Primary care - Bone Pain Flashcards

1
Q

Examples of condns managed in non chronic management

A

Diabetes, copd, hypertension, asthma, cardiac disease

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2
Q

Why are more people attending the GP

A
Higher population
Aging population 
Worse diets 
Better trining for nurses 
Better diagnostic tools
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3
Q

The difference in life expectancy between skilled and unskilled workers

A

5 yrs due to b being more educated, less manual work, more likely, to get time off work, better nutrition, lifestyle, living condns

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4
Q

Alcohol’s effect on their body

A

Starts off causing fatty liver and leads to fibres and scar tissue being laid on liver
Destroys synapses and acts as a risk factor for condns e.g. gout and hypertension

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5
Q

Classes of anti-hypertensive drugs

A

ACE inhibitors (-il)
Ca channel blockers (-ine)
Mild diuretics
Alpha blockers

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6
Q

Factors stopping pts from consulting a GP

A
Ignorance 
Lack of knowledge 
Embrassment 
Bad past experience 
Fear of wasting time 
Being male 
Unsympathetic
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7
Q

Treatment of impetigo

A

Flucloxacillin

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8
Q

Abx used for UTI

A

Cephalosporin (limited use due to resistance)
Trimethoprim
Co-amoxiclav
Nitrofurantoin (not in pt w/ renal failure)

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9
Q

What is heart failure

A

Weakness of heart muscle

Cant pump blood as well –> swollen ankles (can’t counter gravity), fluid build-up in lungs

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10
Q

Treatment of heart failure

A

Beta blockers

Cant be given to asthmatics (causes bronchoconsstriction)

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11
Q

Red flag symptoms for bone cancer

A
Wt loss 
Fatigue 
Sweat
Aches 
Pain that wakes pt at night
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12
Q

Primary cancers that spread to bone

A
Breast 
Prostate 
Thyroid 
Kidney 
Bowel 
Lung (bronchiole)
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13
Q

Lab tests for bone cancer

A
FBC 
Leikocytes 
Infl markers 
Bone group (Ca, PO4, ALP)
Urine 
X-rays 
Isotope bone scans
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14
Q

Prognosis for bone cancer

A

Not good, manage w/ radiotherapy, analgesia, steroids & hormonal treatment

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15
Q

Why is osteoporosis common in menopause

A

Due to the lack of oestrogen

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16
Q

How does osteoporosis usually present

A

Low trauma fracture e.g. FOOSH

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17
Q

Common osteoporotic fracture site

A

Collapsed vertebrae
Colles
NOF

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18
Q

Why is osteoporosis very expensive to treat

A

Long lasting psychological effects on the pt

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19
Q

Pathophysiology of OP

A

Increased osteoclast and reduced osteoblasts

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20
Q

What can increase risk of OP

A

Long term steroids

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21
Q

What drugs can be given for OP

A

Bisphosphonates - zeolendronate

AdCal

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22
Q

Treatment of OP

A

Weight bearing exercise can help, stop smoking and drinking, OT & physio
HRT can also help but increases risk of strokes so prescribe lowest dose and give for shortest time

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23
Q

Dx of osteomyelitis

A

Swabs

Lab tests

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24
Q

Treatment of OM

A

Surgical debridement

IV abx

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25
Q

Usual infections causing OM

A

Staph A

Strep

26
Q

Types of shoulder dislocation

A

Anterior

Posterior

27
Q

Treating skin infections of Strep and Staph

A

Penicilins e.g. flucloxacillin

Macrolides e.g. erythromycin

28
Q

Characteristics of multiple myeloma

A

Overproduction of plasma cells
Bone marrow does not produce enough Hb
Increased Ca and thrombocytopenia on bloods

29
Q

X-rays of multiple myeloma

A

Thinning of bone

30
Q

Urine of MM pts

A

Bence Jones proteins

31
Q

Treatment of MM

A

Chemo
Bisphosphonate
Radiotherapy

32
Q

What can atrial fibrillation cause

A

Blood clotting, treat w/ Warfarin

33
Q

Varicose veins

A

Increase pressure on superficial veins, veins dilate and valves stop working can cause varicose eczema or ulcers

34
Q

Causes of varicose veins

A

Pregnancy, inactivity, obesity -treated by stripping veins

35
Q

Golfers elbow

A

Affects medial epicondyle

36
Q

Tennis elbow

A

Affects lateral epicondyle

37
Q

What can cause elbow effusions

A

infections
Rheumatic disease
Olecranon bursitis (resting on your elbow a lot, more proximal than rheumatoid nodules - drain fluid)

38
Q

Oedema definition

A

Accumulation of interstitial fluid in lower limbs

39
Q

Common causes of oedema

A
Infection
DVT
Neoplastics
Iatrogenic
Congenital & trauma - can be uni or bilateral and usually acute
40
Q

Things that can lead to oedema

A
Increased capillary pressure
Decreased lymphatic drainage
Increased venous pressure (heart failure)
Infections
Ruptured Bakers cyst
Decreased protein in blood
Amlodypine
41
Q

Treatrnent of oedema

A

Elevation of legs, elastic stockings, diuretics

42
Q

Main risk associated with DVT

A

PE

43
Q

What can air in the bloodstream cause

A

Blood clots

44
Q

How can fat enter the bloodtsream

A

Trauma (fracture)

45
Q

Presentation of DVT

A
Normally unilateral swelling
V similar to cellulitis 
Tender, swollen calf
Red 
Hot 
Painful to dorsiflex 
If the girth of one thigh is 3cm bigger than the other - clear sign
46
Q

Risk factors for DVT - Virchow’s triad

A

Stasis - immobility, bed, post-op, leg in cast, long journeys, varicose veins
Damage to blood vessel wall - trauma, infection
Hypercoagability

47
Q

Conditions increasing risk of DVT

A
Age
Infection
Infl
Vascular factors e.g strokes
Neoplasms
Haematological factors
Immunological problems(anti phospholipid)
Iatrogenic (surgery, drugs)
Combined pill and HRT
Congenital
Obstetrics
Nephrotic syndrome
Lifestyle (smoking)
Idiopathic
Family hx
48
Q

Wells riks score fro DVT

A

Help GP diagnose whether pt needs to be referred to secondary care -2 to 9. Points for diff things and cellulitis reduces 2 points

49
Q

Treatment for DVT

A

Refer to DVT clinic
Tests d dimer - degradation of clot
Give heparin s/c or NOAC

50
Q

Lower limb infections

A

Usually bacterial, come from break in skin

Mainly cellulitis, can present similar to DVT

51
Q

Treatment from lower limb infections

A

Erythromycin

Clarithromycin

52
Q

Investigations for soft tissue swelling

A

FBC - wbc as sign of infection
Raised infl markers
Swabs for ulcerative condns

53
Q

Haemotoma

A

Bruise

54
Q

Thrombolitis

A

Varicose veins get inflamed, treat w/ oral anti-infl or gel

55
Q

Ulcer definition

A

Break in continuity of surface membrane

56
Q

Benefits of exercising

A

Increased circulation
Increased mental health
Weight control - being overweight is a risk factor for several diseases
Prevents limbs from seizing up

57
Q

Peptic ulcers cause

A

Excess acid, steroid, smokin

58
Q

Presentation of peptic ulcers

A

Pain epigastric then radiates to back

59
Q

Haematesisis

A

Vomiting fresh blood

60
Q

Malena

A

Sign of upper gastric bleed