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Management CP3 > MDD > Flashcards

MDD Flashcards

1
Q

Gout: Acute and Chronic

A

Acute: Fast acting NSAID - naproxen. Colchicine if CCF,CKD or chemo. Aspirate and corticosteroid injection aborts attack. Early mobilisation important.

Chronic: Hypouricaemic drugs, allopurinol = xanthine oxidase inhibitors. Uric acid levels measured every month and tried to be kept at the lower end of normal.
Lifestyle advice, reduce alcohol, total calorie/cholesterol, avoid certain foods e.g. offal and spinach.

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2
Q

Psuedogout

A

Acute similiar to gout - responds well to joint aspiration.

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3
Q

Fibromyalgia

A 
Education 
Aerobic exercise - swimming, running 
 - encourages sleep and tries to stop the cycle
Healthy balanced diet 
Low dose amitryptilline - 10-75mg nocte
- many people intolerant 
CBT helpful for coping strategies
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4
Q

Septic Arthritis/Osteomyelitis

A 
ABCDE resus and sepsis 6 
Admit under orthopaedics 
IV abx after aspiration - 2g fluclox 6hrly
Pain relief 
In-theatre washout (source control)
Early rehab improves outcome
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5
Q

Osteoarthritis

A

Education, weight loss, physio, topical NSAIDs and paracetemol for pain 1st line and oral w/ PPI cover 2nd line, supports and walking aids and steroid injection. Finally joint arthroplasty/arthrodesis.

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6
Q

Osteoporosis

A

Osteopenia - lifestyle advice - no smoking, alcohol, exercise and incerase calcium intake
Osteoporosis - weekly bisphosphonates - alendronic acid weekly - if cannot tolerate then use risondronate instead. Use with AdCal as adjunct.
HRT can be considered in post-meno women
Testosterone in males with hypo-gonadism
PTH analogue intermittent if all other treatment fails.

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7
Q

Osteomalacia

A

Vit D replacement high dose for 4 weeks then maintenance. IV if malnourished and activated if hepatic/renal failure.

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8
Q

Paget’s disease of the bone

A

Simple analgesia for pain and bisphosphonates for disease modification.

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9
Q

Carpal Tunnel.

A

Rest, physio, NSAIDs, splint in dorsiflexion, steroid injection, decompression surgery.

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10
Q

De Quervains tenosynovitis

A

Rest, spica splint, NSAIDs, steroid injection, compartemt release surgery if goes on >6m.

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11
Q

Base of thumb OA

A

Rest, NSAIDs, surgical: denervation, trapeziectomy, basal arthroplasty.

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12
Q

Medial and Lateral epicondylitis

A

Rest, NSAIDs, physio, clasp splint, surgery if above fails

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13
Q

Cubital Tunnel

A

Physio, splint (nocturnal), NSAID and steroid injection. Surgery if progressive and signs of permanent nerve damage.

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14
Q

Olecranon Bursitis

A

Ice and compression bandage. Rest, NSAIDs topical/PO. Aspirate, steroid injection.

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15
Q

Adhesive Capsulitis

A

NSAIDs, physio, steroid injection if not improved in 2 months. If hasn’t healed in 2y then surgery is an option.

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16
Q

Chronic rotator cuff tendonitis

A

NSAIDs, steroid injection if severe. Physio, surgery if impingement = arthroscopic decompression.

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17
Q

Acute rotator cuff tendonitis

A

USS/MRI diagnostic

Rest in sling, NSAIDs, steroid inj if severe. Should resolve in 1-3 weeks.

18
Q

Rotator cuff tear

A

USS/MRI or arthroscopy is diagnostic.
Acute: heat exercises and local anaesthetic injection to distinguish partial and complete tear. If young - surgery, if old - leave it.

19
Q

Trochanteric bursitis

A

Steroid Injection - if total hip replacement then pt. needs to be in laminar flow theatre.
Physio to stretch fascia lata

20
Q

Chondromalacia Patella

A

Physio

21
Q

ACL tear

A

Sprain/partial tear = physio and self resolves
Complete tear - surgical graft repair for young, older patients with low functional demand can be treated conservatively.

22
Q

MCL/LCL tear

A

usually heal by themselves, brace and physio. Almost never need surgery if isolated

23
Q

Meniscal tear

A

Arthroscopic repair if young as will progress to secondary OA if not repaired.

24
Q

Spine Red Flags

A 
Constant progressive pain 
Thoracic spine 
Pain at night 
B sx - fever, wt. loss, night sweats 
History of TB, HIV, prev. malignancy 
Midline tenderness on palpation 
Cauda Equina - bowel/bladder symptoms, saddle anaesthesia, prev. trauma.
25
Q

Simple/mechanical problem

A

Be active within limits, pain relief, physio - 90% recover in 6 weeks. Reassess in 6w if pain hasn’t settled.

26
Q

Acute lumbar disc prolapse

A

Make sure to test myotomes and dermatomes and reflexes!!
Bed rest for 2 weeks w/ NSAIDs.
Epidural injections, MRI and neurosurgical referral.

27
Q

Lumbar canal stenosis

A

Activity modification, physiotherapy. Surgical laminectomy - OA pain will still exist.

28
Q

Cervical spondylitis/brachial neuropathy/cervical radiculopathy

A

Hard support collar, rest, analgesia, sedation as necessary. Usually recovers in 6-12 weeks. Consider neurosurgery referral.

29
Q

Cervical myelopathy

A

Causes include cervical canal stenosis

Refer to neurosurgery urgently.

30
Q

Ank Spond

A

NSAIDs, physio, annual assessment, biologics if no improvement

31
Q

Cervical disc prolapse

A

support collar, rest, analgesia, sedation 6-12 weeks, can do root block.

32
Q

Rheumatoid Arthritis

A

General Management:
When diagnosed Methotrexate combined with one other DMARD sulfasalazine/hydroxychloroquine and also a short course of oral prednisolone. If the above does not control the disease and they still have a disease activity score of over 5.5, can consider biologics.

33
Q

Ankylosing Spondylitis

A

Important to catch early to prevent sydesmophyte formation and calcification of joints. Ca lead normal life with good Rx.

  • Early morning exercise to maintain posture and spinal motility
  • Slow release NSAIDs to relieve pain at night and in early morning.
  • Methotrexate can be used for peripheral arthritis
    TNF-a blockers can be used for all aspects of joint inflammation e.g. infliximab
    Biologics = TNFa blockers
34
Q

Reactive Arthritis

A

NSAID and local corticosteroid injection. If relapse then sulfasalazine is often used (methotrexate and TNF-a blocker can also be used in relapse)

35
Q

Psoriatic Arthritis

A

One Joint - full dose NSAIDs +/- corticosteroid injections

More than one joint - treat as per RA, prognosis is better. Methotrexate helps with skin also.

36
Q

SLE

A

Avoid sunlight and reduce CV risk factors
Monitor for signs of infection (neutropenia) and treat early
Mild disease NSAIDs and hydroxychloroquine (skin, arthralgia and fatigue)
Severe disease (involving CV/kidney) - prednisolone w/ DMARDs such as azathioprine

37
Q

APL

A

Hx of severe thrombosis - warfarin, target INR 3-4
W/out thrombotic Hx - low dose aspirin ad lifestyle advice - avoid prolonged immobilisation and oestrogen containing drugs.

38
Q

Sjorgren’s Syndrome

A

Artificial tear replacement

39
Q

Limited cutaneous sclerosis

A

Digital sympathemectomy
remove calcinosis if symptomatic
treatment of oesophageal problems

40
Q

Diffuse cutaneous sclerosis

A

Immunosuppressant therapy - aim to prevent complications and gradually withdraw as the disease stabilises

41
Q

Poly/dermatomyositis

A

prednisolone/DMARDs until myositis is clinically inactive. IVIG therapy may be used in some cases

Management CP3 (4 decks)

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