Clinical Medicine

Musculoskeletal

AKT High-Yield Breakdown

Musculoskeletal problems account for around 30% of GP consultations. The AKT tests red flag recognition, NICE-concordant management pathways, safe use of NSAIDs and steroids, and when to refer. Key areas include back pain red flags, osteoporosis fracture risk assessment, gout management, and soft tissue injury management.

What You'll Learn

Master the back pain red flag criteria, FRAX-based osteoporosis management, urate targets in gout, allopurinol timing rules, NICE guidelines for osteoarthritis and fibromyalgia, and the shoulder examination findings that indicate urgent referral.

Targeted practiceMCQ format

Practise Musculoskeletal MCQs

From back pain red flags and cauda equina to gout allopurinol timing, FRAX-based osteoporosis management, and soft tissue injury treatment — tackle focused MCQs across the full Musculoskeletal curriculum.

Start Musculoskeletal practice

Back Pain

Back pain is one of the most common presentations in primary care. The priority is differentiating mechanical low back pain (the vast majority) from serious spinal pathology using red flag recognition.

Red Flags for Serious Spinal Pathology

Back pain red flags requiring urgent investigation (MRI spine ± same-day referral): age <20 or onset >50, history of cancer, unexplained weight loss, fever or systemic symptoms, night pain (rest pain waking from sleep), progressive neurological deficit, bilateral leg weakness, saddle anaesthesia or bladder/bowel dysfunction (cauda equina).

Cauda equina syndrome: bilateral leg weakness/numbness, perianal/saddle anaesthesia, urinary retention or incontinence, faecal incontinence — surgical emergency, refer to A&E immediately
Vertebral fracture: thoracic or lumbar pain + risk factors (osteoporosis, corticosteroid use, minimal trauma in elderly) — MRI or CT if fracture suspected
Spinal infection (discitis/osteomyelitis): fever, raised CRP/ESR, localised spinal tenderness, history of IV drug use or recent procedure
Spinal malignancy: primary (rare) or metastatic (breast, prostate, lung, renal, thyroid) — constant pain worse at night, weight loss, known primary

Mechanical Low Back Pain

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