Primary Care - Soft Tissue Flashcards
When does bone density start decreasing
30
Which bones are injured in a Colles fracture
Radius
Ulna
Vitamin D levels in osteoporosis
Normal
Common pathogens causing OM
Strep
Staph A
TB
Haemophilus
What % of MM pts have bone pain
60
Main anti-hypertensive drugs
ACE inhibitors
Then Ca channel blockers e..g amlodipine (side effects incl swollen ankles and facial)
Surgical sieve
Congenital Acquired Neoplastic Metabolic Infective Traumatic Autoimmune Vascular Infl Degenerative Idiopathic
Infections seen in epidermis
Impetigo
Folliculitis
Erysipela
Infections seen in dermis
Cellulitis
Infections seen in fascia
Necrotising fasciitis
Infections seen in muscle
Myonecrosis
Causes of oedema (blood vessels)
Increased plasma volume Reduced plasma oncotic pressure Increase in permeability of capillaries Increased hydrostatic pressure of capillaries Obstruction of lymphatic drainage
Pitting oedema
How to elicit - press gently on oedematous skin w finger
Stop and you still see dent left behind
Typically caused by fluid accumulation
Non-pitting oedema
Doesn’t leave a dent
Causes are lymphoedema, myxoedema
Causes of dependent oedema
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
Causes of non-pitting lower limb oedema
Hypothyroidism
Lymphoma - blocked lymph channels, radiation
Lipoedema
Allergy: increased capillary permeability, angio-oedema
Common soft tissue conditions seen in GP
Leg oedema
Cellulitis
Bursitis
Ulcers
Signs of chronic venous insufficiency
Telangiectasia - spider veins Varicose veins Oedema Pigmentation Eczema Lipodermatosclerosis
Soft tissue examination - look
Site if any swelling Colour changes Varicose veins Ulceration Signs of chronic venous insufficiency Scars Skin conditions/ rashes
Soft tissue examination - feel
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
Leg ulcer definition
Long lasting (chronic) sore that takes >2 weeks to heal. Most common is venous
Symptoms of leg ulcers
Pain
Itching
Swelling
Discoloured and hardened skin in ulcer
Other common types of leg ulcers
Arterial Diabetic Vasculitic Traumatic malignant
Arterial leg ulcers
Caused by poor blood circulation in their arteries, usually occur on foot rather than the leg
Diabetic leg ulcers
Caused by the high blood sugar, usually occur on foot rather than leg
Vasculitic leg ulcers
Associated w/ chronic infl disorders e.g. RhA and lupus
Boutonnière deformity
PIP fixed flexion, DIP hyper extension
Swan-neck deformity
PIP hyper extension, DIP flexion
Examination of a lump - look
Location Contour Pulsation Colour Surface
Examination of a lump - feel
Temp Pulsation Tenderness Mobility Consistency Fluctuation Reducability Trans illumination - shining a light through, if light shines its full of liquid
3S’s, 3C’s, 3T’s, 1F
Site Size Shape Contour Colour Consistency Tenderness Tethering Trans illumination Fluctuance
How does Dupuytrens present
Nodules
How does Dupuytrens progress
Causes stiffening of the finger and spreads across other fingers
Treatment of Dupuytrens
Surgery so hands will be fully functional
Questions to ask pts presenting with lesions on their hands
Which is their dominant hand
What is their job
How is it affecting their function
When is it causing problems
Presentation of trigger finger vs Dupuytrens
Trigger finger is bone and can resolve
Duputrens is gradual onset and soft tissue
Similarities between trigger finger and dupuytrens
Both cause similar functional disturbance and are more common in older people
Ddx for DVT
Cellulitis
Ruptured baker’s cyst
Ddx for olecranon bursitis
Rheuematoid nodule Gout Psuedogout Inflamed cyst Lipoma
Cyst definition
Closed sac with a distinct lining membrane that develops abnormally in the body
Investigations for DVTs
D-dimer
Doppler ultrasound of the deep venous system of the lower leg
Diagnosing varicose veins
Tourniquet test
