MSK Flashcards

Question

Osteoarthritis

Answer 1

This is where the smooth surface of a joint thins and becomes rougher. This means that when you are using the joint, the roughness can cause pain and swelling and limit the ability to use that joint. We’ve moved away from the term wear and tear to wear and repair as I lost the time in osteoarthritis people have flares of their disease and then the joint repairs itself and they have an improvement of their symptoms but may have a further flare in the future Osteoarthritis is very common Most often seen in the weight-bearing joints such as the hips and the knees but can happen in any joints the hands are another common site.

Answer 2

Weight management Exercise Strength strengthening of muscle Footwear Physiotherapy Analgesia Steroids Occupational therapy for activities of daily living Surgery

Answer 3

Early menopause Low BMI less than 19 Alcohol greater than three units per day Family history Long-term steroids Previous agility fracture Smoking F over x years old and with a fragility fracture may need to consider just start bisphosphonate****** look up Assessed with a frax or Q fracture cure gives a 10 year risk of fracture those of intermediate or high risk to be referred for DEXA scan Blood test prior to starting bisphosphonates- fbc, ESR, u&e, tft, calcium phosphate vitamin D LFTs Management is with the best phosphonate for those with a T less than -2.5 Weight-bearing exercise Calcium and vitamin D Avoidance of falls Balance exercises Stop smoking

Answer 4

Need to be taken correctly Often once weekly on an empty stomach with a large glass of water and have to sit up for 30 minutes afterwards Should have an examination from a dentist to ensure teeth okay? Small risk of osteoporosis of the jaw Most common side-effect is reflux and GI If this occurs changed to different bisphosphonate If still intolerant can be referred to rheumatology for consideration of IV treatment Should have calcium intake assessed and if less than threshold of 700 give supplements everyone should have vitamin D Treatment should be for five years and then review often with a repeat DEXA scan In certain situations you can start this phosphonate without DEXA scam such as impatience who are predicted to be on long-term steroids

Answer 5

Inflammatory arthritis Polyarthritis Often symmetrical Morning stiffness Systemic upset - tiredness weight loss Skin and respiratory symptoms Risk cardiovascular disease 40 to 60 years old Autoimmune process Often includes small joints of hands and feet Pain swelling reduce function Erythema fever weight loss, history of cancer systemic upset -red flags Morning stiffness lasting longer than 30 minutes Ask about deformity of joints and loss of function Investigations full blood count Crp/esr Anti-ccp ??RF X-ray joint Urgent referral, if small joints of hands or feet involved more than one joint involved or more than three months since the onset of symptoms Treatment include analgesia, disease modifying drugs, Surgery steroids may be used in the flare however they are not to be started in primary care unless guided by rheumatology NSAIDs all the best option for painkillers ? Add PpI Physio and OT MDT with specialist nurse input Aware of increased risk of cardiovascular disease and osteoporosis Social care direct referrals for housing adjustments and carers might be required Family history Assess activities of living and work affect Smoking Medication

Answer 6

This is a condition of inflammation of the large muscles often affecting the shoulders and the hips Most commonly in people over 50 and last longer than two weeks ESR and CRP often raised Rapid response to steroid treatment Consider starting bis- phosphonate due to the fact they will be on long-term steroids as needs a slow titration off steroids once symptoms improved Muscle pain stiffness Which muscle groups are affected? Worse early morning Difficulty getting up for a chair Difficulty combing hair Any feelings of any joints? Vision loss or headache could be assigned temporal arthritis needs urgent review including jaw clarification Other medication Affect on quality of life and work Help at home Preline 15 mg daily reducing to maintenance dose of 5 mg daily treatment often for around two years. Giant cell arthritis high dose pregnant lung 40 to 60 though I think 80 eye I involvement Ensure patient has a steroid card and is warned about sick day rules with steroids

Answer 7

Lateral epicondylitis 30 to 50 years old Altered loading pattern Improves with rest, painkillers, and physio Ensure you know, left or right handed Effect on sports quality of life and work Explanation : tennis elbow is inflammation of the tendon that connects the muscle to the bone at the elbow. It often causes pain localised the area. It can often be associated with certain activities hence why it’s called tennis elbow. Modification of activities Painkillers Occasionally, steroid injections are used Elbow splint or support Physiotherapy If not improving, refer for surgery or Botox injection

Answer 8

Thumb and lateral two fingers Numbness, pins and needles Factors, pregnancy weight gain rheumatoid arthritis, hypothyroidism diabetes abnormal position of the wrist Explanation : there is a thick band across the wrist and the nerve called the median nerve travels under this. This supplies the sensation to the thumb and two fingers and also some small muscles of the hand. Anything that causes swelling around the wrist can press on this nerve as it goes through this tunnel under this thick fibre brand Treatment options are splinting steroid injections and surgery Wasting at the muscles of the hand is red flag - thenar muscles Involvement of all the nerve distribution could be a sign of cubital tunnel syndrome this is where the owner nervous compressed as it goes around the funny bone Symptoms aggravating relieving factors Weakness in hand Tingling Abnormal sensation Sparing of little finger Worse at night Relief by shaking hands Worsened by holding phone vibration or typing Ask if left right handed Activities of living and effect on work

Answer 9

This is an inflammatory arthritis Causes urate crystals Red heart swollen, painful joint Often only one joint affected Main differential diagnosis is septic arthritis Treated acutely with non-steroid anti-inflammatories, steroids, colchicine Bloods to look at urate Cardiovascular risk assessment Triggers, including alcohol, medication, dehydration, certain food Discussion about long-term uric acid lowering treatment- allopurinol with cochine cover 5m aim urate <0.36 Cardiovascular review

Answer 10

Thickening of the tendon sheath that cause a permanent fixed position Most commonly affects the ring a little finger Ask about left or right handed and effective quality of life Treatment options are conservative or surgery

Answer 11

Generalised joint pain Hyper mobile joints Back pain Dislocations Abdo pain Palpitation POTS Easy bruising Stress incontinence Hands on floor Elbow extension Little finger extend Knee extension Lots of genetic genes

MSK Flashcards

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