Modules

• Year 1
  • Introduction to Year 1 and Year Outcomes
  • Fundamentals of Medicine
  • Cardiorespiratory 1
  • Metabolism 1
  • Locomotor 1
  • Brain and Behaviour 1
  • Human Development 1
  • Medicine in Society 1
  • Clinical Communication Skills
  • Student Selected Component (SSC)
• Year 2
  • Introduction to Year 2 and Year Outcomes
  • Cardiorespiratory 2
  • Metabolism 2
  • Brain and Behaviour 2
  • Human Development 2
  • Human Sciences and Public Health 2
  • Locomotor 2
  • Cancer Week
  • Moving and Handling Training
  • Year 2 Lifesaver Programme
  • Clinical Communication Skills
  • Medicine in Society 2
  • Extended Patient Contact
  • Student Selected Component (SSC)
• Year 3
  • Introduction to Year 3 and Year Outcomes
  • Clinical Science and Professionalism (Weeks 1-3)
  • Cardiovascular, Respiratory and Haematology (CR3)
  • Gastroenterology and Cancer (MET3A)
  • Public Health
  • Endocrinology and Renal Medicine (MET3B)
  • General Practice and Community Care
  • Student Selected Component (SSC)
  • Clinical and Communication Skills
• Year 4
  • Introduction and Year 4 Outcomes
  • Obstetrics and Gynaecology
  • Child Health
  • HIV & Sexual Health
  • Musculoskeletal
  • Health Care of the Elderly
  • Neuroscience
  • Dermatology
  • General Practice and Community Care
  • Psychiatry
  • Ear, Nose and Throat
  • Global Health and Ethics
  • Ophthalmology
  • Clinical & Communication Skills
  • Student Selected Component (SSC)
• Year 5
  • Introduction to Year 5 and Year Outcomes
  • Teaching Week 1
  • Teaching Week 2
  • Anaesthesia & ITU (AN & ITU)
  • Breaking Bad News
  • Clinical Pharmacology & Therapeutics
  • Community Care
  • Doctors as Teachers and Educators (DATE)
  • Emergency Medicine (EMERG MED)
  • General (Internal) Medicine (G(I)M)
  • Immediate Life Support (ILS)
  • Student Assistantship
  • Simulation
  • Surgery
  • Student Selected Component (SSC)
• Year GEP 1
  • Cancer Week
  • Movement and Posture
  • Carriage of Oxygen
  • Human Sciences and Public Health
  • Digestion, Growth and Metabolism
  • Infection and Immunity
  • Ethics
  • Brain and Behaviour
  • Human Development
  • Clinical Communication Skills
  • Medicine in Society (GEP)

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Year 4 MusSkel4: Musculoskeletal

• Prof Bruce Kidd
• b.l.kidd@qmul.ac.uk

Teaching Material for this Module

Introduction

The modules aims to develop students understanding of the diagnosis and management of the common rheumatological and orthopaedic conditions including fractures.

The program consists of introductory lectures,  small group tutorials in both rheumatology and orthopaedics, attendance in outpatient clinics and theatre sessions

Key learning outcomes

1. Can apply to medical practice, the biomedical scientific principles, method and knowledge relevant to musculoskeletal disease  (GMC TD 8)
2. Can demonstrate knowledge of relevant drug actions: therapeutics and pharmacokinetic: drug side effects and interactions (GMC TD 8f)
3. Can carry out a consultation with a patient with a musculoskeletal disease  (GMC TD 13)
4. Can diagnose and understand the basic management of a patient with a musculoskeletal disease  (GMC TD 14)
5. Can carry out, under supervision, specified practical procedures (GMC TD 18)

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Index

• General Outcomes for the Musculoskeletal System
• The patient with joint pain
• The patient with a hot swollen joint
• The patient with myalgia
• The patient with regional pain / soft tissue disease
• The patient with back pain
• Rheumatoid arthritis
• Connective Tissue Diseases and Vasculitis
• Spondyloarthritis
• Osteoarthritis
• Crystal Arthropathies
• Osteoporosis and Metabolic Bone Disease
• Chronic Widespread Pain
• Trauma, Fractures & Soft Tissue Injuries
• Infections of Bones and Joints
• Bone tumours / Malignancy
• Paediatric Joint Diseases

• General Outcomes for the Musculoskeletal System
  • Medical knowledge: ANATOMY (TD 8.1)
    • Bones and Joints
      1. Can describe the functional anatomy of synovial joints and the spine
    • Muscles, Nerves and Connective Tissue
      1. Can describe the distribution of the major nerve roots and peripheral nerves
  • Clinical skills: HISTORY (TD 13 a-b)
    • Musculosketal History
      1. Can obtain a detailed musculoskeletal history from a patient presenting with either arthralgia, mylagia, back pain or chronic widespread disease
  • Clinical skills: PHYSICAL EXAMINATION (TD 13 c)
    • Examining the Patient
      1. Can identify, using the GALS (Gait, Arms, Legs Spine) screen, normality and regional abnormality of the musculoskeletal system
      2. Can perform a detailed examination of the peripheral joints and spine
  • Clinical skills: PLANNING AND INTERPRETING INVESTIGATIONS (TD 14 c-d)
    • Musculosketetal Imaging
      1. Can identify the characteristic radiological abnormailities of the common rheumatic diseases including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, pseudogout, psoriatic arthritis and disorders affecting the spine
      2. Can identify the characteristic radiological abnormailities, complications and management of the common upper limb fractures, including: Clavicle, Humeral head/neck/shaft, Supracondylar, Olecranon, Radius and Ulnar, and Scaphoid.
    • Musculoskeletal Investigation
      1. Can describe the diagnositic features of synovial fluid in the common rheumatological disorders (RA, OA, gout) as well infection
  • Clinical skills: PRESCRIBING DRUGS SAFELY AND EFFECTIVELY (TD 17 a-h)
    • Analgesic Drugs
      1. Be able to distinguish between the following terms and conditions: Pain secondary to inflammation; Neuropathic pain; Pain secondary to malignancy; WHO analgesic ladder
      2. Know how to select the type, route, dose and frequency of analgesia to maximise efficacy and reduce harm
      3. Knows the indications for choosing, giving and monitoring the following medications: Aspirin; Non-steroidal anti-inflammatory drugs (NSAIDs) - Ibuprofen, Naproxen, Diclofenac; Cyclo-oxygenase 2 selective inhibitors (Coxibs) eg Celecoxib; Local Anaesthesi
• The patient with joint pain
  • General Topics
    1. Can list a differential diagnosis for a patient presenting with acute polyarthritis
    2. Can list a differential diagnosis for a patient presenting with persistant polyarthritis.
• The patient with a hot swollen joint
  • Differential diagnosis
    1. Can list a differential diagnosis for a patient presenting with a hot swollen joint.
  • Snovial fluid assessment
    1. Can describe the diagnositic features of synovial fluid in the common rheumatological disorders (RA, OA, gout) as well infection
• The patient with myalgia
  • Approach to diagnosis
    1. Can list a differential diagnosis for a patient presenting with myalgia
    2. Can list a differential diagnosis for a patient with chronic widespread musculoskeletal pain
  • Polymyalgia rheumatica
    1. Describe the clinical features, pathology, diagnosis and treatment of polymyalgia rheumatica
    2. Can describe how to diagnose and treat giant cell arteritis
• The patient with regional pain / soft tissue disease
  • Shoulder
    1. Can describe the features and treatment of frozen shoulder, rotator cuff tendinopathy, subacromial bursitis and biceps tendinopathy
  • Elbow
    1. Can describe the clinical features and treatment of lateral and medial epicondylitis, olecranon bursitis and ulnar berve entrapment (cubital tunnel syndrome)
  • Wrist & Hand
    1. Can describe the clinical features and treatment of carpal tunnel syndrome, wrist ganglions, DeQuervain's tenosynovitis, Dupuytrens contracture, trigger finger
  • Hip
    1. Can describe the features and treatment of trochanteric bursitis, transient synovitis of the hip, OA of the hip
  • Knee
    1. Can describe the features and treatment of meniscal tears, anterior cruciate ligament tear, medial collateral ligament sprain, Osgood-Schlatters disease, iliotibial band syndrome, patellofemoral pain syndrome
  • Ankle & Foot
    1. Can describe the features and treatment of bunions, plantar fasciitis, achilles tendinitis and Mortons neuroma
• The patient with back pain
  • General Topics
    1. Can describe the common causes of back pain
    2. Understands the concept of red and yellow flags
    3. Can describe the difference between referred and radicular symptoms
    4. Can describe six red flag features and understand their diagnostic value
  • Disc disease
    1. Can describe the pathogenesis of an acute disc prolapse
    2. Can describe the features and predisposing causes of discitis
  • Cauda equina syndrome
    1. Can describe the clinical features and complications of the cauda equina syndrome
  • Spondylosis, spondylolisthesis and spondylolysis
    1. Knows the clinical and radiological features of spondylosis, spondylolisthesis and spondylolysis
• Rheumatoid arthritis
  • General outcomes
    1. Knows the pathophysiology, and clinical and radiological features of rheumatoid arthritis
    2. Knows about the use of disease modifying anti-rheumatic drugs (DMARDs) in RA
    3. Knows how to diagnose and treat a patient with rheumatoid arthritis
• Connective Tissue Diseases and Vasculitis
  • General
    1. Describe clinical features and diseases associations of Sjogrens syndrome
  • SLE
    1. Describe the autoantibodies commonly associated with the connective tissue disorders
    2. Discuss the clinical features, pathology and systemic manifestations of systemic lupus erythematosus
    3. Can describe the clinical features and treatment of the anti-phospholipid syndrome
  • Scleroderma
    1. Can describe the clinical features and management of systemic sclerosis / scleroderma
  • Polymyositis
    1. Understands the clinical features, diagnosis and overall management of polymyositis and dermatomysoitis
  • Vasculitis
    1. Can outline a simple classification of vasculitis
    2. Can list the clinical features and basic management of the major vasculitides
• Spondyloarthritis
  • General Topics
    1. Understands the association between genetic (HLA B27) and environmental factors in spondyloarthropathy
  • Ankylosing spondylitis
    1. Can describe the clinical and radiological features and treatment of ankylosing spondylitis
  • Reactive arthritis
    1. Can describe the clinical features and treatment of reactive arthritis
  • Psoriatic arthritis
    1. Can describe the main patterns of joint disease in psoriatic arthritis and their radiological features
• Osteoarthritis
  • General Topics
    1. Can describe the pathology, clinical & radiological features and treatment of osteoarthritis
    2. Can describe the surgical approach to degenerative joint disease
• Crystal Arthropathies
  • Gout
    1. Can list the causes and clinical features of gout
    2. Can differentiate between acute treatment and chronic prophylaxis of gout
    3. Can describe the microscopic features of synovial fluid in gout
  • Pseudogout
    1. Can describe the clinical and radiological features, and treatment, of calcium pyrophosphate arthropathy (pseudogout)
• Osteoporosis and Metabolic Bone Disease
  • Metabolic Bone Disease General
    1. Understands the causes of elevated and reduced serum calcium levels, the pathophysiology of vitamin D deficiency, and the effects of parathyroid disorders on the musculoskeletal system
  • Osteoporosis
    1. Understands the pharmacology and use of the following medications for Osteoporosis: Biphosphonates - Alendronate; Vitamin D; Calcium; Hormone Replacement Therapy - Oestrogen; Testosterone; Selective Oestrogen Receptor Modulators
    2. Is able to identify risk factors for Osteoporosis and give appropriate prophylaxis (non-pharmacological and pharmacological)
    3. Can describe the pathogenesis, clinical features, treatment and complications of osteoporosis
  • Osteomalacia
    1. Can discuss the pathogenesis, clinical features, treatment and complications of osteomalacia
  • Paget's Disease
    1. Understand the aetiology, clinical features, pathology and complications of Paget's disease of bone
• Chronic Widespread Pain
  • Fibromyalgia
    1. Can diagnose and treat a patient with chronic widespread pain / fibromyalgia
• Trauma, Fractures & Soft Tissue Injuries
  • General Outcomes
    1. Can describe a classification scheme for fractures
    2. List local and general complications post orthopaedic surgery
  • Emergency conditions
    1. Can describe the causes, clinical features and management of compartment syndrome (any site), neurovascular injury (any site), septic arthritis, open fractures and cauda equina
  • Shoulder injuries
    1. Can describe the features and treatment of recurrent shoulder dislocation, AC joint separation, clavicle fracture and biceps tendon rupture
  • Elbow injuries
    1. Can describe the clinical features and management of olecranon fracture, radial head fracture and dislocation
  • Wrist & hand injuries
    1. Can describe the features and management of distal radius fracture, scaphoid fracture, mtacarpal/phanageal fracture and tendon injuries
  • Hip injuries
    1. Can describe the features and management of fractured neck of femur and pubic ramus fracture
  • Knee injuries
    1. Can describe the features and management of meniscal tears, anterior cruciate ligament tear, medial collateral ligament sprain, patella fracture
  • Ankle injuries
    1. Can describe cfeatures and managment of ankle fractures, metatarsal stress fractures, Lisfranc injury and Achilles tendon rupture
• Infections of Bones and Joints
  • Osteomyelitis and septic arthritis
    1. Can outline the aetiology, pathology and sequelae of osteomyelitis and septic arthritis
    2. Understands how to investigate musculoskeletal infection and how to interpret the results including synovial fluid analysis
    3. Can describe the clinical features and management of bone and joint infections
• Bone tumours / Malignancy
  • General topics
    1. Can describe the diagnosis and management of the more common benign and malignant bone tumours
    2. Understand the diagnosis and management of other malignant conditions, such as myeloma and other haematological conditions, that can affect the musculoskeletal system
• Paediatric Joint Diseases
  • General Topics
    1. Understand the different age presentations of the three childhood hip conditions
    2. Can describe the clincal features and management of the common paediatric orthopaedic disorders (DDH, CTEV, Perthe's disease, SUFE)

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