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Year 3 - GP Block > MSK & Lower Back > Flashcards

MSK & Lower Back Flashcards

1
Q

Cauda equina

  1. S&S
  2. Management
A

S&S

  1. Spine/leg pain
  2. Peri-anal numbness
  3. Bladder/bowel dysfunction (eg. cannot hold midstream)

Mx

  1. Emergency surgery
    - Decompressive laminectomy
  2. VTE prophylaxis
  3. Supportive therapy
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2
Q

Metastatic Spinal Cord Compression (MSCC)

  1. S&S
  2. Mx
A
  1. Back pain
    Paraesthesia
    Bladder/bowel loss of tone
    Hyper reflexia
  2. Refer for surgery
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3
Q

Spinal infection

  1. S&S
  2. Mx
A
  1. Fever
    Weakness/paralysis
    Spinal pain
    Meningism
  2. Abx + Sepsis 6
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4
Q

Septic arthritis
1. S&S

  1. Mx
A
  1. Warm, red joint
    Very painful
    Febrile
    Loss of function
  2. Urgent ortho referral
    (Washout and ABx)
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5
Q

Cervical Spondylitic Myelopathy (CSM)

  1. S&S
  2. Mx
A

CSM

  1. Paraesthesia and weakness
  2. Imbalance
  3. Pain and neck stiffness

Mx

  1. Hard cervical collar
    - mild - moderate disease
  2. Surgical decompression
    - moderate to severe
    - fusion or immobilisation
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6
Q

Cauda equina

- Red flags

A

Cauda equina

  1. Perineal numbness
  2. Inability to stop urinating mid-stream
  3. DRE: Cannot ‘bear down’
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7
Q

Back pain

- Red flag differentials

A

Back pain red flag DDx

  1. Cauda equina
    - Bowel/bladder
    - Sciatica and saddle
  2. Metastatic SCC
    - Sensory loss
    - Hemiplegia/paresis
    - Paraplegia/paresis
    - Autonomic
  3. Trauma
    - High energy
    - Midline tenderness
    - GCS
  4. Epidural abscess
    - DM
    - IVDU
    - Relieved by rest
  5. Acute pancreatitis
    - Mid-epigastric/LUQ
    - Relieved leaning forward
    - Gallstones/ETOH hx
6. AAA
 Triad:
 - Abdo/back pain
 - Pulsatile mass
 - Hypotension
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8
Q

MSK back pain

- 5 Eliminations

A

MSK back eliminations

  1. Neurological
  2. Neoplastic
  3. Inflammatory
  4. Fracture
  5. Referred
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9
Q

MSK Back Pain

- Classfication

A

MSK Back Pain

  1. Acute
  2. Sub-acute
  3. Chronic
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10
Q

MSK Back Pain

- S&S

A

MSK Back S&S

  1. Obesity or poor posture
  2. Prior or FHx
  3. Stress and psychiatric
  4. Radiation
    - Not beyond knee
  5. No red flags
  6. No Fs
    - Fever
    - Fluctuance
    - Freak on palpation
  7. Pain Character
    - Dull, gnawing, tearing, burning, spasming
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11
Q

MSK Back Pain

- Acute/SA Mx

A

Acute/SA MSK back Mx

  1. Education and resume
  2. Temperature treatment
    - Heat/Ice
  3. Physiotherapy
  4. Massage/acupuncture
  5. Lumbar spinal manipulation
  6. Analgesia
    - NSAID
    - Paracetamol
    - Weak opioid
  7. Muscle relaxant
    - Cyclobenzaprine
    - Tizanidine
    - Metaxalone
    - Diazepam
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12
Q

Opioid

  1. Potencies
  2. Duration
A

Opioids

  1. Codeine 0.1x
    Dihydrocodeine 0.1x
    - 3-6
  2. Hydrocodone 0.66x
    - 4-8
  3. Morphine 1.0x
  4. Oxycodone 1.5x
    - 3-4
  5. Hydromorphone 5x
    - 4-5
  6. Methadone 5x
    - 8-12
  7. Buprenorphine SL 80x
    - 6-8

Buprenorphine TD 100x
- 72-168

  1. Fentanyl TD 100x
    - 72
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13
Q

MSK Back pain

- Chronic mx

A

Chronic back pain mx

  1. Exercise and physio
    - Yoga/pilates/massage
  2. Pharmacotherapy
    - NSAID
    - Opiates
  3. Thermal annular procedures
  4. Surgery
    - Rarely advised
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14
Q

Osteoporosis

- S&S

A

Osteoporosis S&S

  1. Old/thin/white/female
  2. Back pain
  3. Kyphosis
  4. Fragility fractures
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15
Q

Bursitis

- S&S

A

Bursitis S&S

  1. Pain at site
  2. Active RoM Loss
  3. RFs
    - Mechanical stress eg. occupation
    - Abnormal gait
    - Autoimmune
  4. Swelling
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16
Q

Bursitis

- Mx

A

Bursitis Mx
- Non-septic

  1. Paracetamol
  2. NSAIDs
  3. CST injection
  4. Surgery
    - Refractory
    - Bursectomy
17
Q

Septic bursitis

- Mx

A

Septic bursitis

  1. ABx
    - Dicloxacillin
  2. Aspiration
  3. Debridement and lavage
18
Q

Osteoarthritis

- Mx

A

OA Mx

  1. Conservative
  2. Topical analgesia
    - Capsaicin
    - Diclofenac
  3. CST (IArt)
  4. Hyaluronic acid (IArt)
  5. Duloxetine
  6. Surgery
19
Q

Plantar fasciitis

- Pain pattern

A

Plantar fasciitis pain

  1. First morning steps
  2. End of day
20
Q

Metatarsalgia

  1. S&S
  2. Common example
A

Metatarsalgia

  1. Mid-foot pain
  2. Morton’s neuroma
    - Inter-digital tenderness
21
Q

Gout

- Acute Mx

A

Acute Gout Mx

  1. NSAID
  2. CST
    eg. Prednisolone
  3. Colchicine
  4. IL-1 i
    - Canakinumab
22
Q

Gout

- Chronic Mx

A

Chronic Gout Mx

  1. Allopurinol
  2. NSAID
  3. Febuxostat
  4. Uricosuric
    - Sulfinpyrazone
    - Probenecid
23
Q

Painful arc

- Meaning

A

Painful arc

  • 45-120 pain
  • Active more than passive
  • Impingement
24
Q

Hands

- RA vs OA

A

Hands

  1. OA
    - Herbeden’s
    - Bouchard’s
  2. RA
    - Proximal IP
    - MCPS
    - Swan neck
    - Boutonniere’s

Year 3 - GP Block (13 decks)

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