Examinations

Question 1

Describe how charcot’s arthopathy forms

Answer 1

• Loss of protective sensation, patients will continue to weight-bear on very significant soft tissue abnormalities, thereby exacerbating the problem.
• Progressive destruction of the bones, joints and soft tissues.
• Neuropathy, abnormal loading, repeated microtrauma cause osteolysis, fractures, dislocation and deformity
• Rocker-bottom foot may develop.

Question 2

How many systems are there?

Answer 2

7

Question 2

What are the 7 important systems to review?

Answer 2

• CNS
• CVS
• Resp
• GIT
• GUT (genitourinary)
• MSK
• MISC (miscellaneous) thyroid disorders, cancer, lumps and bumps, eating habits, anorexia

Question 2

What makes up an MSK inspection

Answer 2

Consent, chaperone, exposure, privacy, confidentiality
- Inspection begins as soon as you lay eyes
- Standing then laying (30-45)
- Compare (Always do the good side first, ask them where they have pain)
- Front/back/sides
- No touching!! (As soon as you touch, palpation has begun)

Question 3

What do you look for on inspection

Answer 3

Body habitus
Gait
Walking aid
Deformity
Contour (of the limbs)
Amputation
Bulk/wasting
Length rotation
Trendelenberg’s
Asymmetry
Skin changes
Discolouration
Haematoma
Scar
Swelling
Oedema
Varicose veins
Ulcer

Question 4

What is the nerve supply to the gluteus medius and minmus?

Answer 4

Superior gluteal nerve

Question 5

Causes of haematoma

Answer 5

• Trauma
• Anticoagulants (DOAC, warfarin)

Question 6

What three failures cause oedema

Answer 6

• Heart
• Kidney
• Liver

Question 7

Causes of non-pitting oedema?

Answer 7

• Lymphatic obstruction (parasitic obstruction)
• Inflammation
• Fibrosis

Question 8

What do you assess in palpation?

Answer 8

• Superficial/temperature/tenderness
• Deep lumps
• Movement (active vs passive)
• Special tests

Question 8

What things do you look for on palpation

Answer 8

• Temperature
• Tenderness
• Lump/mass
• Dermatomes
• Tone
• Power
• Reflexes
• Clonus
• Varicose veins
• Peripheral pulses
• Oedema
• Bony prominence
• Swelling
• Collection
• Measure bulk
• Buerger’s test

Question 9

What level is the knee jerk reflex?

Answer 9

L4/L5

Question 10

What is the purpose of cartilage?

Answer 10

• Smooth surfaces
• Shock absorber
• Protects the bone

Question 11

What types of collagen do cartilage and bone have?

Answer 11

• Cartoolige= collagen 2
• Bone has type 1 (much stronger)

Question 12

What are the special tests of the knee examination?

Answer 12

• Patella tap (squeezing the suprapatellar bursa)

Question 13

Why would there be swelling in the knee?

Answer 13

• Bursitis
• Trauma

Question 14

What is the varus stress test assessing?

Answer 14

The lateral collateral ligament

Question 15

What is the McMurrary test?

Answer 15

Testing the medial and lateral menisci

Question 16

What is the JVP and why is there a double pulse?

Answer 16

Increased pressure in the internal jugular vein
Double waveform
a wave (right atrial contraction)
v wave (venous filling when the tricuspid valve is closed)

Question 17

Why do you get hyperlipidaemia in patients with nephrotic syndrome?

Answer 17

Excessive loss of protein
The liver compensates for the loss of albumin by increasing the synthesis of albumin and other proteins, including lipoproteins. This results in increased production of very-low-density lipoprotein (VLDL) and low-density lipoprotein (LDL).

Corneal arcus and xanthelasma