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MBBS - Year 1 > Primary care - Spinal Disorders > Flashcards

Primary care - Spinal Disorders Flashcards

1
Q

`Which infl condo usually presents as pain in distal limbs

A

PMR

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2
Q

Treatment of PMR

A

Prednisolone

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3
Q

People most affected by PMR

A

Women over 50

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4
Q

2 drugs causing SLE

A

Carbamazepine

Hydralazine

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5
Q

Which hormone is related to SLE

A

Oestrogen

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6
Q

Drugs for treating Raynaud’s

A

Iloprost
Sidenifil
Ca channel blockers

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7
Q

Most common prevention of ALPS

A

Vascular thrombosis - DVT/PE
Recurrent miscarriages
Strokes in those under 45

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8
Q

Dx test for APLS

A

Anti-cardolipin antibodies

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9
Q

Treatment of scleroderma

A

BP management
PPI
Vasodilators
Exercise

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10
Q

Managed abx

A

Broad spectrum e.g. co-amoxiclav, quinolone, cephalosporins

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11
Q

When can you use managed abx

A

When pts are allergic to other abx or when drugs are restsnat

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12
Q

Treatment of 59 yo man w chest infection

A

Amoxiccilin 500mg TDS

Clarithromycin 250-500mg BDS

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13
Q

Treatment of 30 yo man w MBP

A

NSAIDs and paracetamol
Rest
Muscle relaxant - diazepam

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14
Q

Concerns about diazepam

A

Can be addictive - valium

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15
Q

Treatment of 49 yo woman w/ acid reflux

A

PPI e.f. omeprazole or lansoprazole

If n to getting better could be H. Pylori infection - treat with PPI and 2 anti-bacterials

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16
Q

Treatment of 3 yo with impetigo

A

Flucloxacillin 125-500mg QDS 5-7days

Topical fusidic acid

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17
Q

Treatment of 7 yo with bacterial sore throat

A

Penicillin V

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18
Q

Ddx of back pain - trauma

A

Whiplash
Fracture
Other muscular strains

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19
Q

Ddx of back pain - cancer

A

Myeloma

Bone secondaries

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20
Q

Ddx of back pain - structural/degerative

A

Spondylosis
Spondylolisthesis
Gross scoliosis/ kyphosis

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21
Q

Spondylosis

A

Spinal OA with osteophyte formation and disc degeneration

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22
Q

Ddx of back pain - metabolic

A

Osteoporosis with vertebral collapse
Osteomalacia
Paget’s

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23
Q

Ddx of back pain - infections

A

Shingles
Discitis
Osteomyelitis – bacterial/TB
Epidural abscess

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24
Q

Ddx of back pain - infl

A

Ankylosing spondylitis
PMR
Coccodynia

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25
Q

Ddx of back pain - referred pain

A 
Hip
Abdo
Kidney/Bladder
Ovary
Pelvis
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26
Q

Yellow flags

A 
Belief that pain and activity is harmful
Sickness behaviours
Social withdrawal
Emotional problems
Problems/dissatisfaction at work
Overprotective family
Inappropriate expectations of treatment
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27
Q

Common symptoms seen with prolapsed discs

A

Radicular pain due to spinal nerve root compression
Shooting, sharp pain
Usually unilateral
Localised pain due to prolapsing itself
Limited lifting of spine (straight-leg test)

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28
Q

Signs of severe prolapsed dose which requires urgent referral

A

Drop foot and affected motor function

29
Q

Therapeutics for prolapsed disc

A

Neuropathic pain doesn’t always respond to typical analgesia so given gabapentin or amitriptyline

30
Q

Clinical features of spinal stenosis

A

Causes bilateral buttock and leg pain
Paraesthesia
Numbness in legs when walking

31
Q

Relieving factors for spinal stenosis

A

Rest

Leaning forward - widens spinal canal

32
Q

Ix for spinal stenosis

A

MRI

33
Q

Treatment for spinals the noses

A

Spinal decompression

Refer immediately

34
Q

Types of laxatives

A

Bulk laxatives - draw water in

Stimulant laxatives - causes bowels to contract

35
Q

Common laxatives

A

Senna
Lactulose
Macrogol

36
Q

Why is colchicine only used for acute flares of gout

A

Fairly toxic is max 12 tablets

QDS 3 days or BDS 6 days

37
Q

Ramipril

A

ACE inhibitor
Anti-hypertensive
Can give pts irritating cough

38
Q

Causes of atherosclerosis

A

Smoking

High cholesterol

39
Q

Q risk

A

Risk of having heart attack in 1o years

40
Q

When should pt be advised to lower cholesterol

A

If Q score is above 10

41
Q

Femoral artery blockage presentation

A

Pain
Numbness
Cold
Reduced sensation

Surgical emergency

42
Q

Causes of cauda equina syndrome

A

Compression of the spinal cord and the nerves/nerve roots arising from the cauda equina

43
Q

Most common cause of CES

A

Prolapsed IVD

44
Q

Risk factors for CES

A 
Older Age
High Impact Sports
Being Overweight or Obese
Manual Job/Labour
Genetic Predisposition for Prolapsed Disc
Previous Severe Back Injury
45
Q

Ddx for CES

A

Radiculopathy – presents with radiating back pain but no faecal, urinary, or sexual dysfunction.
Cord compression – a surgical emergency similar to CES but is characterised by upper motor neurone signs.

46
Q

Mx of CES

A

Lumbar decompression surgery (laminectomy or discectomy) must be done quickly to prevent permanent damage e.g. paralysis of the legs, loss of bladder and bowel control, sexual function, or other problems

47
Q

Prognosis of CES

A

Variable depending on the cause, patient factors and the time from symptom onset to surgery.
Even with treatment, around 20% of patients do not regain full function
May require catheter or physio/ot

48
Q

Epidemiology of radiculopathies

A

Most common in 50+

More men affected than women

49
Q

Symptoms associated with radiculopathies

A

General weakness
Radiating pain (i.e. compression of a nerve in the cervical spinal area may cause issues within the forearm)
Lack of control within the specific muscle
Potential numbness
Paraesthesia

50
Q

Ix for radiculopathies

A

Full examination
MRI
Electromyography to examine how the muscles are functioning - by comparing them at rest and during contraction

51
Q

Mx for radiculopathies

A

Most are self - limiting
PT
NSAIDs/ steroids
Surgery in extreme cases

52
Q

NSAIDs for OA

A 
Treatment for up to 12 weeks 
Etoricoxib 60mg 
Diclofenac 150mg 
Ibuprofen 2400 mg 
Naproxen 1000 mg
53
Q

NSAIDs for AxSpa

A

Treatment for up to 6 weeks
Non selective NSAIDs
Coxibs

54
Q

NSAIDs for rotator cuff tendinopathy

A

Non-selective for up to 4 weeks

55
Q

Adverse events for NSAIDs

A

GI adverse events
Myocardial infarction
Stroke
Heart failure

56
Q

What does testing reflexes allow

A

Lower and upper motor neurone lesions to be distinguished reliably

57
Q

When is reflex testing essential

A

If you suspect spinal cord and cauda equine compression, acute cervical or lumbar disc compression

58
Q

Reflexes in arms

A

Biceps - C5/6 myotome
Brachioradialis - C6 myotome
Triceps - C7/8 myotome

59
Q

Reflexes in legs

A

Knee - L3/4 myotome

Ankle - S1/2 myotome

60
Q

Explaining process of testing reflexes to pt

A

Reflexes in the arms, legs and jaw will be tapped
This will be painless
They shouldn’t be alarmed if their limbs jerk nor concerned if they don’t

61
Q

Interpreting reflex testing

A

Absent jerk points to lower motor neurons lesion

Very brisk reflection suggest an upper motor lesion

62
Q

Sciatica

A

Clinical dx based on symptoms of radiating pain in one leg with or without associated neurological deficits on examinations

63
Q

What is sciatica caused by

A

Infl or compression of the lumbosacral nerve roots (L4 - 5) forming sciatic nerve usually by disc herniation or rarely trauma

64
Q

Mx of sciatica

A

Most pt’s improve over time with conservative treatment incl exercise, manual therapy and pain management

65
Q

Imaging for sciatica

A

Imaging only requested if pain persists for 12+ weeks or the pt develops progressive neurological deficits

66
Q

Symptoms of sciatica

A

Unilateral leg pain more severe than low back pain
Pain most commonly radiating posteriorly at the leg and below the knee
Numbness and/or paresthesia in the involved lower leg
+ve neural tension test (straight leg/ femoral nerve)
Muscle weakness/ absence of tendon reflexes/ sensory deficit

67
Q

Prognosis of sciatica

A

Most people experience an improvement in symptoms over times with either conservative treatment or surgery
Low back pain radiating to leg indicator of poor prognosis - increased pain, disability and poor QoL

68
Q

Examples of manual therapy

A

Spinal mobilisation

69
Q

Red flags for referral - sciatica

A

Severe or progressive neurological deficits
Suspicion of cauda equina syndrome with signs of urinary retention and/or decreased anal sphincter tone
Suspicion of cancer or infection
Hx of trauma
Persistent sciatica for 12 weeks from onset of symptoms despite conservative care

MBBS - Year 1 (93 decks)

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