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Medicine Phase 2a MSK and Rheumatology > General > Flashcards

General Flashcards

1
Q

What is osteomalacia

A

Inadequate mineralisation of osteoid framework

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2
Q

Osteomalacia Clinical presentation

A

Proximal muscle weakness and pain
Low bone density
In children: bowed legs and knock knees (Rickets in children)

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3
Q

Pathophysiology of osteomalacia

A

Normal bone mineralisation depends on adequate calcium and phosphate.
Vitamin D promotes calcium absorption in intestines, promotes bone resorption (by increasing osteoclast number)

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4
Q

Aetiology of osteomalacia

A

Profound vit D deficiency

Lack of exposure to sunlight and/or GI malabsorption

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5
Q

Osteomalacia epidemiology

A

More common in pigmented skin and elderly

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6
Q

Treatment of osteomalacia

A

Oral calciferol

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7
Q

Diagnostic test of osteomalacia

A

X-ray (defective mineralisation)

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8
Q

When is an illness due to work?

A

Symptoms improve away from work or on holiday e.g. occupational asthma
Characteristic distribution of rash eg contact dermatitis
Sensorineural deafness with characteristic pattern on audiogram caused by noise
A cluster of cases in a workplace
Exposure to hazard can be linked to disease and exposure would not have occurred away from work
An injury is said to due to work when it has been caused by work, or work has substantially contributed to the injury

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9
Q

What are the epidemiological principles of causality

A 
Bradford Hill criteria:
Strength of association (high and significant odds ratios)
Consistency in association
Exposure-response relationship
Specificity
Temporal relationship
Coherence of evidence
Biologically plausible
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10
Q

Risk factors in work place for MSK problems

A 
Heavy manual handling (>20Kg)
Lifting above shoulder height
Lifting from below knee height
Incorrect manual handling technique
Forceful movements
Fast repetitive work; poor postures; poor grip
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11
Q

True or false:
Employers have a legal duty to avoid hazardous manual handling; undertake a risk assessment; reduce the risk of injury to as low as is reasonably practicable

A

Very True

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12
Q

Examples of MSK conditions of upper limb resulting from work

A 
Carpal Tunnel Syndrome
Hand-arm vibration syndrome (HAVS)
Tenosynovitis
Epicondylitis
Repetitive strain disorder
Rotator cuff problems
Thoracic Outlet syndrome
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13
Q

Examples of MSK conditions of lower limb resulting from work

A

*Osteoarthritis of hip and/or knee

Plantar fasciitis, Housemaid’s knee

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14
Q

Tests of Carpal Tunnel Syndrome

A

Tinel’s and Phalen’s provoking tests

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15
Q

Aetiology of Carpal Tunnel Syndrome

A

May be caused by forceful and repetitive work
Extremes of flexion-extension of wrist eg painters, meat processors – Prescribed Disease IIDB (A12)
Hand-transmitted vibration (ORs 3-14) – Prescribed Disease IIDB (A12)

Associated with obesity, short stature, pregnancy, OCP, diabetes, hypothyroidism, RA, acromegaly

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16
Q

What nerve is compressed in carpal tunnel syndrome

A

Median nerve

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17
Q

Cause of Hand-arm vibration syndrome

A

Excessive exposure to hand-transmitted vibration (>2.5m/s2 per 8 hour day)
Chain saws, angle grinders, jack hammers, drills

Exclude other causes of neuropathy in hands

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18
Q

Features of Hand-arm vibration syndrome

A

Cause of second Raynaud’s phenomenon
Vascular (blanching) and neural (tingling, numbness and loss of dexterity) components
Hypothenar hammer syndrome (occlusion of ulnar artery and superficial palmar arch)

19
Q

cause of tenosynovitis

A

Most commonly caused by inflammation of APL and EPB tendon-sheath
High risk if job requires forceful and repetitive hand movements

20
Q

Test of tenosynovitis

A

Finkelstein’s test

21
Q

Treatment of tenosynovitis

A

NSAIDs, steroid injection, rest
Change job
Prescribed Disease for IIDB (A8)

22
Q

Cause/epidemiology of epicondylitis

A

Common in the general population, tennis players (lateral) and golfer’s (medial)
Associated with forceful flexion-extension of the wrist or forceful pronation-supination

23
Q

Main symptom of epicondylitis

A

Weakness of grip

24
Q

Test of epicondylitis

A

Cozen’s test

25
Q

Treatment of epicondylitis

A

NSAIs, steroid injection, clasp, rest, surgery

May be caused by work but NOT a Prescribed Disease for IIDB

26
Q

What is Repetitive strain disorder?

A

Non-specific pain in the hand

e.g. Writers cramp (prescribed disease for IIDB)

27
Q

Treatment of Repetitive strain disorder

A

Rest breaks, job rotation, reduced force, ergonomically neutral working postures

28
Q

What is IIDB

A

Industrial Injuries Disablement Benefit

29
Q

Features of Rotator Cuff problems and jobs that can cause it

A

Tendonitis or tear
May be associated with shoulder impingement and osteoarthritis of acromioclavicular joint
Painful arc
Jobs which involve heavy manual handling, lifting above shoulder height and throwing are high risk

30
Q

Which tendon is most commonly affected in rotator cuff problems

A

Supraspinatus tendon

31
Q

Sign of rotator cuff problem

A

Hawkin’s sign

32
Q

What is thoracic outlet syndrome

A

Pain or tingling down arm or blanching of fingers related to posture of arm
Compression of trunks of brachial plexus or subclavian artery in neck (under the clavicle)

33
Q

Cause of thoracic outlet syndrome

A

Cervical rib, cervical band or other abnormalities of anatomy in neck
Associated with poor posture or loading of shoulders

34
Q

Sign of thoracic outlet syndrome and other diagnostic tests

A

Roos sign
X-ray, MRI, NCTs
(treat with surgery)

35
Q

Causes of OA of hip

A

Associated with CDH, slipped epiphyses, Perthe’s disease

Occupationally associated with heavy manual work and a lot of walking eg farming

36
Q

Treatment of OA of hip

A

Weight loss, NSAIs, paracetamol, arthroplasty

Prescribed Disease for IIDB (A13) for farmers >10 years in job

37
Q

Causes of OA of knee

A

Associated with obesity, trauma and menisectomy
Occupationally associated with heavy manual work and knee flexion-extension (eg prolonged stair climbing, squatting, kneeling)

38
Q

OA of knee is a prescribed disease for IIDB for what profession

A

Miners

Carpet/floor layers >10 years in job

39
Q

Getting person with MSK problems back to work - things to consider

A

Are there any barriers for the patient to returning to work?
Fitnote
Rehabilitation back to work (phased return, restricted duties, workplace modifications)
Confidence for work may have been lost
Access to Work service
Does the employer have an occupational health service? (If so, and with the patient’s consent, write to them)

40
Q

Causes of mechanical back pain

A

Associated with heavy manual handling, stooping and twisting whilst lifting, exposure to whole body vibration, psychosocial distress, smoking and dissatisfaction with work

41
Q

MRI scan of mechanical back pain

A

Disc degeneration and bulging discs on a MRI scan are a normal finding

42
Q

Treatment of mechanical back pain

A

Avoid prolonged inactivity and maintain normal activities within limits of back pain
Simple, compound analgesics or NSAIs

Spinal manipulative therapy may benefit
Spinal exercises, behavioural therapy and workplace adaptations all have a small benefit

43
Q

Important legal organisations or legalisations to be aware of in MSK injury

A
  • Equality Act and reasonable adjustments for the disabled or ill
  • Industrial Injury Disablement Benefit (DWP) – a no fault state run compensation system for loss of earnings
  • Personal injury litigation for work-related injuries or illnesses – claim for compensation must be started within three years of injury/illness
  • Access to Medical Reports Act - A patient can be lawfully dismissed for incapability due to ill health (different from redundancy)
  • Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) to the HSE – CTS, HAVS or tenosynovitis
44
Q

Example illnesses that need to be reported to HSE according to RIDDOR

A

Carpal Tunnel Syndrome
Hand-arm vibration syndrome
Tenosynovitis

Medicine Phase 2a MSK and Rheumatology (18 decks)

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