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end of y3 > STI > Flashcards

STI Flashcards

1
Q

articular joint pain

A
  • maximal tenderness on palpation at joint line
  • pain regardless of active/passive movement
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2
Q

when to refer for STI?

A

1) serious injury
2) ligament rupture
3) infection-related causes to prevent sepsis
4) malignancy, metastasis
5) if visceral condition (gal stone, pancreatitis)

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3
Q

tldr phases of inflammation (immune cells part)

A

1) initial immune response
2) impaired healing, scarring, fibrosis
3) regeneration

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4
Q

phases of inflammation - initial immune response

A

1) neutrophil activation and recruitment

  • rapid recruitment to site of injury or inflammation for pathogen containment and neutralisation

2) monocyte - macrophage activation

  • differentiation of monocyte into pro-inflammatory macrophage
  • enhance inflammatory response through phagocytosis and release of pro-inflammatory cytokines (TNF-alpha, IL-1b)

3) adaptive immune function

  • activation of T and B cells for more targeted response to pathogen
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5
Q

phases of inflammation - impaired healing, scarring, fibrosis

A

1) tissue damage and inflammation

  • DAMPS trigger prolonged inflammation -> further activate pro-inflammatory macrophage and cytokine release

2) Scar formation and fibrosis

  • pro-inflammatory macrophages promote extracellular matrix deposition via MMP -> Scarring and fibrosis

3) regeneration inhibition

  • excessive scarring impair normal tissue function
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6
Q

phases of inflammation - regeneration

A

1) Resolution of inflammation

  • transition from pro-inflammatory to anti-inflammatory macrophages

2) tissue repair and regeneration

  • anti-inflammatory macrophages release growth factors -> stimulate angiogenesis and cell proliferation for tissue regeneration

3) scar prevention

  • anti-inflammatory cytokine IL-10 secreted by anti-inflammatory macrophages inhibit excessive scarring
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7
Q

standard non pharmaco for all STI

A

1) PRICE

  • protection, rest, ice, compression, elevation

2) no HARM

  • heat, alcohol, re-injury, massage
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8
Q

sprains general

A

bone to bone connective tissue

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9
Q

lateral ankle sprain

A
  • most common
  • affect anterior talofibular ligament
  • caused by inversion of foot
  • sudden onset of pain on side of foot after ‘pop’ sound
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10
Q

severities of ankle sprain

A

1) Grade I

  • mild stretching of ligament with microscopic tears
  • mild swelling and tenderness
  • able to bear weight and ambulate w minimal pain
  • treatment: PRICE, X HARM

2) Grade II

  • incomplete tear of ligament
  • moderate pain, swelling, tenderness, ecchymosis
  • painful weight bearing and ambulation
  • restriction in range of motion and function
  • treatment: non pharmaco + topical NSAIDS -> PO NSAID/celecoxib -> paracetamol

3) Grade III

  • complete tear of ligament
  • severe pain, swelling, tenderness, ecchymosis
  • cannot bear weight or ambulate
  • significant instability, loss of motion and function
  • refer to A&E
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11
Q

tendonitis general

A
  • tendon inflammation
  • muscle to bone connective tissue
  • tendinosis: persistent tendinopathy
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12
Q

clinical presentation of tendonitis

A

1) local pain and dysfunction on active use
2) unlikely to be painful on passive movement
3) inflammation but unlikely visible swelling
4) degeneration

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13
Q

possible causes of tendonitis

A

1) overuse
2) sports injury
3) inflammatory rheumatoid disease
4) calcium apatite deposition from metabolic disturbances
5) drug induced: fluoroquinolone antibiotics (ciproflox) or statin

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14
Q

common locations of tendonitis

A

1) shoulder: rotator cuff tendinopathy
2) elbow: tennis/golf elbow
3) wrist
4) hip (lateral)
5) ankle: Achilles tendinopathy (pain on back of heel)

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15
Q

treatment of tendonitis

A

1) Standard non pharmaco
2) topical NSAID -> PO NSAID/celecoxib -> paracetamol

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16
Q

bursitis general

A
  • inflammation of bursae
  • bursae: fluid filled sac like structure around joints that cushion tendons/muscles from adjacent bones
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17
Q

acute bursitis causes

A
  • trauma/injury
  • crystal induced processes (gouty arthritis)
  • infection (septic bursitis)
18
Q

clinical presentation of acute bursitis

A
  • pain when joints fully flexed (active and passive)
  • adjacent bursa compressed -> increased intra-bursal pressure -> pain
19
Q

treatment of acute bursitis

A

1) Standard non pharmaco
2) topical NSAIDs -> PO NSAID/celecoxib -> paracetamol

20
Q

chronic bursitis causes

A
  • overuse
  • prolonged pressure
  • inflammatory arthritis
21
Q

chronic bursitis clinical presentation

A
  • more swelling and thickening
  • minimal pain
  • secondary changes to contracture and muscle atrophy related to immobility
22
Q

chronic bursitis treatment

A

refer to doctor

23
Q

location of bursitis

A

1) superficial locations

  • elbow, kneecap, posterior upper thigh region
  • cushions skin and bones

2) Deep locations

  • hip, shoulder
  • reduce friction of muscles as they glide over each other
  • consider giving intra-bursal glucocorticoid
24
Q

general plantar fasciitis

A
  • injury and inflammation of plantar fascia
  • fibrous attachment connecting heel bone to base of toes
  • most common cause of heel pain
25
Q

aetiology of plantar fasciitis

A
  • prolonged standing, jumping, running on hard surfaces
  • flat feet/high arched feet
  • tight hamstring -> decreased knee extension -> increased loading on forefoot -> increased stress on plantar and stretches it
  • higher risk in runners
26
Q

clinical presentation of plantar fasciitis

A
  • pain that worsen when walking/running esp in early morning or after periods of inactivity
  • pain lessens w increased activity but will be worse at the end of the day due to prolonged weight bearing
27
Q

treatment of plantar fasciitis

A

1) standard non pharmaco
2) topical NSAID -> PO NSAID/celecoxib -> paracetamol

28
Q

differential diagnosis of plantar fasciitis

A

1) neurologic cause

  • nerve entrapment: paraesthesia and numbness
  • neuropathic pain: nocturnal pain
  • S1 radiculopathy: radiating pain from posterior aspect of leg to heel

2) skeletal causes

  • calcaneal stress fracture, bone contusion: prior trauma or excessive weight bearing
  • osteomyelitis: Fever, constant pain
  • neoplasm: nocturnal pain

3) soft tissue causes

  • Achilles tendinopathy, bursitis
  • fat-pad atrophy: old, pain, absent in morning but develop and worsen as day goes by
  • plantar fascia rupture: sudden onset, visible swelling and ecchymosis

4) inflammatory disorders

  • reactive arthritis: PH/FH of inflammatory disease
  • sarcoidosis: erythematous nodosum
29
Q

when to refer for plantar fasciitis

A

numbing pain, nocturnal pain, fever, sudden onset of pain, constant pain regardless of movement, PMH of inflammatory systemic conditions

30
Q

adhesive capsulitis (frozen shoulder) - clinical presentation

A

1) unilateral (non-dominant side)
2) limited reaching overhead, to the side, across chest

31
Q

adhesive capsulitis (frozen shoulder) - phases

A

self limiting

1) initial phase (2-9 months)

  • diffuse, severe, disabling shoulder pain
  • worse at night
  • increasing stiffness

2) intermediate phase (4-12 months)

  • stiffness and severe loss of shoulder motion
  • pain gradually lessens
  • refer to physiotherapist if very debilitating

3) recovery phase (5-24 months)

  • gradual return in range of motion
32
Q

when to refer for adhesive capsulitis (frozen shoulder)

A
  • marked loss of motion
  • assess systemic symptoms of infection, malignancy, associated chronic illness
33
Q

adhesive capsulitis (frozen shoulder) - management

A

1) topical NSAIDs -> PO NSAIDs/celecoxib -> paracetamol
2) Range of motion exercises
3) intraarticular glucocorticoid + physical therapy

34
Q

lower back pain classification

A

1) Acute < 4 wks
2) subacute 4 - 12 wks
3) chronic > 12 wks

35
Q

causes of lower back pain

A

overuse, injury

36
Q

when to refer for lower back pain

A

1) neurologic symptoms

  • motor weakness, fall, gait instability, numbness, loss of bowel/bladder function

2) chronic glucocorticoid use, old, trauma, PMH of osteoporotic/trauma
3) unintended weight loss, PMH of malignancy
4) fever, malaise, recent spinal infection/epidural catheter placement, immunocompromised, haemodialysis, recent endocarditis/bacteraemia
5) constant pain, symptoms pointing to underlying cause (severe abdominal pain)

37
Q

pharmaco for back pain

A

1) acute and subacute

  • topical NSAID -> PO NSAID/celecoxib -> paracetamol
  • skeletal muscle relaxants (arcoxia)

2) chronic

  • topical NSAID -> PO NSAID/celecoxib -> paracetamol
  • weak opioids
38
Q

non pharmaco for back pain

A

1) RICE no HARM
2) refer to physio for back stretching exercises
3) maintain correct posture while sitting/standing
4) use correct lifting/moving techniques
5) engage in low impact core strengthening exercises to improve spine (swim, brisk walk)
6) avoid smoking and stressful situations
7) X lie down to rest cuz worsen muscle stiffness
8) maintain healthy diet cuz extra weight can add strain

39
Q

terminologies for myalgia

A

1) myalgia: muscle pain, soreness, stiffness
2) myopathy: muscle disease
3) myositis: muscle inflammation

40
Q

aetiology of myalgia

A

overuse, exercise

41
Q

differential diagnosis for myalgia

A
  • infections: dengue, influenza, covid, endocarditis, impending sepsis
  • drug induced

1) ciprofloxacin, bisphosphonates, aromatase inhibitors
2) statin-induced rhabdomyolysis

  • symptoms: proximal symmetric muscle weakness, nocturnal cramping, stiffness, tendon pain, fatigue
  • discontinue statin if CK > 10X ULN w/wo unexplained weight loss
  • drink large quantities of water to facilitate renal excretion of myoglobin to prevent renal failure
42
Q

management of myalgia

A

1) standard non pharmaco
2) warm up before exercising

end of y3 (8 decks)

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