Primary Care - Connective Tissue Flashcards by Jasmine Sappor

Changes in fluid leading to oedema

Increased fluid or water retention
Decreased oncotic pressure due to loss of proteins
Increased capillary hydrostatic pressure

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Most commonly dislocated carpal bone

Lunate

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Ganglion cysts

Vey common in wrist
Smooth, round swelling
Not inflamed over dorsum

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Ddx for ganglion cyst

Sebaceuous cysts

Lipomas

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Where are Heberden’s nodes found

DIPJ

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Where are Bouchard’s nodes found

PIPJ

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What can skin bruising be indicative of

Steroid use

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OA bone changes seen in hand examinations

Heberden’s and Bouchard’s

Squaring of MCPs and 1st CMCJ

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RhA bone changes seen in hand examinations

Loss of knuckle guttering 
Swan neck deformity 
Z shaped thumb 
Ulnar deviation 
Palmar subluxation of MCPs
*Palmar erythema

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Dupytrens

Hypertrohy or contraction of flexor tendon sheaths, palpable

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What can pain during internal rotation during a shoulder exam indicate

Posterior shoulder dislocation

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Determining between mechanical and muscular pain in examination

No pain on passive movement = muscular

Still painful on passive movement = mechanical

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High arc pain in shoulder abduction

Acromioclavicular joint pathology e.g. arthritis

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Middle arc pain in shoulder abduction

Rotator cuff pathology e.g. tear or supraspinatus tendinitis

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Loss of external rotation - shoulder exam

Indicative of adhesive capsulitis (frozen shoulder)

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Common pathology seen in shoulder exam

Supraspinatus tendinitis 
Rotator cuff tears 
Frozen shoulder 
Anterior shoulder instability (dislocation)
OA

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Identifying supraspinatus tendinitis in a shoulder exam

Painful mid arc

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Identifying rotator cuff tears in a shoulder exam

Supraspinatus wasting

Weakness of abduction

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Identifying OA in a shoulder exam

Painful movement in all direction

OA usually affects large, weight-bearing joints

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Common pathology seen in foot and ankle exam

Pes plantus (flat foot)
Hallux valgus
Gout
Achilles tendon rupture

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Pes plantus

Loss of medial arch

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Hallux valgus

Painful bunions of m medial aspect of MTP joint

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Identifying gout in a foot and ankle examination

Tender, erythematous, inflamed joint (usually MTP)

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TATT vs fatigue

Exertional dyspnoea 
Muscle weakness 
Excessive sleepiness 
Loss of motivation 
General debility 
Concealed concerns - pt reluctant to bring up other issues

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Measuring excessive sleepiness

Epworth sleep score

Lifestyle and SH q's when pts are TATT

Ask about mood/ stress/ depression Excessive consumption of alcohol Ask about drug taking, incl cigarettes and caffeine Ask about work/home Substance abuse Has there been any significant event in the pt's life

Ddx of being tatt

``` Congenital Degenerative Infl Neoplastic Iatrogenic ```

Non-organic causes for being tatt

Psychological stress/ overwork Depression Fibromyalgia CFS

Medications causing tiredness

Beta-blockers Chronic alcohol excess Benzodiazepine Chemotherapeutic agents

Malignancy causing tiredness

Haemotoligcal Solid organ Disseminated

Respiratpty causes causing tiredness

Obstructive sleep apnoea | COPD

Cardiac causes of being tatt

Congestive cardiac apnoea | Bradyarrythmia

Haematological causes of being tatt

Anaemia | Haematological malignancy e.g. lymphoma

Endocrine causes of being tatt

``` Hypothyroidism Hypercalcaemia Diabetes mellitus Adrenal insufficiency Hypopituitarism ```

Infection causes of being TATT

``` Infectious mononucleosis TB HIV Infective endocarditis Lyme disease ```

Chronic infl condns causes of being TATT

RhA Infl bowel disease Connective tissue disorder e.g. SLE

What do NICE suggest if tiredness has persisted for 3 months+

Urinalysis for protein and blood Bone biochem Creatinine kinase

Other investigations for tiredness

``` FBC for anemia U&Es LFT's - could indicate alcohol abuse ESR, CRP and test for glandular fever TFT Ca Vit D PHQ ```

TFT

Thyroid function test

PHQ

Pateinet health questionnaire - depression module

Symptoms required to diagnose CFS

At least 4/8 Post exertion Malisse lasting more than 24 hrs Unresting sleep Significant impairment of short term memory or conc Muscle pain Multi-joint pain without swelling or redness Headaches of a new type, pattern or severity Tender cervical or axillary lymph nodes A sore throat that is frequent or recurrent

Symptoms of Cushing's syndrome

``` Thinning off the skin Thin arms and legs (muscle wasting)/ weakness Hypertension Buffalo humo 'Moon' face (w/ red cheeks) Obesity Poor wound healing Striae (stretch marks) ```

Wrist examination - look

Position of wrist Muscle bulk in forearm and hand Scars

Wrist examination - feel

Distal end of ulna and radius and styloid processes | Joint space between radius and ulna and carpal bones

Wrist examination - move (active, passive, resisted )

Flexion Extension Abduction Adduction

Pain caused by L2 nerve root lesion

Across upper thigh

Weakness caused by L2 nerve root lesion

Hip flexion and adduction

Pain felt in L3 nerve root lesion

Across lower thigh

Weakness caused by L3 nerve root lesion

Hip adduction | Knee extension

Reflex affected by L3 nerve root lesion

Knee jerk

Where is the pain associated with a L4 nerve root lesion

Across knee to MM

Weakness caused by L4 nerve root lesion

Knee extension Foot inversion Dorsiflexion

Where is the pain associated with a L5 nerve root lesion

Lateral shin to dorsum of foot and hallux

Reflex affected by L4 nerve root lesion

Knee jerk

Weakness caused by L5 nerve root lesion

Hip extension and abduction Knee flexion Foot and hallux dorsiflexion

Reflex affected by L5 nerve root lesion

Hallux jerk

Where is the pain associated with a S1 nerve root lesion

Posterior calf to lateral foot and little toe

Weakness caused by S1 nerve root lesion

Knee flexion Foot and toe plantarflexion Foot eversion

Reflex affected by S1 nerve root lesion

Ankle jerk

Testing for cauda equina

Rectal exam | Checking for tone (reduced)

Causes of cauda equina

2' malignancy Cervical disc prolapse Haematoma Congenital lumbar disease

Symptoms of cauda equina

``` Back and radicular pain down the legs Saddle anaestheis a Asymmetrical, atrophic, areflexic paralysis of the legs Sensory loss in a root distribution Loss of blaster and bowel control ```

Areflexic

Muscles that do not respond to stimuli