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YEAR 3 GP - RT > Tutorial 2 - Main musculoskeletal conditions presenting to GP: > Flashcards

Tutorial 2 - Main musculoskeletal conditions presenting to GP: Flashcards

1
Q

Name common reasons for back pain presenting to general practice.

A
  • Pulled muscle / strain
  • slipped disc / Sciatica / cauda equina syndrome
  • Ankylosing spondylitis
  • Osteoporosis / broken bone
    -Vertebral tumour
    -Vertebral osteomyelitis (infection)
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2
Q

What is a slipped disc and what can it cause ?

A
  • Slipped disc is when part of the intervertebral discs herniate out.
  • When they herniate out they can apply pressure on nerve roots.
  • One condition not to miss would be sciatica - pinching of the sciatic nerve.
  • Red flag condition - caudal equina syndrome.
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3
Q

What is sciatica ?

A
  • Sciatica is compression of the lumbosacral nerve roots (L4 - S1) which form the sciatic nerve.
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4
Q

Name 4 symptoms of sciatica.

A
  • Saddle anaesthesia
  • Urinary / bladder dysfunction ( often urinary retention )
  • Sharp / burning pain in lower back, buttocks, posterior thigh, calves.
  • Weakness in myotome distribution.
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5
Q

Name 4 risk factors for sciatica.

A
  • Old age ( degenerative changes )
  • Obesity
  • Smoking
  • Occupational i.e. heavy lifting regularly.
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6
Q

What investigations can you order to confirm a sciatica diagnosis ?

A

MRI.

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7
Q

How do you diagnose sciatica ?

A
  • Presence of symptoms (pain, weakness ,anaesthesia , urinary dysfunction)
  • Conduct a spinal examination ( with special tests )
  • Imaging i.e. MRI
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8
Q

What is the management for sciatica ?

A
  • Reassure patient that symptoms of sciatica should go within 4 - 6 weeks.
  • Urge patient to continue remaining as active as possible.
  • Offer analgesics such as paracetamol / ibuprofen.
  • If appropriate NSAIDS / opioids ( but explain risks of long term use ).
  • Offer physiotherapist ( NHS waiting times can be long, so maybe prompt for a private one )
  • If pain does not resolve / progresses can be admitted for surgery.
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9
Q

What is cauda equina syndrome ?

A
  • The caudal equina is a bundle of nerves travelling from the Lower back region to supply the lower limbs and pelvic organs.
  • Thus, caudal equina syndrome is the compression of all of these nerves.
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10
Q

What are the symptoms of caudal equina syndrome ?

A
  • Bilateral sciatica
  • Progressive weakness in knee flexion, foot eversion, dorsi flexion etc.
  • Difficulty initiating micturition
  • Loss of sensation of rectal fullness
  • saddle anaesthesia
  • Erectile dysfunction
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11
Q

What is the management for cauda equina syndrome ?

A
  • Refer onto hospital for urgent decompression ASAP.
  • Surgery within 8 hours of onset of symptoms has a good prognosis.
  • If left can have permanent urinary / bladder dysfunction.
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12
Q

What is ankylosing spondylitis ?

A
  • Chronic inflammatory condition.
  • Results in inflammation / fusion/ stiffness of vertebral joints - especially the sacro - iliac joint.
    -Inflammation can also progress to other parts of body such as the eyes / blood vessels etc.
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13
Q

How does ankylosing spondylitis present ?

A
  • Chronic back pain / stiffness that improves with activity.
  • Dactylitis ( swelling of a toe / finger)
  • Fatigue
  • Enteritis ( inflammation of GI tract )
  • Arthiritis ( predominantly lower limb )
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14
Q

What are some risk factors for ankylosing spondylitis ?

A
  • Autoimmune condition - presence of HLA - B27 gene.
  • Men > female
  • Presents early adulthood / late adolescents
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15
Q

What are the investigations for ankylosing spondylitis ?

A
  • Difficult to diagnose BUT
  • Blood test for inflammation
  • genetic test for HLA - B27 gene
  • MRI / X - RAY scans
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16
Q

What is the management for ankylosing spondylitis ?

A
  • Exercise
  • Physiotherapy ( slow bone fusion / stiffness )
  • Medication ( NSAIDS - ibuprofen , paracetamol, opioid - codeine, anti TNF therapy, monoclonal antibodies, corticosteroids, DMARDS.
  • Surgery
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17
Q

How does vertebral bone cancer present ?

A
  • Pain at the site of the tumour
  • Back pain which radiates to other parts of the body, and is worse at night
  • Loss of sensation to temperature and pain
  • Loss of bowel / bladder control
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18
Q

Which cancers often metastasise to the vertebrae ?

A
  • Lung
  • Prostate
  • Breast
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19
Q

What investigations can be done for vertebral cancer ?

A
  • Biopsy
  • MRI scan
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20
Q

What investigations can be done for vertebral cancer ?

A
  • Biopsy
  • MRI scan
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21
Q

What is the management for vertebral tumour ?

A
  • Monitoring - if benign and growing at a slow speed
  • Surgery
  • Radiation therapy
22
Q

What is osteoporosis ?

A
  • Osteoporosis is a disease categorised by a low bone mass index and progressive deterioration of bone tissue - making fractures more likely.
23
Q

How would osteoporosis present ?

A
  • Back pain
  • Fracture easy
  • Stooped posture / loss of height
24
Q

Name some risk factors for osteoporosis.

A
  • Female sex
  • Menopause
  • Ageing
  • Vitamin D / calcium deficiency
  • Smoking
  • Use of oral corticosteroids
25
Q

What is a BMD and T score ?

A
  • Bone mineral density
  • Duel energy x - ray test
  • Reports back a T score
  • T score between 0 and -1 is normal, T score from -1 to -2.49 considered as osteopenia and below -2.5 considered as osteoporosis.
26
Q

What is the management for osteoporosis ?

A
  • Bisphosphonates ( oral or injection ) i.e. alendronic acid
  • Calcium / vitamin D supplements
  • HRT / testosterone
27
Q

What is vertebral osteomyelitis ?

A
  • Painful vertebrae infection
  • Staph aureus infection.
28
Q

How does vertebral osteomyelitis present ?

A
  • Back pain that does not get better with movement / pain relief.
  • Weight loss
  • Weakness
29
Q

What are some risk factors for vertebral osteomyelitis ?

A
  • Dialysis
  • Inject drugs using unclean needles ( recreational drugs ? )
  • Immunocompromised state
30
Q

What investigations should be ordered for suspected vertebral osteomyelitis ?

A
  • FBC
  • CRP
  • Blood / fluid / pus culture
  • Biopsy
  • Imaging - MRi scan
31
Q

How is vertebral osteomyelitis treated ?

A
  • Antibiotic course for infection.
32
Q

How is vertebral osteomyelitis treated ?

A
  • Antibiotic course for infection.
33
Q

What is osteoarthritis ?

A
  • Osteoarthiritis is a type of arthiritis
  • It involves the wear and tear of the synovial joints
  • Leading ultimately to bone on bone rubbing, which causes pain.
34
Q

How would osteoarthritis present ?

A
  • Pain / swelling - improves with rest
  • Morning stiffness < 30 mins
  • Grating / crackling sensation
  • Bone spurs
35
Q

What are the risk factors for osteoarthritis ?

A
  • Family history
  • Females
  • Obesity
  • Increasing age
  • Trauma ( occupational / injury etc ).
36
Q

What investigations can be carried out for osteoarthritis ?

A
  • Lab tests ( blood test - rule out rheumatoid, joint fluid analysis - rule out infection / gout )
  • X - ray
37
Q

What would XRAY of osteoarthritis show ?

A
  • LOSS:
  • Loss of joint space
  • Osteophytes
  • Subchondral sclerosis
  • Subchondral cysts
38
Q

What is the management for osteoarthritis ?

A
  • Self management advice i.e. lose weight if needed
  • Offer psychosocial help for depression / anxiety
  • Analgesics i.e. NSAIDS - ibuprofen, opioids - codeine.
  • Joint replacement surgery.
39
Q

What is inflammatory arthiritis ?

A
  • Ankylosing spondylitis
  • Rheumatoid arthirtis
  • Gout
  • Psorotic arthiritis
40
Q

What is rheumatoid arthiritis ?

A
  • Autoimmune condition
  • Body attacks synovial joints
  • Later on in disease can present with signs of systemic inflammation.
41
Q

What are the symptoms of rheumatoid arthiritis ?

A
  • pain / stiffness - symmetrical
  • Commonly affects small joints in hands and feet
  • Swollen
  • Morning Stiffness lasts longer than 30 mins
  • Pain better with use
42
Q

What are the risk factors for rheumatoid arthiritis ?

A
  • Increasing age
  • Female gender
  • Family history
  • Smoking
43
Q

What investigations can be done for suspected rheumatoid arthiritis ?

A
  • Rheumatoid factor (rF)
  • Anti CCP
  • X - ray
44
Q

What would X-ray of rheumatoid arthiritis look like ?

A
  • Loss of joint space
  • Osteoporosis
  • Peri - articular erosions
  • Subluxation
45
Q

What is the treatment of rheumatoid arthiritis ?

A
  • Medical therapy - DMARDS, Anti TNF therapy, Monoclonal antibodies
  • Analgesia
  • Physiotherapy
  • Surgery - joint replacement
46
Q

What is gout ?

A
  • Gout is a type of inflammatory arthiritis
  • Often due to rate crystals forming inside and around joints secondary to hyperuricemia.
47
Q

How does gout present ?

A
  • Intense joint pain
  • Lingering discomfort
  • Red / swollen / tender joint
  • Limited range of motion
48
Q

Name some risk factors for gout.

A
  • Diet - alcohol, red meats
  • Obese - body produces more uric acid
  • Medication - i.e. ACEI can increase uric acid levels
  • men and women (after menopause)
  • Family history
49
Q

What investigations can be done if gout is suspected ?

A
  • Joint fluid test - presence of crystals
  • Blood test - level of uric acid
  • Xray
  • Dual energy CT scan ( visualise crystals )
50
Q

What is the management for gout ?

A
  • NSAIDS / corticosteroids - control pain
  • Allopurinol - control levels of uric acid in body
  • Exercise
  • Diet - limit foods high in purines such as mussels and alcohol.

YEAR 3 GP - RT (24 decks)

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