Locomotor

Question 1

presentation of osteoarthritis

Answer 1

pain, relieved by rest, stiffness in the morning

Question 2

Signs related to osteoarthritis

Answer 2

crepitus, instability
Heberden’s nodes at DIP
Bouchard’s nodes at PIP

Question 3

Xray findings for osteoarthritis

Answer 3

LOSS
loss of joint space
osteophytes
subarticular sclerosis
subchondral cysts

Question 4

What is rheumatoid arthritis

Answer 4

chronic autoimmune disease causing symmetrical polyarthritis + systemic involvement due to synovial inflammation

Question 5

symptoms of rheumatoid arthritis

Answer 5

joint pain worse at rest
morning stiffness
affects hands and feet first

Question 6

what are some extra-articular manifestations of RA?

Answer 6

vasculitis
fibrosing alveolitis
pleural/pericardial effusion
Carpel tunnel
scleritis
peripheral neuropathy

Question 7

common deformities associated with RA

Answer 7

ulnar deviation
dorsal wrist subluxation
Boutonniere or swan neck deformity
Z thumb

Question 8

what serology results would you expect in RA

Answer 8

RF +ve in 70%
anti-CCP highly specific but not widely available
RF +/-ve doesn’t confirm or deny, but a good prognostic indicator

Question 9

management of RA

Answer 9

symptomatic - corticosteroids, Intr-articular injections
NSAIDs ineffective
DMARDs - sulfasalazine, methotrexate
Biologics - etanercept, adalimumab, infliximab
lifestyle

Question 10

common causative organisms of septic arthritis

Answer 10

staph aureus

streptococci

Question 11

types of septic arthritis?

Answer 11

Native (natural) joint infection

prosthetic joint infection

Question 12

how would you investigate septic arthritis?

Answer 12

Joint aspiration for synovial fluid microscopy
blood cultures
leucocytosis

xrays of no value

Question 13

management of septic arthritis

Answer 13

empirical IV Abx - flucloxacillin / clindamycin
oral switch for 6 weeks
wash joint, immobilise initially then physio
replace prosthesis

Question 14

what disorders affects the intervertebral discs

Answer 14

Disc herniation
degenerative disc disease
discitis

Question 15

symptoms of septic arthritis

Answer 15

painful, red, hot, swollen joint
usually one sided
knee involved in 50% cases

Question 16

what is sciatica

Answer 16

pain, tingling and numbness due to nerve root entrapment in the lumbosacral spine
90% cases caused by a herniated disc

Question 17

management of herniated disc

Answer 17

most will improve over time
analgesia
benzos if muscle spasm
tricyclic antidepressant if persistent

Question 18

What bone density scores indicate osteoporosis

Answer 18

(-1) - (-2.5)SD = osteopenia

Question 19

risk factors for osteoporosis

Answer 19

oestrogen deficiency (post menopause)
vitamin D deficiency, hyperparathyroidism
glucocorticoids

Question 20

Investigating osteoporosis?

Answer 20

Xray for microfractures etc

DEXA scan gold standard

Question 21

management of osteoporosis

Answer 21

bisphosphonates - alendronate
calcium + vit D
strontium ranelate
raloxifene
HRT