Here are the answers to your questions:
1. Define acute haematogenous osteomyelitis (1 mark)
Acute haematogenous osteomyelitis is a bacterial infection of the bone that typically occurs following bacteremia (the presence of bacteria in the bloodstream), leading to the infection of the bone marrow and surrounding bone tissue.
2. Clinical presentation of acute haematogenous osteomyelitis (3 marks)
- Fever: Often presents with high fever due to systemic involvement.
- Localized Pain and Tenderness: Specific pain in the affected area, often accompanied by swelling and tenderness.
- Limited Range of Motion: Depending on the affected bone, there may be limited movement due to pain and inflammation.
3. Describe anatomic position (3 marks)
The anatomic position refers to a standardized way of describing the human body in a position that allows for clear and consistent communication about anatomy. In this position:
- The individual stands upright.
- The feet are placed together or slightly apart.
- The arms are at the sides with palms facing forward.
- The head is level and facing forward, with the eyes looking straight ahead.
4. Mention two emergency bone infections (2 marks)
- Osteomyelitis: Infection of the bone.
- Septic Arthritis: Infection in a joint, which can also affect the surrounding bone.
5. Outline the management of acute haematogenous osteomyelitis (3 marks)
- Antibiotic Therapy: Initiate IV antibiotics tailored to the most likely pathogens (e.g., Staphylococcus aureus).
- Surgical Intervention: Drainage of any abscess or infected material may be necessary.
- Supportive Care: Pain management, hydration, and possibly immobilization of the affected area to facilitate healing.
6. Give two differentials of acute haematogenous osteomyelitis (2 marks)
- Fracture: Especially in the presence of trauma.
- Tumor (Bone Tumor): Such as osteosarcoma, which may present similarly.
7. A 5-year-old child presents with fever and painful proximal right leg; malaria is negative. What is your tentative diagnosis? (1 mark)
Tentative Diagnosis: Acute haematogenous osteomyelitis of the proximal femur.
8. What other investigation can you order? (2 marks)
- MRI of the affected limb: To assess the extent of bone involvement and soft tissue changes.
- Bone Biopsy: If necessary, to identify the specific organism.
9. Outline your management (3 marks)
- Start IV antibiotics based on local guidelines (e.g., cefazolin and clindamycin for suspected staphylococcal infection).
- Surgical drainage if there is an abscess or significant pus collection.
- Supportive care, including analgesics and physical therapy as needed.
10. A sixty-year-old man presents with a painful right knee for 6 months. No history of trauma. What is your tentative diagnosis? (1 mark)
Tentative Diagnosis: Osteoarthritis of the knee.
11. What investigation can you order? (1 mark)
- X-ray of the knee joint: To assess for signs of osteoarthritis, such as joint space narrowing and osteophytes.
12. How can you manage this man? (2 marks)
- Conservative management: Including weight loss, physical therapy, and analgesics (e.g., NSAIDs).
- Joint injections: Consider corticosteroid injections for pain relief if conservative measures fail.
13. A seventy-year-old woman presents with symmetrical, bilateral metacarpophalangeal joint swelling and deformity of hands and feet. What is your tentative diagnosis? (1 mark)
Tentative Diagnosis: Rheumatoid Arthritis.
14. Mention two investigations you can order (1 mark)
- Rheumatoid factor (RF) and anti-CCP antibody tests: To support the diagnosis of rheumatoid arthritis.
- X-ray of the hands and feet: To assess for joint erosions and other changes.
15. How can you manage the woman? (3 marks)
- Disease-modifying antirheumatic drugs (DMARDs): Such as methotrexate to slow disease progression.
- Non-steroidal anti-inflammatory drugs (NSAIDs): For pain and inflammation management.
- Physical therapy: To maintain joint function and mobility.
16. List four indications for amputation (4 marks)
- Severe peripheral vascular disease: Leading to avascular necrosis of a limb.
- Malignant tumors: Involving the bone or soft tissues.
- Severe trauma: With devastating injury that cannot be salvaged.
- Chronic infections: Such as osteomyelitis not responsive to other treatments.
17. Explain how you can manipulate a fracture of the distal radius and ulna in a ten-year-old child (3 marks)
- Gentle traction: Apply longitudinal traction to align the fracture fragments.
- Realignment: Manually manipulate the distal fragment into the correct alignment using your fingers to guide it into position.
- Stabilization: Once reduction is achieved, maintain pressure while applying a backslab or cast to stabilize the fracture.
18. A twenty-year-old man has been diagnosed with posterior hip dislocation. Explain how you can reduce the dislocation (3 marks)
- Patient Positioning: Position the patient supine on a table.
- Traction and Lever Technique: Apply gentle traction to the leg while simultaneously flexing the knee and rotating the hip. Utilize a hand or lever (using the knee as a fulcrum) to push the femoral head back into the acetabulum.
- Confirmation: Confirm successful reduction through clinical assessment and imaging.
19. How do you maintain the reduction? (1 mark)
- Hip Spica Cast or Brace: Apply a hip spica cast or brace to immobilize the joint and maintain the reduction.
20. Mention three complications you expect from this dislocation (3 marks)
- Avascular Necrosis: Due to disrupted blood supply to the femoral head.
- Sciatic Nerve Injury: Resulting in motor or sensory deficits.
- Post-Traumatic Arthritis: Leading to long-term joint problems.
21. A six-year-old child presents with painful right hip. No history of trauma, febrile, and tender on examination. What is your tentative diagnosis? (1 mark)
Tentative Diagnosis: Septic arthritis or osteomyelitis of the hip.
22. Mention three investigations you can order (3 marks)
- Ultrasound of the hip: To assess for effusion.
- Blood tests: Including CBC, ESR, and CRP for infection markers.
- MRI of the hip: To evaluate for osteomyelitis.
23. How can you manage the child? (3 marks)
- Intravenous antibiotics: Start broad-spectrum antibiotics, then tailor based on culture results.
- Surgical intervention: Consider joint aspiration (arthrocentesis) or urgent surgical drainage if indicated.
- Supportive care: Analgesia and physical therapy as the condition improves.
24. A thirty-year-old man presents with an acutely swollen left knee. He says he had swelling and pain in the right elbow a week before the present complaint. What is your tentative diagnosis? (1 mark)
Tentative Diagnosis: Reactive arthritis or possible infection.
25. What investigation can you do (1 mark)
- Joint aspiration: To analyze synovial fluid for signs of infection, crystals, or other abnormalities.
26. How can you manage this man (1 mark)
- NSAIDs or corticosteroids for inflammation relief; consider antibiotics if there's evidence of infection.
27. A five-year child has been applied a pop below the elbow. Give four instructions to the mother (4 marks)
- Keep the cast dry: Avoid getting the cast wet; cover it during bathing.
- Monitor for symptoms of complications: Look for increased pain, swelling, or numbness.
- Elevate the arm: To reduce swelling.
- Follow-up appointments: Ensure regular follow-ups for cast check and possibly for removal.
28. During your practical, you observed open reduction and internal fixation (ORIF) of the patella. What is the function of the patella? (1 mark)
- Function of the Patella: It acts as a sesamoid bone that increases the leverage of the quadriceps muscle, enhancing the efficiency of knee extension.
29. Mention two implants used to fix the patella (2 marks)
- Tension Band Wire: Often used for patellar fractures.
- Patellar screws: Specific screws designed for fixation of patellar bone.
30. About fracture neck of femur. How do you manage at a district hospital? (2 marks)
- Initial Management: Immobilize and manage pain; provide supportive care.
- Referral for Surgery: Urgent referral to a facility where surgical intervention (such as hip pinning or hip replacement) can be performed.
31. What instructions do you give to nurses in the ward (3 marks)
- Monitor vital signs: Regularly check for signs of infection or complications post-surgery.
- Assess pain levels: Ensure adequate pain control.
- Mobility assistance: Provide assistance with mobilization as per post-operative protocol.
32. What counseling message do you give to the patient and guardian on discharge after six weeks? (2 marks)
- Follow-up appointments: Emphasize the importance of follow-up for rehabilitation and monitoring recovery.
- Weight-bearing precautions: Advise on gradual weight-bearing activities and the use of assistive devices as needed.
33. A ten-year boy presents with four small wounds on the distal leg for one year. No history of trauma. What is your tentative diagnosis? (1 mark)
Tentative Diagnosis: Possible non-healing ulcers or chronic granulomatous lesions, potentially due to underlying conditions (like a neurotrophic ulcer or a chronic infection).
34. What investigation can you order? (2 marks)
- Skin biopsy: To evaluate the histopathology of the tissue.
- Wound culture: To identify any infective organism present.
35. How can you manage this child? (3 marks)
- Topical treatment: Antiseptic wound care and dressing changes.
- Address underlying conditions: Treat any systemic issues, such as anemia or immunodeficiency.
- Referral: Consider referral to a specialist for further evaluation and possible surgical intervention if the ulcers do not heal.
36. Mention three disadvantages of POP (3 marks)
- Weight: Potentially heavy and cumbersome, leading to discomfort.
- Moisture retention: Can trap moisture, leading to skin complications.
- Locked joints: It limits joint movement and can lead to stiffness if not monitored during the healing process.
37. List five factors that determine the time of fracture healing (5 marks)
- Age of the patient: Younger individuals generally heal faster.
- Type of fracture: Simple fractures tend to heal faster than complex or comminuted fractures.
- Location of the fracture: Certain bones heal faster than others (e.g., mid-shaft of the femur vs. neck of the femur).
- Vascular supply: Good blood supply promotes faster healing.
- Presence of infection: Infection can significantly delay the healing process.
38. About compartment syndrome. What are the clinical presentations? (5 marks)
- Pain: Severe pain out of proportion to the injury.
- Paresthesia: Tingling or burning sensations in the affected limb.
- Pallor: Changes in skin color, usually mottled or pale.
- Pulselessness: Weak or absent pulses in the affected limb.
- Paralysis: Loss of function or strength in the limb due to nerve compression.
39. Mention three causes (3 marks)
- Fractures: Particularly in the tibia or forearm, leading to swelling and increased pressure.
- Crush injuries: Impacts that compress compartments.
- Tight bandages or casts: Improperly applied dressings that restrict circulation.
40. How is it managed? (3 marks)
- Immediate elevation: Elevate the affected limb to reduce swelling.
- Fasciotomy: Surgical intervention to relieve pressure by opening the fascia and allowing swelling to subside.
- Monitor and manage pain: Provide analgesics and reassess regularly to ensure complications do not arise.
41. What is the function of the fibula? (1 mark)
- Function of the Fibula: It provides lateral support to the ankle joint and serves as an attachment site for muscles; while it bears little weight, it helps stabilize the bone structure of the lower leg.
These answers provide a comprehensive overview of several topics related to orthopedics and emergency medicine. Please review them carefully to ensure they meet your understanding and educational objectives.