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TCBL > Joints, Rashes, Confusion and Falls > Flashcards

Joints, Rashes, Confusion and Falls Flashcards

1
Q

differences between the presentation of inflammatory vs. non-inflammatory arthritis

A

inflammatory- pain and stiffness worse in mornings (>30 minutes) and on inactivity, joint swelling, systemic symptoms
non-inflammatory- pain and stiffness worse after activity/ end of day, bony swelling,

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2
Q

what are the red flags for cauda equina syndrome?

A

bilateral neurological deficit of the legs
recent onset urinary retention
recent onset incontinence
perianal/perineal sensory loss (saddle paresthesia)

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3
Q

what are red flags for spinal fracture?

A

sudden onset severe central spinal pain- relieved by lying down
Hx of trauma
deformity of the spine
point tenderness over vertebral body

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4
Q

what are red flags for spinal cancer?

A

over 50 years
gradual onset of symptoms
severe unremitting pain which remains when supine- disturbs sleep
weight loss
Hx of cancer- breast, lung, prostate, renal, thyroid

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5
Q

what are the x-ray changes in osteoarthritis?

A

loss of joint space
osteophytes
subarticular sclerosis (increased bone density)
subchondral cysts

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6
Q

which joints are commonly affected in osteoarthritis?

A 
hips 
knees
sacra-iliac joints
DIPJs 
wrist 
carpometacarpal joint in the base of thumb
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7
Q

how is osteoarthritis managed?

A

conservative- education, weight loss, physiotherapy, OT, orthotics
medical- analgesia (pain ladder), intra-articular steroid injections
surgery- joint replacement

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8
Q

how does rheumatoid arthritis present?

A

symmetrical distal polyarthropathy
pain and stiffness mostly in small joints of the hands and feet normally worse in the morning/after rest
boggy joint swelling
systemic symptoms

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9
Q

which joints are commonly affected in rheumatoid arthritis?

A 
PIP and MCP joints 
wrists and ankles 
metatarsophalangeal joints 
cervical spine 
knee, hip, shoulder
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10
Q

what signs are seen in the hands in advanced rheumatoid arthritis?

A

boggy swelling
Z thumb
swan neck (hyperextended PIP and flexed DIP)
boutonnieres (hyperextended DIP and flexed PIP)
ulnar deviation

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11
Q

what are the X-ray changes seen in rheumatoid arthritis?

A

joint destruction and deformity
erosions
periarticular osteopenia
soft tissue swelling

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12
Q

what blood tests are important in rheumatoid arthritis?

A

inflammatory marker- CRP, ESR

rheumatoid factor and anti-CCP

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13
Q

what is DAS28?

A

disease activity score for rheumatoid arthritis

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14
Q

how is rheumatoid arthritis managed?

A

1st line- DMARD mono therapy (methotrexate, lefunomide, sulfasalazine)
2nd line- 2 DMARDs in combination
3rd line- methotrexate plus a biological therapy (usually anti-TNF e.g. infliximab)
NSAIDS/COX2 inhibitors + PPI- symptom control

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15
Q

how does septic arthritis present?

A 
rapid onset 
single joint- usually knee
red, hot, swollen and painful joint 
stiffness and reduced range of motion
systemic symptoms- fever, lethargy, sepsis
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16
Q

how is septic arthritis managed?

A

joint aspiration- sample sent for gram staining, culture and sensitivities
IV antibiotics given until sensitivities are known
antibiotics usually continues for 3-6 weeks

17
Q

what are negatively bifringent needle shaped urate crystals suggestive of?

A

gout

18
Q

what are positively bifringent rhomboid shaped calcium phosphate crystals suggestive of?

A

pseudogout

19
Q

how is bone mineral density measured?

A

DEXA scan

20
Q

what scoring systems are there for osteoporosis?

A

Qfracture

FRAX

21
Q

how is osteoporosis managed?

A 
CONSERVATIVE
maintain a healthy weight 
adequate calcium and vitamin D intake 
avoiding falls 
MEDICAL 
bisphosphonates- alendronate, risedronate 
HRT- post menopause
22
Q

how do bisphosphonates need to be taken?

A

on an empty stomach and have to sit upright for 30 minutes before eating or moving to prevent reflux and oesophageal erosions

23
Q

what is the typical presentation of a neck of femur fracture?

A

shortened and externally rotated leg

24
Q

what is the definition of sepsis?

A

life-threatening organ dysfunction caused by a disregulated immune response to infection

25
Q

what are scoring systems for sepsis?

A

SIRS criteria

QSOFA

26
Q

what are the components of the sepsis 6?

A

take- blood cultures, lactate, urine output

give- oxygen, broad spectrum IV antibiotics, IV fluids

27
Q

what os the definition of delirium?

A

a common clinical syndrome characterised by disturbed consciousness, cognitive function or perception which has an acute onset and fluctuating course

28
Q

what are the subtypes of delirium?

A

hypoactive delirium
hyperactive delirium
mixed

29
Q

what are tools to assess cognitive function?

A

4AT test

AMT 10

30
Q

systemic approach to X-ray interpretation

A
  1. patient details
  2. quality of image
  3. bones- cortical margins, fracture, bone surface/contours (irregular, erosive, osteophytes), bone density, alignment
  4. Joint space and cartilage- narrowed, widened, effusion
  5. soft tissues- swelling, laceration, presence of gas
  6. anything else- foreign body, replacement, metal work
31
Q

what areas are most affected by eczema?

A

flexor surfaces, face and neck

32
Q

what are the lesions in eczema typically like?

A

erythematous, vesicular, weepy and itchy
scratching can lead to excoriations and lichenification
may have nail pitting and ridging

33
Q

which areas are commonly affected by psoriasis?

A

extensor surfaces and scalp

34
Q

how is acne managed?

A

topical therapies- benzoyl peroxide, topical antibiotics, topical retinoids
last line- oral retinoids e.g. isoretinoin, prescribed by specialists only

35
Q

what is the difference between erysipelas and cellulitis?

A

erysipelas has a well defined red raised border
cellulitis is more diffuse
cellulitis involves deeper tissue than erysipelas

36
Q

what are the 3 most common types of skin cancer?

A

basal cell carcinoma
squamous cell carcinoma
malignant melanoma

37
Q

appearance of the different types of skin cancer

A

BCC- small skin-coloured papule or nodule with a pearly rolled edge, may have a necrotic or ulcerated centre
SCC- keratotic, ill-defined nodule which may ulcerate
malignant melanoma- pigmented lesion, asymmetrical shape, irregular colour, changing in size/colour

38
Q

when should you refer people with the 2WW skin cancer pathway?

A

scoring 3 or more on the 7 point checklist
2 points- change in size, irregular shape, irregular colour
1 point- diameter >7mm, inflammation, oozing, change in sensation

TCBL (4 decks)

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