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MBBS - Year 1 > Primary care - Spinal Disorders > Flashcards

Primary care - Spinal Disorders Flashcards

1
Q

`Which infl condo usually presents as pain in distal limbs

A

PMR

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2
Q

Treatment of PMR

A

Prednisolone

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3
Q

People most affected by PMR

A

Women over 50

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4
Q

2 drugs causing SLE

A

Carbamazepine

Hydralazine

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5
Q

Which hormone is related to SLE

A

Oestrogen

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6
Q

Drugs for treating Raynaud’s

A

Iloprost
Sidenifil
Ca channel blockers

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7
Q

Most common prevention of ALPS

A

Vascular thrombosis - DVT/PE
Recurrent miscarriages
Strokes in those under 45

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8
Q

Dx test for APLS

A

Anti-cardolipin antibodies

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9
Q

Treatment of scleroderma

A

BP management
PPI
Vasodilators
Exercise

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10
Q

Managed abx

A

Broad spectrum e.g. co-amoxiclav, quinolone, cephalosporins

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11
Q

When can you use managed abx

A

When pts are allergic to other abx or when drugs are restsnat

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12
Q

Treatment of 59 yo man w chest infection

A

Amoxiccilin 500mg TDS

Clarithromycin 250-500mg BDS

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13
Q

Treatment of 30 yo man w MBP

A

NSAIDs and paracetamol
Rest
Muscle relaxant - diazepam

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14
Q

Concerns about diazepam

A

Can be addictive - valium

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15
Q

Treatment of 49 yo woman w/ acid reflux

A

PPI e.f. omeprazole or lansoprazole

If n to getting better could be H. Pylori infection - treat with PPI and 2 anti-bacterials

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16
Q

Treatment of 3 yo with impetigo

A

Flucloxacillin 125-500mg QDS 5-7days

Topical fusidic acid

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17
Q

Treatment of 7 yo with bacterial sore throat

A

Penicillin V

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18
Q

Ddx of back pain - trauma

A

Whiplash
Fracture
Other muscular strains

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19
Q

Ddx of back pain - cancer

A

Myeloma

Bone secondaries

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20
Q

Ddx of back pain - structural/degerative

A

Spondylosis
Spondylolisthesis
Gross scoliosis/ kyphosis

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21
Q

Spondylosis

A

Spinal OA with osteophyte formation and disc degeneration

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22
Q

Ddx of back pain - metabolic

A

Osteoporosis with vertebral collapse
Osteomalacia
Paget’s

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23
Q

Ddx of back pain - infections

A

Shingles
Discitis
Osteomyelitis – bacterial/TB
Epidural abscess

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24
Q

Ddx of back pain - infl

A

Ankylosing spondylitis
PMR
Coccodynia

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25
Ddx of back pain - referred pain
``` Hip Abdo Kidney/Bladder Ovary Pelvis ```
26
Yellow flags
``` Belief that pain and activity is harmful Sickness behaviours Social withdrawal Emotional problems Problems/dissatisfaction at work Overprotective family Inappropriate expectations of treatment ```
27
Common symptoms seen with prolapsed discs
Radicular pain due to spinal nerve root compression Shooting, sharp pain Usually unilateral Localised pain due to prolapsing itself Limited lifting of spine (straight-leg test)
28
Signs of severe prolapsed dose which requires urgent referral
Drop foot and affected motor function
29
Therapeutics for prolapsed disc
Neuropathic pain doesn’t always respond to typical analgesia so given gabapentin or amitriptyline
30
Clinical features of spinal stenosis
Causes bilateral buttock and leg pain Paraesthesia Numbness in legs when walking
31
Relieving factors for spinal stenosis
Rest | Leaning forward - widens spinal canal
32
Ix for spinal stenosis
MRI
33
Treatment for spinals the noses
Spinal decompression | Refer immediately
34
Types of laxatives
Bulk laxatives - draw water in | Stimulant laxatives - causes bowels to contract
35
Common laxatives
Senna Lactulose Macrogol
36
Why is colchicine only used for acute flares of gout
Fairly toxic is max 12 tablets | QDS 3 days or BDS 6 days
37
Ramipril
ACE inhibitor Anti-hypertensive Can give pts irritating cough
38
Causes of atherosclerosis
Smoking | High cholesterol
39
Q risk
Risk of having heart attack in 1o years
40
When should pt be advised to lower cholesterol
If Q score is above 10
41
Femoral artery blockage presentation
Pain Numbness Cold Reduced sensation Surgical emergency
42
Causes of cauda equina syndrome
Compression of the spinal cord and the nerves/nerve roots arising from the cauda equina
43
Most common cause of CES
Prolapsed IVD
44
Risk factors for CES
``` Older Age High Impact Sports Being Overweight or Obese Manual Job/Labour Genetic Predisposition for Prolapsed Disc Previous Severe Back Injury ```
45
Ddx for CES
Radiculopathy – presents with radiating back pain but no faecal, urinary, or sexual dysfunction. Cord compression – a surgical emergency similar to CES but is characterised by upper motor neurone signs.
46
Mx of CES
Lumbar decompression surgery (laminectomy or discectomy) must be done quickly to prevent permanent damage e.g. paralysis of the legs, loss of bladder and bowel control, sexual function, or other problems
47
Prognosis of CES
Variable depending on the cause, patient factors and the time from symptom onset to surgery. Even with treatment, around 20% of patients do not regain full function May require catheter or physio/ot
48
Epidemiology of radiculopathies
Most common in 50+ | More men affected than women
49
Symptoms associated with radiculopathies
General weakness Radiating pain (i.e. compression of a nerve in the cervical spinal area may cause issues within the forearm) Lack of control within the specific muscle Potential numbness Paraesthesia
50
Ix for radiculopathies
Full examination MRI Electromyography to examine how the muscles are functioning - by comparing them at rest and during contraction
51
Mx for radiculopathies
Most are self - limiting PT NSAIDs/ steroids Surgery in extreme cases
52
NSAIDs for OA
``` Treatment for up to 12 weeks Etoricoxib 60mg Diclofenac 150mg Ibuprofen 2400 mg Naproxen 1000 mg ```
53
NSAIDs for AxSpa
Treatment for up to 6 weeks Non selective NSAIDs Coxibs
54
NSAIDs for rotator cuff tendinopathy
Non-selective for up to 4 weeks
55
Adverse events for NSAIDs
GI adverse events Myocardial infarction Stroke Heart failure
56
What does testing reflexes allow
Lower and upper motor neurone lesions to be distinguished reliably
57
When is reflex testing essential
If you suspect spinal cord and cauda equine compression, acute cervical or lumbar disc compression
58
Reflexes in arms
Biceps - C5/6 myotome Brachioradialis - C6 myotome Triceps - C7/8 myotome
59
Reflexes in legs
Knee - L3/4 myotome | Ankle - S1/2 myotome
60
Explaining process of testing reflexes to pt
Reflexes in the arms, legs and jaw will be tapped This will be painless They shouldn’t be alarmed if their limbs jerk nor concerned if they don’t
61
Interpreting reflex testing
Absent jerk points to lower motor neurons lesion | Very brisk reflection suggest an upper motor lesion
62
Sciatica
Clinical dx based on symptoms of radiating pain in one leg with or without associated neurological deficits on examinations
63
What is sciatica caused by
Infl or compression of the lumbosacral nerve roots (L4 - 5) forming sciatic nerve usually by disc herniation or rarely trauma
64
Mx of sciatica
Most pt’s improve over time with conservative treatment incl exercise, manual therapy and pain management
65
Imaging for sciatica
Imaging only requested if pain persists for 12+ weeks or the pt develops progressive neurological deficits
66
Symptoms of sciatica
Unilateral leg pain more severe than low back pain Pain most commonly radiating posteriorly at the leg and below the knee Numbness and/or paresthesia in the involved lower leg +ve neural tension test (straight leg/ femoral nerve) Muscle weakness/ absence of tendon reflexes/ sensory deficit
67
Prognosis of sciatica
Most people experience an improvement in symptoms over times with either conservative treatment or surgery Low back pain radiating to leg indicator of poor prognosis - increased pain, disability and poor QoL
68
Examples of manual therapy
Spinal mobilisation
69
Red flags for referral - sciatica
Severe or progressive neurological deficits Suspicion of cauda equina syndrome with signs of urinary retention and/or decreased anal sphincter tone Suspicion of cancer or infection Hx of trauma Persistent sciatica for 12 weeks from onset of symptoms despite conservative care

MBBS - Year 1 (93 decks)

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