Integrated Specialties A - Year 4 MSK End of block Assessment (60% - missing Q9a,b,c) Flashcards
Select the most likely diagnosis from the scenario An adolescent boy with insidious onset of vague knee pain and swelling with a history of locking in his knee and a mobile pea sized lump occasionally appearing.
Osteochondritis dissecans - pain / effusions can occur as well as pseudolocking of the knee
Select the most likely diagnosis from the scenario A 30 year old joiner getting up from a squatting position with a sudden pain in the inner aspect of his knee and inability to fully extend. He has a springy 15° block to full extension.
Bucket Handle Mensical tear
Select the most likely diagnosis from the scenario A 20 year old footballer who has a non-contact injury to his knee whilst turning. He felt something “pop” and quickly developed swelling in his knee. After returning to football he feels a “jump”in his knee on twisting and turning.
ACL rupture
Bone on bone medial compartment osteoarthritis in a varus knee in a retired builder
Total joint replacement
End stage rheumatoid arthritis of the wrist
Athrodesis
Displaced intracapsular hip fracture in an elderly nursing home resident with dementia
Option A -= Hemiarthroplasty - preferred to treat intracpasular hip fractures in residents with restricted mobility and cognitive impairment Total hip replacement - preferred to treat fractures for slightly younger more active patient
Bilateral leg pain with saddle anaesthesia, weakness, loss of reflexes and urinary incontinence.
J - Cauda Equina syndrome
Back pain with weight loss, bilateral leg weakness, spasticity and an extensor plantar response
B - spinal cord compression (possible malignancy)
Broad based gait, hypereflexia and extensor plantar response with instability on flexion extension views of the cervical spine. No history of trauma.
Rheumatoid arthritis
This is a risk factor for avascular necrosis and Dupuytren’s contracture
Alcohol abuse
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Chronic renal failure Leads to fluid retention and renal osteodystrophy Renal osteodystrophy has been classically described to be the result of hyperparathyroidism secondary to hyperphosphatemia (reduced phosphate excretion) combined with hypocalcemia due to an inability in the kdneys to activate vitamin D
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Rheumatoid arthritis
* Humeral shaft fracture * Anterior dislocation of the shoulder * Grossly displaced supracondylar fracture of the elbow
Humeral shaft fracture - Radial nerve palsy Anterior dislocation of the shoulder - Axillary nerve palsy Grossly displaced supracondylar fracture of the elbow - Median nerve palsy (these fractures can also injury the brachial artery - volkmann’s ischaemic contracture)
Which condition is most likely to produce a transient carpal tunnel syndrome?
Pregnancy
Which condition is most likely to cause carpal tunnel syndrome and extensor tendon rupture at the wrist?
Rheumatoid arthritis
Which condition is most commonly associated with Dupuytren’s contracture?
Alcohol abuse
52 year old diabetic with spontaneous onset of shoulder and loss of all movements including external rotation
Adhsesive capsulitis / frozen shoulder
45 year old with a “painful” arc on elevating the shoulder, wasting of supraspinatus and weakness of abduction.
rotator cuff tear
42 year old weightlifter with anterior shoulder pain and pain on adducting his arm across his chest
anterior dislocation of the shoulder
* Colles fracture * Scaphoid fracture * Isolated fracture of radial shaft
Colles fracture - extensor pollicis longus rupture Scaphoid fracture - avascular necrosis Isolated fracture of radial shaft - dislocation distal radioulnar joint
50 year old overweight male with longstanding intermittent backache and stiffness, worse after activity and relieved by rest.
Spondylosis / mechanical back pain
Back pain, increased signal between vertebrae on MRI scan with raised CRP and a history of intravenous drug abuse.
Discitis
Teenager with low back pain, otherwise well, worse at night and dramatically relieved by aspirin. CT scan demonstrates a radiolucent nidus with a surrounding halo of dense sclerotic bone.
Osteoid osteoma
