Locomotor Flashcards

Question

What are the symptoms of septic arthritis?

Answer 1

Classic picture= single swollen joint with pain on active or passive movement. Knee is involved in 50% of cases. Fevers and rigors in the majority of cases

Answer 2

Joint usually swollen, warm, tender, and exquisitely painful on movement An effusion may be obvious

Answer 3

``` Rheumatoid arthritis Vasculitis Crystal arthropathies - gout - pseudo gout ```

Answer 4

Urgent joint aspiration for synovial fluid microscopy and culture FBC- show elevated WCC, ESR CRP inflammatory markers Blood cultures Imaging - CT and MRI show Periarticular abscesses

Answer 5

Antibiotics started IV initially for 2-3 weeks before switching to oral for a further 2-4 weeks Flucloxacillin Cefotaxine for gram -ve organisms for gonococcal arthritis Repeated percutaneous aspiration Splint limb in position of function

Answer 6

Cauda equina syndrome: - saddle (perianal) anaesthesia or paraesthesia - recent onset of bladder dysfunction - recent onset of faecal incontinence - severe/progressive neurological deficit in lower extremities Spinal fracture - sudden onset of severe central pain in the spine, relieved by lying down - major trauma - minor trauma (strenuous lifting with osteoporosis) - structural deformity of the spine High risk of permanent damage to the compressed nerve: - significant muscle weakness or wasting - loss of tendon reflexes - presence of positive babinski reflex

Answer 7

Bouts of back pain v common | Less than 1 in 20 are due to prolapsed disc

Answer 8

Most common in

Answer 9

Cause not clear Some people may have a weaker outer part of affected disc

Answer 10

``` Occupation (lots of lifting or sitting) Weight-bearing sports Smoking Obesity Increasing age ```

Answer 11

Sciatica - unilateral leg pain - in buttocks and lower limb - numbness, paraesthesia, weakness or loss of tendon reflexes - backache/pain Thoracic disc herniation - symptoms similar to lumbar disc lesions Cord compression: - neurosurgical emergency - thoracic spine can lead to paraplegia - may be clonus/babinski positive

Answer 12

Sciatic scoliosis - pt may stand with leg to one side Range of back movements severely limited in all planes Tenderness in midline of lower back Neuro exam- at corresponding level of prolapse may find muscle weakness, diminished reflexes, sensory loss L5 impairment - weakness of big toe extension, knee flexion, S1 impairment - weak plantarflexion, weak eversion of foot,

Answer 13

``` Abdominal pain in elderly AAA RA Mechanical back pain Cauda equina syndrome Pelvic fractures ```

Answer 14

MRI v sensitive at showing disc herniations CT myelography Plan X-rays

Answer 15

Analgesia- paracetamol, NSAIDs, opioids - benzodiazepines if muscle spasms - gabapentin Lifestyle- keep active, heat and massage Physiotherapy Surgery

Answer 16

Common chronic inflammatory autoimmune disease

Answer 17

Prevalence of 1% of UK population

Answer 18

Genetic susceptibility Smoking, alcohol Diabetes

Answer 19

Arthritis usually starts as insidious symmetrical polyarthritis, often with nonspecific systemic symptoms RA typically causes symmetrical joint synovitis of small joints of hands and feet Pain, swelling and heat in affected joints Pain WORSE AT REST/DURING INACTIVITY Stiffness in the morning

Answer 20

``` Symmetrical, distal small joint arthritis involving PIP, MCP, wrist, MTP, ankle knee and cervical spine joints Hand deformities: - ulnar deviation - swan neck and boutonnières deformity - Z deformity of the thumb ``` rheumatoid nodule Muscle wasting and tendon rupture

Answer 21

Pain relief - paracetamol ➡️ NSAIDs + PPI Disease modifying anti rheumatic drugs (DMARDs) - methotrexate and sulfasazaline

Answer 22

A disorder of synovial joints, characterised by focal areas of damage to the articulate cartilage, remodelling of underlying bone and the formation of osteophytes and mild synovitis. Knees, hips and the small joints of the hands are the most commonly affected joints