Brainscape's Knowledge GenomeTM

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


See full index

Yr3 GP > MSK conditions > Flashcards

MSK conditions Flashcards

1
Q

Describe Achilles tendinopathy

A

Pain, swelling and impaired function of the Achilles tendon
Common in active people

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

List complications of Achilles tendon injury

A

Tendon rupture
Negative impact on a person’s ability to work and carry out their usual activities
Limitation in sporting activity

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

Describe the signs and symptoms of Achilles tendinopathy

A

Aching pain in the heel
-pain is aggravated by activity or pressure to the area
Stiffness in the tendon
-may occur in the morning or after a period of prolonged sitting
Tenderness, swelling & crepitus along the tendon

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

Describe the diagnosis of Achilles tendinopathy

A

Usually a clinical diagnosis (imaging is not routinely recommended)
Examination – exclude Achilles tendon rupture:
1) Tenderness on palpation
2) Evaluate the range of motion of the ankle, pain worsens with passive dorsiflexion of the ankle

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

List differentials for Achilles tendinopathy

A

Retrocalcaneal bursitis
Plantaris tendinopathy
Dislocation of the peroneal/other plantar flexor tendons
Posterior ankle impingement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the management of Achilles tendinopathy

A

Arrange admission/same-day referral to orthopaedics if Achilles tendon rupture is suspected
Most common causes:
1) Fluoroquinolone antibiotics – discontinue
2) Hypercholesterolemia
3) Diabetes mellitus
Advice: cold packs, paracetamol, rest, can weight bear
Refer to physio for assessment if their symptoms fail to improve within 7-10 days
DO NOT INJECT CORTICOSTEROIDS INTO/AROUND THE TENDON

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

Describe ankylosing spondylitis

A

Axial spondyloarthritis characterised by sacroiliitis (inflammation of the sacroiliac joints) on x-ray

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

List the signs and symptoms of ankylosing spondylitis

A

Chronic back pain and stiffness that improves with exercise, not rest
Sacroiliac joint and spinal fusion
Arthritis and enthesitis
Dactylitis
Fatigue
Extra-articular manifestations – anterior uveitis, psoriasis, IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List complications of ankylosing spondylitis

A

Spinal fractures
Hip involvement
Osteoporosis
Anterior uveitis

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

Describe the diagnosis of ankylosing spondylitis

A

Chronic or recurrent low back pain, fatigue and stiffness:
-45 years or younger
- > 3 months
-worse in the morning, improving with movement
Refer to a rheumatologist for confirmation of the diagnosis

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

Describe the criteria for diagnosing ankylosing spondylitis

A

Modified New York criteria:
Clinical criteria:
-low back pain: present for more than 3 months, improvement by exercise but not relieved by rest
-limitation of lumbar spine motion in both the sagittal and frontal planes
-limitation of chest expansion relative to normal values for age and sex
Radiological criteria: sacroiliitis on x-ray
Diagnose: if the radiological criterion is present & at least one clinical criterion
Other: ASAS classification criteria for axial spondyloarthritis

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

List differential diagnosis for ankylosing spondylitis

A

Degenerative/mechanical problems eg. degenerative disc disease, spondylosis, congenital vertebral anomalies
Fractures
Infectious sacroiitis
Bone metastasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the management of ankylosing spondylitis

A

NSAIDs, if contraindicated standard analgesic
Confirmed diagnosis: flare management plan, NSAIDs, TNF-alpha inhibitors (may be greater risk of skin cancer)

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

Describe Baker’s cysts

A

Not true cysts
Distension of the gastrocneumius-semimembranosus bursa behind the knee
Primary cysts: not associated with underlying disease of the knee joint & found mainly in children
Secondary cysts: associated with underlying disease of the knee joint

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

Describe the diagnosis of a Baker’s cyst

A

Swelling and pain, may be aggravated by walking
Present with acute symptoms – if the cyst dissects/ruptures, history of a sudden ‘pop’
Examine the person standing and in the supine position – inspect and palpate the popliteal fossa for masses (bulge in medial popliteal fossa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List differential diagnosis for a Baker’s cyst

A

DVT
Superficial thrombophlebitis
Popliteal artery aneurysm
Lipoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the management of a Baker’s cyst

A

Arrange a same-day assessment in secondary care if any red flags are identified
Identify & optimise management of any underlying condition
Asymptomatic – no treatment
Simple analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe bunions

A

A toe deformity when the great toe laterally deviates away from the midline towards the lesser toes
Causes medial prominence of the first metatarsal head & overlying bursa may also become inflamed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe the diagnosis of bunions

A

Progressive pain at the medial aspect of the first MTP and/or medial aspect of the forefoot
Difficulty wearing shoes
Lateral deviation of the hallux at the first MTP joint
Medial prominence of the first metatarsal head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

List complications of bunion deformity

A

MTP joint pain
Difficulty finding comfortable footwear
OA of the first MTP joint
Impaired balance and increased risk of falls

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

List differential diagnosis for bunions

A

Hallux rigidus
Gout
Fracture
Inflammatory joint disease
Osteomyelitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe the management of bunions

A

Self-care: wear low-heeled, wide-fitting shoes with a soft sole
Offer referral to podiatry for a footwear assessment
Consider referral to the local MSK service

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

Describe carpal tunnel syndrome

A

Entrapment neuropathy caused by compression of the median nerve in the carpal tunnel at the wrist
Majority of cases are idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe the diagnosis of carpal tunnel syndrome

A

Intermittent paraesthesia
Numbness
Altered sensation
Burning/pain
All in the distribution of the median nerve
Examination – wasting of the thenar eminence muscles, weakness of median nerve movements, positive Phalen’s & Tinel’s test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

List differentials for carpal tunnel syndrome

A

Cubital tunnel syndrome
Cervical nerve root entrapment
De Quervains tenosynovitis
Osteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Describe the management of carpal tunnel syndrome

A

6-week trial of conservative treatment in primary care:
1) Use of wrist splint in a neutral position at night
2) A single corticosteroid injection into the carpal tunnel
3) Hand exercises and median nerve mobilisation techniques
Review after 6 weeks, arrange referral if seems appropriate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe giant cell arteritis

A

Chronic vasculitis characterised by granulomatous inflammation in the walls of medium and large arteries
Usually affects people over 50 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

List complications of giant cell arteritis

A

Vision loss
Large artery complications – aortic aneurysm, aortic dissection & large artery stenosis
Cardiovascular disease

29
Q

Describe the diagnosis of giant cell arteritis

A

Age > 50 and one of the following:
1) New-onset headache, usually in the temporal region
2) Temporal artery abnormality, occasionally the overlying skin is red & pulsation may be reduced/absent
Other symptoms include: visual disturbances, scalp tenderness, intermittent jaw claudication

30
Q

List differentials for giant cell arteritis

A

Herpes zoster
Cluster headache or migraine
Acute angle closure glaucoma

31
Q

Describe the management of giant cell arteritis

A

Medical emergency – early treatment with effective doses of glucocorticoids may prevent serious complications
If new visual loss -> urgent same day assessment by an ophthalmologist
Urgently discuss with a specialist & refer using a fast track local GCA pathway (diagnosis will be confirmed in secondary care)

32
Q

Describe gout

A

Type of arthritis caused by monosodium urate crystals forming inside and around joints
Causes sudden flares of severe pain, heat & swelling

33
Q

List risk factors for gout

A

Hyperuricaemia
Increasing age
Excess body weight or obesity
Male sex
Diet – excess alcohol, sugary drinks, meat & seafood

34
Q

List complications of gout

A

CVS disease
Chronic arthritis
CKD
Joint damage
Renal stones
Tophi

35
Q

Describe the diagnosis of gout

A

Rapid onset of severe pain together with redness and swelling in one or both MTPJs
Tophi
History of previous self-limiting attacks supports the diagnosis
Examination – warm, red and swollen joints, tophi

36
Q

List differentials for gout

A

Bursitis
Haemochromatosis
Pseudogout
Osteoarthritis

37
Q

Describe the management of gout

A

Acute flare-ups: NSAID at the maximum dose, colchicine, short course of oral corticosteroid
Prevention: urate-lowering therapy, offer allopurinol or febuxostat first-line, colchicine

38
Q

Describe Lyme disease

A

Infection caused by bacteria called Borrelia burgdorferi which are transmitted to humans following a bite from an infected tick

39
Q

List complications of Lyme disease

A

Severe neurological symptoms
Lyme arthritis

40
Q

Describe the diagnosis of Lyme disease

A

Clinical diagnosis of Lyme disease in people with erythema migrans (at the site of a tick bite, round or oval in shape, pinkish in colour, usually flat, expands over days to weeks)
Without erythema migrans -> clinical presentation & laboratory testing is used to guide diagnosis and treatment

41
Q

List differentials for Lyme disease

A

Tick bite hypersensitivity reaction
Cellulitis
Erythema multiforme

42
Q

Describe the management of Lyme disease

A

Prescribe oral antibiotics – doxycycline first line, amoxicillin & azithromycin second line
NB: a Jarisch-Herxheimer reaction may develop in the first 24 hours of treatment with any abx for Lyme disease

43
Q

What is Morton’s neuroma?

A

Compression neuropathy of the common digital plantar nerve
Occurs mostly in the third intermetatarsal space
Not a true neuroma, but a benign fibrotic thickening of the nerve due to constant irritation

44
Q

Describe the diagnosis of Morton’s neuroma

A

Pain in the forefoot, most commonly in the third intermetatarsal space -> sharp, stabbing, burning, shooting
Altered sensations & feeling a ‘lump’ in the show on weight bearing
Pain is intermittent as episodes occur with long intervals between attacks
Examination – pain is elicited on applying pressure to the involved inter-metatarsophalangeal space

45
Q

List differentials for Morton’s neuroma

A

Biomechanical problems – anomalies of the forefoot bone structure, instability issues, obesity
Soft tissue problems – focal plantar keratosis, plantar fibromatosis, plantar fat pad atrophy
Bone and joint disease – stress fractures, OA

46
Q

Describe the management of Morton’s neuroma

A

Advice: avoid high heels & shoes with a constricting tow box/thin soles, use a metatarsal pad, avoid impact activities
Consider NSAIDs if necessary
Consider referral if symptoms persist

47
Q

Describe olecranon bursitis

A

Occurs when the bursa is irritated and inflamed:
1) Non-septic: sterile inflammation resulting from various causes including trauma or overuse
2) Septic: infection resulting from seeding of the bursal sac with micro-organisms

48
Q

Describe the diagnosis of olecranon bursitis

A

Swelling over the olecranon process thar appears over several hours to several days, may be tender of warm, is fluctuant
Movement at elbow is painless except on full flexion
History of preceding trauma or bursal disease

49
Q

List differentials of olecranon bursitis

A

Rheumatoid arthritis
Septic arthritis
Gout
Cellulitis

50
Q

Describe the management of olecranon bursitis

A

Rest, ice and reduced activity
Compressive bandaging
Consider aspiration to improve function and comfort
If none of the above works = corticosteroid injection
Give oral abx if aspiration not possible in septic bursitis

51
Q

Describe Osgood-Schlatter disease

A

Apophysitis of the tibial tuberosity that causes anterior knee pain during adolescence and is usually self-limiting
-result of repetitive strain from the patella tendon at its insertion on the ossification centre of the tibial tuberosity

52
Q

Describe the diagnosis of Osgood-Schlatter disease

A

If there are no features suggestive of another cause of knee pain, OSD may be diagnosed clinically
Pain starts in adolescence and is:
1) Localised to tibial tuberosity
2) Gradual in onset & initially mild and intermittent
3) Unilateral (bilateral in 30%)
4) Relieved by rest
Examination – tenderness over the tibial tuberosity, pain provoked by resisted knee extension

53
Q

List the differentials of Osgood-Schlatter disease

A

Tumour
Inflammatory arthritis
Trauma
Infection

54
Q

Describe the management of Osgood-Schlatter disease

A

Symptoms usually resolve over time
Pain relief
Reduction in activity may be sufficient to control pain

55
Q

Describe osteoporosis

A

Disease characterised by low bone mass and structural deterioration of bone tissue -> increase in bone fragility and susceptibility
Asymptomatic, often remains undiagnosed until a fragility fracture occurs

56
Q

Describe plantar fasciitis

A

Condition in which there is persistent pain associated with degeneration of the plantar fascia as a result of repetitive microtears in the contracted fascia
Common condition, especially in people aged 40-60 years

57
Q

Describe the diagnosis of plantar fasciitis

A

Usually diagnosed by the history and physical examination findings alone
History – initial insidious onset of heel pain, intense heel pain during the first steps after waking/after a period of inactivity; pain reduces with moderate activity
Examination – tenderness on palpation of the plantar heel area, limited ankle dorsiflexion range, positive ‘windlass test’ (pain by extension of the first MTPJ)

58
Q

List differentials of plantar fasciitis

A

Achilles tendonitis
Flexor hallucis longus tendinopathy
Calcaneal stress fracture

59
Q

Describe the management of plantar fasciitis

A

Most people will make a complete recovery within a year
Self-care advice: rest the foot, wear shoes with good arch support & cushioned heels
Simple analgesics to provide symptom relief

60
Q

Describe polymyalgia rheumatica

A

Chronic, systemic rheumatic inflammatory disease characterised by aching and morning stiffness in the neck, shoulder and pelvic girdle
Cause of PMR is unknown

61
Q

List complications of polymyalgia rheumatica

A

Giant cell arteritis
Complications of long-term corticosteroid treatment

62
Q

Describe the diagnosis of polymyalgia rheumatica

A

Age > 50 years presenting with at least 2 weeks of:
1) Bilateral shoulder and/or pelvic girdle pain
2) Stiffness lasting for at least 45 minutes after waking or periods of rest
Other features: low-grade fever, fatigue, anorexia, weight loss & depression, peripheral musculoskeletal signs: carpal tunnel syndrome, peripheral arthritis, swelling with pitting oedema

63
Q

List differentials of polymyalgia rheumatica

A

Cervical and lumbar spondylosis
Osteoarthritis
Bilateral adhesive capsulitis and rotator cuff disorders
Thyroid disease

64
Q

Describe the management of polymyalgia rheumatica

A

Reduce the dose of prednisolone slowly when symptoms are fully controlled (typically treatment is required for between 1-2 years)
Ensure the person is provided with a blue steroid card
Arrange routine reviews one week after any change in dose and at least every 3 months in the first year following diagnosis
Ask about symptoms of GCA

65
Q

What is tennis elbow?

A

Tendinosis (chronic symptomatic degeneration of the tendon) that affects the common attachment of the tendons of the extensor muscles of the forearm to the lateral epicondyle of the humerus
Women and men are affected equally, peak incidence between 35-54 years of age

66
Q

Describe the diagnosis of tennis elbow

A

History – pain present in the dominant arm in the region of the lateral epicondyle with radiation down the extensor aspect of the forearm, symptoms exacerbated by wrist extension
Examination – localised point tenderness on palpation over and/or distal to the lateral epicondyle & along the common extensor tendon, resisted middle finger extension may be painful (Maudsley’s test), grip strength may be reduced

67
Q

List differentials of tennis elbow

A

Rheumatoid arthritis
Septic arthritis
Cervical radiculopathy
Elbow osteoarthritis

68
Q

Describe the management of tennis elbow

A

Advice: heat/ice, rest the arm, analgesia
No response to initial treatment after 6 weeks = consider arranging referral to physio, do not routinely offer corticosteroid injection
No response to treatment 6-12 months after initial presentation, consider referral to an orthopaedic surgeon for evaluation

Yr3 GP (4 decks)

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