GP Topics
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15 terms
Terms | Definitions |
|---|---|
 Back Pain - Causes - 15 - 30 | Postural, mechanical, prolapsed disc, trauma, fractures, ankylosing spondyloarthropathies, spondylosithesis, pregnancy |
| Back Pain - Causes - 30 - 50 | Postural, degenerative joint disease, prolapsed disc, discitis, spondyloarthropathies |
| Back Pain - Causes - >50 | Postural, degenerative, osteoporotic collapse, Paget's, malignancy (lung, breast, prostate, thyroid, kidney), myeloma Other causes: referred pain, spinal stenosis, cauda equina tumours, spinal infection |
| Back Pain - Prevention of back pain | Regular exercise; optimal weight; advice reposture, working environment, and lifting techniques; correct uneven leg length of >2-3cm measured from pubis to medial malleolus. |
| GI - Back Pain - Red Flags | <20y. or >55y. Non-mechanical pain Thoracic pain Past history of carcinoma HIV Taking steroids Unwell Weight â†" Widespread neurology Structural deformity |
| GI - Back Pain - Acute - Management | Explain the likely natural history - avoid bed rest Don't X-ray routinely (unless < 25 or SI joints) Prescribe analgesia Consider referral for physiotherapy, chiropractic, or osteopathy |
| GI - Back Pain - Chronic - Management | Exclude spinal pathology and lesions amenable to surgery Consider referral to a pain clinic. Analgesics Tricyclic antidepressants Other approaches - back supports, heel raises, TENS |
| GI - Carpal Tunnel - Investigations | Phalen's test - hyperflexion of wrist for 1min. triggers symptoms Tinnel's test - tapping over the carpal tunnel causes paraesthesiae Nerve conduction studies |
| GI - Carpal Tunnel - Management | Night splints; carpal tunnel steroid injection (p.192); surgery to divide the flexor retinaculum is curative in mild/moderate disease |
| Hip Pain - Causes | Buttock pain - PMR, sacroilitis, vascular insufficiency, referred from back. Groin pain - hip joint disease (OA, RA, Paget's, osteomalacia), fracture, osteitis pubis, hernia, psoas abscess. Lateral thigh pain - trochanteric bursitis, referred pain from back, enthesitis (spondyloarthropathies), gluteus medius tear, meralgia paraesthetica, fascia lata syndrome. |
| OA of Hip -management | Analgesia (e.g. regular paracetamol, NSAIDs), education, weight â†", exercise, correction of unequal leg length. Walking stick ± shock-absorbing shoe insoles can help. Consider referral for physiotherapy (muscle strengthening exercises may â†" pain) or to orthopaedics for consideration of hip resurfacing or replacement |
| Osteoporosis - Investigations | DEXA scan if <75y. Exclude other causes of pathological fracture (e.g. malignancy, osteomalacia, hyperparathyroidism). Check FBC, ESR, TSH, Cr, bone and liver function testsâ€"all should be normal. Consider checking serum paraproteins/urine Bence Jones protein, bone scan, and FSH/testosterone/LH (if hormonal status is unclear). |
| RA - Non articular features | Rheumatoid nodules (especially extensor surfaces of forearms). Vasculitis - digital infarction, skin ulcers, mononeuritis. Eye - Sjögren's syndrome, episcleritis, scleritits. Lungs - pleural effusions, fibrosing alveolitis, nodules. Heart - pericarditis, mitral valve disease, conduction defects. Skin - palmar erythema, vasculitis, rashes. Neurological - nerve entrapment e.g. Carpal tunnel, mononeuritis, and peripheral neuropathy. Felty's syndrome |
| Felty's syndrome | RA, splenomegaly, and leucopenia. longstanding RA Recurrent infections lymphadenopathy pigmentation persistent skin ulcers Splenectomy may improve the neutropenia |
| HTN - Referral | Malignant hypertensionâ€"E Renal impairmentâ€"U/S/R Suspected 2° hypertensionâ€"S/R Patients <35y.â€"R Multiple risk factorsâ€"R BP difficult to treatâ€"R Pregnancyâ€"to obstetrician; urgency depends on stage of pregnancy and clinical features |
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