Surgery - Orthopaedics Flashcards
(148 cards)
1
Q
risk factors for OA?
A
NAME?
2
Q
which joints are commonly affected in OA?
A
NAME?
3
Q
LOSS: X-ray changes seen in OA?
A
NAME?
4
Q
presentation of OA?
A
NAME?
5
Q
hand signs seen in OA?
A
- bouchard’s nodes (PIPs)- heberden’s nodes (DIPs)- squaring of base of thumb- weak grip- reduced ROM
6
Q
how is OA diagnosed?
A
does not require investigations if:- age >45- typical pain w/ activity- no morning stiffness (or <30 mins of morning stiffness)
7
Q
management of OA?
A
NAME?
8
Q
analgesic ladder in OA?
A
- PO paracetamol + topical NSAIDs2. add PO NSAIDs (+PPI)3. weak opioids (codeine)other options:- topical capsaicin - intra-articular steroids
9
Q
what is a compound fracture?
A
when skin is broken and the broken bone is exposed to air
10
Q
what is a stable fracture?
A
when sections of the bone remain in alignment at the fracture
11
Q
what is a pathological fracture?
A
when a bone breaks due to underlying bone abnormalities
12
Q
give some causes of pathological fractures
A
- bony mets- osteoporosis- paget’s disease of the bone
13
Q
which cancers commonly metastasise to the bone?
A
NAME?
14
Q
what is a colle’s fracture?
A
transverse fracture of the distal radius
15
Q
which fractures are commonly caused by falling onto an outstretched hand (FOOSH)?
A
- colle’s fracture| - scaphoid fracture
16
Q
main complication of a pelvic fracture?
A
intra-abdominal bleeding, which can then cause shock / death
17
Q
common sites for pathological fractures?
A
- femur| - vertebral bodies
18
Q
what is a fragility fracture? commonest cause?
A
- fracture due to weakness of bone| - osteoporosis
19
Q
what is the FRAX score?
A
risk of fragility fracture within the next 10 years
20
Q
how can bone mineral density be calculated?
A
using a DEXA scan
21
Q
which T-score range means there is osteopenia?
A
-1 to -2.5
22
Q
which T-score range means BMD is normal?
A
more than -1
23
Q
T-score range indicating osteoporosis?
A
less than -2.5
24
Q
WHO criteria for severe osteoporosis?
A
T-score < -2.5 AND a fracture
25
prophylaxis of fragility fractures in osteoporotic pts?
#NAME?
26
key side effects of bisphosphonates?
#NAME?
27
what are the 3 key goals of fracture management?
#NAME?
28
2 methods of achieving mechanical alignment in fracture management?
- closed reduction (manipulating the limb)| - open reduction (surgery)
29
complications of a fracture?
#NAME?
30
presentation of fat embolism syndrome?
- onset is typically 24-72h after a fracture- respiratory distress- petechial rash- cerebral involvement
31
how can fat embolism syndrome be prevented?
by operating early on the fracture
32
RFs for hip fracture?
- ageing| - osteoporosis
33
how can hip fractures be classified?
- intra-capsular| - extra-capsular
34
describe the capsule of the hip joint
#NAME?
35
describe the blood supply to the hip joint
- retrograde blood supply| - supplied by medial and lateral circumflex femoral arteries
36
when is a hip fracture classed as intra-capsular?
- when there is a break in the femoral neck| - this is proximal to the intertrochanteric line
37
how can intra-capsular hip fractures be classified?
using Garden classification: - grade I = incomplete- grade IV = fully displaced
38
main complication of an intra-capsular hip fracture?
avascular necrosis
39
how can non-displaced intra-capsular hip fractures be treated?
interval fixation with screws
40
describe a hemiarthroplasty. which pts get offered this?
#NAME?
41
describe a total hip replacement. which pts get offered this?
- replacing both head of femur and acetabulum| - pts who are independently mobile and fit for surgery
42
which is worse: extra-capsular or intra-capsular hip fracture?
- intra-capsular| - in an extra-capsular fracture, the blood supply is left intact, so the head of femur doesn't need to be replaced
43
types of extra-capsular hip fracture?
- intertrochanteric| - subtrochanteric
44
how are intertrochanteric (extra-capsular) hip fractures treated?
dynamic sliding hip screw
45
how are subtrochanteric (extra-capsular) hip fractures treated?
intramedullary nail
46
presentation of a hip fracture?
#NAME?
47
investigations for a hip fracture?
- initially: X-ray in 2 views (AP and lateral)| - MRI / CT where X-ray is -ve but fracture still strongly suspected
48
what might be seen on an AP view X-ray in a hip injury? what does this indicate?
- shenton's line| - indicates #NOF
49
management of a hip fracture?
- analgesia- X-ray in 2 views- VTE risk assessment - bloods, ECG for pre-op assessment - operate within 48h (improves prognosis)- orthogeriatrics input
50
recovery time following a hip replacement surgery?
pt should be able to bear weight immediately!
51
what is compartment syndrome?
when the pressure in a fascial compartment is too high
52
what is acute compartment syndrome? how is it treated?
#NAME?
53
5Ps: presentation of acute compartment syndrome?
#NAME?
54
describe the pain felt in acute compartment syndrome. which areas might be affected?
- disproportionate to initial injury (fracture / crush)- unresponsive to analgesia- worse on passive stretching of muscles- legs are most common, but also: forearms, feet, thighs
55
how can acute compartment syndrome be differentiated from acute limb ischaemia?
in compartment syndrome, pulses remain present (whereas there's pulselessness in ALI)
56
investigation for acute compartment syndrome?
needle manometry (measures pressure in compartment)
57
initial management of acute compartment syndrome?
#NAME?
58
definitive management of acute compartment syndrome?
emergency fasciotomy
59
what is chronic compartment syndrome typically associated with?
exertion
60
presentation of chronic compartment syndrome?
#NAME?
61
investigation and management of chronic compartment syndrome?
- needle manometry| - may offer fasciotomy
62
what is osteomyelitis?
bacterial infection of the bone and bone marrow
63
how can ostemyelitis occur?
- haematogenous spread of a bacterium| - direct contamination (e.g. from a fracture / surgery)
64
commonest causative organism of osteomyelitis?
staph aureus
65
RFs for osteomyelitis?
#NAME?
66
presentation of osteomyelitis?
#NAME?
67
investigations for osteomyelitis?
#NAME?
68
signs on X-ray in osteomyelitis?
#NAME?
69
which bloods are relevant in osteomyelitis?
- WCC| - inflamm markers (CRP, ESR)
70
management of osteomyelitis?
- surgical debridement of infected bone / tissue| - ABx
71
ABx of choice in acute osteomyelitis? how long is the course of these?
- flucloxacillin for 6w- may add on rifampicin / fusidic acid after week 2 - clindamycin if pen allergic
72
ABx of choice in osteomyelitis caused by MRSA?
either: vancomycin or teicoplanin
73
how long are ABx taken for in chronic osteomyelitis?
3+ months
74
management of osteomyelitis caused by an infected prosthetic joint?
complete revision surgery (replacing the joint again)
75
what are the 3 types of bone sarcoma?
#NAME?
76
which organism causes kaposi's sarcoma? which condition is this associated with?
- HHV 8| - end-stage HIV (it is an AIDS-defining illness)
77
commonest type of bone Ca?
osteosarcoma
78
presentation of sarcoma?
#NAME?
79
investigations for sarcoma?
#NAME?
80
which CT scan is particularly important in sarcoma? why?
- CT thorax| - lungs are most common place for it to spread to
81
management of sarcoma?
#NAME?
82
what is sciatica?
irritation of the sciatic nerve
83
how long does acute lower back pain last?
should improve within 1-2 weeks
84
average recovery time after sciatica?
4-6 weeks
85
causes of mechanical back pain?
#NAME?
86
causes of neck pain?
#NAME?
87
describe torticollis
- waking up with unilateral neck stiffness| - caused by muscle spasm
88
red flag causes of back pain?
#NAME?
89
causes of back pain not directly related to the spine?
#NAME?
90
which nerves make up the sciatic nerve?
L4 - S3
91
presentation of sciatica?
- unilateral buttock pain- shoots down the leg, "electric shock" like- pins and needles- numbness- motor weakness- loss of reflexes
92
main causes of sciatica?
things that compress the lumbosacral nerve:- herniated disc- spondylolisthesis- spinal stenosis
93
what is spondylolisthesis?
when one vertebra is out of alignment with the rest
94
why is bilateral sciatica a red flag?
could indicate cauda equina syndrome
95
findings O/E in back pain? what could each of these indicate?
#NAME?
96
what test can be performed to diagnose sciatica?
sciatic stretch test
97
describe the sciatic stretch test
- pt lies on their back with leg straight- lift one leg from ankle to 90 degs- then dorsiflex ankle - if sciatic pain felt, then there's sciatica- symptoms improve on flexing knee
98
main cancers that metastasise to bone?
#NAME?
99
investigations for spinal fractures?
X-ray / CT spine
100
investigation for suspected cauda equina?
emergency MRI (within hrs of presentaion)
101
investigations for suspected ankylosing spondylitis?
#NAME?
102
key finding on X-ray in late-stage ankylosing spondylitis?
- "bamboo spine"| - everything is fused together
103
finding on MRI spine in early stages of ankylosing spondylitis?
bone marrow oedema
104
analgesic ladder for lower back pain?
#NAME?
105
management of sciatica?
#NAME?
106
pathophysiology of cauda equina syndrome?
compression of nerve roots at L2 - L3
107
causes of cauda equina syndrome?
#NAME?
108
red flags for cauda equina syndrome?
LMN signs: - saddle anaesthesia- loss of sensation in bladder and rectum- urinary retention / incontinence - faecal incontinence- bilateral sciatica - bilateral / severe motor weakness- reduced anal tone on PR
109
management of cauda equina syndrome?
#NAME?
110
key features of metastatic spinal cord compression to differentiate it from cauda equina syndrome?
- UMN signs instead of LMN| - back pain that is worse on coughing or straining
111
management of metastatic spinal cord compression?
#NAME?
112
pathophysiology of spinal stenosis?
narrowing of spinal canal causing compression on spinal cord and nerve roots
113
typical age group affected by spinal stenosis?
pts aged 60+
114
causes of spinal stenosis?
#NAME?
115
presentation of spinal stenosis?
#NAME?
116
investigations for spinal stenosis?
- MRI = first line| - ABI to r/o PAD
117
management of spinal stenosis?
#NAME?
118
which nerve is affected in meralgia paraesthetica?
lateral femoral cutaneous nerve
119
presentation of meralgia paraesthetica?
- NO motor symptoms!!!- burning - numbness- pins and needles- cold sensations - localised hair loss... all on upper outer thigh region
120
which action worsens the pain felt in meralgia paraesthetica?
hip extension
121
presentation of trochanteric bursitis? (incl. O/E)
#NAME?
122
what are the 4 ligaments of the knee?
#NAME?
123
presentation of a meniscal tear?
- young pt who heard a "pop" after doing a twisty movement - pain, referred to hip / back- swelling- stiffness, reduced ROM- knee locking - knee "gives way"
124
tests done O/E for suspected meniscal tear?
- mcmurray's test| - apley grind test
125
according to the ottawa rules, which pts require a knee x-ray (after a knee injury)?
high suspicion of bony fracture in these cases:- aged 55+- patellar tenderness- fibular head tenderness- can't flex past 90 degs- can't weigh bear
126
investigation for meniscal tear?
- MRI knee| - arthroscopy of knee = gold standard
127
management of meniscal tear?
#NAME?
128
RICE: conservative management of meniscal tears?
#NAME?
129
demographic affected by osgood-schlatter disease?
pts aged 10-15 years old
130
pathophysiology of osgood-schlatter disease?
inflamed tibial tuberosity, where patellar tendon goes in
131
presentation of osgood-schlatter disease?
- unilateral, gradual onset knee pain| - visible / palpable lump at tibial tuberosity (permanent!)
132
management of osgood-schlatter disease?
#NAME?
133
where do baker's cysts present?
popliteal fossa
134
conditions associated with baker's cysts?
#NAME?
135
presentation of baker's cyst?
#NAME?
136
differentials for a lump in the popliteal fossa?
- baker's cyst- DVT- abscess- popliteal artery aneurysm- ganglion cyst- lipoma - varicose vein- tumour
137
investigation for baker's cyst?
USS knee
138
which bone does the achilles tendon attach to?
calcaneus bone
139
RFs for achilles tendinopathy?
#NAME?
140
presentation of achilles tendinopathy?
#NAME?
141
management of achilles tendinopathy?
#NAME?
142
presentation of achilles tendon rupture?
- sudden onset achilles / calf pain- snapping sound / sensation- feeling like someone hit them in the back of the leg :(- positive simmonds calf squeeze test (no plantar flexion)
143
how is achilles tendon rupture diagnosed?
on USS
144
management of achilles tendon rupture?
#NAME?
145
presentation of plantar fasciitis?
#NAME?
146
management of plantar fasciitis?
#NAME?
147
how can the extent of deformity in a bunion be assessed?
weight-bearing X-ray
148
commonest cause of shoulder pain and stiffness?
adhesive capsulitis
