Primary Care - Connective Tissue Flashcards
Changes in fluid leading to oedema
Increased fluid or water retention
Decreased oncotic pressure due to loss of proteins
Increased capillary hydrostatic pressure
Most commonly dislocated carpal bone
Lunate
Ganglion cysts
Vey common in wrist
Smooth, round swelling
Not inflamed over dorsum
Ddx for ganglion cyst
Sebaceuous cysts
Lipomas
Where are Heberden’s nodes found
DIPJ
Where are Bouchard’s nodes found
PIPJ
What can skin bruising be indicative of
Steroid use
OA bone changes seen in hand examinations
Heberden’s and Bouchard’s
Squaring of MCPs and 1st CMCJ
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
Dupytrens
Hypertrohy or contraction of flexor tendon sheaths, palpable
What can pain during internal rotation during a shoulder exam indicate
Posterior shoulder dislocation
Determining between mechanical and muscular pain in examination
No pain on passive movement = muscular
Still painful on passive movement = mechanical
High arc pain in shoulder abduction
Acromioclavicular joint pathology e.g. arthritis
Middle arc pain in shoulder abduction
Rotator cuff pathology e.g. tear or supraspinatus tendinitis
Loss of external rotation - shoulder exam
Indicative of adhesive capsulitis (frozen shoulder)
Common pathology seen in shoulder exam
Supraspinatus tendinitis Rotator cuff tears Frozen shoulder Anterior shoulder instability (dislocation) OA
Identifying supraspinatus tendinitis in a shoulder exam
Painful mid arc
Identifying rotator cuff tears in a shoulder exam
Supraspinatus wasting
Weakness of abduction
Identifying OA in a shoulder exam
Painful movement in all direction
OA usually affects large, weight-bearing joints
Common pathology seen in foot and ankle exam
Pes plantus (flat foot)
Hallux valgus
Gout
Achilles tendon rupture
Pes plantus
Loss of medial arch
Hallux valgus
Painful bunions of m medial aspect of MTP joint
Identifying gout in a foot and ankle examination
Tender, erythematous, inflamed joint (usually MTP)
TATT vs fatigue
Exertional dyspnoea Muscle weakness Excessive sleepiness Loss of motivation General debility Concealed concerns - pt reluctant to bring up other issues
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
