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Description
Flashcards by Sameet Govan, updated more than 1 year ago
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Created by Sameet Govan
about 9 years ago
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| Question | Answer |
| radiological features of gout | soft tissue swelling, punched out periarticular bone |
| viral arthritis's | hep B Mumps enterovirus |
| sero -ve spondyloarthropathies | usually SI joints inflammation --> calcification of bony tendon extraarticular - uveitis |
| ankylosing sponylitis | a chronic progressive inflammatory arthropathy predominantly affecting the spine and sacroiliac joints present with severe pain and spinal stiffness leading to spinal fusion and bamboo vertebrae peripheral joints, entheses (tendon or ligament attachments to bone), and extra-articular sites such as the eye [2] and bowel are frequently affected diagnose with x-ray, if -ve then can do an MRI of pelvis |
| how to treat an intracapsular hip fracture | risk of avascular necrosis - put in an austin moore prosthesis |
| where does pseudo gout tend to be? | knees |
| raynauds | Primary tends to be symmetrical asymmetrical more likely to be secondary Cold --> white --> blue --> warm --> red |
| the two types of systemic sclerosis | limited cutaneous SS (limited cutaneous (less severe internal organ involvement and better prognosis) has less severe internal organ involvement) and defuse systemic SS) |
| scleroderma clinical trial inclusion diagnosis | Criteria (item; subitem; weight/score) Skin thickening of the fingers of both hands extending proximal to the metacarpophalangeal joints (9) Skin thickening of the fingers (only count the highest score) puffy fingers (2) whole finger, distal to MCP (4) Finger tip lesions (only count the highest score) digital tip ulcers (2) pitting scars (3) Telangiectasia (2) Abnormal nail-fold capillaries (2) Pulmonary arterial hypertension and/or interstitial lung disease (2) Raynaud’s phenomenon (3) Scleroderma-related antibodies (any of anticentromere, antitopoisomeraseI [anti-ScL 70], anti-RNA polymerase III) (3) Add the maximum weight (score) in each category to calculate the total score. Patients having a total score of 9 or more are classified as having definite systemic sclerosis. Patients having a total score of 6-8 can be considered as having probable scleroderma, although this classification has not been evaluated. |
| LeRoy classification of scleroderma according to extent of skin involvement | Diffuse cutaneous systemic sclerosis: skin thickening on the proximal extremities or the trunk in addition to face and distal extremities. Limited cutaneous systemic sclerosis: skin thickening confined to sites distal to the elbows and knees, but can also involve the face. |
| CREST syndrome | CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) |
| generic complications to any # | Damage to neurovascular bundle Damage to other structures |
| shoulder ant vs post dislocation | Ant - worry about axillary nerve post - light bulb appearance as internally rotates, difficult or impossible to externally rotate |
| nerve to worry about in humeral shaft fracture | radial nerve - wrist drop |
| distal humorous # worry | brachial artery and median nerve |
| pneumonic for Galeazzi and Monteggia fracture-dislocations | Grimus G: Galeazzi R: radius I: inferior M: Monteggia U: ulna S: superior |
| Monteggia fracture-dislocation | Monteggia fracture-dislocation - Lateral A 'Monteggia' injury comprises a fracture of the ulnar shaft with dislocation of the radial head at the elbow |
| Galeazzi fracture-dislocation | Galeazzi fracture-dislocation - AP A 'Galeazzi' injury is a fracture of the radial shaft with dislocation of the ulna from its articulation with the radius at the distal radio-ulnar joint. |
| Base of thumb fracture is called what | Bennett's # |
| Polymyalgia rheumatica is typically which joints | shoulders and hips |
| rs3pe | remitting symmetrical synovitis - associated with malignancy in older people |
| cut off age for temporal arteritis | <50 then question diagnosis |
| biopsy of temporal arteritis | Full thickness involvement and giant cells - skip lesions can be present |
| Dequervians involves which tendon | abductor pollicis brevis |
| What is Cushings reflex in head injury | increased BP and bradycardia |
| what are sprains and strains | Sprain is a ligament Strain is a tendon |
| whats the danger in perches disease | avascular necrosis of femoral head |
| what do you initially give to someone with a pelvic fracture | Pelvic binder (e.g. Sam sling) |
| O'Donoghue's unhappy triad | ACL tear MCL tear/sprain Medial meniscal tear |
| 5 p's of compartment syndrome | paraesthesis paralysis pallor pulseless perishingly cold |
| Jones fracture | 5th metatarsal base - can get non-union |
| March fracture | stress fracture of 2nd metatarsal |
| signs of prosthetic joint infection | may be few sings at wound radiological features - loss of cement interface, prosthesis movement, periosteal reaction Low threshold to refer |
| -ve and +vely birefringement crystals | -ve -- gout +ve pseudogout |
| most common joints for gout | 1st MTPJ and knee |
| most common joints for pseudogout | knee's, wrists or hips |
| treatment of pseudogout | NSAID and refer to orthopaedics |
| viral causes of arthritis | rubella hep b mumps EBV enteroviruses |
| what is GCS definition of severe head injury | 8 or less |
| what is GCS definition of minor head injury | 13-15 |
| Criteria for immediate CT in head injury (NICE) | GCS <13 GCS less than 15 2hrs post injury Neurodeficit suspected skull #/CSF leak post traumatic seizure vomiting x2 or more |
| criteria for CT within 8 hours not meeting the immediate CT criteria for head injury | Any LOC or amnesia - if Y then see criteria Age>64 coagulopathy dangerous mechanism of injury retrograde amnesia >30mins |
| What is Lofgrens syndrome | a classic sarcoidosis - ankle disease, erythema nodosum and bilateral hillier lymphadenopathy |
| Caplan syndrome | This is pulmonary fibrosis, usually in coal miners who have rheumatoid arthritis (RA) |
| the broad categories of ACR/EULAR criteria for RA | Joint involvement Serology acute phase reactants duration of symptoms RA is 6 or more points |
| where are herbedens and bouchards nodes | herb - DIP bouch - PIP |
| effect of PTH on electrolytes | secreted in response to low Ca and high PO4 Renal - increased Ca absorption and PO4 excretion Bone - increased resorption Gut - increased calcium absorption |
| effect of vit d on electrolytes | increased resorption of into bone Increased Ca absorption increased urinary calcium reabsorption |
| Myelopathy vs radiculopathy | Radiculopathy is the term for one or more pinched nerves or nerve roots along the spine. Pressure where the nerve connects to the spine (nerve root) can cause pain, weakness and other symptoms. *(LMN)* Myelopathy is the term for compression of the spinal cord, rather than the nerve root. Myelopathy can be difficult to detect because it usually develops gradually. *(UMN)* |
| how to test for flexor digitorum profundus injury | bend finger tip only |
| how to test for flexor digitorum superficialis | hold all fingers extended and flex just one finger. FDP unable to flex just one but FDS is able to |
| fallout sign? | flexor tendon injury - bend fingers, one left up |
| extensor tendon injury | droop of the digit with palm down |
| extensor tendon injury distal to PIP | drooping of tip of finger known as mallet finger deformity |
| complications of fracture | Local - non union, mal union, ulcers, muscle wasting, joint stiffness, reflex sympathetic dystrophy (RSD), painful scar, infection, nerve injury general - anaesthetic, bedsores, pneumonia, DVT and PE, systemic inflammatory response to injury/fat embolism |
| principles of treating extra-articular fractures | If it is a satisfactory position (may need to be reduced) and stable then can just support If reduce but not stable then percutaneous/minimally invasive fixation if unsatisfactory position ad unable to reduce close then open reduction and internal fixation |
| Principles of treating intra-articular fractures | Undisplaced - maintain anatomical reduction - until stable then mobilise avoiding displacement if displaced then anatomically reduce, rigid fixation, early mobilisation of the joint if unlikely to heal then replace (NOF) if impossible to fix then consider replacement |
| classification of growth plate injuries | Salter harris Pneumonic S: slipped (type I) A: above (type II) L: lower (type III) T: through or transverse or together (type IV) R: ruined or rammed (type V) |
| Which salter harris have good prognosis | I-III provided early manipulation |
| most common salter harris | Type 2 |
| which salter harris require surgery | III and IV I and II can be done in A&E, III-V refer |
| management of colles | reduce if displaced. in very old or frail then may accept greater deformity K wire or plating if cannot secure |
| neurovascular concern in anterior shoulder dislocation | axillary (circumflex) nerve palsy - regimental badge Axillary artery |
| causes of anterior shoulder dislocation | most commonly fall |
| causes of posterior should dislocation | often from electric shock, epileptic fit, fall on outstretched hand or direct blow on front of shoulder |
| inferior shoulder dislocation | rare arm held in abduction |
| management of clavicle # | normally sling. if overlapping, attempt to correct |
| humeral shaft # and which nerve may be affected | radial |
| supracondylar fracture and neurovascular | Brachial artery check median, ulnar and radial nerves |
| galeazzi and monteggia fractures management in adults and children | Basically, open reduction and fixation in adults, manipulation in children |
| what is a batons fracture | like a smiths but only anterior portion involved |
| when to internally fix in scaphoid # | displacement, or angulation |
| scaphoid and complex regional pain syndrome | pain more severe and long lasting usually following an injury |
| sudecks atrophy and scaphoid | thought to be dysfunction of sympathetic nervous system, involved in regulation of blood supply to affected part Burning pain, shiny skin, may perspire more, pain prevents movement leading to wasting |
| metacarpal and phalangeal #s | acceptable position and stable then can buddy strap Unstable injuries - K wires or other fixation method |
| Mallet finger | Forced flexion at DIP of extended finger distal extensor tendon slip is torn from attachment at bone |
| game keepers thumb | rupture of ulnar collateral ligament |
| musculocutaneous nerve weakness and sensory change | Weak elbo flexion and suppination Sensory loss of lateral forearm |
| median nerve lesions | Ulnar deviation on wrist flexion thumb movements lost sensory loss median nerve area thenar atrophy paralysis due to loss of pronators, radial flexor of the wrist, flexors of PIP joints, flexors of terminal joint of thumb, index and middle finger abductor and opponens pollicis Ape hand |
| Ulnar nerve injury | 1 and half of forearm flexors, all intrinsic muscles except thinner eminence and 1st lumbrical radial deviation with wrist flexing, abd and add of fingers and add of thumb lost extension lost at DIP and PIP of little and wring fingers sensory loss ulnar nerve area Mild claw hand with proximal lesions and severe claw hand with distal lesions (as unopposed FDP (part paralysed in proximal lesion) - ulnar paradox |
| froments signs | Froment's sign is a test for ulnar nerve palsy which specifically tests the action of adductor pollicis. The patient is asked to hold a piece of paper between the thumb and a flat palm as the paper is pulled away. Normally an individual will be able to hold the paper there with little or no difficulty. However, the patient with an ulnar nerve palsy will flex the thumb to try to maintain a hold on the paper. |
| Treatment of slipped upper femoral epiphysis | Stable (slips not severe, usually can walk with crutches) - single percutaneous cannulated screw Unstable (usually unable to walk even with crutches) - pinning in situ or open reduction and manipulation Could also conservative with 12 weeks in hip spica but run risk of further slipping |
| femoral neck fractures | Intracapsular - subcapital and transcervical Extracapuslar - intertrochanteric and pertrochanteric |
| Garden classification hip fracture | |
| Garden # and treatments | 1 and 2 - open fixation with dynamic hip screw or multiple cannulated screws total hip replacement (or austin moore hemiarthroplasty - in not a very long or active life) - type 4 or other high risk Under 60 could do open reduction an internal fixation in 3 and 4 |
| Treatment of extra capsular fractures | Undisplaced Treatment is internal fixation with a dynamic hip screw or cephalomedullary nail. [60] Displaced (stable or unstable) Operative management includes internal fixation with either a dynamic hip screw, [20] or a cephalomedullary nail. |
| weber classification of ankle fractures | Case courtesy of Dr Frank Gaillard, Radiopaedia.org |
| the scaphoid of the foot | the talus group 1 to 4 - closed in group 1 group 2 onwards consider open with increasing frequency, 4 do open all the time |
| Maisonneuve fracture | Maisonneuve fracture is an unstable fracture typically involving the medial tibial malleolus and/or disruption of the distal tibiofibular syndesmosis along with a fracture of the proximal fibula shaft. The deltoid ligament can be frequently disrupted. |
| lisfranc fracture dislocation | Subtypes There are two types of Lisfranc fracture-dislocation: Homolateral A homolateral injury is the lateral displacement of the 1st to 5th metatarsals, or of 2nd to 5th metatarsals where the 1st MTP joint remains congruent. Divergent A divergent injury is the lateral dislocation of the 2nd to 5th metatarsals with medial dislocation of the 1st metatarsal. |
| Spinal shock | hypotension no tachycardia due to loss of sympathetic tone causing peripheral vasodilation |
| GCS | |
| GCS for children | |
| GCS and coma | 8 or less |
| How is trauma care audited | Trauma audit and research network |
| What is ARDS | presence of interstitial fluid in lungs despite normal pulmonary arterial and venous pressure Often need ITU, intubation and ventilation |
| what is multi organ failure and when does it become systemic inflammatory response syndrome | 2 or more organs failed becomes SIRS in the absence of sepsis |
| Ottawa knee rule for x-ray | >55yrs isolated patella tenderness fibula head tenderness inability to flex to 90degrees inability to bear weight (not applicable in under 18 or non traumatic situations) |
| bits and bobs regarding opiods | Morphine - contraindicated in raised ICP, biliary colic and renal failure Oxycodone - first line alt to morphine diamorphine (aka heroin) - parenteral admin in palliative care codeine - 10% caucasians can't convert to active form Co-proxamol - interacts with warfarin - enhances anticoagulation effect Pethidine - can use in obstetric Fentanyl - heat increases absorption alfentanyl - useful in renal failure |
| Differential diagnosis of menu vacuum (bow legged) after 2 years | Blounts disease - developmental disorder characterized by disordered growth of the medial aspect of the proximal tibial physis resulting in progressive lower limb deformity. Rickets Hypophosphataemic rickets - sex - linked dominant inheritance osteogenesis imperfecta metaphyseal chondroplasia - inherited disorder of bone growth |
| painful hip differential diagnosis | transient synovitis - most likely, after rest infection congenital dysplasia of hip (0-3 ish) Perthes (3-10 ish) Slipped upper femoral epiphysis (10-15 yrs ish) |
| SUFE - what to do | usually requires operative stabilisation |
| very dangerous causes of painful limp (danger signs - severe pain, night pain, severe tenderness) | Ewings sarcoma osteosarcoma leukaemia |
| When to do operative correction of bow legs and knock knees | Intercondylar distance of >6cm or intermalleolar distance >8cm in a 10 yrs or older |
| types of scoliosis | Postural - secondary or compensatory and disappears when the patient sits structural - con correctable |
| what is perthes disease | idiopathic avascular necrosis/osteonecrosis of the femoral epiphysis |
| four features to differentiate between septic arthritis and transient synovitis | fever, non-weigh bearing, ESR of atleast 40mm/hr and serum WBC >12,000 cells per mm3 |
| The phases of frozen shoulder | Phase 1 - pain and stiffness phase 2 - pain usually gradually subsides but still stiff Phase 3 - shoulder becomes less stiff |
| De quervians | Reactive thickening of the sheath around the extensor policies braves and abductor policies longs tendon |
| Tendon involved in tennis elbow | extensor carpi radialis tendon |
| osteoporosis osteopaenia osteomalacia rickets (juvenile osteomalacia) Pagets disease | Osteoporisis - reduced bone mineral density and disruption of normal microarchitecture. 2.5SD below normal peak bone mass Osteopaenia - BMD between 1 and 2.5 SD below the young adult reference mean Osteomalacia and rickets - defects in bone mineralisation due to vitamin D deficiency Pagets - distortion of the processes of bone resorption and remodelling |
| causes of drug induced lupus | Minocycline and hydralazine |
| SLE rash and arthritis management | steroid creams, NSAIDs and hydroxychloroquine More persistent - oral steroids +/- azathioprine, methotrexate or cyclosporine A as sparing immunosuppressant |
| two main anti-phospholipids in antiphospholipid syndrome | lupus anticoagulant and anticardiolipin |
| Burns calculation | Wallace rule of nines - limbs 9%, legs 18% each front chest 18%, back 18%, head 9%, perineum 1% Lund and browder chart - compensates for variation in body shape with age |
| Juxtaarticular osteopenia/osteoporosis is an early sign of what | inflammatory arthritis |
| Who typically gets haemarthrosis | Elderly with minimal trauma Warfarin Cancer (haemophillia A also) |
| Risk factors to septic arthritis | prosthetic joints RA DM Ca old age IVDU recent intra-articular procedures |
| how to treat septic arthritis | 2 weeks IV Abx then 4 weeks oral usually flucloxacillin - 2g QDS, clindamycin in penicillin allergy 2nd/3rd gen cephalosporins (gr -ve sepsis) |
| Acute gout treatment | NSAIDS --> colchicine if intolerant --> steroids if intolerant to that |
| treatment in ongoing gout | 1st line - allopurinol or febuxostat 2nd line: uricosuric drug 2nd line: intravenous pegloticase NSAID has to be continued for 6 months when reaching target uric acid level, which is < one third of normal range (<0.32) |
| what is milwaukee shoulder | hydroxyapatite crystals with severe destruction of joint as seen on x-ray |
| morning stiffness time limit cut off for inflamm | >30mins remember rest stiffness also |
| What kind of things can cause a reactive arthritis and prognosis | URTI, GU, GI rule of thirds - third get better in 3 to 6 months, third need more DMARDs, third need longer term DMARDs |
| Classical joint distributions in RA vs psoriatic | RA multiple small joints, symmetrical, MCP, PIP Psoriatic - mainly large oligoarthritis, asymmetrical |
| how many joints is an oligoarthritis | <4 |
| investigations in new onset RA | ESR, CRP FBC - anaemia, WCC RF Anti-CCP - only if clinical but RF -ve U+E LFT x-ray hands and feet |
| polymyalgia rheumatica | early morning stiffness + pain (more stiff) - shoulders and hips, age group 70s, F>M high chance getting bursitis in shoulder steroids make better in 10-15 minutes |
| When to give tetanus vaccine/immunoglobulin in trauma setting? | people should have had 5 vaccines by adult age: 2 months 3 months 4 months 3-5 years 13-18 years Intramuscular human tetanus immunoglobulin should be given to patients with high-risk wounds (e.g. Compound fractures, delayed surgical intervention, significant degree of devitalised tissue) irrespective of whether 5 doses of tetanus vaccine have previously been given If vaccination history is incomplete or unknown then a dose of tetanus vaccine should be given combined with intramuscular human tetanus immunoglobulin for high-risk wounds |
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