Vitamin D values
< 30 = Deficient – high dose replacement
30 – 50 = Insufficient – medium dose
> 50 = Sufficient - none
What does vitamin d do?
- Helps regulate amount of calcium and phosphate in the body.
- These in turn required to keep bones, teeth and muscles healthy.
- Check levels in suspected fragility fractures
Indications for DEXA scan
- High fragility fracture risk score (Frax or Qfracture)
- Over 50 yrs with history of fragility fractures
- Under 40 with major risk factor for fragility fracture + refer to FLS
Diagnosis of osteoporosis using DEXA scan- value
T score of -2.5 or below is a diagnosis of osteoporosis
Indications for Vitamin D levels
osteomalacia (or rickets)
fargility fractures
Can you differentiate between osteomalacia and osteoporosis using DEXA
No
What is osteomalacia?
metabolic bone disease characterised by incomplete mineralisation of the underlying mature organic bone matrix
inadequate levels of calcium, phosphate or vitamin D,
What is arthroscopy?
Surgical procedure where thin telescope with light source (arthroscope) to look inside joints.
Diagnostic or Arthroscopic surgery.
Mainly used to investigate or treat knee problems.
Can be used in other joints too.
Indications for joint aspiration
any patients with inflamed joints with no established diagnosis.
Joint aspiration of gout vs septic arthritis:
Gout: needle shaped negatively-birefringent uric acid crystals
Septic arthritis:
1. joint fluid aspiration appears cloudy or purulent
- cell count with WBC > 50,000 is considered diagnostic for septic arthritis
- gram stains only identifies infective organism 1/3 of time
Rheumatoid + osteoarthritis inflammatory differences
High ESR + CRP = RA
Normal ESR + CRP = Osteroarthritis
When to refer urgently for rheumatoid arthritis?
- Small joints of the hands or feet are affected
- More than one joint is affected
- There has been a delay of 3 months or longer between the onset of
symptoms and the person seeking medical advice - Do not delay referral if blood tests are normal or results have not returned from the laboratory.
- Early intervention may help prevent irreversible joint damage
Ix for SLE
- Anti-dsDNA
- Anti-smith
antibodies - ANA +
–> confirmatory of SLE with symptoms
Anti-CCP specific to…
Rheumatoid arthritis
Rheumatoid factor
Non- specific marker
Rheumatoid arthritis markers
Anti-CCP
RF
What is ANA?
Non specific marker for autoimmune disease.
Nearly all patient have +’ve ANA and this is positive in many cases.
Acute compartment syndrome symptoms
Mainly PAIN
Late signs (Ischemic Limb): Pallor Paraesthesia Perishingly cold Pulselessness Paralysis
Ix for Acute compartment syndrome
Clinical diagnosis (early signs/patient at risk) Compartment pressure monitoring.
Symptoms of cauda equina
Back pain
Uni/bilateral leg pain
Bowel and bladder dysfunction
Reduced power lower limb
Signs of cauda equina
- Bilateral sciatica
- Urinary retention (50-70%)
- Faecal incontinence
- Saddle anaesthesia
- Loss of anal tone
Ix for CES
Urgent MRI
Sx for Cervical spine fracture
Neck pain/tenderness
Neck spasm
Reduced range of movement
Occipital headache
Indication for imaging for symptoms of cervical spine fracture
Intoxication OR
Altered GCS OR
Neck pain or tenderness OR
Distracting Injury
