Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 GP > MSK > Flashcards

MSK Flashcards

1
Q

MSK screening assessment

A

GALS

  • gait
  • arms
  • legs
  • spine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Red flag symptoms for cauda equina

A
  • perianal numbness
  • bilateral sciatica
  • faecal and urinary incontinence
  • painless retention of fluid
  • impotence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Red flag symptoms for spinal fracture

A

Major trauma

Sudden onset central spinal pain, better when lying down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Red flag symptoms for infection

A

Fever
Immunocompromised - HIV, Diabetes
TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Sciatica

A

Pain arising from lower back, radiating to BELOW the knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management of non- specific lower back pain

A

Conservative:

  • weight loss
  • pain relief - NSAID
  • physiotherapy
  • CBT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Diagnosis of back pain

A

History
Examination
Neurological examination - loss of sensation, reflexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cauda equina management

A

Surgical decompression within 48 hrs of sphincter symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When to use opiod

A

If NSAID is contraindicated

Can be used +/- paracetamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

NSAID use

A

Prescribe weakest dose for the shortest time
Consider PPI adjunct
Take with meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Sciatica management

A

If chronic and nothing else has worked: Epidural injections with local anaesthetics

Spinal decompression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Clinical presentation of osteoarthritis

A
  • initially asymmetrical monoarthritis (can develop into polyarthritis)
  • gradual onset
  • functional impairment
  • pain worse at end of day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which joints does OA normally affect

A

DIPJ and first CMCJ at base of thumb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

RF for OA

A 
Age 
Obesity 
Repetitive movements
FHx 
Hip OA - Female
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Signs of OA on Xray

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Management of OA

A 
Conservative: 
Weight loss 
Smoking cessation
Muscle strengthening
Hot/cold compresses 
Appropriate footwear

Pharmacological:
Paracetamol
NSAIDs - topical gel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Q

Score for OA of hip and knee management

A

Oxford hip and knee score

26
Q

RA presentation

A
  • 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
Q

Signs of RA hand

A 
Rheumatoid nodules 
Ulnar deviation 
Herberden's and Bouchard's nodes (commonly PIPs) 
Z thumb 
Swan neck deformity
28
Q

Extra-articular and systemic features of RA

A 
Vasculitis 
Malaise
Fatigue 
Fever 
Sweats 
Weight loss
29
Q

Investigations of RA

A

Bloods:

  • FBC
  • U+Es
  • LFTs
  • CRP
  • RF

Xray (not commonly done) - mainly clinical diagnosis

30
Q

Management of RA

A

Refer pt with persistant synovitis with unknown cause to rheumatologist - 3ww

31
Q

When to urgently refer RA pt

A

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
Q

When to suspect flare of RA

A

Worsening signs or symptoms of: stiffness, pain, joint tenderness, loss of function, snovitis

Increase in CRP

33
Q

Management of RA flare

A

Seek specialist advice

Offer short term glucocorticoid injection if localised flare

34
Q

Bursitis presentation

A 
Swelling on joint 
Gradual onset - hours to days
Painless - can be tender or warm 
Fluctuant 
History of trauma or skin abrasion
35
Q

Features of septic bursitis

A 
Increased tenderness and pain 
Red, hot, swollen 
Local cellulitis 
Fever 
Immunocompromised
36
Q

Management of bursitis

A

Conservative:

  • rest, ice, reduced activity
  • avoid trauma
  • tubigrip
If septic:
- aspirate and culture 
- abx - flucloxacillin 
(if allergic - clarithromycin) 
- review after 7 days
37
Q

Osteoporosis pathophysiology

A

Low bone mass and structural deterioration of bone tissue

38
Q

Causes of osteoporosis

A

Ageing - osteoclast activity has higher activity than osteoblasts

Menopause - lack of oestrogen therefore osteoclast activity not inhibited

39
Q

Complications of osteoporosis

A

Hip fractures

Vertebral fractures

40
Q

Which joints does gout normally affect?

A

Metatarsophalangeal joint 78%

  • midfoot, ankle, knee
  • fingers, wrist and elbow joints
41
Q

Presentation of gout

A 
Severe pain 
Swelling 
Redness 
Warmth 
Tenderness 
Tophi
42
Q

RF for gout

A

Alcohol intake
Drug use - ACEi, Beta blockers, diuretics
FHx

43
Q

Investigations for gout

A

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
Q

Management of gout

A

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
Q

If cannot tolerate NSAIDs in gout

A

A short course of oral corticosteroids or a single intramuscular corticosteroid injection

  • if intra-articular injection is not possible
  • in oligo-/polyarticular gout.
46
Q

Mx if acute monoarticular gout and co-morbidity provided the diagnosis is certain, the person (and joint) are suitable for injecting

A

Joint aspiration and intra-articular corticosteroids

47
Q

Allopurinol in gout

A

Do not stop allopurinol or febuxostat during an acute attack of gout if the person is already established on these drugs

48
Q

Gout follow up

A

Check serum uric acid
BP
HbA1c, lipid profile, renal function
Manage underlying conditions e.g. HTN

49
Q

Prevention of gout

A
  • 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
Q

Who should receive urate lowering drugs

A 
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
Q

Septic arthritis presentation

A 
Systemically unwell (with or without a temperature) 
Acute painful, hot, swollen joint.
52
Q

Inflammatory arthritis - Seropositive:

A
  • RA
  • SLE
  • scleroderma
  • Vasculitis
  • Sjogren’s
53
Q

Inflammatory arthritis - seronegative

A 
Ankylosing spondylitis 
Psoriatic arthritis 
Reactive arthritis 
Inflammatory bowel disease arthritis 
Infective arthritis
54
Q

SLE summary

A

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
Q

When is Cyclophosphamide used in SLE

A

Cyclophosphamide is reserved for treatment of life-threatening disease, particularly lupus nephritis, vasculitis and cerebral disease

56
Q

Psoriatic arthritis summary

A

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
Q

Reactive arthritis summary

A

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
Q

Ankylosing spondylitis

A

Bone fusion

Signs:
Xray - bamboo spine

Year 3 GP (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions