Medicine Finals Revision
,Contents
• Orthopaedics - 3 • ENT - 92
• Rheumatology -11 • Ophthalmology - 101
• Haematology - 19 • Neurology - 110
• Dermatology - 28 • Gastro & hepatology - 120
• Cardiology - 39 • Obstetrics - 142
• Vascular - 47 • Gynaecology - 156
• Respiratory - 52 • Paediatrics - 170
• Endocrinology - 61 • Psychiatry - 190
• Renal - 77 • Anatomy - 202
• Urology - 85 • ALS - 208
,Orthopaedics
, Healing # Management: Upper limb nerve d
Fractures • Reduce, restrict &
By regeneration =
tissue back to
Radial nerve
Fracture healing: original form rehabilitate • Humeral shaft #
1. Fracture • RICE
By repair = scar • ‘Saturday night p
haematoma • Avoid HARM
• Angiogenesis # Axillary nerve:
complications: (Heat, Alcohol,
2. Callus formation Reinjury, • Surgical neck of h
• Precursor cells and Acute
Massage) → • Anterior shoulder
fibroblasts replace • Haemorrhage blood flow and
the clot • Nerve palsy dislocation
3. Woven bone forms swelling
Early Median nerve:
• Becomes less mobile
• Woven = immature • Compartment The ulnar paradox: • Supracondylar # o
weak bone syndrome Proximal lesions of • Carpal tunnel syn
4. Union of bone • Infection the ulnar nerve Ulnar nerve:
• Collagen laid down • DVT produce a less
and mineralised
• Fat emboli prominent • Compression eith
5. Remodelling cubital tunnel in t
• Haversian canals (long bone #) deformity than or at Guyon’s can
created Late distal lesions wrist
• Osteoclasts remove • Mal / non
callus ‘Lesion closer to • Supracondylar # o
union
• Lamellar bone
• OA
the paw → a worse • Stab wounds to fo
(properly laid) claw’ wrist
,Growth plate #’s Wrist # Smith’s Scap
Com
Paediatric #’s involving the growth plate Colles' fracture: carp
• Fall onto # ris
are classified by the Salter-Harris system extended
outstretched supp
Think hands Caus
• ‘Dinner fork
‘Back type deformity O/E
door’ • Dorsal (back of and
hand) in th
displacement anat
and angulation
of the distal Smith's fracture: snuf
fragment • Volar (palmar)
angulation of Ix =
Type Injury pattern distal radius ulna
Colles’ fragment
I Fracture through the physis only (x-ray often Rx =
• Garden spade Imm
normal) deformity
II Fracture through the physis and metaphysis • Caused by falling (fixa
backwards onto Com
III Fracture through the physis and epiphysis to the palm of an Prox
include the joint outstretched
hand or falling avas
IV Fracture involving the physis, metaphysis and with wrists necr
epiphysis flexed dista
V Crush injury involving the physis (x-ray may supp
resemble type I, and appear normal)
, # Healing Head of femu
Hip # Immediate Haematoma formation = Retinacular
medial & later
0-2 weeks Inflammation
# = a break in the 2-3 weeks Callus formation Classificatio
continuity of a 4-6 weeks Union Garden’s cla
bone 6-8 weeks Consolidation
(intracapsu
• I – Imcom
Description: 1-2 years Remodelling
• II – comp
• Bone i.e. forearm Hip # displaced
radiograph • Shortened and externally • III – comp
rotated Rx: partial dis
• Open / closed Intracapsular:
• Shenton’s line • IV – comp
• Location – • Garden I or II = complete
proximal, middle, screw fixation (low
distal risk of AVN)
• Garden III or IV =
• Simple, hemiarthroplasty or
comminuted THR
• Angulation – Extracapsular:
dorsal, ventral • 4x more common in women • Dynamic hip screw
• Mortality 33% <1 year • Intramedullary nail
, Rx: Talar sh
Ankle # Dependent on the Weber classification
– based on the level of the fibular Widenin
medial
fracture in relation to the sydesomosis.
Ottawa ankle rules – A = Stable
Associa
determine which pts increase
B = Borderline post-tra
require ankle x-rays:
Malleolar pan (medial C = Unstable → surgery arthritis
or lateral) DVT prophylaxis if likely to be immobile Unstabl
following surgery Need o
AND
Bone tenderness at the surgeon
posterior edge or tip of If persistent feeling of ankle instability,
the lateral malleolus XR full-length tibia & fibula
?Maisonneuve # = # where the energy
(A) radiates from the malleolus → proximal
OR fibula # which can be missed by the
traditional ankle # XR series
Bone tenderness at the
posterior edge of tip of
the medial malleolus
(B) Complication:
OR • PE
Inability to weight bear
immediately and in the • Fat embolism in femur or
ED for 4 steps tibia if pep the bone marrow
for an IM nail
, Osteopenia:
Osteomalaci
Osteoporosis Osteopenia Dexa = T-Score between
-1 and -2.5 Rickets (in ch
Low bone mineral density & mass Rx = Ca + Vit. D Inadequate minerali
RFx = age, white, female, early Bisphosphonates considered in bone → soft bones
menopause, smoking, low BMI, weight postmenopausal women with Causes:
bearing exercise, steroids #NOF/hip risk (FRAX score) • Ca - malabsorp
Sx = #’s – Hip, wrist (FOOSH), vertebral → DEXA scores are reported as "T- problems or overa
kyphosis scores" and "Z-scores." resorption i.e.,
The T-score = comparison of a hyperparathyroidi
Ix: person's bone density with that of a • Vit D - sunlig
• Dexa – T-score < -2.5 S.D. healthy Thirty-year-old of the same
• Bone biochem all normal (ALP, Ca, PO4) sex. Sx:
The Z-score is a comparison of a • Bone pain
Rx: person's bone density with that of
• Lifestyle – Exercise, X smoking an average person of the same age • Proximal muscle w
• Ca + Vit. D and sex.
• Bowed legs (ricket
• Bisphosphonates Ix:
• High affinity for hydroxyapatite → • Ca, PO4, Vit D
osteoclastic apoptosis
• Denosumab • ALP, PTH
• Ab to RANKL (on osteoblasts) Rx:
which prevents osteoclast • Vit D supplements
differentiation • Bisphosphonates
• S/C 6/12
, Knee Injury Child & adolescent knee in
Ruptured • Sport injury Chondromalacia • Teenage girls, fo
ACL • Mechanism: high twisting force applied to a bent knee patellae injury to knee e.
• Typically presents with: loud crack, pain and RAPID joint patella
swelling (haemoarthrosis) • Typical history o
• Management: intense physiotherapy or surgery downstairs or at
• Tenderness, qua
Ruptured • Mechanism: hyperextension injuries
PCL • Tibia lies back on the femur Osgood- • Seen in sporty t
• Paradoxical anterior draw test Schlatter • Pain, tendernes
over the tibial tu
Rupture of • Mechanism: leg forced into valgus via force outside the leg
MCL • Knee unstable when put into valgus position Osteochondritis • Pain after exerc
Rupture of • Mechanism: direct blows to the medial aspect of the leg dissecans • Intermittent sw
LCL which puts strain on the LCL ligament locking
• Sx = slow developing joint effusion and lateral joint line Patellar • Medial knee pai
tenderness subluxation lateral subluxati
Meniscal • Rotational sporting injuries patella
tear • Delayed knee swelling Knee may give w
• Joint locking (Patient may develop skills to 'unlock' the knee Patellar • More common
• Recurrent episodes of pain and effusions are common, tendonitis teenage boys
often following minor trauma • Chronic anterior
Iliotibial • Lateral knee pain common in people who run (1 in 10 that worsens af
band runners) • Tender below th
syndrome • Sx = tenderness 2-3cm above the lateral joint line examination
, Paget’s disease of bone: Muscle contraction:
Notes Increased bone turnover → lots of weaker woven bone 1. Actin wrapped by tro
tropomyosin
Sx = bone pain, bowing of tibia, skull bossing
Osteomyelitis
Ix = raised ALP, Ca and Phosphate 2. Ca binds to troponin
Staph Aureus (commonest) Complication = deafness due to auditory nerve 3. Tropomyosin moves
Salmonella (in sickle cell) entrapment actin binding site
Ix = MRI Periosteum surrounds the bone and 4. Actin-myosin cross b
Rx = Abx contains the nerve endings 5. Myosin head pivots →
contraction
Osteogenesis imperfecta: MM → Bence 6. New ATP binds to rel
• Autosomal dominant disorder of type 1 jones proteins in head
collagen (COL1A OR COL1A2) the urine 7. ATP split into ADP &
• Signs/Sx = Frequent #, blue sclera next bridge formatio
Cancers that
• Rx = bisphosphonates, IM nods metastasise to Osteoblasts
bone: • Build bone
Condition Notes
• Breast • Have RANKL which -->
Adhesive Common in middle-age and diabetics differentiation and bon
capsulitis Characterised by painful, stiff movement • Bronchus • Osteoprotegerin (OPG)
(frozen Limited movement in all directions • Byroid (Thyroid) osteoclasts
shoulder) Osteoclasts
• Bidney (Kidney) • Resorb bone by releasi
Supraspinat Rotator cuff injury • Bostate • Large phagocytic, mult
us Painful arc of abduction between 60 and (Prostate) cells
o
tendonitis 120
• Bowel
Tenderness over anterior acromion
,Contents
• Orthopaedics - 3 • ENT - 92
• Rheumatology -11 • Ophthalmology - 101
• Haematology - 19 • Neurology - 110
• Dermatology - 28 • Gastro & hepatology - 120
• Cardiology - 39 • Obstetrics - 142
• Vascular - 47 • Gynaecology - 156
• Respiratory - 52 • Paediatrics - 170
• Endocrinology - 61 • Psychiatry - 190
• Renal - 77 • Anatomy - 202
• Urology - 85 • ALS - 208
,Orthopaedics
, Healing # Management: Upper limb nerve d
Fractures • Reduce, restrict &
By regeneration =
tissue back to
Radial nerve
Fracture healing: original form rehabilitate • Humeral shaft #
1. Fracture • RICE
By repair = scar • ‘Saturday night p
haematoma • Avoid HARM
• Angiogenesis # Axillary nerve:
complications: (Heat, Alcohol,
2. Callus formation Reinjury, • Surgical neck of h
• Precursor cells and Acute
Massage) → • Anterior shoulder
fibroblasts replace • Haemorrhage blood flow and
the clot • Nerve palsy dislocation
3. Woven bone forms swelling
Early Median nerve:
• Becomes less mobile
• Woven = immature • Compartment The ulnar paradox: • Supracondylar # o
weak bone syndrome Proximal lesions of • Carpal tunnel syn
4. Union of bone • Infection the ulnar nerve Ulnar nerve:
• Collagen laid down • DVT produce a less
and mineralised
• Fat emboli prominent • Compression eith
5. Remodelling cubital tunnel in t
• Haversian canals (long bone #) deformity than or at Guyon’s can
created Late distal lesions wrist
• Osteoclasts remove • Mal / non
callus ‘Lesion closer to • Supracondylar # o
union
• Lamellar bone
• OA
the paw → a worse • Stab wounds to fo
(properly laid) claw’ wrist
,Growth plate #’s Wrist # Smith’s Scap
Com
Paediatric #’s involving the growth plate Colles' fracture: carp
• Fall onto # ris
are classified by the Salter-Harris system extended
outstretched supp
Think hands Caus
• ‘Dinner fork
‘Back type deformity O/E
door’ • Dorsal (back of and
hand) in th
displacement anat
and angulation
of the distal Smith's fracture: snuf
fragment • Volar (palmar)
angulation of Ix =
Type Injury pattern distal radius ulna
Colles’ fragment
I Fracture through the physis only (x-ray often Rx =
• Garden spade Imm
normal) deformity
II Fracture through the physis and metaphysis • Caused by falling (fixa
backwards onto Com
III Fracture through the physis and epiphysis to the palm of an Prox
include the joint outstretched
hand or falling avas
IV Fracture involving the physis, metaphysis and with wrists necr
epiphysis flexed dista
V Crush injury involving the physis (x-ray may supp
resemble type I, and appear normal)
, # Healing Head of femu
Hip # Immediate Haematoma formation = Retinacular
medial & later
0-2 weeks Inflammation
# = a break in the 2-3 weeks Callus formation Classificatio
continuity of a 4-6 weeks Union Garden’s cla
bone 6-8 weeks Consolidation
(intracapsu
• I – Imcom
Description: 1-2 years Remodelling
• II – comp
• Bone i.e. forearm Hip # displaced
radiograph • Shortened and externally • III – comp
rotated Rx: partial dis
• Open / closed Intracapsular:
• Shenton’s line • IV – comp
• Location – • Garden I or II = complete
proximal, middle, screw fixation (low
distal risk of AVN)
• Garden III or IV =
• Simple, hemiarthroplasty or
comminuted THR
• Angulation – Extracapsular:
dorsal, ventral • 4x more common in women • Dynamic hip screw
• Mortality 33% <1 year • Intramedullary nail
, Rx: Talar sh
Ankle # Dependent on the Weber classification
– based on the level of the fibular Widenin
medial
fracture in relation to the sydesomosis.
Ottawa ankle rules – A = Stable
Associa
determine which pts increase
B = Borderline post-tra
require ankle x-rays:
Malleolar pan (medial C = Unstable → surgery arthritis
or lateral) DVT prophylaxis if likely to be immobile Unstabl
following surgery Need o
AND
Bone tenderness at the surgeon
posterior edge or tip of If persistent feeling of ankle instability,
the lateral malleolus XR full-length tibia & fibula
?Maisonneuve # = # where the energy
(A) radiates from the malleolus → proximal
OR fibula # which can be missed by the
traditional ankle # XR series
Bone tenderness at the
posterior edge of tip of
the medial malleolus
(B) Complication:
OR • PE
Inability to weight bear
immediately and in the • Fat embolism in femur or
ED for 4 steps tibia if pep the bone marrow
for an IM nail
, Osteopenia:
Osteomalaci
Osteoporosis Osteopenia Dexa = T-Score between
-1 and -2.5 Rickets (in ch
Low bone mineral density & mass Rx = Ca + Vit. D Inadequate minerali
RFx = age, white, female, early Bisphosphonates considered in bone → soft bones
menopause, smoking, low BMI, weight postmenopausal women with Causes:
bearing exercise, steroids #NOF/hip risk (FRAX score) • Ca - malabsorp
Sx = #’s – Hip, wrist (FOOSH), vertebral → DEXA scores are reported as "T- problems or overa
kyphosis scores" and "Z-scores." resorption i.e.,
The T-score = comparison of a hyperparathyroidi
Ix: person's bone density with that of a • Vit D - sunlig
• Dexa – T-score < -2.5 S.D. healthy Thirty-year-old of the same
• Bone biochem all normal (ALP, Ca, PO4) sex. Sx:
The Z-score is a comparison of a • Bone pain
Rx: person's bone density with that of
• Lifestyle – Exercise, X smoking an average person of the same age • Proximal muscle w
• Ca + Vit. D and sex.
• Bowed legs (ricket
• Bisphosphonates Ix:
• High affinity for hydroxyapatite → • Ca, PO4, Vit D
osteoclastic apoptosis
• Denosumab • ALP, PTH
• Ab to RANKL (on osteoblasts) Rx:
which prevents osteoclast • Vit D supplements
differentiation • Bisphosphonates
• S/C 6/12
, Knee Injury Child & adolescent knee in
Ruptured • Sport injury Chondromalacia • Teenage girls, fo
ACL • Mechanism: high twisting force applied to a bent knee patellae injury to knee e.
• Typically presents with: loud crack, pain and RAPID joint patella
swelling (haemoarthrosis) • Typical history o
• Management: intense physiotherapy or surgery downstairs or at
• Tenderness, qua
Ruptured • Mechanism: hyperextension injuries
PCL • Tibia lies back on the femur Osgood- • Seen in sporty t
• Paradoxical anterior draw test Schlatter • Pain, tendernes
over the tibial tu
Rupture of • Mechanism: leg forced into valgus via force outside the leg
MCL • Knee unstable when put into valgus position Osteochondritis • Pain after exerc
Rupture of • Mechanism: direct blows to the medial aspect of the leg dissecans • Intermittent sw
LCL which puts strain on the LCL ligament locking
• Sx = slow developing joint effusion and lateral joint line Patellar • Medial knee pai
tenderness subluxation lateral subluxati
Meniscal • Rotational sporting injuries patella
tear • Delayed knee swelling Knee may give w
• Joint locking (Patient may develop skills to 'unlock' the knee Patellar • More common
• Recurrent episodes of pain and effusions are common, tendonitis teenage boys
often following minor trauma • Chronic anterior
Iliotibial • Lateral knee pain common in people who run (1 in 10 that worsens af
band runners) • Tender below th
syndrome • Sx = tenderness 2-3cm above the lateral joint line examination
, Paget’s disease of bone: Muscle contraction:
Notes Increased bone turnover → lots of weaker woven bone 1. Actin wrapped by tro
tropomyosin
Sx = bone pain, bowing of tibia, skull bossing
Osteomyelitis
Ix = raised ALP, Ca and Phosphate 2. Ca binds to troponin
Staph Aureus (commonest) Complication = deafness due to auditory nerve 3. Tropomyosin moves
Salmonella (in sickle cell) entrapment actin binding site
Ix = MRI Periosteum surrounds the bone and 4. Actin-myosin cross b
Rx = Abx contains the nerve endings 5. Myosin head pivots →
contraction
Osteogenesis imperfecta: MM → Bence 6. New ATP binds to rel
• Autosomal dominant disorder of type 1 jones proteins in head
collagen (COL1A OR COL1A2) the urine 7. ATP split into ADP &
• Signs/Sx = Frequent #, blue sclera next bridge formatio
Cancers that
• Rx = bisphosphonates, IM nods metastasise to Osteoblasts
bone: • Build bone
Condition Notes
• Breast • Have RANKL which -->
Adhesive Common in middle-age and diabetics differentiation and bon
capsulitis Characterised by painful, stiff movement • Bronchus • Osteoprotegerin (OPG)
(frozen Limited movement in all directions • Byroid (Thyroid) osteoclasts
shoulder) Osteoclasts
• Bidney (Kidney) • Resorb bone by releasi
Supraspinat Rotator cuff injury • Bostate • Large phagocytic, mult
us Painful arc of abduction between 60 and (Prostate) cells
o
tendonitis 120
• Bowel
Tenderness over anterior acromion
