Integrated Specialties A - Year 4 MSK End of block Assessment (60% - missing Q9a,b,c)

Question 1

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.

Answer 1

Osteochondritis dissecans - pain / effusions can occur as well as pseudolocking of the knee

Question 2

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.

Answer 2

Bucket Handle Mensical tear

Question 3

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.

Answer 3

ACL rupture

Question 4

Bone on bone medial compartment osteoarthritis in a varus knee in a retired builder

Answer 4

Total joint replacement

Question 5

End stage rheumatoid arthritis of the wrist

Answer 5

Athrodesis

Question 6

Displaced intracapsular hip fracture in an elderly nursing home resident with dementia

Answer 6

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

Question 7

Bilateral leg pain with saddle anaesthesia, weakness, loss of reflexes and urinary incontinence.

Answer 7

J - Cauda Equina syndrome

Question 8

Back pain with weight loss, bilateral leg weakness, spasticity and an extensor plantar response

Answer 8

B - spinal cord compression (possible malignancy)

Question 9

Broad based gait, hypereflexia and extensor plantar response with instability on flexion extension views of the cervical spine. No history of trauma.

Answer 9

Rheumatoid arthritis

Question 10

This is a risk factor for avascular necrosis and Dupuytren’s contracture

Answer 10

Alcohol abuse

Question 11

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Answer 11

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

Question 12

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Answer 12

Rheumatoid arthritis

Question 13

* Humeral shaft fracture * Anterior dislocation of the shoulder * Grossly displaced supracondylar fracture of the elbow

Answer 13

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)

Question 14

Which condition is most likely to produce a transient carpal tunnel syndrome?

Answer 14

Pregnancy

Question 15

Which condition is most likely to cause carpal tunnel syndrome and extensor tendon rupture at the wrist?

Answer 15

Rheumatoid arthritis

Question 16

Which condition is most commonly associated with Dupuytren’s contracture?

Answer 16

Alcohol abuse

Question 17

52 year old diabetic with spontaneous onset of shoulder and loss of all movements including external rotation

Answer 17

Adhsesive capsulitis / frozen shoulder

Question 18

45 year old with a “painful” arc on elevating the shoulder, wasting of supraspinatus and weakness of abduction.

Answer 18

rotator cuff tear

Question 19

42 year old weightlifter with anterior shoulder pain and pain on adducting his arm across his chest

Answer 19

anterior dislocation of the shoulder

Question 20

* Colles fracture * Scaphoid fracture * Isolated fracture of radial shaft

Answer 20

Colles fracture - extensor pollicis longus rupture Scaphoid fracture - avascular necrosis Isolated fracture of radial shaft - dislocation distal radioulnar joint

Question 21

50 year old overweight male with longstanding intermittent backache and stiffness, worse after activity and relieved by rest.

Answer 21

Spondylosis / mechanical back pain

Question 22

Back pain, increased signal between vertebrae on MRI scan with raised CRP and a history of intravenous drug abuse.

Answer 22

Discitis

Question 23

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.

Answer 23

Osteoid osteoma