MSK

Question 1

Plantar fasciitis features

Answer 1

• worse in the morning on waking up

Question 2

Difference between metatarsalgia and stress fracture of metatarsal

Answer 2

In metatarsalgia pain will be continuous and constant, stress fracture is aggravated by weight bearing. Both at forefoot

Question 3

Management of acute sciatica

Answer 3

Usually conservative mx for first 6-8 weeks
Regular non-opioid analgesics with review (NSAIDS for 10-14d)
If severe pain, add opioid
Walking and swimming
Weekly/biweekly follow up
CS if very severe pain

Question 4

Chronic sciatica management

Answer 4

Reassurance
Epidural anaesthesia
Amitryptyline

Question 5

How to manage epicondylitis both medial and lateral

Answer 5

Rest
Wait
Physio
Intra-articular steroids

Question 6

Vertebral dysfunction management

Answer 6

• analgesia
• keep active
• one week off work initially
• benzos if ongoing muscle spasm
• physiotherapy and exercises
• reassurance
• educate about proper lifting
• follow-up

Question 7

Rheumatoid arthritis features

Answer 7

• symmetrical
• MCP, PIP and wrist joints of hand
• knee, ankle, MTP joints
• keratoconjunctivitis sicca
• Felty syndrome
• Caplin syndrome

Question 8

Tests for Rheumatoid Arthritis

Answer 8

• rheumatoid factor, anti-CCP
• elevated ESR or CRP
• X-ray: loss of joint space, bone erosion, osteopenia, soft tissue swelling

Question 9

Treating rheumatoid arthritis

Answer 9

NSAID

DMARDS: methotrexate, folic acid

Question 10

Septic arthritis management

Answer 10

Urgent joint aspiration, microscopy and culture

Empirical antibiotics ceftriaxone and vancomycin

Question 11

Tests for gout:

Answer 11

Serum uric acid, FBC and ESR (unchanged)
X-ray: punched out erosions/rat-bite
Joint aspiration: polarized light microscopy shows strong negative birefringence and needle-shaped

Question 12

Immediate management gout

Answer 12

NSAIDS (indomethacin)
Corticosteroid (prednisolone) 
Colcichine 
- if NSAIDs CI 
- can cause diarrhoea, n&v 
NO ASPIRIN

Question 13

Long-term mx gout

Answer 13

Treat underlying cause
Drink a lot of water, no alcohol, no fasting, no purine-rich food, no thiazides, aspirin
Lose weight
Allopurinol 100-300mg OD if >1 acute attack a year, tophi, kidney stones, hyperuricemia. can cause rash and allergy
Febuxostat
Probenecid

Question 14

Osteoarthritis X-ray findings

Answer 14

• loss of joint space
• osteophytes
• subchondral cysts
• subchondral sclerosis

Question 15

Management of osteoarthritis

Answer 15

Lifestyle 
- non weight bearing exercise 
- LOW 
Pharmaco 
- topical NSAID, PCM, oral NSAIDS 
- intra-articular injection of CS/hyaluronic acid 
- Duloxetine 
- opioids 
Physiotherapy and physical therapy 
Surgery 
- joint replacement

Question 16

Rotator cuff tension patho management

Answer 16

Rest during acute phase
Analgesics and NSAIDS (up to 4 weeks)
Peritendon/subacromial injection if no tears on ultrasound
Physiotherapy
Surgery - if after 3-6 months still ongoing

Question 17

Temporal arteritis featured, tests, management

Answer 17

Headache, scalp tenderness, jaw claudication, amaurosis fugax, sudden unilateral blindness

Temporal artery biopsy > skip lesion, ESR >100mm/he

Management is high dose steroids

Question 18

Reactive arthritis features

Answer 18

Urethritis + conjunctivitis +/- iritis + arthritis

Question 19

Adhesive capsulitis treatment

Answer 19

Analgesia 
Oral corticosteroids for severe pain
Hydrodilatation 
Severing adhesions under arthroscopic control 
Active exercises