1
Q
hip fracture location
A
- intracapsular: sub capital, transcervical, basicervical
- intertrochanteric
- subtrochanteric
2
Q
hip intracapsular fracture classification
A
Garden
- stage 1: incomplete fracture line or impacted fracture
- stage 2: complete fracture line, non displaced
- stage 3: complete fracture line, partially displaced
- stage 4: complete fracture line, completely displaced
3
Q
intracapsular wrist fractures
A
barton (distal radius, dorsal displacement) volar plate (palmar displacement)
4
Q
extra capsular wrist fracture
A
- colles (dorsal displacement): dinner fork appearance
- smiths (palmar displacement)
5
Q
ankle fracture classification
A
Webber
- type A: below syndesmosis, no talor drift
- type B: distal extent of syndesmosis
- type C: above level of syndesmosis, talor drift
6
Q
management of ankle fracture
A
- weber A: can walk straight away/cast
- weber B: see if theres a tailor drift on standing (XRAY), if not the fracture is stable: cast
- weber C: surgery
7
Q
hip intracapsular fracture management
A
garden: 1;, 2 give it a screw, 3, 4 arthroplasty
8
Q
hip extra capsular fracture management
A
- DHS or IM nails
9
Q
def pathological fracture and causes
A
fracture through abnormal bone
causes: osteoporosis, osteomalacia, osteopenia, tumours, infection, metabolic bone disease, medications
10
Q
hip surgery complications
A
- infections (chest, UTI, surgical site)
- DVT/PE
- delirium
- pressure sores
- death
- dislocate
- leg length discrepancy
- non union
- avascular necrosis
11
Q
fracture management:
A
- resuscitation (ABCDE and infection management)
- reduce (immobilisation)
- restriction (stabilisation and neurovascular supply preservation: joint above and below immobilised)
- rehabilitate
open fracture: debrideded and lavaged within 6h
12
Q
growth plate fractures classification
A
Salter Harris system:
type 1: fracture goes through physics
type 2: fracture through physis and metaphysics
type 3: fracture through physis and epiphysis to include the joint
type 4: fracture through physis, metaphysics and epiphysis
type 5: crush injury involving the physis
13
Q
common humerus fracture
A
supracondylar fracture of humerus
14
Q
common types of childhood fractures
A
- complete
- toddlers fracture (oblique tibial fracture in infants)
- plastic deformity (stress on bone resulting in deformity without cortical disruption)
- greenstick fracture (unilateral cortical breach )
- buckle fracture (incomplete cortical disruption resulting in periosteal haematoma only)
15
Q
mechanical back pain causes
A
spondylosis disc herniation spondylolisthesis spinal stenosis fractures idiopathic
16
Q
inflammatory cause of back pain
A
spondyloarthopathies
17
Q
infectious cause of back pain
A
vertebral osteomyelitis
epidural abscess
septic discitis
18
Q
metabolic cause of back pain
A
osteoporotic compress fracture
page’s disease
19
Q
referred pain to spine
A
- major viscera
- retroperitoneal structures
- urogenital
- aorta
- hip
20
Q
difference between spondylosis and spondylitis
A
- spondylitis is inflammatory
- spondylosis is degenerative
21
Q
spinal stenosis presentation
A
- gradual onset
- pain
- legs: bilateral or unilateral pain, weakness, parasthesia (also in buttocks)
- unsteadiness of gait
- induced by standing or walking
- reduced by sitting or flexing forward
22
Q
what is spondylolisthesis
A
anterior displacement or vertebra on bone beneath it (secondary to degenerative changes in disc and facet joint)
23
Q
ankylosis spondylisis presentation
A
- young man
- lower back pain/sacroiliac joint pain (+ pain at night that gets better on getting up)
- stiffness (worse in the morning, gets better with exercise)
- peripheral arthritis
- linked with spondyloarthropathies (FH)
+ the As:
- apical fibrosis, anterior uveitis, aortic regurg, achilles tendonitis, AV node block, amyloidosis, card equine syndrome
24
Q
causes of structural neck pain
A
- mechanics/non specific
- prolapsed intervertebral disc
- cervical myelopathy
25
causes of inflammatory neck pain
- RA
- polymyalgia rheumatica and GCA
- spondyloarthropathies
26
causes of infectious neck pain
- discitis
- osteomyelitis
- paraspinal abscess
27
causes of metabolic neck pain
Paget's disease
28
degenerative causes of shoulder pain
- capsulitis
- biceps rupture
- adhesive capsulitis
29
inflammatory causes of shoulder pain
- RA
- bursitis
- tendinitis
30
traumatic causes of shoulder pain
- fractures
- subluxation/dislocation
- rotator cuff tear
31
rotator cuff injury presentation
- shoulder pain worse on abduction
- painful arc of abduction (subacromial impingement between 60-120° or pain in first 60° for tears)
- tenderness over anterior acromian
- muscle weakness indicates tear
32
adhesive capsulitis presentation
- middle aged women
- external rotation most affected
- three phases: painful freezing phase, adhesive phase, recovery phase
- can be bilateral
- episodes lasts 6-12 months
33
fibromyalgia presentation
- widespread musculoskeletal pain
- hyperalgstic spotes
- stiffness
- sleep disturbances
- associations: IBS, depression, fatigue on waking
34
pathogenesis of rheumatoid arthritis
autoimmune synovitis and synovial hypertrophy
35
antibodies in RA
RF
| anti-CCP
36
risk factors for RA
- genetics
- age
- diet
- smoking
- infectious agents
37
presentation of RA
- athralgia (symmetrical, small joints of hands and feet)
- stiffness worse in the morning
- boggy swelling
- insidious presentation
- extraarticular: anaemia, scleritis, interstitial lung disease etc)
38
RA investigations
- blood tests (infection + antibodies)
| - XRAY joint
39
RA management
- physio/excercise
- NSAIDS
- DMARDs (conventional or biological)
- glucocorticoids as short term for flare ups
40
pathogenesis of gout
deposition of rate crystals in the joint (inflammatory)
- increase uric acid production
- decrease uric acid output
41
risk factors for gout
- male
- alcohol intake
- purine intake
- diuretics
- metabolic syndrome
- CKD
- leukaemia
42
presentation of gout
- acute onset
- monoarthitis
- pain, swelling, erythema
- joint affected: 1st MTP, ankle, wrist, knee
- tophi
43
investigations for gout
- serum urate
- bloods: FBC, CRP, ESR (check for septic arthritis), LFTs, U&Es
- joint aspiration (strongly negative befringence needle shaped)
- XRAY
44
management of gout
- conservative: education, lifestyle
- acute: NSAIDs, colchicine, steroids (from first to last, dependent on contraindications): continue for 6 months if prescribing allopurinol
- prophylaxis: allopurinol
45
differentials for one hot swollen joint
- septic arthritis
- gout
- pseudo gout
- haemarthrosis
- psoriatic arthritis
- reactive arthritis
46
septic arthritis presentation
- knee
- acute red swollen joint
- warm to touch
- restriction of movement
- fever
- history of trauma, infection
47
risk factors for pseudo gout
5hs
- haematomochrosis
- hyperparathyroidism
- hypothyroidism
- hypomagnesium
- hypo phosphate
- acromegaly + Wilson's disease
48
presentation of pseudo gout
- mono arthritis
- knee, wrist, shoulder
- red, painful and hot
- low grade fever
- large tense joint effusion
49
investigations for pseudo gout
- bloods: raised WCC, ESR, CRP
- joint aspiration: weekly positive befringement rhomboid shaped crystals + rule out septic arthritis
- X ray: chondrocalcinosis
50
management pseudo gout
NSAIDS
| intra articular, intramuscular or oral steroids
51
psoriatic arthopathy presentation
- joint: symmetrical polyarthiris (similar to RA)
- nail changes
- dactylitis
- rashes on extensor surfaces
52
management of psoriatic arthritis
NSAIDS
| DMARDS
53
reactive arthritis presentation
classic triad
- arthritis
- urethritis
- conjunctivitis
- associated with GI and GU infections
54
management of reactive arthritis
- NSAIDS, intra articular steroids
| - sulfasalazine and methotrexate (if persistent)
55
risk factors for osteoarthritis
- age
- obesity
- previous injury
- intense sport activity
- leg deformity
- genetics
56
clinical presentation of osteoarthritis
- asymmetrical painful joints (weight bearing and hands)
- relieved by rest, exacerbated by exercise
- weather affects it
- stiffness (reduced joint movement)
- tenderness on palpation
- joint effusion on acute exacerbations
- crepitations
57
investigations for osteoarthritis
Xray
58
management of osteoarthritis
- conservative: education, weight loss, xcercise/physio, heat/cold therapy
- pharmacological: analgesia + intra articular steroids
- surgical: replacement
59
risk factors for SLE
- genetics (asian and african)
- UV radiation
- smoking
- virus/bacteria
- oestrogen
60
presentation of SLE
classical:
- women of childbearing age
- fever
- joint pain
- rash
+ malar rash, photosensitive rash, hair loss, mouth ulcers, renal involvement, seizures, psychosis, anaemia, Raynaullds, thrombocytopenia, fatigue, pleuritis, pericarditis
61
investigations for SLE
- bedside: BP, urine dip (red cell casts, proteinuria)
- bloods: FBC, WBC, CRP, ESR, platelets, U&Es, LFTs
- inflam: ANA, ENAs,(Ro/La/RNP/Sm), dsDNA, C3/C4
- 24h urinary protein/ protein:creatinine ratio
62
management of SLE
- monitoring (regular urinalysis, BP, renal, lipid and glucose profile)
- inflammation (hydroxychloriqune, steroids, methotrexate)
- treat symptoms
63
complications of SLE
- cardiovascular risk (disease +glucocorticoids)
- pregnancy (morbidity, meds are toxic)
- renal
- joint deformity
64
different types of large vessel vasculitis
- giant cell arthritis
| - Tokaysu's arthritis
65
different types of medium vessel arthritis
- polyarthritis nodosa
| - Kawasaki disease
66
different types of small vessel disease
- microscopic polyangitis
- granulomatosis with polyangitis
- eosinophilic granulomatous with polyangitis (Churg Strauss syndrome)
67
eosinophilic granuomatus with polyangitis presentation
- resp: asthma, haemoptysis, pneumonitis, nasal polyps, paranasal sinusitis
- heart: pericardial effusion, MI, myocarditis
- skin: purpura reticularis
- renal: glomerulonephritis, renal failure, hypertension
- NS: mononeuritis monosimplex, strokes
- ophthalmology: anterior uveitis
- gastro: mesenteric infarction, bowel perforation
Year 4
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