MSK Flashcards
(58 cards)
1
Q
MSK screening assessment
A
GALS
- gait
- arms
- legs
- spine
2
Q
Red flag symptoms for cauda equina
A
- perianal numbness
- bilateral sciatica
- faecal and urinary incontinence
- painless retention of fluid
- impotence
3
Q
Red flag symptoms for spinal fracture
A
Major trauma
Sudden onset central spinal pain, better when lying down
4
Q
Red flag symptoms for cancer
A
- 50+ yo
- Severe unremitting pain that remain when the person is supine
- Aching night pain that disturbs sleep
- unexplained weight loss
- PMHx of CA
5
Q
Red flag symptoms for infection
A
Fever
Immunocompromised - HIV, Diabetes
TB
6
Q
When to suspect ankylosing spondylitis
A
- Pain at night, not relieved when supine
- stiffness in morning, not relieved with movement
- gradual onset of symptoms
- Uveitis
7
Q
Sciatica
A
Pain arising from lower back, radiating to BELOW the knee
8
Q
Management of non- specific lower back pain
A
Conservative:
- weight loss
- pain relief - NSAID
- physiotherapy
- CBT
9
Q
Diagnosis of back pain
A
History
Examination
Neurological examination - loss of sensation, reflexes
10
Q
Cauda equina management
A
Surgical decompression within 48 hrs of sphincter symptoms
11
Q
When to use opiod
A
If NSAID is contraindicated
Can be used +/- paracetamol
12
Q
NSAID use
A
Prescribe weakest dose for the shortest time
Consider PPI adjunct
Take with meals
13
Q
How to prevent back pain
A
Good posture Correct manual handling Exercising and stretching regularly Avoid sitting for long periods of time Healthy weight Supportive mattress
14
Q
Sciatica management
A
If chronic and nothing else has worked: Epidural injections with local anaesthetics
Spinal decompression
15
Q
Clinical presentation of osteoarthritis
A
- initially asymmetrical monoarthritis (can develop into polyarthritis)
- gradual onset
- functional impairment
- pain worse at end of day
16
Q
Signs of OA
A
- Bony swellings - Herberdens nodes
- joint deformity
- Joint effusions (knee).
- Joint warmth and/or tenderness (synovitis).
- Muscle wasting and weakness.
- Restricted and painful range of joint movement, crepitus
- joint instability
17
Q
Which joints does OA normally affect
A
DIPJ and first CMCJ at base of thumb
18
Q
OA in hands signs
A
- Thenar eminence muscle wasting
- The CMC joint may develop a fixed flexion deformity, with hyperextension of the distal joints.
- Advanced disease - ‘squaring’
- ulnar deviation at affected joints.
- Herberden’s nodes
19
Q
Signs of hip OA
A
- Pain in the anterior groin on walking or climbing stairs
- Pain which may occur at rest and may disturb sleep.
- Painful restriction of internal rotation with the hip flexed.
- An antalgic gait
- A fixed flexion external rotation deformity, with compensatory increased lumbar lordosis and pelvic tilt.
20
Q
Signs of Knee OA
A
- Bilateral and symmetrical, affecting the medial tibiofemoral commonly
- Unilateral osteoarthritis of the knee is usually secondary to predisposing trauma or disease.
- Knee gives way
- Crepitus and tenderness along the joint line or with pressure on the patella.
- Restricted flexion and extension.
- Small-to-moderate effusions.
- Varus deformity
- Antalgic gait
21
Q
RF for OA
A
Age Obesity Repetitive movements FHx Hip OA - Female
22
Q
Signs of OA on Xray
A
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis
23
Q
Management of OA
A
Conservative: Weight loss Smoking cessation Muscle strengthening Hot/cold compresses Appropriate footwear
Pharmacological:
Paracetamol
NSAIDs - topical gel
24
Q
When to refer an OA pt
A
Occupation therapist - activities of daily living affected
Podiatrist - insoles
Orthopaedic surgeon - not controlled with conservative management and severe pain
25
Score for OA of hip and knee management
Oxford hip and knee score
26
RA presentation
- Symmetrical, mainly small joints of hands and feet affected
- can be affected at any age but commonly 40s
- Morning stiffness that persists for more than 1 hour
- Pain worse at rest and better on movement
27
Signs of RA hand
```
Rheumatoid nodules
Ulnar deviation
Herberden's and Bouchard's nodes (commonly PIPs)
Z thumb
Swan neck deformity
```
28
Extra-articular and systemic features of RA
```
Vasculitis
Malaise
Fatigue
Fever
Sweats
Weight loss
```
29
Investigations of RA
Bloods:
- FBC
- U+Es
- LFTs
- CRP
- RF
Xray (not commonly done) - mainly clinical diagnosis
30
Management of RA
Refer pt with persistant synovitis with unknown cause to rheumatologist - 3ww
31
When to urgently refer RA pt
Within 3 working days if:
- polyarticular
- small joints of hand or feet affected
- delay of 3+ months between onset of symptoms and seeing GP
32
When to suspect flare of RA
Worsening signs or symptoms of: stiffness, pain, joint tenderness, loss of function, snovitis
Increase in CRP
33
Management of RA flare
Seek specialist advice
| Offer short term glucocorticoid injection if localised flare
34
Bursitis presentation
```
Swelling on joint
Gradual onset - hours to days
Painless - can be tender or warm
Fluctuant
History of trauma or skin abrasion
```
35
Features of septic bursitis
```
Increased tenderness and pain
Red, hot, swollen
Local cellulitis
Fever
Immunocompromised
```
36
Management of bursitis
Conservative:
- rest, ice, reduced activity
- avoid trauma
- tubigrip
```
If septic:
- aspirate and culture
- abx - flucloxacillin
(if allergic - clarithromycin)
- review after 7 days
```
37
Osteoporosis pathophysiology
Low bone mass and structural deterioration of bone tissue
38
Causes of osteoporosis
Ageing - osteoclast activity has higher activity than osteoblasts
Menopause - lack of oestrogen therefore osteoclast activity not inhibited
39
Complications of osteoporosis
Hip fractures
| Vertebral fractures
40
Which joints does gout normally affect?
Metatarsophalangeal joint 78%
- midfoot, ankle, knee
- fingers, wrist and elbow joints
41
Presentation of gout
```
Severe pain
Swelling
Redness
Warmth
Tenderness
Tophi
```
42
RF for gout
Alcohol intake
Drug use - ACEi, Beta blockers, diuretics
FHx
43
Investigations for gout
Most of the time not needed - clinical diagnosis
Joint fluid microscopy and culture
Serum uric acid measured 4 - 6 weeks after acute attack to confirm hyperuricaemia
Xray - soft tissue swelling and subcortical cysts
44
Management of gout
Conservative:
- Rest and elevate the limb
- Keep exposed in cool environment
- ice pack
- Lifestyle advice - reduce alcohol intake, weight loss
Pharmacological:
- NSAIDs (oral colchicine) max dose - continue 1 -2 days after the attack
- co prescribe a PPI
45
If cannot tolerate NSAIDs in gout
A short course of oral corticosteroids or a single intramuscular corticosteroid injection
- if intra-articular injection is not possible
- in oligo-/polyarticular gout.
46
Mx if acute monoarticular gout and co-morbidity provided the diagnosis is certain, the person (and joint) are suitable for injecting
Joint aspiration and intra-articular corticosteroids
47
Allopurinol in gout
Do not stop allopurinol or febuxostat during an acute attack of gout if the person is already established on these drugs
48
Gout follow up
Check serum uric acid
BP
HbA1c, lipid profile, renal function
Manage underlying conditions e.g. HTN
49
Prevention of gout
- Urate lowering therapy (ULT) life long
1st line - allopurinol
2nd line - febuxostat
- Consider prescribing colchicine when initiating or increasing the dose of a ULT as prophylaxis against acute attacks secondary to ULT, and continue for up to 6 months.
50
Who should receive urate lowering drugs
```
Two or more attacks of acute gout in 12 months.
Tophi
Chronic gout arthritis.
Joint damage
Renal impairment (eGFR less than 60 ml/min)
A history of urinary stones
Diuretic use
Young age of onset of primary gout.
```
51
Septic arthritis presentation
```
Systemically unwell (with or without a temperature)
Acute painful, hot, swollen joint.
```
52
Inflammatory arthritis - Seropositive:
- RA
- SLE
- scleroderma
- Vasculitis
- Sjogren's
53
Inflammatory arthritis - seronegative
```
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
Inflammatory bowel disease arthritis
Infective arthritis
```
54
SLE summary
Pt demographic: women in 40s, Afro- Caribbean
Presentation:
- Remitting and relapsing
- malar rash
- malaise, alopecia, headache
- arthralgia
- secondary fibromyalgia ( pain all over body)
- Raynaud's
Investigations:
- Bloods - FBC, ESR
- Serology - Anti nuclear factor (ANA), Anti dsDNA, Anti-Ro/La
- Urinalysis - haematuria/ proteinuria
Management: Refer to radiologist
Conservative:
- avoid sun exposure
Pharmacological:
- paracetamol/ NSAIDs
- if not enough - corticosteroids or DMARDs
55
When is Cyclophosphamide used in SLE
Cyclophosphamide is reserved for treatment of life-threatening disease, particularly lupus nephritis, vasculitis and cerebral disease
56
Psoriatic arthritis summary
Inflammation, pain and swelling of joints in some people who have psoriasis
Management: refer to a rheumatologist
- NSAIDs
- Intra-articular steroid injection
- DMARDs
- skin ointments
- Steroid creams
- Retinoid tablets - vit A
57
Reactive arthritis summary
Reactive arthritis commonly affects young adults, most frequently white and carrying the HLA-B27 allele
Causes: C. trachomatis and Chlamydia pneumoniae are the most frequent
Presentation:
- develops 2-4 weeks after a genitourinary or gastrointestinal infection
- acute, with malaise, fatigue, and fever.
- asymmetrical, predominantly lower extremity, oligoarthritis
- Heel pain
- Triad: urethritis, conjunctivitis, and arthritis
```
Ix:
Bloods: FBC, ESR, CRP
Serology: HLA B27
Joint aspiration - rule out septic arthritis
Stool culture
```
```
Mx:
Physiotherapy
NSAIDs
Corticosteroids
Abx - treat causative organism
```
58
Ankylosing spondylitis
Bone fusion
Signs:
Xray - bamboo spine
