1
Q
causes of ckd (rank)
A
- diabetes
- htn
- gn
- adpkd
2
Q
**in ckd what are the 5 functions affected and hence clinical presentation
A
- fluid & sodium balance via RAAS -> fluid retention -> peripheral edema
- rbc pdn; less epo, less rbc -> anaemia
- less activation of vitamin d -> less absorption of ca -> hypoca -> renal osteodystrophy
- electrolyte acid base imbalances; reduced po43- and k+ excretion = hyper both
- hyper k = arrhythmias
- hyper po43- + hypoca = secondary PTH - waste excretion; increase urea -> urea encephalopathy or pericarditis
3
Q
criteria for ckd
A
egfr < 60 ml/min/1.73m2 for more than 3 months OR at least one: albuminuria, hematuria, electrolyte acid-base imbalances and imaging showing structural abnormalities
4
Q
eskd criteria
A
irreversible kidney dysfunction with eGFR < 15 mL/min/1.73 m2
OR
manifestations of uremia requiring chronic renal replacement therapy
5
Q
what are ultrasound findings suggestive of ckd
A
- reduce kidney length < 10cm
- reduced cortical thickness
- increase cortical echogenicity
- cysts
- calcifications
6
Q
**acute management for ckd/indications for emergency dialysis
A
AEIOU
- refractory metabolic acidosis
- refractory hyperk
- intoxication
- overload
- uremic
insert central venous catether for immediate access if patient does not have a permenant mature avf
7
Q
**chronic ckd mgt
A
- treat the reversible cause of AoCKD
- reduce damage to kidneys
- slow progression of disease causing the damage (ie. DM, HTN)
- reduce damage by drugs (lower dose of statins for eg) - manage complications
- anaemia
- bone health
- creatinine
- electrolyte
- diet
- fluid overload
- goals (does pt need RRT?)
8
Q
how to manage acute refractory hyperk
A
- stop any exogenous sources of K
- IV calcium gluconate 10% in 10mins
- IV 10u insuline with 40ml of 50% dextrose
- oral resonium for increased K excretion in gut
9
Q
how much sodium and protein per day in ckd patients?
A
na <2g/day
protein < 0.8g/kg/day
10
Q
chronic mgt of hyperk
A
- diet
- k binding resins (resonium)
- diuretics (remove k via urine)
11
Q
how to treat the different uremic emergencies
A
uremic encephalopathy or pericarditis -> urgent dialysis via CVC
12
Q
how to manage fluid overload in ckd pt
A
- fluid restriction 1l/day
- loop diuretics like furosemide
- distak k sparring (less preferred because you want to excrete the k out)
13
Q
what is esrf in terms of ckd
A
ckd stage 5
14
Q
management of esrf
A
renal replacement therapy
1. hemodialysis
2. peritoneal dialysis
3. renal transplant
15
Q
types of dialysis for renal
A
- cvc (emergency)
- avf/av graft (requires surgery, most common)
- ijv tunnelled or non-tunnelled catether (not good candidate for surgery)
- peritoneal dialysis
16
Q
how long does it take for avf to mature
A
6 weeks
17
Q
what are signs of maturity in avf?
A
palpable thrill and audible bruit, easily cannulated and sustain repeated needle punctures w/o infiltration or hematoma
18
Q
PD vs HD
A
PD
- home based therapy
- painless
- risk of peritonitis
- treatment must be done 4 times per day
- no surgery
HD
- avf very common - either brachiocephalic or radiocephalic
- av graft is used when patient’s arteries or veins are unsuitable to be used (collapsed, small)
- need surgery
- ijv tunnelled catether allows for non-surgical HD
19
Q
clinical symptoms of nephrotic syndrome
A
PEAS
- proteinuria (severe, >3.5g/day)
- edema
- albumin (low)
- serum lipids and cholesterol low
20
Q
causes of nephrotic syndrome
A
**diabetic nephropathy
young: mcd
old:
focal segmental glomerulosclerosis
membranous GN
membranoproliferative GN
secondary:
lupus nephritis
amyloid nephropathy in multiple myeloma & RA
21
Q
describe the immunofluorescence i will see for diabetic nephropathy
A
effacement of podocytes
22
Q
complications of nephrotic syndrome
A
ckd
renal vein thrombosis
thromboembolism (dvt)
severe proteinuria:
- less immunoglobulins -> more prone to infxn
- anemia
- hypothyroidism
- vitamin deficiency
- protein malnutrition
23
Q
quantitative assessment of nephrotic syndrome
A
- 24h urine protein
- UACR
- UPCR**
24
Q
what is the lupus nephritis “full house” pattern?
A
IgG, IgM, IgA, C3, C1q
25
features of afib on ecg
irregularly irregular rhythm
absent p wave
fibrillatory waves
26
4 pillars of HF
1. ACE/ARBs/ARNIs
2. Beta blockers
3. mineralocorticoid
4. SGLT2 inhibitors
27
IE organisms
strep viridans
strep bovis
staph aureus
HACEK
28
causes of MR
IHD, RHD, IE
29
suspected IE, blood culture comes back as a HACEK organism, how to manage?
IV ceftriaxone
30
suspected IE, blood culture comes back as strep viridans/bovis/staph aureus, what is the pharmacological mgt?
vancomycin + gentamicin
31
in a patient with afib and a known valvular heart disease, what pharmaco should he be started on?
warfarin
32
post metallic heart valve, what anticoagulant to use?
warfarin
33
pharm for non-valvular Afib
NOAC (rivaroxaban, dabigatran, apixaban)
34
target inr for afib (with and without mitral valve)
non-mitral: 2-3
mitral: 2.5-3.5
35
what are the indications to start warfarin
valvular Afib
MS
metallic heart valve
36
3 specific grave's features
1. proptosis, grave eye signs
2. pretibial myxedema (non-pitting)
3. thyroid acropachy (clubbing, soft tissue swelling, periosteal formation of fingers)
37
normal T4 level range
10-20
38
**investigations for grave's
biochemical
1. TFT looking at fT4 (10-20) and TSH (0.45-4.5)
2. TRAb, anti-TPO antibody and anti-thyroglobulin antibody (TgAb)
3. FBC looking for anemia or raised TW suggestive of infection (precipitant of thyrotoxicosis)
4. Baseline LFTs prior to starting tx
5. UPT prior to starting tx
imaging
1. ECG TRO AF
2. US thyroid
3. thyroid uptake scan
39
what are the 4 signs suggestive of active grave's disease
1. retrobulbar pain
2. pain on eye movement
3. eyelid erythema and edema
4. conjunctival injection -> exposure keratitis
40
management of hyperthyroid
1. ATDs (carbimazole or PTU) - counsel for agranulocytosis, drug rash and drug-induced liver injury
2. beta blockers (CI in asthmatics)
3. steroids (ie. hydrocort or dexa) to further inhibit peripheral conversion of T3 to T4
4. cholestyramine to prevent reabsorption of free conjugated thyroid hormones
OR radioactive iodine
non-pharm
- smoking cessation
- counsel on pregnancy
surgical - thyroidectomy
41
CAP bacteria + treatment
h influenza
moraxella catarrhalis
strep pneumonia
PO augmentin
42
HAP bacteria + treatment
pseudomonas
klebsiella
MRSA, staph aureus
piptazo +/- vancomycin
43
what are the 6 types of parkinson plus syndrome
1. msa (cerebellar involvement)
2. progressive supraocular palsy (vertical gaze palsy + doll eye manuever +ve)
3. corticobasal degeneration (generalised ataxia and apraxia)
4. lewy body dementia (early onset of dementia, hallucinations and psychosis)
5. vascular parkinsonism (significant cvs risk factors, multiple lacunar strokes)
6. extrapyramidal (drug-induced like anti-psychotics)
44
PD signs
face - reduced facial expression, hypomimia, hypophonia
UL
- asymmetrical unilateral pill-rolling resting tremor
- bradykinesia
LL (gait): shuffling festinant gait, stooped posture with reduced arm swing, turning in numbers, difficulty initiating and stopping
PPS
- cerebellar involvement
- vertical gaze palsy
- postural hypotension and instability
- urinary incontinence
45
mgt for pd
non pharm: ptot speech therapy
pharm:
<65, mild - dopamine agonist like bromocriptine
>65, severe - levi-dopa - monitor for dyskinesia, N&V and postural hypotension
on mardopa, if symptoms do not get better over 3-4 months -> consider PPS or secondary parkinsonism as ddx
46
endocrine confirmatory test for the following common disorders
1. cushings
2. acromeg
3. diabetes
4. pheochromocytoma
5. conn's syndrome
1. overnight low dose dexamethasone suppression test
2. serum IGF-1 and GH
3. 2 readings of abnormal fasting blood glucose +/- OGTT (HbA1c more for glycemic control)
4. serum metanephrines
5. serum renin and aldosterone
47
rheum antibodies
1. dsDNA
2. anti CCP
3. anti topoisomerase-1 (Scl-70)
4. anti-Jo-1, PL12 and/or 7
1. SLE
2. RA
3. ILD or scleroderma
4. dermatomyositis
48
differentiate between the degrees of HB in ECG features
1st degree: sinus rhythm YES + consistent prolonged PR interval
2nd degree
mobitz 1: progressively increasing PR interval until a P wave is conducted but no QRS that follows
mobitz 2: consistent PR interval but some P waves do not conduct a QRS after
3rd degree
av dissociation, no r/s between P and QRS wave, random multiple P waves + random QRS waves that don't correspond to each other
49
what is swan neck and boutonniere's deformity
swan neck: DIPJ flexion, PIPJ hyperextension
boutonniere's: DIPJ hyperextension, PIPJ flexion
50
deformity in z thumb
interphalangeal joint (IP) flexion
mcpj hyperextension
cmc flexion
51
9As of ank spon
anterior uveitis
atlantoaxial subluxation
apical fibrosis
aortic regurgitation
av nodal block or arrhythmias
amyloidosis
achilles tendinitis
52
management for Addisonian crisis
IV hydrocort
53
what are the features of acute hepatic decompression?
ascites
jaundice
coagulopathy
encephalopathy
variceal bleeding
oliguria from HRS
54
what is the surgical option for RECURRENT ascites?
transjugular hepatic portosystemic shunt: within the liver connect the portal vein to the hepatic vein to reduce blood pressure
55
risk factors for gallstone disease
fat, female, fertile, 40
56
what are the 4 complications of hop CA that i must screen for?
1. 4Bs (bleed - anaemia, burrow - cholangitis, burst - peritonitis, block - GOO)
2. mets LLBB
3. pancreatic dysfunction
-exocrine: stearrhoea, vit ADEK deficiency
- endocrine: DM
4. paraneoplastic
- hyperca: urinary stones, bone pain
- dermatomyositis: proximal weakness
- carcinoid syndrome
57
what are features of ischemia stroke on ct brain non contrast
effacement of sulci
hypodense areas
gray white matter differentiation loss
58
palpable mass in epigastric region, differentials and how to tell them apart?
1. pancreatic ca - retroperitoneal mass that does not move with inspiration
2. hcc - move with inspiration, cannot get above mass
3. cholangiocarcinoma - rhc globular shaped mass, can get above the mass
4. AAA - pulsatile and expansile mass
59
patient has a PMHx of hereditary spherocytosis and G6PD deficiency.
what meds would predispose him to jaundice/bilirubin gallstones?
antimalarials, co-trimoxazole
60
US HBS signs of cholecystitis
1. sonographic murphy's sign
2. enlarged GB with thickened walls
3. pericholecystic fluids or fat stranding around GB
4. presence of gallstones (prominent posterior acoustic shadowing)
61
tokyo guidelines for cholangitis
1. evidence of systemic inflammation - fever, crp
2. evidence of cholestasis - hyperbil, ALP/GGT
3. imaging show CBD dilation > 6mm
62
describe arterial, venous, neuropathic ulcers
arterial: deep, punched out, ischemic or necrotic base, most common at lateral malleolus or toes
venous: superficial, irregular sloping edges, granulation sloughy base, most common at medial malleolus
neuropathic: painless deep punched out ulcer with surrounding callus and sensory loss, most common on soles of foot
63
BCR-ABL +ve, t(9,22)
CML
64
10yo child, palpable rash, abdominal pain, hematuria
hsp
65
10yo child, non-palpable rash, bruising, epistaxis, gum bleeding
itp
66
nerve and arteries of the thyroid that must be careful in thyroidectomy
external carotid artery > superior thyroid artery <-> external laryngeal nerve > cricothyroid muscle > tenses vocal folds creating high pitch sound
- ELN injury = voice become very deep, loss of pitch
inferior thyroid artery <-> recurrent laryngeal nerve > all the muscles of the larynx except cricothyroid > creates voice
- RLN injury = hoarseness of voice or aphonia (total loss of voice)
67
what features from the hx will make you suspect the following thyroid CA?
1. papillary TC
2. follicular TC
3. medullary TC
4. thyroid lymphoma
5. anaplastic TC
1. previous radiation to HNN or exposure to ionising radiation, cervical lymphadenopathy
2. spread to lung bone brain
3. MEN syndrome (multiple endocrine neoplasia) - will have pituitary, adrenal excess stmptoms
4. hx of hashimoto's
5. rapidly growing, compressive symptoms
68
psommoma bodies and ground glass nuclei on FNAC
this type of thyroid cancer is a/w ?
papillary thyroid Ca
previous exposure to ionising radiation or radiation to HNN
69
vascular and/or capsular invasion on FNAC
follicular TC
70
highly pleomorphic, undifferentiated thyroid cells
anaplastic
71
trabeculae of spindle cells, amyloid deposition from calcitonin
this type of thyroid cancer is a/w ?
medullary TC
multiple endocrine neoplasia (MEN) syndrome
72
top 3 post thyroidectomy complications
1. transient hypoparathyroidism
2. neck hematoma
3. RLN injury
73
symptoms of hyperca
bones groans moans stones
- bone pain
- cholelithiasis
- fatigue lethargy
- urolithiasis
74
symptoms of hypoca
how to test
muscle tetany (twitches/spasms), cramps
fingertip numbness and tingling
cvs: arrythmias, hypotension
test for chvostek's sign - tap on facial nerve to see if facial muscles twitch
75
h pylori triple therapy (exact doses)
amoxicillin 1mg BD
clarithromycin 500mg BD
omeprazole 20mg BD
76
if h pylori triple therapy fail, whats next
quadruple therapy
tetracycline 500mg QDS
metronidazole 400mg BD
colloidal bismuth 120mg QDS
omeprazole 20mg BD
77
how do i check for h pylori eradication after triple therapy
amoxi and clari and ome for 2 weeks
just ome for 6 weeks
after 6 weeks, hold off all meds for 2 weeks then do urea breath test again
if still positive -> start quadruple therapy
78
acute mgt for PUD perf
insert 2 large bore IV cannulas and start fluid resus 500ml over 30mins
insert IDC, strict I/O charting, vitals monitoring
keep patient NBM
send for pre-op bloods + blood cultures
**drugs
1. IV omeprazole
2. IV analgesia
3. IV broad spec empirical antibxs - ceftriaxone and metronidazole
79
ogd for pud and gastric ca, what am i investigating for
1. visualize and confirm the tumour/ulcer
2. stage it using forest/boorman classification
3. biopsy (for PUD is TRO malignancy, for gastric CA is to confirm the type via histo)
4. rapid urease breathe test
80
**management of HYPERacute stroke
hyperacute (within first 6-12hrs)
1. stabilise ABCs
2. assess patient's NIH stroke scale
3. IV tissue-type plasminogen activator (tPA) (ie. thrombolytics) within 6hrs of symptom onset
4. STAT CT brain non contrast TRO hemorrhagic stroke
5. confirm ischemia, if large vessel and symptoms within 6hrs > do thrombolectomy
81
after hyperacute management of stroke, what do i need to monitor for in acute management (24-36hrs later)?
**REPERFUSION INJURY > sudden rush of blood flow back to brain > cerebral oedema > raised ICP (patient gets confused, drowsy, N&V)
monitor for aspiration pneumonia and DVT
restart heparin early if patient has known poorly controlled afib to prevent 2' thrombosis
82
chronic management of stroke
bed bound cxs: sores, infection, dvt/pe, aspiration pneumonia
start early PT/OT/ST
vascular/cardiac imaging (ie. CT angio or TTE) to find stroke etiology
83
pharmacological management post stroke
lifelong aspirin + 1 year of added clopidogrel
consider anticoags if patient has afib - valvular (warfarin), non-valvular (rivaroxiban)
84
diverticulitis management
based on hinchey classification
stage 1/2 (pericolonic abscess) can be managed conservatively - analgesia, low fibre diet, IV ceft & metronidazole
stage 3/4 (peritonitis SURGICAL EMERGENCY) - same as above + prepare patient for emergent laparatomy peritoneal washout and surgical resection
85
indications for emergent surgery in IO
bowel ischemia
volvulus
peritonitis
86
crohn's vs uc in colonoscopy findings
crohns: transmural with deep ulcerations and fissuring, high risk of abscess formations, cobblestoning appearance of mucosa, skip lesions, involves whole colon EXCEPT the rectum
uc: superficial, shallow ulcers with pseudo polyps, affects from rectum to proximal colon
87
extra git manifestations of ibd
eyes (conjunctivitis, uveitis, scleritis)
mouth (ulcers)
face (rashes)
joint (tenderness, swelling)
kidney (change in urine o/p)
**primary sclerosing cholangitis > check for jaundice
88
crohn's scope findings
affect whole colon EXCEPT rectum
skip lesions
cobblestoning appearance
transmural involvement with deep ulcerations, fissuring and abscess formations
a/w fistula and strictures
89
uc scope findings
affect rectum to proximal colon
diffused, non-sparring
superficial ulceration (limited to mucosa)
shallow ulcers with pseudo polyps and crypt abscesses
not a/w fistulas and strictures
90
which type of ibd has higher risk of developing crc
uc
91
what are the 2 complications of ibd and how TRO them out
peritonitis/pneumoperitoneum - erect CXR looking for free air under diaphragm
toxic megacolon - supine abdominal XR
92
criteria to diagnose DKA
1. serum blood glucose > 14
2. urine ketones 3+ or more
3. pH < 7.3 of HCO3- < 15
93
criteria to diagnose HHS
1. plasma blood glucose > 33
2. arterial pH > 7.3, hco3 > 15
3. ABSENCE of ketonuria or ketone in blood
4. serum osmolality > 330
94
pathophysio of DKA
more common in insulin deficiency
no insulin = tricks the cells into thinking that the body is "starving" due to reduced glucose uptake
hence to compensate, there is increased lipolysis and ketones are a byproduct of lipolysis
glucose levels remain high because there is reduced peripheral uptake of glucose and gluconeogenesis and increase glycogenosis as the body thinks it is "starving"
95
pathophysio of HHS
more common in T2DM where there is insulin resistence
there is sufficient insulin to prevent ketosis by inhibit lipolysis but not enough to control blood glucose levels
severe hyperglycaemia (>33) from reduced peripheral uptake and gluconeogenesis
hence there is profound osmotic diuresis > massive fluid loss > clinically patient will be very dehydrated > sodium loss > hyperosmolar
96
segond fracture
bony avulsion of lateral tibia where ACL inserts
97
what is the classification for trigger finger
green's
stage 1: pain over a1 pulley
stage 2: catching but can still actively extend digit
stage 3: need passive extension to fully straighten
stage 4: unable to passively extend, fixed flexion contracture
98
borders of inguinal canal
medial - lateral border of the rectus abdominis muscle
lateral - inferior epigastric vessels
inferior - inguinal ligament
99
haemorrhoids grading
grade 1: prominent blood vessels
grade 2: spontaenous reduction
grade 3: requires manual reduction
grade 4: cannot be reduced at all
100
3month old nbnb vomiting after feeding, non-projectile, a/w arching of back
how to confirm
GERD
ddx with 24h pH oesophageal monitoring
101
1 month old projectile vomiting, poor feeding and weight gain
how to confirm
hypertrophic pyloric stenosis
ultrasound
102
3 month old bilious vomiting
malrotation
103
<1 year old infant presenting with soft abdomen, generally well but has a non-indentable sausage shaped mass in the right abdomen
passing red currant jelly stools
how to confirm
how to manage
intussusception
us look for target sign to confirm diagnosis
air enema reduction - contraindicated if there is peritonitis or pneumoperitoneum
104
delayed passage of meconium > 24h
how to confirm
Hirschsprung's disease
do a suctional rectal biopsy – LF absence of ganglionic cells & aperistalsis of aganglionic colon
105
4 week old baby persistent jaundice > 2 weeks, clay coloured stools
how to confirm
biliary atresia
supine axr looking for double bubble sign - one in stomach one in proximal duodenum
106
mgt of undescended testes
wait until 6 months and see if testes descend spontaenously, if >6 months no descent = orchidopexy
107
psa more than _ no good
4
108
top 5 primary cancers that spread to bone
breasts kidney liver prostate thyroid
109
features of benign tumour on xray
borders well defined
expansion smooth
**NARROW zone of transition
intact cortex
good periosteal reaction
no soft tissue mass
110
what is the one type of bone tumour that is painful and this pain is relieved with NSAIDs
osteoid osteoma
111
well defined tumour in hand/finger bone
enchondroma
112
10yo boy whose xray shows a bone tumour with "sunburst" appearance
osteosarcoma
113
10yo boy with bone tumour on xray showing onion-skinning periosteal reaction
ewing sarcoma
114
osteosarcoma vs chondrosarcoma
osteo - additional bone hence there will be sclerotic changes
chondro - cartilage cells
115
anterior shoulder dislocation
axillary nerve
numbness over regimental badge/deltoid region
116
humeral supracondylar fracture
radial or median nerve
117
humeral shaft fracture
radial
weakness in wrist extensors
wrist drop
118
elbow medial condyle fracture
ulnar nerve
claw hand
loss of sensation of medial 2.5 digits
119
posterior hip dislocation
sciatic nerve
paralysis of LL, weakness in knee extension and all ankle ROM
120
posterior knee dislocation
common peroneal nerve
foot drop
unable to dorsiflex ankle
121
classification for hip fracture
garden's
complete fracture = grade 2
G3 is partial displacement
G4 is full displacement
122
why is nof at higher risk of avn compared to intertrochanteric and subtrochanteric fractures
femoral neck is intracapsular = less blood supply more synovial fluid
lack periosteal layer
123
hip fracture sign on xray
loss of shenton's line
the smooth arc between inferior border of superior pubic rami and inferomedial of femoral head
124
6yo child with limp for 6 weeks, insidious onset and child is otherwise normal.
limited hip abduction and internal rotation
perthes
early degenerative hip disease due to lack of blood supply to femoral head
125
1yo presenting with limp a/w asymmetric skin creases and galeazzi's sign
risk factors
confirm with what PE tests
developmental dysplasia of the hip
breech birth, female, firstborn, family history
barlow: dislocatable hip
ortolani: reducible dislocated hip
126
6yo presenting with 1 week of limp, happened after a viral infection
transient synovitis
127
12yo boy obese presenting with limp and knee pain
o/e leg is externally rotated and shortened
how to confirm
slipped capital femoral epiphysis
posterior inferior displacement of the femoral head epiphysis relative to femoral neck through the grow plate
frog-leg lateral hip xray
128
medications predisposing to
nof fracture
fragility fractures
steroids > avn > nof
bisphosphonates > fragility fractures (ie. shaft of humerus, compression lumbar fractures, distal radius and proximal humerus)
129
child had breech delivery, turned out with torticollis/ palpable lump over left scm
what is the expected finding on ROM?
limited left lateral flexion
unilateral scm contraction causes limitation in
1. ipsilateral lateral flextion
2. contralateral rotation
130
management for scaphoid fracture
high risk of non-union and avn because of poor blood supply
need to repeat xray in 1-2 weeks of injury
thumb spica
131
after total hip replacement, in what position should the hip rest in
abducted and externally rotated
132
12yo boy falls from ladder and sustains a displaced supracondylar fracture.
what nerve injury and sign?
anterior interosseous nerve
unable to make OK sign
133
what is monteggia fracture
proximal ulna and radial head dislocation
134
what is galaezzi fracture
distal radius and distal radioulnar joint disruption
135
60yo female with medial femoral condyle pain
spontaneous osteonecrosis of the knee
136
radiographic feature consistent with acute osteoporotic vertebral compression fracture
anterior wedge deformity with preserved posterior height
137
external fixation for ortho fractures is for
open fractures with significant soft tissue injury
138
what is the position of the hip in posterior dislocation?
FADIR
flexed
adducted
internally rotated
139
**salter harris classification
type 1 - separate growth plate
type 2 (most common) - above growth plate
type 3 - below GP
type 4 - through growth plate
type 5 - shortening of growth plate (crush injury)
140
closed reduction percutaneous pinning
supracondylar fracture in paediatrics
141
closed reduction and casting is done for
1. non displaced or minimally displaced fractures
2. stable fractures that maintain alignment
3. incomplete fractures in children (greenstick)
142
6 month old with asymmetric thigh skin folds and limited abduction of left hip
most appropriate initial investigation
since <6 months = ultrasound
>6 months = xrays
143
5yo child with bowing of legs and widened wrists
defect mineralisation = rickets
144
patient presents with loss of shoulder abduction from 15 to 90 degrees
deltoid
first 15: supraspinatus
beyond 90: scapula and trapezius
145
ankle fracture classification
weber
weber a below syndesmosis
weber b at syndesmosis
weber c above
146
patient presents with loss of sensation over lateral forearm and weakness in elbow flexion after humeral fracture
musculocutaneous nerve
147
ossification centres, CRITOE
capitellum, 1
radial head, 3
inner (medial) epicondyle, 5
trochlear, 7
olecranon, 9
external (lateral) condyle, 11
148
salter harris fracture classification and how does it affect management
1: straight across
2: above
3: below
4: through physis
5: compression of physis
1&2 can conservative, 3-5 requires surgical management for anatomical correction
149
what is a buckle fracture
cortex intact, stress STABLE fracture
150
what is a greenstick fracture
failure of cortex at tension side and plastic deformity of cortex on compression side
unstable fracture
151
supracondylar fracture of humerus in paediatrics is a/w what kind of deformity in long run?
cubitus varus (gunstock deformity)
152
what are the 4 radiological signs in supracondylar fracture to look for
1. posterior fat pad
2. abnormal baumann's angle
3. disruption of anterior humeral line
4. mismatched hourglass sign
153
classification for supracondylar fractures and how to manage each
gartland
g1: no displacement, posterior fat pad
g2a: displaced but not rotated
g2b: rotated and mismatched hourglass sign
g3: displaced angulated and rotated
g1: backslab and change to cast at >90 degrees flexion
g2a - m&r under sedation then cast
g2b and 3 requires CRPP kiv open
154
lateral condyle fractures is a/w with
cubitus valgus deformity in long run
disruption of radiocapitellar line
155
10yo boy with pain at tibial tuberosity
osgood schlatter
156
10yo boy who runs alot having pain at the heel
sever's disease/calcaneal apophysitis
157
classification for open fracture
gustilo anderson
- based on size, soft tissue damage and contamination
type 1: wound <1cm, mild soft tissue damage and minimal contamination
type 2: wound 1-10cm, moderate soft tissue damage and minimal contamination
type 3: large with extensive soft tissue damage and contamination by debris
- a: adequate flap coverage
- b: requires free tissue flap coverage
- c: arterial damage requiring vascular repair
158
what are the 4 indications for immediate emergency OT for open fractures according to bapras gudielines
1. devascularized limb
2. polytrauma
3. gross contamination by soi/marine/sewage
4. compartment syndrom
159
what are the 4 stages of secondary healing?
1. haematoma
2. callus formation
3. callus ossification: lamellar bone replaces woven bone
4. remodelling
160
m3 pros
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