiographic significant arthritis
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9
Q

3 complications of joint replacement

A

VTE
peri-prosthetic fracture
infection

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10
Q

1st stage of management of rheumatoid arthritis (3)

A

lifestyle:
MD - physio, OT, podiatry
NSAIDs

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11
Q

what makes COX-2 inhibitors preferable to NSAIDs for pain relief

A

less GI bleeding risk (less significant GI symptoms remain eg. dyspepsia)

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12
Q

what are DMARDs

A

long-term suppressive drug therapy - disease-modifying anti-rheumatic drugs

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13
Q

examples of DMARDs

A

methotrexate and sulfasalazine - good efficacy:toxicity ratio

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14
Q

monitoring with DMARDs

A 
FBC
LFTs
U&Es
BP
Urinalysis
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15
Q

effects of blocking TNF alpha

A

immune: decreases rheumatoid factor, T cell function restored
inflammation: decreased cytokine production in joints (IL1, 6, TNF)
angiogenesis: decreased

joint destruction: decrease damage to bone/carti

haematology: decreased platelets, fibrinogen, restoration of Hb

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16
Q

do not initiate DMARDs in presence of what

A

serious active infection or high risk

17
Q

what is the Salter Harris classification for?

A 
paediatric physeal fractures 
S: separated growth plate
A: above growth plate
L: beLow growth plate
T: through growth plate
ER: erasure of growth plate
18
Q

Treatment of a stable fracture

A

no surgery - hold in correct position until heals - cast/splint/traction

19
Q

Treatment of an unstable fracture

A

surgical fixation with metalwork - usually allows quicker mbilisation of affected limb

20
Q

what is acute compartment syndrome

A

intracompartmental pressure elevated (relative to end capillary-pressure) to a level and duration that causes compromised perfusion of intracompartmental structures

decompression is necessary to prevent muscle necrosis

21
Q

why is decompression required in acute compartment syndrome

A

to prevent muscle necrosis

22
Q

6 Ps of acute compartment syndrome

A 
Pain 
Pain on passive stretch 
Paraesthesia 
Paralysis 
Pulses present 
Palpation
23
Q

Most common cause of limp in child

A

transient synovitis

24
Q

3 causes of a chronic limp in child

A

perthes disease
slipped upper femoral epiphysis SUFE
systemic illness (rheumatic disease or tumour)

25
Q

child with limp with:
hypothyroidism
panhypopiuitarism
hypogonadism

A

SUFE

26
Q

4 causes of child with limp with fever

A

osteomyelitis
septic arthritis
transient synovitis
leukaemia

27
Q

What does Galeazzi test for

A

posterior displacement in the developmentally dysplastic hip

28
Q

child with antalgic gait keeping hip in abduction and external rotation (and low grade fever)

A

transient synovitis

29
Q

typical patient of SUFE

A

Adolescent obese male 10-15 years
bilateral limp
limp and hip pain
positive trendelenburg test

Year 2: Joint Pain (2 decks)

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