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Phase 3a > GP - MSK > Flashcards

GP - MSK Flashcards

1
Q

What does an x-ray show in patients with OA?

A

LOSS:
- Loss of joint space
- Osteophytes forming at joint margins
- Subchondral sclerosis
- Subchondral cysts

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2
Q

Which joints are usually affected in OA?

A
  • Large weight-bearing joints (hip/knee)
  • Carpometacarpal joints
  • DIP/PIP joints
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3
Q

What are the clinical features of OA?

A
  • Pain following activity - improves with rest
  • Unilateral symptoms
  • No systemic upset
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4
Q

What is the management for OA?

A
  • Lifestyle changes = weight loss/muscle strengthening exercises/aerobic fitness
  • Topical NSAIDs (first line)
  • Oral NSAIDs + PPI
  • Intra-articular steroid injections
  • Joint replacement
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5
Q

What will an x-ray show in RA?

A

LOSE
- Loss of joint space
- Osteopenia
- Soft tissue swelling
- Erosions

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6
Q

What are the clinical features of gout?

A
  • Maximal intensity develops within 12 hours
  • Pain
  • Swelling
  • Erythema
  • Often 1st MTP joint or ankle/wrist/knee
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7
Q

What are the investigations for gout?

A
  • Bloods = uric acid levels (>360 umol/L)
  • Synovial fluid analysis = needle shaped negatively birefringent monosodium urate crystals under polarised light
  • X-ray = joint effusion/well-defined ‘punched-out’ erosions with sclerotic margins with overhanging edges/preservation of joint space
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8
Q

What is the management for gout?

A
  • FIRST LINE = NSAIDs/colchicine (+PPI)
  • Lifestyle changes = reduce alcohol/lose weight/avoid food high in purines
  • Oral steroids e.g. prednisolone
  • Intra-articular steroid injection
  • Urate-lowering therapy (allopurinol/febuxostat)
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9
Q

What are the clinical features and investigations for pseudogout?

A
  • Knee/wrist/shoulders most commonly affected
  • Pain
  • Swelling
  • Erythema
  • Joint aspiration = weakly-positive birefringent rhomboid-shaped crystals
  • X-ray = chondrocalcinosis
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10
Q

What is the management for pseudogout?

A
  • Aspiration of joint fluid (rule out septic arthritis)
  • NSAIDs
  • Intra-articular/intra-muscular/oral steroids
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11
Q

What are the clinical features of polymyalgia rheumatica?

A
  • Typically >60 years
  • Rapid onset (<1 month)
  • Aching/morning stiffness in proximal limb muscles
  • Polyarthralgia
  • Lethargy/depression
  • Low-grade fever/anorexia/night sweats
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12
Q

What are the investigations for polymyalgia rheumatica?

A
  • Bloods = ESR raised
  • CK and EMG normal
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13
Q

What is the management for polymyalgia rheumatica?

A

Prednisolone

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14
Q

What are red flags for lower back pain?

A
  • Age <20 or >50 years
  • History of previous malignancy
  • Night pain
  • History of trauma
  • Systemically unwell
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15
Q

What are the clinical features of facet joint pain?

A
  • May be acute or chronic
  • Pain worse in morning and on standing
  • Pain over facets
  • Pain worse on extension of back
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16
Q

What are the clinical features and investigations for spinal stenosis?

A
  • Gradual onset
  • Unilateral/bilateral leg pain +/- back pain
  • Numbness/weakness which is worse on walking
  • Pain relieved on sitting down/leaning forwards/crouching down
  • MRI needed to confirm
17
Q

What are the clinical features of ankylosing spondylitis?

A
  • Typically young man with lower back pain and stiffness
  • Usually worse in morning and improves with activity
18
Q

What are the clinical features of peripheral arterial disease?

A
  • Pain on walking - relieved by rest
  • Absent/weak foot pulses and other signs of limb ischaemia
  • Past history may include smoking/vascular diseases
19
Q

What are the clinical features of a prolapsed disc?

A
  • Dermatomal leg pain associated with neurological deficits
  • Leg pain usually worse than back
  • Pain often worse when sitting
20
Q

What is the investigation for lower back pain?

A

MRI - only if:
- Non-specific back pain
- Result will likely change management
- Malignancy/infection/fracture/cauda equina/ankylosing spondylitis suspected

21
Q

What is the management for lower back pain?

A
  • FIRST LINE = NSAIDs (+PPI)
  • Encourage self-management and to stay physically active/exercise
22
Q

What are the clinical features of a hip fracture?

A
  • Pain
  • Shortened and externally rotated leg
  • May/may not be able to weight bear
23
Q

What is the management for hip fractures?

A
  • Intracapsular = internal fixation/hemiarthroplasty/total hip replacement
  • Extracapsular = dynamic hip screw/intramedullary device
24
Q

What is a complication of hip fractures?

A

Avascular necrosis

25
Q

What is the general management for fractures?

A
  • Immobilise fracture including proximal and distal joints
  • Monitor and document neurovascular status
  • Tetanus prophylaxis
  • IV broad spectrum abx for open injuries
  • Open fractures = emergency = thoroughly debrided and lavaged within 6 hours of injury
26
Q

What are the most common causes of septic arthritis?

A
  • Staph. aureus
  • Sexual health history - neisseria gonorrhoea
  • IVDU - pseudomonas aeruginosa

Phase 3a (21 decks)

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