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118 Cards in this Set
- Front
- Back
Dose of adrenaline to give in anaphylactic shock |
IM 0.5mg as 0.5mL of 1:1000 adrenaline |
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1 month and 1 year mortality of NOF # |
10% 30% |
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Management of intertrochanteric hip fracture |
Dynamic hip screw |
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Key sensory area |
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Myotomes |
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Three lines of management of pelvic fracture to stop bleeding |
Pelvic binder (displayed) Embolisation External fixation |
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First, Second and Third line management of epilepsy (with doses) |
1st (jump to 2nd if IV access present) Midazolam 10mg PO or Diazepam 10mg PR 2nd line Lorazepam 4mg IV or Diazepam 10mg IV Phenytoin continuous infusion |
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Two associations of Dupuytren's |
Leddenhose (same as Dupuytren's on foot) Peyronie's (on penis, displayed) |
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Maximum strain that bones can sustain for fracture to unite |
2% (whatever that means) |
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Anatomical underpinning of the lightbulb sign in posterior dislocation |
Greatertuberosity can't be seen because the arm is internally rotated hence the symmetrical pattern that gives the sign its name |
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Best test for axillary nerve damage in anterior shoulder dislocation |
Sensation over regiment's badge (movement is impossible to assess in a dislocated shoulder) |
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What makes impingement syndrome worse: active or passive movements or both? |
Active |
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Abduction of the shoulder causes pain from 160° on. What other test would you do? Why? |
Likely OA of ACJ Scarf test |
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Most common organism causing septic arthritis |
Staph aureus |
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T/F: OA presents with no erosion |
True |
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Pattern recognition Young male with bone pain that is worse at night and relieved by NSAIDs |
Osteoid osteoma |
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Attachements of ACL (precisely) |
Intercondylar eminence of tibia Lateral condyle of femur |
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Management of acid burns (3) |
1) ABC 2) Irrigation with copious water 3) Calcium gluconate |
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How do you evaluate dynamic hip screw placement? |
Tip-apex distance under fluoroscopy (check on Google formula for tip-apex distance) |
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How do you start the brady and tachy algorithm? |
AEIOU ABC ECG IV access O2 Update stats regularly |
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Clinical features of life-threatening asthma |
CHEST Cyanosis Hypotension, low consciousness Exhaustion, poor resp effort Silent chest |
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Initial management of seizure |
A3M3 Avoid injuries: recovery position Air: airway and O2 Access: IV and bloods Monitor: Obs and ECG Muscle relaxant: Lorazepam 4mg IV Manage reversible causes: dextrose or thiamine |
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Treatment of anaphylactic shock (after raising legs, calling for help and lying patient flat) |
CHAOS Chlorphenamine 10mg IV Hydrocortisone 200mg IV Adrenaline 0.5mg in 0.5mL (1:1000) O2 15L/min 100% via non-rebreatheable Saline 0.9% 500mL |
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ECG signs of TCA OD |
1) Sinus tachy 2) PS (PR and QRS) Prolonged 3) Superimposition of P-wave and T-wave |
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Initial treatment of massive PE |
MOT Heparin Morphine 5-10mg IV Oxygen 15L/min 100% Thrombolysis (alteplase 50mg bolus) if peri-arrest Heparin (either LMWH or unfractionated as it has a quicker effect) |
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Actions to be done during CPR in cardiac arrest |
4A Airway management Assess and correct reversible causes (4H4T) Amiodarone (300mg IV after 3rd shock) Adrenaline (1mg IV every 5min) |
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6 causes of mechanical and 5 causes of non-mechanical back pain |
Mechanical – 6S Slipped disc, spinal stenosis, slit (fracture), senile (degenerative), spondylolysis, spondylolisthesis Non-mechanical – TAPIR Tumour (MM, mets, lymphoma, spinal cord) Arthritis (P.A.I.R) Paget's Infection Referred |
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Tragus |
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Pharmacological management of SLE |
HI-P-IC Mild – HCQ and Ibuprofen (NSAIDs) Mod – Prednisolone Sev – Increase prednisolone, Cyclophosphamide |
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Main 3 joints affected in SLE |
Knees Wrist PIP |
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What other arthropathy is PsA a RF for? |
Gout |
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ACR criteria for the diagnosis of RA |
4 or more of the following (the first 4 must be for at least 6 weeks) ◾︎ Morning stiffness for >1 hour ◾︎ Arthritis of 3 joints with soft tissue swelling ◾︎ Arthritis of hand joints: MCPs, PIPs or wrist ◾︎ Symmetrical arthritis: at least one area ◾︎ Rheumatoid nodules ◾︎ RF +ve ◾︎ Periarticular erosions on X-ray |
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T/F: RF +ve is associated with a higher incidence of extra-articular features in RA |
T |
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Two main S/R of MTX |
Nausea and oral ulcer |
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Serious S/E of MTX on lungs |
Allergic alveolitis |
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4 reasons why patients with RA may have small muscle wasting |
Disuse atrophy Compression neuropathy Cervical myelopathy Mononeuritis multiplex due to rheumatoid vasculitis |
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What precaution must be taken before starting Anti-TNF treatment |
TB screen |
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Role of Ultrasound in suspected septic arthritis |
Check for effusion |
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3 most common sites for osteoporotic fractures |
Vertebral body Neck of femur Distal radius (eg Colles) |
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T/F: Alcohol and smoking are RF for Dupuytren's |
F: only alcohol is |
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Clumsy |
Maladroit |
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ARA criteria for the diagnosis of SLE |
At least 4/11: ROSA (minor) RHANA (major) ◾ Rashes (up to 3 points): malar, discoid, photosensitivity ◾ Oral ulcers ◾ Serositis (pleuritis, pericarditis) ◾ Arthralgia ◾ Renal diseases ◾ Haematological (one -aenia) ◾ ANA +ve ◾ Neurological (seizure, psychosis) ◾ Antibodies: dsDNA, Sm, antiphospholipid |
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What should you do if you suspect renal lupus? |
1) Urine microscopy for red cell casts 2) 24h urine collection for quantification of proteinuria 3) Discuss with nephrologist for biopsy 4) If glomerulonephritis is confirmed: aggressive immunosuppression and BP control |
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2 RF for club foot |
Same as DDH Breech Oligohydramnios DDH |
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T/F: Central disc prolapse in the lumbar spine is synonymous to cauda equina syndrome |
True (one is the pathogenesis of the other) |
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Two treatment options for lateral disc prolapse |
Analgesia and wait (prolapsed discs frequently resolve spontaneously) Surgical removal of the disc and decompression of the nerve |
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How long do TKR last? |
15 to 20 years |
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Which of the following is almost guaranteed to be improved by TKR: pain, varus, ROM? |
Pain and varus deformity ROM may not be improved (it's a bonus) and patients should be aware of this. |
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Treatment options algorithm in hip fracture |
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Clinical clearing of C-spine |
A-F then G-J A) Patient oriented B) No drugs or ETOH C) No neck pain D) No neurological signs E) No head injury F) No distracting injury In the neck: G) No bruising H) No deformity I) No tenderness J) Pain-free ROM |
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What do you look for laterally when examining the knee? |
Fixed flexion deformity Posterior tibial subluxation Genu recurvatum |
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What do you offer at the end of the hip exam? |
◾ Measurement of LLD ◾ Ober's test (for iliotibial band pathology) ◾ Groins for hernia ◾ Testicular diseases |
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Score for hypermobility |
Beighton score |
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T/F: Prematurity is a RF for DDH |
True |
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Rheumatoid factor is found in the serum of what percentage of patients with Rheumatoid Arthritis? |
80% |
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T/F: Amyloidosis can occur in AS |
T (yet another "A") |
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Name one other autoimmune condition that is often associated with SLE |
Hypothyroidism |
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What percentage of healthy Caucasians carry HLA-B27 antigen? |
10% |
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2 main electrolyte disturbances that may cause seizures |
Hyponatremia Hypocalcemia |
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What defines unstable tachy and unstable brady? |
Tachy SBP < 90 Heart failure Low GCS IHD
SBP < 90 Heart failure Ventricular arrhythmias HR < 40 |
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Steps in the treatment of Raynaud's (4) |
1) Avoid cold (gloves and hat) 2) Oral vasodilator a) CCB (amlodipine or nifedipine) b) ACEI 3) IV vasodilator 4) Sympathectomy |
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Treatment of Sjögren's |
Eye drops NSAIDs HCQ |
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Besides rash and muscle weakness, two other systems affected by dermatomyositis |
◾ Dysphagia (⟹ aspiration) ◾ Diaphragm weakness (⟹ Orthopnoea) ◾ Interstitial lung disease (anti-Jo1) |
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6 classes of JIA |
◾ Systemic onset JIA ◾ Oligoarticular JIA ◾ Polyarticular JIA ◾ Psoriatic JIA ◾ Enthesitis related JIA ◾ Undifferentiated JIA |
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Diagnostic criteria for systemic onset JIA |
Arthritis associated with fever and accompanied by ≥ 1 of: ◾ Evanescent rash ◾ Lymphadenopathy ◾ Hepatosplenomegaly ◾ Serositis |
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3 RF for chronic anterior uveitis in oligoarticular JIA |
◾ ANA +ve ◾ Girls ◾ < 8years |
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Diagnostic criteria for psoriatic JIA |
1) Arthritis with psoriasis 2) Arthritis with ≥ 2 of ◾ Psoriasis in 1st degree relative ◾ Nail changes ◾ Dactylitis |
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Diagnostic criteria for enthesitis-related JIA |
1) Arthritis with enthesitis 2) Arthritis with ≥ 2 of: ◾ HLA-B27 ◾ HLA-B27 in 1st degree relative ◾ Sacroiliac joint tenderness or inflammatory spinal pain ◾ Anterior uveitis ◾ Boy > 8 |
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How do you calibrate a Guedel airway? |
Incisors to the angle of jaw |
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What articulation enables rotation of the head in the axial plane? Briefly outline its anatomy |
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Outline how the structures of the different vertebrae are adapted to their function |
Cervical Large canal, small body, bifid spinous processes Thoracic Two sets of costo facets (for ribs articulation) Long spinous process inferiorly projecting Lumbar Large body, smaller canal, facets joints are on the side to accommodate flexion, bigger and stronger transverse processes to accommodate muscle attachement |
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Name and locate 4 ligaments of the vertebral column |
Ligamenta flava connect the lamina |
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Outline the location and mechanism of the following fractures: 1) Jefferson 2) Odontoid 3) Hangman's |
1) C1 – Axial compression 2) C2 – Hyperflexion or hyperextension 3) C2 (pars interarticularis) – Hyperextension followed by hyperflexion |
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T/F – Jefferson fracture is likely to lead to neurological deficit |
False, thanks to the capacious canal in C-spine |
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What C-spine injury may lead to monoradiculopathy |
Unifacet dislocation (Bifacet dislocaiton would lead to rapidly progressive signs of cord injury) |
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What is fracture in flexion teardrop fractures? What causes neurological symptoms? |
# Anteroinferior aspect of a cervical vertebral body Neurology due to displacement of the posterior portion of the vertebral body into the spinal canal. |
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A-E |
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F-K |
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3 main ligaments of the elbow and their attachment |
Radial collateral ligament Lateral epicondyle of humerus to annular ligament Ulnar collateral ligament 3 parts (illustrated) Annular ligament Posterior aspect to anterior aspect of radial notch on the ulna, encircles the head of radius |
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Three scars to check in the hip and their significance |
Anterior approach – Typically paediatric Posterior approach (curved) – Typically THR |
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5 scars to check in the knee and their significance |
Midline – TKR Lateral and medial – Collateral ligament repair or open meniscal repair Posterior – Tibial plateau # or tumour Arthroscopy – Meniscal repair, diagnosis, ACL/PCL reconstruction, synovial biopsy |
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Arthroscopy scars – Meniscal repair, diagnosis, ACL/PCL reconstruction, synovial biopsy |
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Midline knee scar – TKR |
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Medial scar – Collateral ligament repair or open meniscal repair |
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What ligament is most important for the stability of the shoulder? |
Coracoacromial ligament It connects two parts of the scapula |
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4 main ligaments of the shoulder |
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Treatment options for fracture of the distal radius |
1) Closed reduction and cast immobilization for most extra-articular fractures (if dorsal angulation < 5°) 2) Surgical fixation (ORIF or closed reduction and percutaneous pinning) |
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Treatment of scaphoid fracture if: 1) Syable non-displaced of the waist 2) Stable non-displaced of the poles 3) Unstable |
1) ORIF 2) Thumb spica cast immobilization 3) ORIF |
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What makes an ankle fracture unstable? |
Fracture at two points of the ring |
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How do you acquire a mortise view radiograph? |
Ankle at 20° of internal rotation |
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Management of ankle fracture |
Weber A Usually stable, Below knee cast Weber B Sometimes ORIF, Sometimes POP Weber C Usually unstable, ORIF |
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What defines a complete spinal cord injury on ASIA chart? |
A and B and C A) No voluntary anal contraction B) S4-5 sensory scores = 0 C) No anal sensation = No |
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Lister tubercle is on the radius |
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Major stabiliser of ulnar carpus and radioulnar joint? |
Triangylar fibrocartilage complex (TFCC) |
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What is this angle called? |
Radial inclination |
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What is Chauffeur's fracture? |
Fracture of the radial styloid |
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Sensitivity and specificity of Ottawa ankle rules |
Sensitivity – 100% Specificity – 40% |
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What radiographic finding suggests lateral shift of talus? |
Medial clear space > 4mm on mortise view |
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What is the Pott's classification of ankle fractures |
First degree – Unimalleolar Second degree – Bimalleolar Third degree – Trimalleolar |
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What is a trimalleolar fracture |
Fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect of the tibia |
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What is a comminuted fractyre? |
A fracture in many small fragments |
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Management of trimalleolar fracture |
Urgent orthopaedic referral for ORIF |
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What is a Pilon fracture of the ankle? What is its mechanism? |
Fracture of distal tibial metaphysis often comminuted resulting from significant axial load |
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What is Tillaux fracture? |
Salter-Harris Type 3 fracture of the distal tibia, occurring in adolescence due to ongoing fusion of the epiphysis with the metaphysis. |
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Which part of the bone starts to fuse first in the distal tibia during adolescence? |
Medial fuses first |
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What are buckle fractures in children? |
Synonymous to torus fracture |
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What treatment of unstable fracture can we use specifically in children and causes minimal scars? |
Elastic intra-medullary nails |
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What NV structures are at risk in supracondylar humerus fractures? |
Median nerve, radial nerve, anterior interosseous nerve, brachial artery |
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Management of displaced and undisplaced supracondylar fractures of the humerus |
Undisplaced – Casting Displaced – Closed reduction and K-wires |
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Most dramatic complication of supracondylar fractures |
Volkmann's ischaemia Permanent flexion contracture of the hand at the wrist due to ischaemia and fibrosis of the flexor muscles of the forearm. |
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T/F: cartillage can be seen on X-ray as lower density than bone |
False: it is radiolucent |
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Management of displaced and undisplaced fractures of the lateral condyle of the humerus |
Fixation in both cases (unlike undisplaced supracondylar fractures that may be managed with a cast) |
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What are Montaggia and Galiazzi fractures in the forearm |
Montaggia – Ulna # with head of radius dislocation (displayed) Galiazzi – Radius # with distal radio-unlar joint dislocationn |
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Management of "Galiazzi – Radius # with distal radio-unlar joint dislocationn" |
Reduction of radius and reduction of distal radio-ulnar joint |
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What microstructural part of the physis is the weakest zone? |
The hypertrophic zone |
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Treatment of fractures based on SH class |
I – Closed reduction, fixation only if unstable II – Closed reduction with percutaneous fixation III – Anatomic reduction and stable fixation IV – Anatomic reduction and stable fixation V – No treatment available, diagnosed retrospectively |
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T/F: History of trauma is a good discriminant to distinguish injury from bone tumour |
False: bone tumours often also have a history of trauma |
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Name one disease in which extensor tendon may not function in the hand (hence the test) |
RA |