Diseases

What is an open fracture?

Broken skin

What is a closed fracture?

No broken skin

What is a transverse fracture?

Horizontal

What is an oblique fracture?

Slanted

What is a spiral fracture?

Break acquired by twisting force

What is a greenstick fracture?

Fracture in young bones - bends and breaks

What is a comminuted fracture?

Broken in at least two places

What is a simple fracture?

Fracture of bone only

What is a stable fracture?

Bone maintains original alignment

What is a displaced fracture?

Gap between broken fragments

What is a shortened fracture?

Overlap of fragments, shortening

What is a rotated fracture?

Twisting of bone fragment out of position

What is an angulated fracture?

Bone angled away from usual position

What is a complete fracture?

FComplete loss of bone continuity

What is an extra articular fracture?

Fracture outside of a joint

What is an articular fracture?

Fracture within a joint

What is an avulsion fracture?

Chunk of bone attached to ligament/tendon pulled away from the main bone body

What is a Salter-Harris fracture?

Epiphyses

What is a Garden fracture?

Hip

What is a Danis-Weber fracture?

Ankle

What are risk factors for fractures?

Trauma, osteoporosis, metastasis, Paget's disease, non-accidental injuries

How does a fracture present?

Immediate onset of pain following injury, swelling, difficulty moving, abnormal appearance of limb, grating noise/feeling, loss of strength, shock

How do you manage a fracture?

Reduce, stabilise, neurovascular exam, imaging, soft tissue management, rehabilitation, analgesia

What is a dislocation?

Complete loss of joint continuity

What is subluxation?

Partial loss of joint continuity

What are dislocation risk factors?

Previous total hip replacement, car accidents, falls, contact sport, hyper-mobility, Ehlers-Danlos

How does a dislocation present?

Significant pain, swelling, bruising, visible deformity, loss of function/mobility, joint instability

How do you manage a dislocation?

Urgent care, ful neurovascular exam before and after reduction, reduce joint, analgesia, RICE

Where do you get compartment syndrome most commonly?

Lower limb, forearm, gluteal, abdominal compartments

How does acute compartment syndrome present?

Increasing pain despite fracture immobilisation, sensory deficit, muscle tenderness and swelling, excessive pain on passive movement, peripheral pulses may be present

What are the later features of acute compartment syndrome?

Tissue ischaemia, pallor, pulselessness, paralysis, coolness, loss of capillary refill

How does chronic compartment syndrome present?

Triggered by exercise, worsens with exercise, resolves with rest, compromised circulation, hardness of compartment on examination

What are the risk factors of acute compartment syndrome?

Crush injury, fractures, burns, infection, prolonged limb compression, muscle hypertrophy

What are risk factors for chronic compartment syndrome?

Military, repetitive exercise, athletes, runners, football, cycling, tennis, gymnastics, excessive training, 20-25 years old

What investigations are done for compartment syndrome?

X-ray, measure intracompartmental pressure, MRI, US/doppler to exclude occlusion thrombosis and embolism, CPK bloods to identify muscle breakdown

What is a normal intracompartmental pressure?

0-8mmHg

How is compartment syndrome managed?

Urgent decompression by fasciotomy, deep skin and fascia must be divided along the whole length of the compartment, wound left open, consider debridement for muscle necrosis

If fasciotomy is not performed (pressure

Observe limb closely for clinical improvement. If no improvement then must perform fasciotomy

How do you manage chronic compartment syndrome?

Conservative management limiting causative activity, altering training regimen, deep massage treatments, decompressive fasciotomy

How does sepsis present?

Evidence of systematic infection, low BP, high resp rate, low blood pressure, altered mental state, unwell without clear cause, has deteriorated on antibiotics

What is the sepsis six?

Respiratory rate, oxygen saturation, temperature, systolic blood pressure, pulse rate, level of consciousness

What are sepsis risk factors?

Over 75, less than 1 year old, surgery or instrumentation, in dwelling line/cathetar, breach of skin, immunocompromised, immunosuppressed, IV drug misuse, pregnancy

What investigations are done for sepsis?

NEWS2, blood cultures, FBC and lactate, IV fluids, IV antibiotics, urine output monitoring and dipstick, ABG, look for source of infection, glucose, LFTs, clotting screen, renal function

How do you manage sepsis?

Immediate hospital admission, resus, IV rehydrstion, monitoring, preventing other problems e.g. DVTs, IV antimicrobials dependent on clinical circumstances

What virus causes shingles and chickenpox?

Varicella zoster

How does shingles present?

Most commonly affects nerve supplying the skin on the upper face, chest and abdomen, localised pain, red blotchy rash appearing 2-3 days after pain begins developing into itchy vesicular rash

What rash is this?

Shingles

What are risk factors for shingles?

Not having had chickenpox, elderly, immunosuppressed

What investigations are done for shingles?

Diagnosis made on clinical assessment

How is shingles managed?

Antivirals if over 50, immunosuppressed, moderate or severe pain and rash. Analgesia, steroidal treatment

What antivirals are used for shingles?

Aciclovir, famiclovir, valaciclovir

How does influenxa present?

Rapid onset, malaise, retro-orbital headache, fever, myalgia, non-productive cough and sore throat

How does influenza atypically present in children?

Chest pain, epistaxis, photophobia, haematemesis, croup, apnoea, rigors

What are risk factors for influenza?

Over 65, less than 6 months, pregnancy, chronic resp disease, chronic heart disease, CKD, chronic liver disease, diabetes, immunosupressed, morbid obesity

What are the three types of influenza?

A, B, C

How could influenza A be described?

More frequent, major outbreaks

How could influenza B be described?

yearly, circulates with A, less severe

How can influenza C be described?

Mild or symptomatic illness

What investigations can be done for influenza?

Clinical diagnosis usually, can do direct viral culture, PCR, rapid antigen tests

How is influenza managed?

Self management. Oseltamivir and zanamivir used for treatment and PEP if needed

What are potential complications with influenza?

Pneumonia, acute bronchitis, sinusitis, myocarditis, pericarditis, febrile convulsions, myalgia, myositis, rhabdomyolysis, reye's syndrome, encephalomyelitis, transverse myelitis, guillain-barre syndrome, aseptic meningitis, encephalitis, toxic shock, preterm labour

How do rhinovirus present?

Nasal discharge, nasal obstruction, sneezing, sore throat, malaise, cough, hoarseness, anosmi, pressure in ears/sinuses, headache and fever

What are risk factors for rhinovirus?

Very common, children will have more a year than adults

What investigations are done for rhinovirus?

None necessary

How do you manage rhinovirus?

Adequate fluid intake, prevent spread, OTC treatments to help with symptoms

How does herpes simplex present?

Initial infection usually asymptomatic, systemic infection, gingivostomatitis, herpetic whitlow, eczema herpeticum, genital herpes, HSV encephalitis

What are risk factors of herpes simplex?

HSV-1 by 1-2 years, HSV-2 onset of sexual activity

What investigations are done for herpes?

Antibody titres, PCR, viral culture

How is herpes simplex managed?

No cure, antivirals e.g. aciclovir, OTC meds for symptoms

How does EBV present?

Fatigue, fever, inflamed throat, swollen lymph nodes, splenomegaly, hepatomegaly, rash

What are the risk factors of EBV?

Spreads through bodily fluid, very common

What investigations are done for EBV?

Blood test detecting antibodies

How is EBV managed?

No specific treatment, drink fluids, plenty of rest, OTC meds for symptoms

How does cytomegalovirus present?

May cause mononucleosis, most common manifestation is GI, CMV pneumonia is the most serious complication

What are risk factors for cytomegalovirus?

Infection passed through bodily fluids, most HIV positive individuals are seropositive for CMV

What are the investigations for cytomegalovirus?

Serology, antibodies IgM and IgG, cultures, antigen assays, PCR, cytopathology

How is cytomegalovirus managed?

Most patients only need OTC symptom management, immunodeficient patients requite antivirals - graniclovir or foscarnet

How does septic arthritis present?

Single swollen joint with pain on active or passive movement, may present as polyarticular, fevers, rigors, bacteraecemia, effusion, knee most commonly affected then hip, shoulder, ankle, wrists

What are the risk factors of septic arthritis?

Elderly, immunosuppressed, prosthetic joint, diabetes, prior joint damage, joint surgery, skin infection, immunodeficiency

What investigations are done for septic arthritis?

FBC, arthrocentesis, culture, PCR, radiography

How is septic arthritis managed?

Start IV antibiotics ASAP then after 2-3 weeks switch to oral, limb should be splinted in position of function

What is the presentation of osteoarthritis?

Joint pain, functional limitations, localised loss of cartilage, remodelling of adjacent bone, inflammation, no morning stiffness/lasts less than 30 mins, pain made worse by exercise, relieved by rest, joint swelling, pain on movement, crepitus, periarticular tenderness, absence of systemic features, bony swelling, osteophytes, Hebedens nodes, Bouchards nodes

Where are Heberden's nodes found?

Distal inter phalangeal joints

Where are Bouchard's nodes found?

Proximal inter phalangeal joints

What are risk factors for osteoarthritis?

Age, heritability, obesity, high/low bone density, joint injury, occupational and recreational stresses, reduced muscle strength, joint laxity, joint malalignment

What investigations are done for osteoarthritis?

Clinical exam, plain radiographs, BMI, MRI

What would a plain radiograph show for osteoarthritis?

Loss of joint space, sclerosis, osteophytes, subchondral cysts

How is osteoarthritis managed?

Based on severity of symptoms, education, exercise encouraged, weight loss, thermotherapy, appropriate footwear and assistive devices, paracetamol, NSAIDs, intraarticular corticosteroids, arthroplasty

How does rheumatoid arthritis present?

Symmetrical insidious polyarthritis, mainly effects small joints, wrist, ankle, cervical spine, bilateral, joint swelling, redness, heat, pain, stiffness, progressive joint destruction, loss of function, swan neck, boutonnieres, z deformities, ulnar deviation

What are some extra-articular presentations of rheumatoid arthritis?

Secondary Sjogren's, scleritis, episcleritis, leg ulcers, rashes, nail fold infarcts, rheumatoid nodules

What are the risk factors of rheumatoid arthritis?

More common in women, peak onset 30-50m smoking, HLA DR4 and DRI

What invesigations are done for rheumatoid arthritis?

Anti-CCP, rheumatoid factorm x-ray, clinical examination

How is rheumatoid arthritis managed?

NSAIDs, measure CRP monthly, short term steroids for flares, intro-articular steroids, methotrexate, leflunomide, sulfasalazine, DMARDs, biologics including anti-TNF

What is stage 1 of lyme disease?

Bullseye rash around site of bite, within 3-36 days. May be the only manifestation. Untreated, can last for some weeks but eventually resolves.

What is stage 2 of lyme disease?

Flu-like illness. Joint & muscle pains, headache, fever, tiredness, nausea, vomiting – more common in the USA.
Neurological in 10% of untreated cases: facial nerve palsies, meningitis, mild encephalitis, peripheral mononeuritis. Cardiovascular problems

What is stage 3 of lyme disease?

Arthritis – more common in USA. Large joints.
Acrodermatitis chronica atrophicans – skin condition
Late neurological – polyneuropathy, vertigo, encephalomyelitis, psychosis.
Chronic Lyme disease – persistence despite therapy.

What are risk factors for lyme disease?

Very rare, mostly aquired abroad, transmitted by ticks

What investigations are done for lyme disease?

Clinical assessment, ELISA

How is lyme disease managed?

Oral antibiotic 2-3 weeks – doxycycline or amoxicillin. Cefuroxime if both are contraindicated.

How does psoriatic arthritis present?

Dactylitis, inflammatory pain, joint swelling, enthesitis, psoriatic nail changes, conjunctivitis, symmetrical polyarthritis, arthritis mutilans