CLINICAL PLACEMENT

Question 1

what are red flags for cauda equina?

Answer 1

bilateral sciatica 
bladder dysfunction
tingling or numbness in saddle area between legs and arouns anus
bowel dysfunction
alteration of sexual sensation

Question 2

what is polymyalgia rheumatica?

Answer 2

an inflammatory disorder that causes muscle pain and stiffness especially in shoulders, neck and pelvic girdle

Question 3

what are side effects of steroids?

Answer 3

Indigestion or heartburn.
increased appetite, which could lead to weight gain.
fluid retention
difficulty sleeping.
reduce bone mineral density (corticosteroids)
changes in mood and behaviour, such as feeling irritable or anxious.
an increased risk of infections – especially chickenpox, shingles and measles.
high blood sugar or diabetes.
Cusings syndrome
eye problems e.g. cataracts or glaucoma

Question 4

what condition is polymyalgia rheumatica often associated with?

Answer 4

giant cell arteritis

aka temporal arteritis

Question 5

whats the usual patient that has polymyalgia rheumatica ?

Answer 5

over 50 years old
women
caucasian

Question 6

what are the symptoms of polymyalgia rheumatica?

Answer 6

bilateral shoulder pain that may radiate to the elbow
bilateral pelvic girdle pain
pain worsens with movement
pain intereferes with sleep
>45 mins stiffness in the mornings

systemic symptoms - fatigue, weight loss, low grade fever, low mood

Question 7

how do we diagnose polymyalgia rheumatica?

Answer 7

clinical presentation
good response to steroids
inflammatory markers e.g. ESR and CRP raised
exclude differentials e.g. SLE, osteoarthritis and rheumatoid arthritis

Question 8

how do we treat polymyalgia rheumatica?

Answer 8

steroids
start with prednisolone - if no response after 1 week then its not PMR and you should stop steroids
if at 3-4 weeks of treatment there has been a good response, slowly start to reduce dose

Question 9

what is chronic pain?

Answer 9

pain for over >3 months with no tisse damage

Question 10

what are examples of chronic pain?

Answer 10

fibromyalgia
neuropathies
pain from amputations

Question 11

what are risk factors for chronic pain?

Answer 11

Acute back pain with neurological signs.
Multimorbidity.
Comorbid personality disorder.
Psychological distress.
Pain-related disability.
History of trauma or chronic pain.
Sleep disorders — poor sleep increases the intensity and duration of chronic pain.
Surgical and medical interventions.

Question 12

what is the Beighton score?

Answer 12

screening for hypermobility

Question 13

why do most people avoid aspirin as an NSAID?

Answer 13

due to its blood thinning effects

Question 14

what are the issues with opiods?

Answer 14

tolerance issues
side effect of constipation
respiratory depression risk

Question 15

what are examples of opiods?

Answer 15

codeine
tramadol
morphine
dihydrocodeine
fentanyl

Question 16

what are some side effects of tramadol?

Answer 16

Nausea, vomiting, constipation, lightheadedness, dizziness, drowsiness, or headache may occur.

Question 17

what are neuropathic/atypical pain killers?

Answer 17

gabapentin
amitryptiline
pregabalin

Question 18

what do pain clinics do?

Answer 18

have some alternative pain killers e.g. nerve blocks or medical marihuana
recognise patients pain
give all patients CBT to change how they view their pain
spend longer sessions with patients

Question 19

what is fibromyalgia?

Answer 19

widespread musculoskeletal pain accompanied by fatigue, sleep memory and mood issues