Week 3 Flashcards by Iseoluwa Ojo

_______________ is the most common arthropathy and is a leading cause of pain and disability in the Western world.

Osteoarthritis (OA)

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Osteoarthritis (OA) is a condition characterised by the ______________ and _____________ of the underlying bone.

progressive loss of articular cartilage

remodelling

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Osteoarthritis is traditionally thought of as a ‘_____________’ disease which occurs as we age.

wear and tear

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The pathogenesis of Osteoarthritis involves a __________ of _______ and remodelling of bone due to an active response of ____________ in the articular cartilage and the inflammatory cells in the surrounding tissues.

degradation; cartilage

chondrocytes

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In osteoarthritis

The release of enzymes from these cells break down ________ and _________, destroying the articular cartilage. The exposure of the underlying subchondral bone results in ___________, followed by reactive remodelling changes that lead to the formation of _______ and _________________.

The joint space is ———————- over time.

collagen and proteoglycans

sclerosis

osteophytes; subchondral bone cysts

progressively lost

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Risk factors for primary OA include ___________,_________,__________, and __________

obesity, advancing age, female gender, and manual labour occupations.

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Clinical features of OA include _________ and __________ , worsened with _________* and relieved by ______.

pain and stiffness in joints

activity; rest

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_______ in OA tends to worsen throughout the day, whereas ________ tends to improve.

Pain

stiffness

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Prolonged OA results in ________ and a _______________.

deformity

reduced range of movement

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On examination in OA, inspect for deformity; there are some common characteristic findings depending on the joint affected, such as __________ (swelling of PIPJs) or ____________ (swelling of DIPJs) in the hands, and _____________ deformity or varus malalignment in the knees.

Bouchard nodes

Heberden nodes

fixed flexion

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Joint stiffness and pain that improves with activity is characteristically seen in ___________ arthropathies (e.g. ________________

inflammatory

rheumatoid arthritis

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Osteomyelitis is defined as ________________, either _______ or ________.

an infection of bone

acute or chronic

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Osteomyelitis In adults, the _________ are the most commonly affected bones, whilst in children, __________ are more commonly affected.

vertebrae

long bones

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Most cases of osteomyelitis are ________ and ________ in origin, however it can also be _————- and rarely can even be __________ in origin.

acute and bacterial

chronic; fungal

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Osteomyelitis can be caused by 3 main routes:

—————————— spread

_________________ into the bone (e.g. following _____________)

_________ spread from _____________ (e.g. adjacent _____________)

Haematogenous

Direct inoculation of micro-organisms ; an open fracture

Direct; nearby infection ; septic arthritis

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The most common causative organisms for osteomyelitis include _________ (most common), —————- , Enterobacteur spp.,___________,______________ (especially in intravenous drug users), and __________ (especially in patients with sickle cell disease)

S. aureus

Streptococci

H. Influnzae ; P. aeruginosa

Salmonella spp.

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In chronic cases of osteomyelitis , the infection can lead to —————- of the affected bone, resulting in _________ and __________ of the surrounding bone.

devascularisation

necrosis; resorption

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In chronic osteomyelitis, after devascularization of the dead bone, it leads to a “ _________ ” piece of dead bone, termed a ___________, which acts as a __________ for infection (and cannot be penetrated by antibiotics, as it is ————-).

floating; sequestrum

reservoir; avascular

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In chronic osteomyelitis, An ____________ can also form, following the sequestrum formation, whereby the region becomes ________ in a _________ of ___________ bone.

involucrum

encased; thick sheath

new periosteal

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Risk factors for developing osteomyelitis include —————-, ___________ (such as long term steroid treatment or AIDS), _______________ or_____________

diabetes mellitus

immunosuppression

alcohol excess, or intravenous drug use.

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Osteomyelitis and the Diabetic Foot

______ infections occur frequently in diabetic patients, these infections are often due to minor trauma, but due to a combination of _________ and _________ disease, infection often develops quickly and can initially go unnoticed.

__________ infection can therefore increase the risk of osteomyelitis developing.

Foot

neuropathy; small vessel

Soft tissue

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It is important to suspect osteomyelitis in any diabetic patient with a ________ or __________ infection. Any suspected case should have an MRI scan to confirm the diagnosis.

deep or chronic foot

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Clinical Features of osteomyelitis

Patients will usually present with ___________* in the affected region and associated _____________________.

severe pain

low grade pyrexia

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Clinical features of osteomyelitis

Pain is (constant or intermittent?) and can be worse at ________. Cases may present with non-specific symptoms or possibly with a previous history of recent trauma.

On examination, the site will be ________, with potential overlying ________ and ________. If the lower limb is affected, the patient may be unable to __________.

Ensure you examine for potential sources of the infection, such as _______________________ from intravenous drug use, cellulitic areas, penetrating wounds, or stigmata of concurrent infection in another body system.

Constant ; night

tender; swelling and erythema

weight bear

pock marks or sinuses

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The main differentials for suspected cases of osteomyelitis include _____________, _________ injuries (including soft tissue injury or fractures), and primary or secondary bone tumours.

septic arthritis traumatic

Potts disease is an infection of the ________ and ____________ by _____________. Patients will present with __________ +/- neurological features, with associated _________ and non-specific infective symptoms.

vertebral body; intervertebral disc Mycobacterium tuberculosis back pain; low grade fever

Pott’s disease The infection will initially start in the __________ before spreading to the —————- regions, typically affecting the ______________ region of the spine.

intervertebral disc para-discal thoraco-lumbar

Pott’s disease _____________ is the gold-standard investigation for suspected cases. Most cases will require a prolonged course of anti-TB medication, however surgical intervention may be required for abscess drainage in the case of extensive spinal destruction.

MRI imaging

Management of osteomyelitis If the patient is clinically well, patients will require ___—-term ——————- therapy (>4 weeks), tailored to any cultures available or otherwise following local antimicrobial protocols. This is usually the mainstay of treatment for osteomyelitis, with no surgical intervention is needed. However, in cases where the patient clinically deteriorates or imaging shows progressive bone destruction, then surgical management may be required. At this stage, _______________ of the infected bone is required, ensuring any samples are sent for culture and sensitivity. In severe or chronic cases, large debridements and complex reconstruction may be needed.

long; intravenous antibiotic surgical debridement

Complications of osteomyelitis Poorly managed acute osteomyelitis may lead to ______ and even mortality. Associated _________ or soft tissue infections may occur. Children may develop ______ disturbances as a result of _____________. _______________ is rarely required in modern practice. Recurrence of infection can occur, often associated with premature cessation of antibiotics. Chronic osteomyelitis can occur in immunocompromised patient, under-treated patients, or virulent or resistant organisms.

sepsis; septic arthritis Growth; premature physeal closure Amputation

Chronic Osteomyelitis Patients with chronic osteomyelitis will present with localised ongoing ________ and non-specific infection symptoms (e.g. malaise or lethargy). There may be a draining sinus tract and they may have difficulties in mobility.

bone pain

Septic arthritis refers to the ______________. It requires a _____ index of suspicion and can affect both ________ and _____________.

infection of a joint high native and prosthetic joints

The main causative organisms that lead to septic arthritis are __________ (most common in adults), __________ spp., _______ (more common in sexually active patients), and _________ (especially in those with sickle cell disease).

S. aureus; Streptococcus Gonorrhoea; Salmonella

Septic arthritis Bacteria will ‘seed’ to the joint from a —————- (e.g. recent cellulitis, UTI, chest infection), a direct inoculation, or spreading from _____________.

bacteraemia adjacent osteomyelitis

Septic arthritis can cause irreversible articular cartilage damage leading to severe ____________.

osteoarthritis

Risk Factors The main risk factors for developing septic arthritis are increasing _____, any ___________ disease (e.g. rheumatoid arthritis), diabetes mellitus or immunosuppression, chronic kidney disease, hip or knee joint ___________, or intravenous drug use

age; pre-existing joint prosthesis

Clinical Features of septic arthritis Patients will most commonly present with a __________ joint causing severe pain. ________ will be in around 60% of affected individuals (although its absence should not rule out septic arthritis).

single swollen; Pyrexia

Clinical features of septic arthritis On examination, the joint will appear ________,_________, and _______, causing pain on ___________ movements. An effusion may also be evident.

red, swollen, and warm active and passive

Clinical features of septic arthritis Often the joint is ______ and the patient will not tolerate any passive movement at all, and will be unable to weight bear. Symptoms are more florid and obvious in ______ joint injection; in _______ joint infections, the features can be more subtle.

rigid native prosthetic

The main complications of septic arthritis are ________ and _________

osteoarthritis and osteomyelitis.

A Marjolin ulcer is a _____________ malignancy that arises in the setting of _____________ skin, _____________ scars, and _____________ wound

cutaneous malignancy previously injured skin longstanding scars chronic wound

Traditionally the metabolic response to injury is divided into an initial period of catabolism followed by an anabolic phase of repair and tissue healing. The catabolic phase begins at the time of injury and is characterised by _______volaemia, decreased __________, reduced _______, ________ and ————.

hypo basal metabolic rate cardiac output hypothermia and lactic acidosis

The main physiological role of this catabolic phase is to ————- and ________________ and thus maximise sur- vival chances for future recovery.

conserve both circulating volume and energy stores

A series of neurohormonal responses accompany these catabolic phase efects and trigger a _________________________, where body stores are mobilised for recovery and repair.

systemic infammatory response syndrome (SIRS)

The catabolic efects of metabolic response to injury include muscle _______, weight ——— and hyper___________ , which themselves increase the risk of complications, especially _________.

breakdown; loss glycaemia sepsis

‘__________ ’ perioperative care helps to preserve homeostasis following elective surgery

Stress-free

Shock is a systemic state of _______________ that is inadequate for ________________. With insufcient delivery of _________ and ___________ , cells switch from _________ to ————— metabolism. If perfusion is not restored in a timely fashion, cell death ensues.

low tissue perfusion normal cellular respiration oxygen and glucose aerobic to anaerobic

Ischaemic cell death releases ________ into the circula- tion, leading to systemic __________ and (acidosis or alkalosis?) , as well as further damage to molecules that systemically activate the ________ and _________ system.

potassium hyperkalaemia and acidosis immune; coagulation

Systemic response to shock CVS- _________ Respiratory-_____________ Renal-____________ Endocrine -___________

Widespread vasoconstriction Compensatory respiratory alkalosis Reduced urine output, further vasoconstriction Activated RAAS system

Non-haemorrhagic causes include _________, excessive fuid loss due to ________,_________,_________ , evaporation or ‘ ___________ ’, where fuid is lost into the _____________ and _________ , as for example in bowel obstruction or pancreatitis.

dehydration vomiting, diarrhoea, urinary loss third-spacing gastrointestinal tract and interstitial spaces

In anaphylaxis shock , vasodilatation is due to _________, while in high spinal cord injury there is failure of ___________ and adequate ___________ (neurogenic shock).

histamine release sympathetic outfow and adequate vascular tone

Multiple organ failure is defned as —————————————

two or more failed organ systems.

Effects of organ failure ● Cardiac: ___________ failure ● Lung: ________________ ● Kidney: ___________ ● Liver: _________ and ________ ● Brain: _________ and _____________

Cardiovascular Acute respiratory distress syndrome Acute renal insuffciency Liver failure and coagulopathy Cerebral swelling and dysfunction

In general, loss of around _____% of the circulating blood volume is within normal compensatory mechanisms. Blood pressure is usually well maintained and only falls after ________% of circulating volume has been lost.

15 30–40

Resuscitation is very diferent if patients are actively bleeding or if they are not bleeding. In patients who are bleeding, the priority is to __________. In patients who are not bleeding, the priority shifts to _________________ (correcting the shock state).

stop bleeding normalising end-organ perfusion

Forms of Haemorrhage _________ and ________ haemorrhage ___________,__________, and _____________ haemorrhage _________ and _________ haemorrhage

Revealed and concealed Primary, reactionary and secondary Surgical and non-surgical

Primary haemorrhage is haemorrhage occurring _________ as a result of ___________ Reactionary haemorrhage is ________ haemorrhage (within _________) Secondary haemorrhage is due to ___________ of a vessel. It usually occurs ________ after injury

immediately; an injury (or surgery). delayed; 24 hours sloughing of the wall; 7–14 days

Reactionary haemorrhage is usually due to _______________ by resuscitation, _____________ and __________. Reactionary haemorrhage may also be due to technical failure, such as ——————

dislodgement of a clot normalisation of blood pressure vasodilatation slippage of a ligature.

Secondary haemorrhage is precipitated by factors such as ________, ______ necrosis (such as from a _______) or malignancy.

infection pressure drain

Surgical and non-surgical haemorrhage Surgical haemorrhage is due to a _________ and is ———————- (eg ________) or other techniques such as angioembolisation. Non-surgical haemorrhage is general bleeding from __________ and _________ due to __________ and cannot be ___________ (except packing). Treatment requires correction of the coagulation abnormalities.

direct injury amenable to surgical control (e.g. suture ligation) raw surfaces and mucous membranes coagulopathy; stopped by surgical means

There are four main groups of hospital acquired infections (HAIs) : __________ infections , __________ infections , _________ and _________

respiratory urinary tract bacteremia SSIs

A major SSI is defned as a wound that either __________________________ or needs a __________________________

discharges signifcant quantities of pus spontaneously secondary procedure to drain it

Abscesses need _________ Antibiotics are indicated if the abscess cavity is ___________________

drainage not left open to drain freely

An open abscess cavity heals by ___________ intention

secondary

Cellulitis and lymphangitis ● (Suppurative or Non-suppurative?) , (poorly or well?) localised ● Commonly caused by streptococci, staphylococci or clostridia ● Blood cultures are often ______tive

Non-suppurative; poorly nega

Gas gangrene ● Caused by _________________ ● ______ and _______ are characteristic ● ______________ patients are most at risk ● ___________________ is essential when performing amputations to remove dead tissue

Clostridium perfringens Gas and smell Immunocompromised Antibiotic prophylaxis

Bacteraemia ● Common after _____________ ● Dangerous if the patient has a _________, which can become infected ● May be associated with systemic organ failure

anastomotic breakdown prosthesis

SIRS is Presence of two out of three of the following: ● __________ or _________ ● Tachycardia (>____/min, no β-blockers) or tachypnoea (>___/min) ●___________ > ___ × 109/litre or <___ × 109/litre

Hyperthermia (>38°C) or hypothermia (<36°C) 90; 20 White cell count; 12; 4

Sepsis is SIRS with a _________________

documented source of infection

General principle in a musculoskeletal examination ??

Look Feel Move

Inversion- movement of the ______ that directs the _______ ———— Eversion- movement of the ______ that directs the _______ ————

Foot; Sole ; Medially Foot; sole; laterally

Assessment of hyper mobility can be done with _________ score but not by that only

Beighton

The spinal column consists of ______ vertebrae with ____ intervertebral discs.

33 23

The fulcrum of the foot is??

The talus

Causes of pes planus(________) ● Normal variant ●_________ syndrome, e.g. ______ syndrome ● Tarsal coalition – rigid and painful _______ ● Tibial posterior dysfunction

Flat foot Hyperlaxity; Marfan’s fat foot

Causes of pes cavus ●________ anomalies, e.g. ______ ● Hereditary sensorimotor neuropathies, such as ____________ disease ● ________ foot (e.g. neuropathic foot) ● Post-compartment syndrome (e.g. Volkmann’s ischaemic contracture)

Spinal; spina bifda Charcot– Marie–Tooth Charcot

Bony sequestrum represents a segment of _______ bone that is separated from _________ by __________. An involucrum denotes a layer of _______ bone that has _________; it can become perforated by tracts.

necrotic; living bone ; granulation tissue living; formed about the dead bone

Presentation of Septic Arthritis -children may be ______ and ______, but adults only express a _________ -usually symptoms only affecting _______ -the joint is ________ and held in a position of __________

Toxic; febrile Low grade Fever One joint Swollen; comfort

Musculoskeletal pain is usually improved by ____ and aggravated by ___________.

rest movement

A Colles fracture is a type of __________(fracture). It's also called a (proximal or distal?) fracture with (plantar or dorsal?) angulation (an ____ward angle).

broken wrist Distal; dorsal up

A Colles fracture aka ______ deformity

Dinner fork

Club foot: aka ___________ knock knees : aka ________ bow- legs : ________

Talipes equinovarus genu valgus genu varus

CAVE- C- __________ A- ________________ V- __________ E- ___________

midfoot cavus forefoot adduction hindfoot varus hindfoot equinox

____________ stiffness in all joints, especially the hands, is a characteristic of rheumatoid arthritis, while ________ stiffness of a specific joint, such as the hip, following _________, is indicative of osteoarthritis.

Early morning generalized short-lived ; inactivity

Muscle power can be classified according to the ____________ scale. • M0:_________________ is visible. • M1: __________ is visible but there is ___________ of the joint. • M2: ________ is possible if _________ • M3: ___________ can _________ but not _______________. • M4: Active movement can ____________ and _________ • M5: There is ______________

Medical Research Council No active contraction Muscle contraction; no movement Active movement; gravity is eliminated. Active movement; overcome gravity ; resistance applied by the examiner overcome gravity and some resistance applied by the examiner. full power against resistance.

ATLS(______________) protocol Primary survey : A-_______ B-_________ C-____________ D-______________ E-_________________

Advanced trauma life support protocol Airway and cervical spine control Breathing and ventilation control Circulation and Haemorrhage/shock control Disability of the neurologic system Exposure and Temperature control

ATLS protocol Secondary survey : Detailed _______ A-_______ M-_________ P-____________ L-______________ E-_________________ Detailed __________

history Allergies Medication PMH, pregnancy, period Last meal before trauma Events related to trauma examination

FAST-_____________

Focused abdominal sonography in trauma

Gustillo -Anderson classification of open fracture Grade 1-? Grade 2-? Grade 3-? 3a 3b 3c

Wound less than 1cm Wound between 1-10cm with no neurovascular injury Greater than 10cm with neuro vascular damage No periosteal stripping Periosteal stripping Neuro vascular stripping

A lucid interval (LI) is the period of time between _____________ after a ________________

regaining consciousness short period of unconsciousness

The 'Raccoon sign' comprises unilateral or bilateral progressive ________ associated with ________. It is also referred to as the 'raccoon eyes' and the ' _______sign. ' The pooling of blood around the eyes is most commonly associated with fractures of the _________________

periorbital ecchymosis; edema panda; base of the anterior cranial fossa.

Battle Sign is defined as bruising over the _______________

mastoid process.

The Lethal Six of thoracic trauma ???

F A T T H O M Flail chest Airway obstruction Tension pneumothorax Tamponade( cardiac) hemothorax(massive) open pneumothorax

The hidden 6??

T-thoracic aortic disruption T-Trancheobronchial disruption E-Esophageal disruption M-myocardial contusion P-pulmonary contusion D-diaphragmatic tear