Muskuloskeletal dan Integumen
Core concepts
Approach joint pain by number, symmetry, and duration: acute monoarthritis (septic until proven otherwise, plus crystal disease), chronic polyarthritis (rheumatoid arthritis, osteoarthritis), and spondyloarthropathy. Know the extra-articular features of rheumatoid arthritis, the difference between osteoarthritis and inflammatory arthritis, and the urgency of septic arthritis and open fractures. Understand osteoporosis and fragility fracture prevention, back pain red flags, and compartment syndrome. Dermatology: describe lesions by morphology and distribution, recognise psoriasis, eczema, urticaria, drug eruptions, and the warning signs of melanoma using the ABCDE rule.
Traps
A hot swollen joint needs aspiration before antibiotics - do not assume gout. Do not give antibiotics before joint aspiration if it can be done promptly. Compartment syndrome is a clinical diagnosis: pain out of proportion and pain on passive stretch, not absent pulses. In back pain, red flags (fever, weight loss, night pain, neurological deficit, cancer history) change the pathway entirely.
Worked example
A 55-year-old with acute severe pain and swelling of the first metatarsophalangeal joint, no fever, and a history of alcohol use. Diagnosis: gout. Rule of thumb: aspirate to exclude septic arthritis and look for negatively birefringent needle-shaped crystals; treat acute gout with NSAIDs, colchicine, or corticosteroids, and start urate-lowering therapy only after the acute attack settles.