Joints, Rashes, Confusion and Falls Flashcards
differences between the presentation of inflammatory vs. non-inflammatory arthritis
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,
what are the red flags for cauda equina syndrome?
bilateral neurological deficit of the legs
recent onset urinary retention
recent onset incontinence
perianal/perineal sensory loss (saddle paresthesia)
what are red flags for spinal fracture?
sudden onset severe central spinal pain- relieved by lying down
Hx of trauma
deformity of the spine
point tenderness over vertebral body
what are red flags for spinal cancer?
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
what are the x-ray changes in osteoarthritis?
loss of joint space
osteophytes
subarticular sclerosis (increased bone density)
subchondral cysts
which joints are commonly affected in osteoarthritis?
hips knees sacra-iliac joints DIPJs wrist carpometacarpal joint in the base of thumb
how is osteoarthritis managed?
conservative- education, weight loss, physiotherapy, OT, orthotics
medical- analgesia (pain ladder), intra-articular steroid injections
surgery- joint replacement
how does rheumatoid arthritis present?
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
which joints are commonly affected in rheumatoid arthritis?
PIP and MCP joints wrists and ankles metatarsophalangeal joints cervical spine knee, hip, shoulder
what signs are seen in the hands in advanced rheumatoid arthritis?
boggy swelling
Z thumb
swan neck (hyperextended PIP and flexed DIP)
boutonnieres (hyperextended DIP and flexed PIP)
ulnar deviation
what are the X-ray changes seen in rheumatoid arthritis?
joint destruction and deformity
erosions
periarticular osteopenia
soft tissue swelling
what blood tests are important in rheumatoid arthritis?
inflammatory marker- CRP, ESR
rheumatoid factor and anti-CCP
what is DAS28?
disease activity score for rheumatoid arthritis
how is rheumatoid arthritis managed?
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
how does septic arthritis present?
rapid onset single joint- usually knee red, hot, swollen and painful joint stiffness and reduced range of motion systemic symptoms- fever, lethargy, sepsis
how is septic arthritis managed?
joint aspiration- sample sent for gram staining, culture and sensitivities
IV antibiotics given until sensitivities are known
antibiotics usually continues for 3-6 weeks
what are negatively bifringent needle shaped urate crystals suggestive of?
gout
what are positively bifringent rhomboid shaped calcium phosphate crystals suggestive of?
pseudogout
how is bone mineral density measured?
DEXA scan
what scoring systems are there for osteoporosis?
Qfracture
FRAX
how is osteoporosis managed?
CONSERVATIVE maintain a healthy weight adequate calcium and vitamin D intake avoiding falls MEDICAL bisphosphonates- alendronate, risedronate HRT- post menopause
how do bisphosphonates need to be taken?
on an empty stomach and have to sit upright for 30 minutes before eating or moving to prevent reflux and oesophageal erosions
what is the typical presentation of a neck of femur fracture?
shortened and externally rotated leg
what is the definition of sepsis?
life-threatening organ dysfunction caused by a disregulated immune response to infection
what are scoring systems for sepsis?
SIRS criteria
QSOFA
what are the components of the sepsis 6?
take- blood cultures, lactate, urine output
give- oxygen, broad spectrum IV antibiotics, IV fluids
what os the definition of delirium?
a common clinical syndrome characterised by disturbed consciousness, cognitive function or perception which has an acute onset and fluctuating course
what are the subtypes of delirium?
hypoactive delirium
hyperactive delirium
mixed
what are tools to assess cognitive function?
4AT test
AMT 10
systemic approach to X-ray interpretation
- patient details
- quality of image
- bones- cortical margins, fracture, bone surface/contours (irregular, erosive, osteophytes), bone density, alignment
- Joint space and cartilage- narrowed, widened, effusion
- soft tissues- swelling, laceration, presence of gas
- anything else- foreign body, replacement, metal work
what areas are most affected by eczema?
flexor surfaces, face and neck
what are the lesions in eczema typically like?
erythematous, vesicular, weepy and itchy
scratching can lead to excoriations and lichenification
may have nail pitting and ridging
which areas are commonly affected by psoriasis?
extensor surfaces and scalp
how is acne managed?
topical therapies- benzoyl peroxide, topical antibiotics, topical retinoids
last line- oral retinoids e.g. isoretinoin, prescribed by specialists only
what is the difference between erysipelas and cellulitis?
erysipelas has a well defined red raised border
cellulitis is more diffuse
cellulitis involves deeper tissue than erysipelas
what are the 3 most common types of skin cancer?
basal cell carcinoma
squamous cell carcinoma
malignant melanoma
appearance of the different types of skin cancer
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
when should you refer people with the 2WW skin cancer pathway?
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
