MSK staaaahf

Question 1

6 standards of hip care

Answer 1

• admitted within 4 hours
• surgery within 48 hours
• prevent pressure ulcers
• managed on an orthopaedic ward
• anti-resorptive drugs for osteoporosis
• multi-disciplinary assessment to prevent future falls

Question 2

CAM

Answer 2

Confusion assessment method (recognising that someone is confused, e.g. old patient who has just broken hip or something)

Question 3

When is analgesia needed in hip care?

Answer 3

On admission
When taking them to x-ray
Pre/intra operatively
Post-operatively

Question 4

Opiate side effects?

Answer 4

Drowsiness
Confusion
Constipation
Dizziness

Question 5

Analgesia pragmatic approach?

Answer 5

Pragmatic approach:
Paracetamol regularly oral or intravenously
Codeine starting 15mg prn but can increase to 30mg QDS max
Morphine prn or reg
Oxycodone if confused on morphine

Question 6

Anti-resorptive therapy?

Answer 6

Should be done whilst inpatient (with follow up arrangements)
Calcium/ Vitamin D intake should be assessed (most get supplmented)
Dual X-ray Bone Densitometry (DeXA) if required
Antiresorportive therapy
Oral (eg alendronic acid)/ iv Bisphosphates (after 5 weeks post fracture)
Denosumab, (Strontium)
Parathyroid hormone therapy if severe osteoporosis

Question 7

Retention of the lumbar lordosis during spinal flexion is an early sign. Later, paraspinal muscle wasting develops

Answer 7

Ankylosing spondylitis

Question 8

Back pain criteria for diagnosing ankylosing spndylitis?

Answer 8

Age of onset <50 years
Insidious onset
Improvement of back pain with exercise
No improvement of back pain with rest
Pain at night with improvement on getting up