Passpaper 2

Question 1

58 year old male scaffolder reports bilateral shoulder pain which moves to his left arm. History of neck pain of three years?

a) how should you investigate this in a GP’s practice? /2

Answer 1

a. upper limb neoro exams of arms
b. shoulder examination
c. hx

Question 2

On examination he has patchy sensory loss on his left hand, loss of his left brachial reflex and cervical tenderness.

b) three causes of this? /3
c) three investigations?

Answer 2

a. cervical spine fractures
b. nerve root compression
c. intervertebral disk prolapse

a. Xray
b. Nerve conduction studies
c. MRI ( for disc and nerves)

Question 3

d) If the investigations pointed towards it being degenerative change, what treatment advice can you give him?
e) what is the likely diagnosis and prognosis

Answer 3

a. Strengthening exercises for muscles around the area
b. Nsaids- with PPI

a. osteoarthritis spine
b. long term management of C-spine pain.