Oxford Clinical I

Question 1

What is the Lasegue’s sign?

Answer 1

Positive Lasegue’s sign is pain below the knee which increases with foot dorsiflexion.

Question 2

What will a positive Lasegue’s sign indicate?

Answer 2

It suggests irritation to the sciatic nerve. The main cause being lumbar disc prolapse.

Question 3

Describe what may be experienced by the patient in a positive femoral stretch test.

Answer 3

In a positive femoral stretch test, pain is felt in front of the thigh on lifting the hip into extension with the patient lying prone (face downwards) and the knee flexed.

Question 4

Spinal stenosis is common in young or elderly patients?

Answer 4

Elderly patients above 50 years old

Question 5

Ankylosing spondylitis is commonly presented in young or elderly patients?

Answer 5

Ankylosing spondylitis is presented in young individuals <40yo

Question 6

What are 3 other alternatives that can be offered if patients cannot benefit from medications for back pain?

Answer 6

Acupuncture, physiotherapy and/or exercise programmes

Question 7

What are the symptoms of acute cauda equina compression?

Answer 7

Alternating or bilateral root pain in legs, saddle anaesthesia (perianal), loss of anal tone on PR, bladder and bowel incontinence

Question 8

Osteoarthritis is more common in females or males?

Answer 8

Osteoarthritis is more common in females.

Question 9

What is septic arthritis?

Answer 9

It is any acutely inflamed joint.

Question 10

Why is septic arthritis dangerous?

Answer 10

Septic arthritis can destroy a joint in under 24 hours

Question 11

What is the key investigation for septic arthritis?

Answer 11

Urgent joint aspiration for synovial fluid microscopy and culture is the key investigation for septic arthritis

Question 12

Is CRP levels normal or elevated in Osteoarthritis?

Answer 12

CRP is slightly elevated in osteoarthritis

Question 13

What are the medications given to treat septic arthritis?

Answer 13

Flucloxacillin 1G QDS IV
(clindamycin if allergic to penicillin)
Vancomycin IG BD IV if MRSA
Cefotaxime IG TDS IV if gonococcal or Gram (-) organisms suspected.

Question 14

What are the main serious side effects of NSAIDs?

Answer 14

GI bleeding and renal impairment

Question 15

Who are the patients who should avoid NSAIDs?

Answer 15

Patients on aspirin, or patients with an active GI ulceration
Patients with severe heart failure

Question 16

Which genetic make-up is associated with rheumatoid arthritis?

Answer 16

HLA DR4

Question 17

Is Fibromyalgia a chronic or acute condition?

Answer 17

Chronic (>3/12)

Question 18

What is Fibromyalgia associated with?

Answer 18

Other somatic syndromes such as chronic fatigue syndrome, irritable bowel syndrome and chronic headache syndromes

Question 19

What is Fibromyalgia?

Answer 19

A chronic condition that causes pain all over the body. Patients may also experience increased sensitivity to pain, chronic fatigue syndrome, chronic headache syndromes and irritable bowel syndrome, morning stiffness, fibro-fog: problems with memory or concentration

Question 20

What are the treatments for fibromyalgia?

Answer 20

antidepressants such as amitriptyline 10-20MG nocte, or analgesics.
CBT can also help.

Question 21

What is allodynia?

Answer 21

Pain in response to non-painful stimuli.

Question 22

What is hyperaesthesia?

Answer 22

Exaggerated perception of pain in response to mildly painful stimulus.