MSK

Question 1

What nerve is most likely to be damaged in a humeral shaft fracture?

Answer 1

Radial

Question 2

An externally rotated hip is most suggestive of what pathology?

Answer 2

Fractured neck of femur

Question 3

If a patient presents with a joint problem, what 4 things should you always ask about?

Answer 3

Pain, stiffness, weakness, loss of movement

Question 4

What muscles are primarily responsible for flexion of the knee? What is the nerve supply?

Answer 4

Hamstrings - supplied by the sciatic nerve (L4-S3)

Question 5

Steinmann’s test assesses for what injury?

Answer 5

Acute meniscal tear

Question 6

Performing internal rotation against resistance assesses which rotator cuff muscle power?

Answer 6

Subscapularis

Question 7

Arterial supply to the hip is largely via which arteries?

Answer 7

Medial and lateral circumflex arteries (branches of the profunda femoris artery)

Question 8

What muscle is the chief flexor of the hip joint? What is its nerve supply?

Answer 8

Iliopsoas - anterior rami of L1-L3

Question 9

Describe Phalen’s test used to assess for carpal tunnel syndrome?

Answer 9

Holding wrist in flexion for 30 seconds should recreate the pain

Question 10

Where should you assess sensation of the median nerve?

Answer 10

Lateral aspect of index finger

Question 11

Loss of which movement is most sensitive for indicating shoulder pathology, especially frozen shoulder?

Answer 11

External rotation

Question 12

If a knee injury is thought to be significant, what is the best investigation to use?

Answer 12

MRI

Question 13

Patients will not be able to straight leg raised if they have damage to which muscles or which nerve?

Answer 13

Quadriceps muscles or femoral nerve

Question 14

During a femoral stretch test, back pain radiating down the anterior leg is suggestive of what pathology?

Answer 14

L4 nerve root compression

Question 15

Pain in the anterior mid-groin is most suggestive of pathology where?

Answer 15

The hip joint itself

Question 16

What spinal movements should be assessed within a GALS exam?

Answer 16

Lateral flexion of cervical spine and flexion of lumbar spine

Question 17

Which movements of the lower limb should be assessed within a GALS exam?

Answer 17

Flexion and extension of the knee, internal rotation of the hip

Question 18

A total hip replacement or posterior hip dislocation are most likely to cause damage to which nerve?

Answer 18

Sciatic (L4-S3)

Question 19

What muscle is responsible for external rotation of the knee joint? What is its nerve supply?

Answer 19

Biceps femoris - supplied by the sciatic nerve (L4-S3)

Question 20

Which nerve is most likely to be damaged in an anterior shoulder dislocation or humeral neck fracture?

Answer 20

Axillary

Question 21

A fixed flexion deformity of the hip is most commonly caused by which pathology?

Answer 21

Osteoarthritis

Question 22

What is the cause of a 1) True and 2) Apparent leg length discrepancy?

Answer 22

1) Bony/joint pathology 2) pelvic tilting (e.g. fixed flexion deformity, scoliosis)

Question 23

Other than the iliopsoas, what other muscles are responsible for flexion at the hip joint? What is their nerve supply?

Answer 23

The anterior compartment of the thigh (quadriceps femoris, sartorius, pectineus) - supplied by the femoral nerve (L2-L4)

Question 24

What muscles are responsible for external rotation of the hip? What is their nerve supply?

Answer 24

Lots of muscles, but specifically the external rotator group, innervated by the lumbosacral plexus (L4-S2)

Question 25

AVN of the femoral head is most likely caused by damage to which artery?

Answer 25

Medial circumflex artery

Question 26

If taking a history of knee pain, what are some useful symptoms to ask about?

Answer 26

Giving way, locking, clicking/catching

Question 27

Where should you assess sensation of the axillary nerve?

Answer 27

Regimental badge patch area

Question 28

A Thomas' test for a fixed flexion deformity is positive if what happens?

Answer 28

The thigh lifts off the couch

Question 29

If a patient presents with a joint problem that you suspect could be systemic, other than those already discussed in the systemic enquiry, what are some other important systems to ask about?

Answer 29

Skin changes and/or eye problems

Question 30

Which nerve is most likely to be damaged in a posterior elbow dislocation?

Answer 30

Ulnar nerve

Question 31

Hearing a 'pop' at the time of a knee injury and developing haemarthrosis within one hour is generally suggestive of what pathology?

Answer 31

ACL rupture

Question 32

An acutely inflamed joint is what until proven otherwise?

Answer 32

Septic arthritis

Question 33

Describe Tinel's test used to assess for carpal tunnel syndrome?

Answer 33

Percussing the median nerve over the ventral aspect of the wrist should recreate the pain

Question 34

What muscles are responsible for hip adduction? What is their nerve supply?

Answer 34

Medial compartment of the thigh (adductor magnus/brevis/longus, gracilis) - supplied by the obturator nerve (L2-L4)

Question 35

Scapula winging is a sign caused by palsy of which nerve?

Answer 35

Long thoracic nerve

Question 36

Anterior and posterior drawer tests assess the stability of what structure?

Answer 36

Anterior and posterior cruciate ligaments

Question 37

True knee locking is a sign of what injury?

Answer 37

Bucket handle meniscal tear

Question 38

A combination of what three knee injuries makes up the 'unhappy triad'?

Answer 38

MCL rupture, medial meniscus tear, ACL rupture

Question 39

What are the two main risk factors for AVN of the hip?

Answer 39

Steroid use and alcohol abuse

Question 40

What special tests should you perform in a shoulder exam of an older person who you suspect may have a rotator cuff tear?

Answer 40

Perform rotator cuff movements against resistance

Question 41

What muscles are responsible for extension of the hip? What is their nerve supply?

Answer 41

Posterior compartment of the thigh (hamstrings- biceps femoris, semimembranosus, semitendinosus) supplied by the sciatic nerve (L4-S3) and the gluteus maximus supplied by the interior gluteal nerve (L5-S2)

Question 42

Which nerve is most likely to be damaged in a Colles fracture?

Answer 42

Median nerve

Question 43

What nerve is damaged to cause a claw hand?

Answer 43

Ulnar nerve

Question 44

The hip joint is primarily innervated by which nerves?

Answer 44

Sciatic, femoral and obturator

Question 45

A hip joint which is shortened and internally rotated is most suggestive of what pathology?

Answer 45

Posterior dislocation

Question 46

What movement of the hand assesses the function of the median nerve?

Answer 46

Thumb abduction

Question 47

Where should you assess sensation of the ulnar nerve?

Answer 47

Medial aspect of the little finger

Question 48

Which muscle is responsible for internal rotation of the shoulder? What is the nerve supply?

Answer 48

Subscapularis - supplied by the upper and lower subscapular nerves (C5/6)

Question 49

What muscles are responsible for internal rotation of the hip? What is their nerve supply?

Answer 49

Gluteus medius and minimus - supplied by the superior gluteal nerve (L4-S1)

Question 50

What are the steps of management for lower limb arthritis?

Answer 50

1) Weight loss (if necessary) 2) Analgesia 3) Physiotherapy 4) Walking aids 5) Surgical intervention

Question 51

What muscle is responsible for flexion and extension of the shoulder?

Answer 51

Deltoid

Question 52

During a straight leg raise, back pain radiating down the posterior leg beyond 90 degrees is suggestive of what pathology?

Answer 52

L5/S1 nerve root compression

Question 53

What muscle is responsible for abduction beyond 15 degrees?

Answer 53

Deltoid

Question 54

What special tests should you perform in a shoulder exam of a young person?

Answer 54

Look for sulcus sign and perform shoulder apprehension tests

Question 55

If the medial collateral ligament is damaged, it is highly likely that what other structure in the knee is also damaged?

Answer 55

Medial meniscus

Question 56

What muscle is responsible for the first 15 degrees of abduction? What is its nerve supply?

Answer 56

Supraspinatus - supplied by the suprascapular nerve (C5/6)

Question 57

What muscles are responsible for hip abduction? What is their nerve supply?

Answer 57

Gluteus medius and minimus - supplied by the superior gluteal nerve (L4-S1)

Question 58

What nerve is damaged to cause wrist drop?

Answer 58

Radial nerve

Question 59

What is the pathology behind impingement syndrome?

Answer 59

Supraspinatus tendonitis

Question 60

What are some particularly important questions to ask when taking a history about back pain?

Answer 60

Does it wake you at night? Any lower limb sensory/motor deficits? Any saddle anaesthesia? Any bladder/bowel changes?

Question 61

Trochanteris bursitis typically presents with pain on what movement?

Answer 61

Resisted abduction

Question 62

What muscle is responsible for adduction and internal rotation of the shoulder?

Answer 62

Teres major

Question 63

What is the nerve supply to the deltoid muscle?

Answer 63

Axillary nerve (C5/6)

Question 64

A Schober's test is within normal range if the gap increases by more than what value on flexion?

Answer 64

5cm

Question 65

What neurovascular structures are most likely to be damaged in a supracondylar fracture of the elbow?

Answer 65

Median nerve and brachial artery

Question 66

You should only do a heel height test in a knee exam if you are suspecting what injury?

Answer 66

Bucket handle meniscal tear

Question 67

How is trochanteric bursitis treated?

Answer 67

Self-limiting, provide analgesia (paracetamol, ibuprofen, steroid injections) and physiotherapy

Question 68

A Trendelenberg gait or a positive Trendelenberg test is caused by unilateral weakness of which group of muscles? This can be secondary to damage to which nerve?

Answer 68

The hip abductors (gluteus medius/minimus) / Superior gluteal nerve (L4-S1)

Question 69

A femoral shaft fracture is likely to result in damage to which neurovascular structures?

Answer 69

Femoral artery and sciatic nerve

Question 70

The scarf test used in the shoulder exam may indicate what problem?

Answer 70

AC joint pathology

Question 71

Jobe's test assesses which rotator cuff muscle power?

Answer 71

Supraspinatus

Question 72

What movement of the hand assesses the function of the radial nerve?

Answer 72

Wrist and finger extension

Question 73

Which muscle is responsible for external rotation of the shoulder? What is the nerve supply?

Answer 73

Infraspinatus (suprascapular nerve) and teres minor (axillary nerve) - both C5/6

Question 74

Performing external rotation against resistance assesses which rotator cuff muscle power?

Answer 74

Infraspinatus/teres minor

Question 75

What muscles are primarily responsible for internal rotation of the knee joint? What is its nerve supply?

Answer 75

Semimembranosus and semitendinosus - supplied by the tibial nerve (L5-S2)

Question 76

Pain in the medial groin is most suggestive of pathology where?

Answer 76

Pubic rami - ? fracture

Question 77

A foot drop is caused by damage to what nerve?

Answer 77

Common fibular nerve (L4-S2)

Question 78

Describe Froment's test used to assess for ulnar nerve damage?

Answer 78

Ask patient to pinch paper between a straight thumb and index finger while pulling the paper away- flexion of the thumb at the DIP joint is a positive test

Question 79

What is usually the first movement to be reduced in hip pathology such as OA?

Answer 79

Internal rotation

Question 80

Where should you assess sensation of the radial nerve?

Answer 80

Dorsal first interosseous space

Question 81

What special tests should you perform in a shoulder exam of a middle-aged person who you suspect may have instability?

Answer 81

Painful arc and Hawkins-Kennedy test

Question 82

What movement of the hand assesses the function of the ulnar nerve?

Answer 82

Finger abduction

Question 83

What three questions should you ask patients before starting a GALS exam?

Answer 83

Do you currently have any pain or stiffness in your joints or muscles? Do you have any difficulty getting dressed? Do you have any difficulty getting up and down stairs?

Question 84

What muscle group is responsible for extension of the knee? What is its nerve supply?

Answer 84

Quadriceps femoris - supplied by the femoral nerve (L2-L4)

Question 85

What is seen in this x-ray?

Answer 85

Left subcapital (intracapsular) hip fracture

Question 86

What is seen in this x-ray?

Answer 86

Left subcapital (intracapsular) hip fracture

Question 87

What is seen in this x-ray?

Answer 87

Left intertrochanteric (extracapsular) hip fracture

Question 88

What is seen in this x-ray?

Answer 88

Left subtrochanteric (extracapsular) hip fracture

Question 89

What is seen in this x-ray?

Answer 89

(Impacted) Left subcapital (intracapsular) hip fracture

Question 90

What is seen in this x-ray?

Answer 90

Right subtrochanteric (extracapsular) hip fracture

Question 91

What is seen in this x-ray?

Answer 91

Left intertrochanteric (extracapsular) hip fracture

Question 92

How are intracapsular (subcapital) hip fractures treated?

Answer 92

Total hip replacement in high functioning patients Hemiarthroplasty in those with poor mobility and/or cognitive impairment

Question 93

How are intertrochanteric extracapsular hip fractures treated?

Answer 93

Dynamic hip screw (DHS)

Question 94

How are subtrochanteric extracapsular hip fractures treated?

Answer 94

IM nail

Question 95

What are some specific things to look at in an x-ray where a hip fracture is suspected?

Answer 95

Trace Shenton's line Look for asymmetry (particularly of the lesser trochanter)

Question 96

What things should you do first when looking at an MSK x-ray?

Answer 96

Confirm patient name/DOB and assess the adequacy of the film

Question 97

How do you assess the adequacy of an MSK x-ray?

Answer 97

Make sure there are AP and lateral views Ensure the joint above and below are imaged Make sure the film isn't rotated and is adequately penetrated

Question 98

What are the 4 steps to looking at an MSK x-ray?

Answer 98

Alignment and joint spaces Bony texture Cortices Soft tissues

Question 99

What should you comment on in the alignment and joint space section of an MSK x-ray?

Answer 99

Are the bones displaced or angulated in any way? Is there any joint space narrowing, new bone formation or subchondral sclerosis?

Question 100

How can you tell that bony texture is normal on an x-ray?

Answer 100

Trabeculae (fine white lines) are visible within the internal matrix of the bone, and there is a thick external covering

Question 101

What sort of things are you looking for when assessing the soft tissues on an x-ray?

Answer 101

Swelling/effusions, foreign bodies

Question 102

How should you describe a fracture?

Answer 102

Location (proximal/middle/distal third of bone x, intra or extracapsular) Complete/incomplete and type Open or closed Any displacement or angulation

Question 103

What are some examples of incomplete fracture types?

Answer 103

Buckle, bowing, greenstick

Question 104

What are some examples of complete fracture types?

Answer 104

Oblique, transverse, comminuted, segmental, spiral

Question 105

How is displacement of a fracture described?

Answer 105

% displacement (in reference to the width of the bone) of the distal fragment anteriorly/posteriorly/medially/laterally

Question 106

How is angulation of a fracture described?

Answer 106

Degrees of angulation of the distal fragment anteriorly/posteriorly/medially/laterally