Back pain
Back pain is an extremely common complaint, accounting for 6% of all General Practice consultations. In the UK nearly 400,000 people lose time from work each year because of back pain. No cause will be found in 30% of patients, but more serious problems, such as disc disease, spondylolisthesis, spinal stenosis, and malignancy must be excluded.
What to learn
How to take a good history of back pain and the important points (site, radiation, onset, aggravating factors, and time pattern) that will lead to diagnosis.
Clinical features of the serious causes: disc disease, spondylolisthesis, spinal stenosis, infection, and malignancy.
An approach to the management of psychogenic and nonspecific back pain.
Osteoarthritis
Osteoarthritis is the most common type of arthritis, occurring in 20% of the population as a whole and in 50% of those over 50 years of age. This disease involves cartilage, which becomes eroded and progressively thinned as the disease proceeds.
What to learn
The pathophysiological changes that occur in cartilage to cause the disease.
Symptoms, signs, and x-ray findings in osteoarthritis.
Rheumatoid arthritis
Rheumatoid arthritis is a common, chronic systemic disease characterized by a symmetrical inflammatory polyarthritis that causes progressive joint damage and disability in young people, and extraarticular involvement of lungs and other organs. It affects about 2% of the population worldwide. Women are affected more often than men (3:1), and there is an association with HLA-DR4 in 70% of sufferers.
What to learn
The pathophysiological changes that occur in the synovium.
Symptoms, signs, and x-ray changes in rheumatoid arthritis, especially features of the rheumatoid hand.
Osteoporosis
Osteoporosis is a common disorder in which a reduction in bone mass esists, includes all components of the bone, not just calcium, as in osteomalacia. Osteoporosis is a major problem that will cause fractures in 40% of Caucasian women and 20% of men.
What to learn
Etiology and risk factors for osteoporosis.
Classification into type 1 (postmenopausal) and type 2 (senile).
Septic arthritis
This results from infection of joints with pyogenic organisms, the most common being Staphylococcus aureus, which can reach the joint via the bloodstream, a local site of infection such as a boil, or occasionally from an adjacent site of osteomyelitis. Septic arthritis constitutes a medical emergency, and the joint can be ruined within 24 hours without treatment.
What to learn
Clinical features of septic arthritis.
Diagnostic approach: joint aspiration and blood culture; x-rays are not useful.
Management with antibiotics and sometimes drainage.
Gout
This is an abnormality of uric acid metabolism in which crystals of sodium urate become deposited in the joints, soft tissue, and urinary tract. It presents primarily with an acute arthritis, as well as tophi, tenosynovitis, and urate kidney stones.
What to learn
Normal uric acid metabolism and pathological mechanisms of urate crystal deposition.
Clinical features, x-ray, and joint aspiration findings in gout.
Myasthenia gravis
This is an acquired condition with a prevalence of 4 in 100,000; it is twice as common in women as in men. It is characterized by weakness and fatigue in proximal limb, ocular, and bulbar muscles. The etiology is not fully understood but myasthenia gravis appears to be autoimmune, with immunoglobulin G (IgG) antibodies to the acetylcholine receptor protein found in the serum. Myasthenia gravis is a common exam topic.
What to learn
Signs and symptoms of myasthenia gravis.
Diagnostic tests: tensilon test and autoantibodies.
Systemic lupus erythematosus (SLE)
This is the most common of the connective tissue diseases and is characterized by the presence of antibodies against nuclear components. It is a multisystem disease, with arthralgia and rashes the most common clinical features, but vasculitis and disorders of the lung, heart, kidney, nervous system, and eye and involvement of the GI tract can all occur.
What to learn
Epidemiology and factors involved in pathogenesis, which is not fully understood.
