14/5 Flashcards
Clinical difference between thyroglossal and thyroid cysts
Thyroid - move on swallowing
Thyroglossal - move on tongue protrusion
Explain OA of the knee.
Sx in Hx
Invx wanted and findings
Mangagement
Degneration of the cartilage within the joint - happens as you get older or if the joint has been used lots/sustained trauma
Pain worse on exertion and improved by rest
Often bilateral but not always
Typically affects big joints e.g. hip and knee
Insidious onset
~ Swelling but not often hot
Invx
knee exam
- crepitations
- joint line tenderness
(on hands can get Bouchards and Heberdens nodes)
XR
L - loss of joint space
O - osteophytes
S - subcondral cysts
S - subarticular sclerosis
Management
1. Lifestyle changes
- weight loss
- physio to strengthen muscles
- OT - walking aids and adjustments to living
- Pain relief
- 1. Paracetomol and topical NSAIDS - NSAIDS and PPI
- Intra-articular joint injections
- ~ Knee replacement
- big surgery - try and manage conservatively
- typically lasts 10-25 years but there are complications
What is the system for answering “what investigations would you do”?
Bedside
Bloods
Imaging
Special tests
What is the system for answering “what management would you do?”
Conservative
Medical
Surgical
Metastatic cord compression is often mistaken for cauda equina syndrome. What can help to differentiate it?
Back pain on coughing and straining - more likely to be metastatic cord compression
- give dexamethasone
VIVA for cauda equina
What?
- compression of the cauda equina (when spinal cord ends there are loose nerves at the bottom of the spine)
- it’s an emergency because it can cause permeant bowel/bladder/sexual dysfunction
sx
- bowel and bladder dysfunction
- saddle parasthesia
- bilateral sciatica
invx
- spine exam
- PR - loss of tone and sensation
bloods = not indicated
imagining = emergency MRI
manage
- surgical decompression of the cauda equina
-
Hx for MSK
SOCRATES+ red flags + TINA
red flags (particularly for back pain)
trauma - recent falls or injury?
infection/cancer - recent infection/cancer anywhere in body? how have u been in yourself recently?
neurological impact - any weakness, numbness, tingling feeling
Autoimmune - stiffness
TINA = trauma, infection, neurological sx and autoimmune
Red flags for back pain
Weight loss, fever, night sweats?
Thoraric back pain
Night-time waking with pain?
Bladder/bowel sx?
Able to feel when you wipe after opening your bowels?
Bilateral tingling?
Back pain specifics for spinal stenosis, sciatica?
Spinal stenosis - worse on uphill, relieved by downhill
Sciatica - worse when bending over
How is generalised back pain (not malignacy, infection or trauma) investigated and managed?
Invx - just back + ~neuro exam
NO MRI or XR
Manage
MDT - GP and likely physio
Conservatively
- exercise groups - specific and provide social support too
- physio back exercises
- education - leaflets about mechanical back pain
Medically
- NSAIDS + PPI
(not recommended to give opioids unless NSAIDS contraindicated)
Surgically
- no surgical intervention required
What kind of IBD is assoc with stone formation?
Crohn’s gives you stones
What kind of diseases are assoc. with pseudogout?
What kind of finding?
Autoimmune
Postive rhomboid
What DMARD is assoc. with retinal toxicity?
Hydrochloroxyine
What is enteric/enteropathic arthritis?
Arthritis that occurs with IBD
What antibody is assoc with drug induced lupus?
Anti-histone
“when you take drugs you get stoned”
