Corrections 2

Question 1

In what 2 scenarios should you avoid giving sulfalazine?

Answer 1

1) G6PD deficiency

2) Allergy to aspirin or sulphonamides (cross-sensitivity)

Question 2

Which DMARD can cause oligospermia?

Answer 2

Sulfalazine

Question 3

When should bisphosphonate treatment be re-assessed?

Answer 3

After 5 years

Repeat FRAX score and DEXA scan to assess need for ongoing treatmnet

Question 4

Where is the most common site of metatarsal stress fractures?

Answer 4

2nd metatarsal shaft

Question 5

Typical mechanism of injury in meniscal tears?

Answer 5

Twisting injuries

Question 6

Features of meniscar tears?

Answer 6

• pain worse on straightening the knee
• knee may ‘give way’
• displaced meniscal tears may cause knee locking
• tenderness along the joint line

Question 7

What is Raynaud’s?

Answer 7

An exaggerated vasoconstrictive response of the digital arteries and cutaneous arteriole to the cold or emotional stress.

It may be primary (Raynaud’s disease) or secondary (Raynaud’s phenomenon).

Question 8

Who does Raynaud’s typically present in?

Answer 8

Young women e.g. 30 y/o with bilateral symptoms

Question 9

Does Raynaud’s typically present with unilateral or bilateral symptoms?

Answer 9

Bilateral

Question 10

What is the most common 2ary cause of Raynaud’s?

Answer 10

Scleroderma

Question 11

Typical age of onset in 1ary vs 2ary Raynaud’s?

Answer 11

1ary - onset <40 y/o

2ary - onset >40 y/o

Question 12

Marfan’s syndrome is caused by a mutation in which protein?

Answer 12

Fibrillin

Question 13

What would you expect to see on an XR in a Colle’s fracture?

Answer 13

Dorsally displaced distal radius fracture

Question 14

1st line mx of carpal tunnel syndrome?

Answer 14

1st –> conservative: wrist splint +/- steroid injection

Trial for 6 weeks

2nd line –> surgical decompression: flexor retinaculum division

Question 15

What accounts for the majority of ocular complications in temporal arteritis?Anterior ischemic optic neuropathy

Answer 15

Anterior ischemic optic neuropathy

Question 16

What condition is a common cause of BILATERAL carpal tunnel syndrome?

Answer 16

RA

Question 17

In ulcers with associated cellulitis, what does the initial improvement of cellulitis with antibiotics but persistent discharge and localised tenderness/swelling indicate?

Answer 17

Abscess formation –> requires surgical drainage

Question 18

What is Simmond’s triad?

Answer 18

1) palpation of tendon

2) calf squeeze test

3) examination of angle of decline at rest

This is used for examining an Achilles’ tendon rupture

Question 19

What score is a useful tool to assess hypermobility?

Answer 19

Beighton score

Question 20

What is involved in a Salter-Harris IV fracture?

Answer 20

Fracture involves the physis, metaphysis and epiphysis

Question 21

What rash may be present in APS?

Answer 21

Livedo reticularis (lace or net-like appearance, which can be blue or purple)

Question 22

What does a positive straight leg test indicate?

Answer 22

Sciatic nerve pain

Question 23

Mx of lower back pain caused by prolapsed disc (i.e. sciatica)?

Answer 23

1st line –> analgesia, physiotherapy, exercises

Trial for 4-6 weeks

2nd line –> consider referral for MRI

Question 24

What may patients who are allergic to aspirin also react to?

Answer 24

Sulfalazine

Question 25

What are the commonent carpal fractures?

Answer 25

Scaphoid fractures

Question 26

Typical mechanism of injury in a scaphoid fracture?

Answer 26

FOOSH

Question 27

What are the main physical signs in a scaphoid fracture?

Answer 27

1) swelling and tenderness in anatomical snuffbox

2) pain on wrist movements

3) pain on longitudinal compression of thumb

Question 28

What is a Galeazzi fracture?

Answer 28

Radial shaft fracture with associated dislocation of the distal radioulnar joint

Question 29

What is a Smith’s fracture?

Answer 29

Reverse Colles’ fracture:

• Volar angulation of distal radius fragment (Garden spade deformity)
• Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed

Question 30

Typical mechanism of injury in an ACL rupture?

Answer 30

High twisting force applied to a bent knee

Question 31

Typical presentation of an ACL rupture?

Answer 31

• loud crack
• pain
• RAPID joint swelling (haemoarthrosis)

often have poor healing

Question 32

Typical mechanism of injury in a PCL rupture?

Answer 32

hyperextension injuries

Question 33

How are ligmanentous injuries of the knee (e.g. ACL rupture) best confirmed?

Answer 33

MRI

Question 34

what type of knee injury is Murray’s test used to test for?

Answer 34

Meniscal tear

Question 35

What 2 tests can be used clinically to investigate ACL rupture?

Answer 35

1) Anterior drawer test

2) Lachman’s test

Question 36

Describe the anterior drawer test

Answer 36

1) the patient lies supine with the knee at 90 degrees

2) the examiner should place one hand behind the tibia and the other grasping the patient’s thigh. It is important that the examiner’s thumb be on the tibial tuberosity

3) the tibia is pulled forward to assess the amount of anterior motion of the tibia in comparison to the femur

4) an intact ACL should prevent forward translational movement

Question 37

Atlantoaxial subluxation is a rare complication of rheumatoid arthritis.

What investigations are required pre-operatively to screen for this complication?

Answer 37

Anteroposterior and lateral cervical spine radiographs