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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

1 month and 1 year mortality of NOF #

10%


30%

Management of intertrochanteric hip fracture

Management of intertrochanteric hip fracture

Dynamic hip screw

Key sensory area

Key sensory area

Myotomes

Myotomes

Three lines of management of pelvic fracture to stop bleeding

Pelvic binder (displayed)
Embolisation 
External fixation

Pelvic binder (displayed)


Embolisation


External fixation

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

3rd line


Phenytoin continuous infusion

Two associations of Dupuytren's

Leddenhose (same as Dupuytren's on foot)
Peyronie's (on penis, displayed)

Leddenhose (same as Dupuytren's on foot)


Peyronie's (on penis, displayed)

Maximum strain that bones can sustain for fracture to unite

2% (whatever that means)

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

Best test for axillary nerve damage in anterior shoulder dislocation

Sensation over regiment's badge (movement is impossible to assess in a dislocated shoulder)

What makes impingement syndrome worse: active or passive movements or both?

Active

Abduction of the shoulder causes pain from 160° on. What other test would you do? Why?

Likely OA of ACJ


Scarf test

Most common organism causing septic arthritis

Staph aureus

T/F: OA presents with no erosion

True

Pattern recognition


Young male with bone pain that is worse at night and relieved by NSAIDs

Osteoid osteoma

Attachements of ACL (precisely)

Intercondylar eminence of tibia
Lateral condyle of femur

Intercondylar eminence of tibia


Lateral condyle of femur

Management of acid burns (3)

1) ABC


2) Irrigation with copious water


3) Calcium gluconate

How do you evaluate dynamic hip screw placement?

Tip-apex distance under fluoroscopy (check on Google formula for tip-apex distance)

Tip-apex distance under fluoroscopy (check on Google formula for tip-apex distance)

How do you start the brady and tachy algorithm?

AEIOU


ABC


ECG


IV access


O2


Update stats regularly

Clinical features of life-threatening asthma

CHEST


Cyanosis


Hypotension, low consciousness


Exhaustion, poor resp effort


Silent chest
Tachy or bradycardia

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

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

ECG signs of TCA OD

1) Sinus tachy


2) PS (PR and QRS) Prolonged


3) Superimposition of P-wave and T-wave

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)

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)

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

Tragus

Pharmacological management of SLE

HI-P-IC


Mild – HCQ and Ibuprofen (NSAIDs)


Mod – Prednisolone


Sev – Increase prednisolone, Cyclophosphamide

Main 3 joints affected in SLE

Knees


Wrist


PIP

What other arthropathy is PsA a RF for?

Gout

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

T/F: RF +ve is associated with a higher incidence of extra-articular features in RA

T

Two main S/R of MTX

Nausea and oral ulcer

Serious S/E of MTX on lungs

Allergic alveolitis

4 reasons why patients with RA may have small muscle wasting

Disuse atrophy


Compression neuropathy


Cervical myelopathy


Mononeuritis multiplex due to rheumatoid vasculitis

What precaution must be taken before starting Anti-TNF treatment

TB screen

Role of Ultrasound in suspected septic arthritis

Check for effusion

3 most common sites for osteoporotic fractures

Vertebral body


Neck of femur


Distal radius (eg Colles)

T/F: Alcohol and smoking are RF for Dupuytren's

F: only alcohol is

Clumsy

Maladroit

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

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

2 RF for club foot

Same as DDH


Breech


Oligohydramnios


DDH

T/F: Central disc prolapse in the lumbar spine is synonymous to cauda equina syndrome

True (one is the pathogenesis of the other)

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

How long do TKR last?

15 to 20 years

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.

Treatment options algorithm in hip fracture



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

What do you look for laterally when examining the knee?

Fixed flexion deformity


Posterior tibial subluxation


Genu recurvatum

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

Score for hypermobility

Beighton score

T/F: Prematurity is a RF for DDH

True

Rheumatoid factor is found in the serum of what percentage of patients with Rheumatoid Arthritis?

80%

T/F: Amyloidosis can occur in AS

T (yet another "A")

Name one other autoimmune condition that is often associated with SLE

Hypothyroidism

What percentage of healthy Caucasians carry HLA-B27 antigen?

10%

2 main electrolyte disturbances that may cause seizures

Hyponatremia


Hypocalcemia

What defines unstable tachy and unstable brady?

Tachy


SBP < 90


Heart failure


Low GCS


IHD



Brady


SBP < 90


Heart failure


Ventricular arrhythmias


HR < 40

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

Treatment of Sjögren's

Eye drops


NSAIDs


HCQ

Besides rash and muscle weakness, two other systems affected by dermatomyositis

◾ Dysphagia (⟹ aspiration)


◾ Diaphragm weakness (⟹ Orthopnoea)


◾ Interstitial lung disease (anti-Jo1)

6 classes of JIA

◾ Systemic onset JIA


◾ Oligoarticular JIA


◾ Polyarticular JIA


◾ Psoriatic JIA


◾ Enthesitis related JIA


◾ Undifferentiated JIA

Diagnostic criteria for systemic onset JIA

Arthritis associated with fever and accompanied by ≥ 1 of:


◾ Evanescent rash


◾ Lymphadenopathy


◾ Hepatosplenomegaly


◾ Serositis

3 RF for chronic anterior uveitis in oligoarticular JIA

◾ ANA +ve


◾ Girls


◾ < 8years

Diagnostic criteria for psoriatic JIA

1) Arthritis with psoriasis


2) Arthritis with ≥ 2 of


◾ Psoriasis in 1st degree relative


◾ Nail changes


◾ Dactylitis

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

How do you calibrate a Guedel airway?

Incisors to the angle of jaw

Incisors to the angle of jaw

What articulation enables rotation of the head in the axial plane? Briefly outline its anatomy



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

Name and locate 4 ligaments of the vertebral column

Ligamenta flava connect the lamina

Ligamenta flava connect the lamina

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

T/F – Jefferson fracture is likely to lead to neurological deficit

False, thanks to the capacious canal in C-spine

What C-spine injury may lead to monoradiculopathy

Unifacet dislocation




(Bifacet dislocaiton would lead to rapidly progressive signs of cord injury)

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.

# Anteroinferior aspect of a cervical vertebral body




Neurology due to displacement of the posterior portion of the vertebral body into the spinal canal.

A-E

A-E



F-K

F-K



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

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

Three scars to check in the hip and their significance

Anterior approach – Typically paediatric
Posterior approach (curved) – Typically THRLateral approach (straight) – Proximal femur #

Anterior approach – Typically paediatric


Posterior approach (curved) – Typically THR
Lateral approach (straight) – Proximal femur #

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


Arthroscopy scars – Meniscal repair, diagnosis, ACL/PCL reconstruction, synovial biopsy

Midline knee scar – TKR

Medial scar – Collateral ligament repair or open meniscal repair

What ligament is most important for the stability of the shoulder?

Coracoacromial ligament




It connects two parts of the scapula

4 main ligaments of the shoulder



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)

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

What makes an ankle fracture unstable?

Fracture at two points of the ring

Fracture at two points of the ring

How do you acquire a mortise view radiograph?

Ankle at 20° of internal rotation

Management of ankle fracture

Weber A


Usually stable, Below knee cast




Weber B


Sometimes ORIF, Sometimes POP




Weber C


Usually unstable, ORIF

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

Lister tubercle is on the radius

Lister tubercle is on the radius

Major stabiliser of ulnar carpus and radioulnar joint?

Triangylar fibrocartilage complex (TFCC)

What is this angle called?

What is this angle called?

Radial inclination

What is Chauffeur's fracture?

Fracture of the radial styloid

Fracture of the radial styloid

Sensitivity and specificity of Ottawa ankle rules

Sensitivity – 100%


Specificity – 40%

What radiographic finding suggests lateral shift of talus?

Medial clear space > 4mm on mortise view

Medial clear space > 4mm on mortise view

What is the Pott's classification of ankle fractures

First degree – Unimalleolar


Second degree – Bimalleolar


Third degree – Trimalleolar

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

Fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect of the tibia

What is a comminuted fractyre?

A fracture in many small fragments

Management of trimalleolar fracture

Urgent orthopaedic referral for ORIF

What is a Pilon fracture of the ankle? What is its mechanism?

Fracture of distal tibial metaphysis often comminuted resulting from significant axial load

Fracture of distal tibial metaphysis often comminuted resulting from significant axial load

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.

It's like a triplane fracture minus one of the transverse component

Which part of the bone starts to fuse first in the distal tibia during adolescence?

Medial fuses first

What are buckle fractures in children?

Synonymous to torus fracture

What treatment of unstable fracture can we use specifically in children and causes minimal scars?

Elastic intra-medullary nails

Elastic intra-medullary nails

What NV structures are at risk in supracondylar humerus fractures?

Median nerve, radial nerve, anterior interosseous nerve, brachial artery

Management of displaced and undisplaced supracondylar fractures of the humerus

Undisplaced – Casting


Displaced – Closed reduction and K-wires

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. 

Volkmann's ischaemia


Permanent flexion contracture of the hand at the wrist due to ischaemia and fibrosis of the flexor muscles of the forearm.

T/F: cartillage can be seen on X-ray as lower density than bone

False: it is radiolucent

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)

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

Montaggia – Ulna # with head of radius dislocation (displayed)




Galiazzi – Radius # with distal radio-unlar joint dislocationn

Management of "Galiazzi – Radius # with distal radio-unlar joint dislocationn"

Reduction of radius and reduction of distal radio-ulnar joint

Reduction of radius and reduction of distal radio-ulnar joint

What microstructural part of the physis is the weakest zone?

The hypertrophic zone

The hypertrophic zone

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

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

Name one disease in which extensor tendon may not function in the hand (hence the test)

RA