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Pastest Flashcards

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1
Q

Most common cause of osteomyelitis in a patient with sickle cell?

A

Salmonella

staph aureus for everyone else

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2
Q

First line for carpal tunnel syndrome?

A

Corticosteroid injection

no role for NSAID

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3
Q

What is the commonest # of childhood?

A

Supracondylar # of the humerus

Often involve brachial artery compromise and involvement of median, radial or ulnar nerve

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4
Q

How are supracondylar # classified?

A

Garland classification

Type 1 = non displaced
Type 2 = angulated with intact posterior cortex
Type 3 = posterior displacement

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5
Q

Back pain worse on extension of the back?

A

Facet joint pain

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6
Q

Ottawa ankle rules

A

X-ray is only required if bony tenderness in the malleolar zone +

Inability to weight bear for 4 steps
Bony tenderness in distal tibia
Bony tenderness in distal fibula

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7
Q

What tests do patient need before starting hydroxychloroquine?

A

Ophthalmology exam due to risk of retinopathy

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8
Q

First line treatment for new RA?

A

Methotrexate + another DMARD e.g. leflunomide

+ a short dose of oral prednisolone to control acute flare

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9
Q

What does anti-Jo 1 antibodies in polymyositis mean?

A

Worse prognosis and increased risk of interstitial lung disease

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10
Q

Syringomeylia

A

Formation of a cystic cavity within the spinal cord

Commonest is with Arnold-chairi malformation

Typically affected the spinothalamic tract —>pain and sensory loss in the upper limbs

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11
Q

Feature of Brown - Sequard syndrome?

A 
Hemisection of spinal cord e.g. stab injury
Ipsilateral paralyses (pyramidal tract) and loss of proprioception and fine touch (dorsal column)

Pain and temperature loss is on the contralateral side (spinthalamic tract cross below the injury)

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12
Q

APTT will be increased in anti-phospholipid syndrome. Associated with anit-cardioplipi and lupus anti-coagulant antibodies. What are the features?

A

C - coagulation defects
L - livedo reticularis
O - obstetric loss
T - thrombocytopenia (low platelets)

1ST DVT = warfarin for 6 months
>1 = lifelong warfarin

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13
Q

Management of reactive arthritis?

A

NSAIDs- can’t pee, can’t see, can’t climb a tree

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14
Q

Which test is used to assess for hyper mobility?

A

Brighton score

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15
Q

Features of anti-synthetase syndrome?

A

Myositis
Cracked hands
Raynauds
Interstitial lung disease

Anti-jo 1

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16
Q

ESR and CK in polymyalgia rheumatica?

A

ESR is elevated
CK is normal (no true myositis)

Remember there is no true weakness - it is limited by pain

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17
Q

Most common eye complication of RA

A

Keratoconjunctiva sicca

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18
Q

Most likely bone tumour in middle age?

A

Chondrosarcoma

‘Popcorn calcification’ and axial skeleton

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19
Q

Distal radial # with volar angulation?

A

Smiths

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20
Q

Intra-articulate # of the base of the 1st MCP

A

Bennets

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21
Q

Bi-malleolar ankle fracture. Often after fall from height?

A

Potts #

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22
Q

Dislocation of the proximal radio-ulnar joint with ulnar #

A

Monteggia #
(usually occurs after fall on outstretched hand with forced pronation)

(PM)

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23
Q

Radial shaft # fracture with dislocation of the radio-ulnar joint

A

Galeazzi #

GD

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24
Q

Retinal haemorrhage after femoral #?

A

Fat embolism

Intra-arterial fat globules is also suggestive

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25
What test is used to conform de quervains tenosynovitis?
``` Finklesteins test (put thumb in closed fist then extend wrist down) ```
26
What is de quervains tenosynovitis?
Inflammation of the sheath containing the extensor policis brevis and abductor policis longus Treat with analgesia or steroid injection
27
Positive lachman test?
ACL rupture Remember that PCL occurs due to hyperextension
28
The sciatic nerve divides into the tibial and commonest peroneal nerves. Features of common peroneal nerve damage?
Foot drop Sensory loss over dorsum of foot Weakness of dorsiflexion, foot eversion and extensor hallucis longus
29
Hills Sach lesion visible of x-ray
Anterior glenohemoral dislocation
30
Rim’s sign, light bulb sign. Trough sign...
All suggestive of a posterior shoulder dislocation
31
IVDU with back pain, fever and likes to lie on back with knees flexed?
Psorias abscess
32
What is the expected calcium and alk phos in pagets disease?
Calcium = Normal | Alk phos = high
33
Alk phos and calcium in osteomalacia?
Low calcium and phosphate | Alk phos is high
34
First line analgesia for managing low back pain?
NSAIDs such as naproxen
35
RF for DDH
- Female - First born - FH - breech - oligohydramnios
36
Teenager hit in knee with hockey stick. Knee is tense and swollen but no # on x-ray. Likely diagnosis?
Patellar disclocation | often spontaneously reduce
37
What is the investigation of choice in suspected osteomyelitis?
MRI
38
Epidural abscess is a complication of discitis
Suspect in a patient with discitis who continues to spike a fever/ is not improving
39
What is osteopetrosis?
Autosomal recessive Present with anaemia or low platelets ‘Marble bone’ - no differentiation between cortex and medulla
40
1 year old presents with FTT, small, big head, and cupping of the epiphysis of long bones
Rickets | Childhood form of osteomalacia (Weak bones due to vitamin D deficiency)
41
Treatment of talipes equinovarus?
Club foot Treat with manipulation and progressive casting e.g. the Ponsetti method Night time braces until 4 years old
42
What is club-foot associated with?
Spina bifida Edwards Cerebral palsy
43
L5 lesion
Loss of foot dorsiflexion and sensory loss dorsum of the foot Remember if L3/L4 then the knee reflex would be reduced If S1 then ankle jerk is reduced
44
Common complication of anterior shoulder dislocation?
Axillary nerve damage - badge patch
45
Red, hot swollen joint with reduced sensation in a patient with a history of poorly controlled DM?
Charcot joint - as there is lots of peripheral neuropathy it is not as painful as might be expected
46
Wasting of the thenar eminence is characteristic of carpal tunnel. Remember the rest of the hand is innervated by ulnar nerve - except...
LOAF muscles - lateral 2 lumbricals - opponens pollicis - abductor pollicis - flexor pollicis brevis
47
Dupuytrens is associated with....
``` Alcohol excess FH Liver disease Manual labour Male ```
48
Classic symptoms of frozen shoulder
Active and passive movement restricted | External rotation worse
49
Treatment of choice for a sub-trochanteric hip #
Interdmedullary nail
50
Suspected cauda equina syndrome
MRI ASAP | Within 6 hours
51
How does the management of an intra-capsular hip fracture vary depending on age/ mobility?
Younger and more active —> total hip replacement Old and less mobile —> hemiarthroplasty
52
Define AVN. What are the risk factors?
Death of bone tissue secondary to loss of blood supply RF = steroids, chemotherapy, alcohol excess and trauma
53
How does AVN present?
Can occur in any joint Often long bones such as femur Asymptomatic —> joint pain Osteopenia, microfractures and collapse of intra-articulate surfaces are seen early on Test with MRI
54
Which antibiotic is associated with tendinitis and new tendon rupture?
Ciprofloxacin
55
What clinical examination should be done in a patient with suspected Achilles’ tendon rupture?
Simmonds triad - look —> altered angle of dangle - feel —> palpate for a gap - move —> squeeze calf - normally there will be plantar-flexion of foot
56
Describe the gustilo and Anderson tissue classification?
Classification of low open # 1 - low energy wound <1cm 2 - >1cm wound with moderate soft tissue damage 3 - high energy >1cm with extensive tissue damage 3a - adequate tissue coverage 3b - inadequate tissue coverage 3c = associated arterial injury
57
Foot drop in an old man who has had a total hip replacement revision?
Sciatic nerve damage | remember common peroneal is an important branch
58
Remember the entire posterior compartment of the lower leg is innervated by the tibial nerve
E.g. soles, gastrocnemius, tibialis posterior and flexors digitorum and hallucis longus
59
Sensation on lateral aspect of foot and weakness of plantar-flexion?
S1
60
``` Knee = L4 Ankle = S1 ```
``` Bicpes = C5 Brachioradialies = C6 Triceps = C7 ```
61
All reflexes are normal but there is reduced dorsiflexion of big toe?
L5 nerve involvement Can’t be L3/4 or S1/S2 as they are involved in reflexes
62
Sensory loss over dorsum of foot =
L5 | Also weakness in foot and big toe dorsiflexion but reflexes are ok
63
Burning thigh pain...
Meralgia parasthetica due to compression of the lateral cutaneous nerve of the thigh
64
Oslers nodes?
Painful pink/ purple lesions on the fingers and toes Caused by immune complex deposition and associated with infective endocarditis and SLE
65
Action in suspected hip fracture (clinically) but x-ray is normal?
MRI is best (but CT may be done to wider availability)
66
Triad of: Claudication in buttocks and thighs Atrophy of leg muscles Impotence
Leriche syndrome Athersosclerotics occlusive disease of abdominal aorta +/or both iliac arteries
67
Investigations in a patient with suspected spinal stenosis?
MRI
68
Describe the different types of nerve damage which can occur following a forceps delivery
Femoral = weak knee extension, loss patella reflex and numb thigh Sciatic = weak knee flexion and foot movement Obturator = weak hip adduction
69
Which nerve supplies biceps brachii?
Musculocutanoues nerve (C5-C7) Elbow flexion
70
Which nerve supplies deltoid muscle?
Axillary C5/C6 Shoulder abduction
71
Which nerve in the upper limb does extension?
Radial
72
Weakness of dorsiflexion, eversion and extensor hallucis longus can all be explained by...
Common peroneal nerve palsy
73
Which muscle does the first 20 degrees of shoulder abduction?
Supraspinatous after that, deltoid takes over SI SA IE TE
74
How does serotonin syndrome present?
Cause by excess SSRI, TCA act Features = restlessness, hyperthermia, tachycardia, confusion, increased reflexes and movement (basically everything increases and D&V is common)
75
Foot drop..
Common peroneal nerve palsy - often due to tight fitting plaster cast
76
What is the correct management for a perforated eardrum?
Discharge and advice to keep dry for 6 weeks while it heals. See GP in 6-8 weeks Surgery is only considered if not healing
77
Patient on metronidazole develops vomiting after having a few drinks. What is happening?
Disulfarim reaction The activity of acetaldehyde is blocked —> large increase in serum acetaldehyde levels following alcohol Patients are sick, dizzy and have a terrible headache. This is how Antabuse (the drug that makes alcohol very unpleasant works
78
Adrenaline in anaphylaxis....
Adult= 500 micgrogram IM Child = 300 microgram IM Child >6 = 150 microgram IM
79
Best investigation in a patient with suspected phaeochromocytoma but normal MRI?
MIBG scan MIBG labelled with radioactive iodine resembles nor-adrenaline and concentrates in adrenals or areas of adrenal phaeochromocytoma
80
What is Waterhouse Friederichsen syndrome?
Primary adrenal failure which is most commonly caused by neisseria meningitidis
81
Remember, LFT and UE are taken from the same blood tube. If LFT could not be performed due to haemolysis then it is possible that a raised K is due to haemolysis too
Take repeat bloods but probably do an ECG just in case
82
Which type of shock is most common in acute pancreatitis?
Fluoxetine d depletion or hypovolaemic due to loss of fluid into the intra abdominal space
83
What is Charcots triad?
Fever, jaundice and RUQ pain which is suggestive of acute cholangitis
84
Likely diagnosis in an ICU patient who develops sudden onset haematemesis with no underlying peptic ulcer disease?
Stress ulceration due ischaaemic injury to the gastric mucosa and disruption of the mucosal barrier Prevent by using PPI/ ranitidine
85
Remember that a central venous line can be really useful in patients with heart failure who need carful fluid balance e.g. you want them hydrated but not overloaded
Remember that a central venous line can be really useful in patients with heart failure who need carful fluid balance e.g. you want them hydrated but not overloaded
86
Type 2 reaction = antibody mediated hypersensitivity e.g. haemolytic anaemia
Type 3 = immune complex mediated e.f. RA or SLE TyPE 4 = T cell medicated e.g.g contact dermatitis
87
Which drug is used for radiation emergencies?
Potassium iodide | used if significant exposure to radioactive iodine
88
Target BP in a patient with a pelvic #
Ideally 100/70 as lower pressure = less bleeding and less clot destruction
89
Smith # are usually managed with MUA or ORIF
Colles fractures are often managed conservatively
90
How is an acute dystonic reaction managed? E.g. after ingestion of metoclopramide?
Drugs such as benztropine or procyclidine | Procyclidine is most likely (it is more available and is used as an anti-Parkinsonism drug)

Acute Care (4 decks)

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