Primary care - Bone Pain Flashcards
Examples of condns managed in non chronic management
Diabetes, copd, hypertension, asthma, cardiac disease
Why are more people attending the GP
Higher population Aging population Worse diets Better trining for nurses Better diagnostic tools
The difference in life expectancy between skilled and unskilled workers
5 yrs due to b being more educated, less manual work, more likely, to get time off work, better nutrition, lifestyle, living condns
Alcohol’s effect on their body
Starts off causing fatty liver and leads to fibres and scar tissue being laid on liver
Destroys synapses and acts as a risk factor for condns e.g. gout and hypertension
Classes of anti-hypertensive drugs
ACE inhibitors (-il)
Ca channel blockers (-ine)
Mild diuretics
Alpha blockers
Factors stopping pts from consulting a GP
Ignorance Lack of knowledge Embrassment Bad past experience Fear of wasting time Being male Unsympathetic
Treatment of impetigo
Flucloxacillin
Abx used for UTI
Cephalosporin (limited use due to resistance)
Trimethoprim
Co-amoxiclav
Nitrofurantoin (not in pt w/ renal failure)
What is heart failure
Weakness of heart muscle
Cant pump blood as well –> swollen ankles (can’t counter gravity), fluid build-up in lungs
Treatment of heart failure
Beta blockers
Cant be given to asthmatics (causes bronchoconsstriction)
Red flag symptoms for bone cancer
Wt loss Fatigue Sweat Aches Pain that wakes pt at night
Primary cancers that spread to bone
Breast Prostate Thyroid Kidney Bowel Lung (bronchiole)
Lab tests for bone cancer
FBC Leikocytes Infl markers Bone group (Ca, PO4, ALP) Urine X-rays Isotope bone scans
Prognosis for bone cancer
Not good, manage w/ radiotherapy, analgesia, steroids & hormonal treatment
Why is osteoporosis common in menopause
Due to the lack of oestrogen
How does osteoporosis usually present
Low trauma fracture e.g. FOOSH
Common osteoporotic fracture site
Collapsed vertebrae
Colles
NOF
Why is osteoporosis very expensive to treat
Long lasting psychological effects on the pt
Pathophysiology of OP
Increased osteoclast and reduced osteoblasts
What can increase risk of OP
Long term steroids
What drugs can be given for OP
Bisphosphonates - zeolendronate
AdCal
Treatment of OP
Weight bearing exercise can help, stop smoking and drinking, OT & physio
HRT can also help but increases risk of strokes so prescribe lowest dose and give for shortest time
Dx of osteomyelitis
Swabs
Lab tests
Treatment of OM
Surgical debridement
IV abx
Usual infections causing OM
Staph A
Strep
Types of shoulder dislocation
Anterior
Posterior
Treating skin infections of Strep and Staph
Penicilins e.g. flucloxacillin
Macrolides e.g. erythromycin
Characteristics of multiple myeloma
Overproduction of plasma cells
Bone marrow does not produce enough Hb
Increased Ca and thrombocytopenia on bloods
X-rays of multiple myeloma
Thinning of bone
Urine of MM pts
Bence Jones proteins
Treatment of MM
Chemo
Bisphosphonate
Radiotherapy
What can atrial fibrillation cause
Blood clotting, treat w/ Warfarin
Varicose veins
Increase pressure on superficial veins, veins dilate and valves stop working can cause varicose eczema or ulcers
Causes of varicose veins
Pregnancy, inactivity, obesity -treated by stripping veins
Golfers elbow
Affects medial epicondyle
Tennis elbow
Affects lateral epicondyle
What can cause elbow effusions
infections
Rheumatic disease
Olecranon bursitis (resting on your elbow a lot, more proximal than rheumatoid nodules - drain fluid)
Oedema definition
Accumulation of interstitial fluid in lower limbs
Common causes of oedema
Infection DVT Neoplastics Iatrogenic Congenital & trauma - can be uni or bilateral and usually acute
Things that can lead to oedema
Increased capillary pressure Decreased lymphatic drainage Increased venous pressure (heart failure) Infections Ruptured Bakers cyst Decreased protein in blood Amlodypine
Treatrnent of oedema
Elevation of legs, elastic stockings, diuretics
Main risk associated with DVT
PE
What can air in the bloodstream cause
Blood clots
How can fat enter the bloodtsream
Trauma (fracture)
Presentation of DVT
Normally unilateral swelling V similar to cellulitis Tender, swollen calf Red Hot Painful to dorsiflex If the girth of one thigh is 3cm bigger than the other - clear sign
Risk factors for DVT - Virchow’s triad
Stasis - immobility, bed, post-op, leg in cast, long journeys, varicose veins
Damage to blood vessel wall - trauma, infection
Hypercoagability
Conditions increasing risk of DVT
Age Infection Infl Vascular factors e.g strokes Neoplasms Haematological factors Immunological problems(anti phospholipid) Iatrogenic (surgery, drugs) Combined pill and HRT Congenital Obstetrics Nephrotic syndrome Lifestyle (smoking) Idiopathic Family hx
Wells riks score fro DVT
Help GP diagnose whether pt needs to be referred to secondary care -2 to 9. Points for diff things and cellulitis reduces 2 points
Treatment for DVT
Refer to DVT clinic
Tests d dimer - degradation of clot
Give heparin s/c or NOAC
Lower limb infections
Usually bacterial, come from break in skin
Mainly cellulitis, can present similar to DVT
Treatment from lower limb infections
Erythromycin
Clarithromycin
Investigations for soft tissue swelling
FBC - wbc as sign of infection
Raised infl markers
Swabs for ulcerative condns
Haemotoma
Bruise
Thrombolitis
Varicose veins get inflamed, treat w/ oral anti-infl or gel
Ulcer definition
Break in continuity of surface membrane
Benefits of exercising
Increased circulation
Increased mental health
Weight control - being overweight is a risk factor for several diseases
Prevents limbs from seizing up
Peptic ulcers cause
Excess acid, steroid, smokin
Presentation of peptic ulcers
Pain epigastric then radiates to back
Haematesisis
Vomiting fresh blood
Malena
Sign of upper gastric bleed
