Primary Care - Soft Tissue

Question 1

When does bone density start decreasing

Answer 1

30

Question 2

Which bones are injured in a Colles fracture

Answer 2

Radius

Ulna

Question 3

Vitamin D levels in osteoporosis

Answer 3

Normal

Question 4

Common pathogens causing OM

Answer 4

Strep
Staph A
TB
Haemophilus

Question 5

What % of MM pts have bone pain

Answer 5

60

Question 6

Main anti-hypertensive drugs

Answer 6

ACE inhibitors

Then Ca channel blockers e..g amlodipine (side effects incl swollen ankles and facial)

Question 7

Surgical sieve

Answer 7

Congenital
Acquired 
Neoplastic
Metabolic 
Infective 
Traumatic 
Autoimmune
Vascular 
Infl 
Degenerative 
Idiopathic

Question 8

Infections seen in epidermis

Answer 8

Impetigo
Folliculitis
Erysipela

Question 9

Infections seen in dermis

Answer 9

Cellulitis

Question 10

Infections seen in fascia

Answer 10

Necrotising fasciitis

Question 11

Infections seen in muscle

Answer 11

Myonecrosis

Question 12

Causes of oedema (blood vessels)

Answer 12

Increased plasma volume 
Reduced plasma oncotic pressure 
Increase in permeability of capillaries 
Increased hydrostatic pressure of capillaries 
Obstruction of lymphatic drainage

Question 13

Pitting oedema

Answer 13

How to elicit - press gently on oedematous skin w finger
Stop and you still see dent left behind
Typically caused by fluid accumulation

Question 14

Non-pitting oedema

Answer 14

Doesn’t leave a dent

Causes are lymphoedema, myxoedema

Question 15

Causes of dependent oedema

Answer 15

Ankle if mobile, scrap if bed bound 
Varicose veins 
Obesity 
Drugs e.g. NSAIDs, steroids 
GI - malabsorption 
Obstructive sleep apnoea 
Acute DVT 
Hip or knee arthroplasty
Chronic venous insufficiency

Question 16

Causes of non-pitting lower limb oedema

Answer 16

Hypothyroidism
Lymphoma - blocked lymph channels, radiation
Lipoedema
Allergy: increased capillary permeability, angio-oedema

Question 17

Common soft tissue conditions seen in GP

Answer 17

Leg oedema
Cellulitis
Bursitis
Ulcers

Question 18

Signs of chronic venous insufficiency

Answer 18

Telangiectasia - spider veins 
Varicose veins
Oedema
Pigmentation 
Eczema
Lipodermatosclerosis

Question 19

Soft tissue examination - look

Answer 19

Site if any swelling 
Colour changes 
Varicose veins 
Ulceration 
Signs of chronic venous insufficiency 
Scars 
Skin conditions/ rashes

Question 20

Soft tissue examination - feel

Answer 20

Temperature 
Tenderness
Palpable deep veins 
Measure girth in both calves -same point on each leg, usually 10cm below tibial tuberosity (discrepancy over 2cm can be sign of DVT)
Peripheral pulses

Question 21

Leg ulcer definition

Answer 21

Long lasting (chronic) sore that takes >2 weeks to heal. Most common is venous

Question 22

Symptoms of leg ulcers

Answer 22

Pain
Itching
Swelling
Discoloured and hardened skin in ulcer

Question 23

Other common types of leg ulcers

Answer 23

Arterial 
Diabetic 
Vasculitic 
Traumatic 
malignant

Question 24

Arterial leg ulcers

Answer 24

Caused by poor blood circulation in their arteries, usually occur on foot rather than the leg

Question 25

Diabetic leg ulcers

Answer 25

Caused by the high blood sugar, usually occur on foot rather than leg

Question 26

Vasculitic leg ulcers

Answer 26

Associated w/ chronic infl disorders e.g. RhA and lupus

Question 27

Boutonnière deformity

Answer 27

PIP fixed flexion, DIP hyper extension

Question 28

Swan-neck deformity

Answer 28

PIP hyper extension, DIP flexion

Question 29

Examination of a lump - look

Answer 29

``` Location Contour Pulsation Colour Surface ```

Question 30

Examination of a lump - feel

Answer 30

``` Temp Pulsation Tenderness Mobility Consistency Fluctuation Reducability Trans illumination - shining a light through, if light shines its full of liquid ```

Question 31

3S's, 3C's, 3T's, 1F

Answer 31

``` Site Size Shape Contour Colour Consistency Tenderness Tethering Trans illumination Fluctuance ```

Question 32

How does Dupuytrens present

Answer 32

Nodules

Question 33

How does Dupuytrens progress

Answer 33

Causes stiffening of the finger and spreads across other fingers

Question 34

Treatment of Dupuytrens

Answer 34

Surgery so hands will be fully functional

Question 35

Questions to ask pts presenting with lesions on their hands

Answer 35

Which is their dominant hand What is their job How is it affecting their function When is it causing problems

Question 36

Presentation of trigger finger vs Dupuytrens

Answer 36

Trigger finger is bone and can resolve | Duputrens is gradual onset and soft tissue

Question 37

Similarities between trigger finger and dupuytrens

Answer 37

Both cause similar functional disturbance and are more common in older people

Question 38

Ddx for DVT

Answer 38

Cellulitis | Ruptured baker's cyst

Question 39

Ddx for olecranon bursitis

Answer 39

``` Rheuematoid nodule Gout Psuedogout Inflamed cyst Lipoma ```

Question 40

Cyst definition

Answer 40

Closed sac with a distinct lining membrane that develops abnormally in the body

Question 41

Investigations for DVTs

Answer 41

D-dimer | Doppler ultrasound of the deep venous system of the lower leg

Question 42

Diagnosing varicose veins

Answer 42

Tourniquet test