MSK

Question 1

Vitamin D values

Answer 1

< 30 = Deficient – high dose replacement
30 – 50 = Insufficient – medium dose
> 50 = Sufficient - none

Question 2

What does vitamin d do?

Answer 2

• Helps regulate amount of calcium and phosphate in the body.
• These in turn required to keep bones, teeth and muscles healthy.
• Check levels in suspected fragility fractures

Question 3

Indications for DEXA scan

Answer 3

1. High fragility fracture risk score (Frax or Qfracture)
2. Over 50 yrs with history of fragility fractures
3. Under 40 with major risk factor for fragility fracture + refer to FLS

Question 4

Diagnosis of osteoporosis using DEXA scan- value

Answer 4

T score of -2.5 or below is a diagnosis of osteoporosis

Question 5

Indications for Vitamin D levels

Answer 5

osteomalacia (or rickets)

fargility fractures

Question 6

Can you differentiate between osteomalacia and osteoporosis using DEXA

Answer 6

No

Question 7

What is osteomalacia?

Answer 7

metabolic bone disease characterised by incomplete mineralisation of the underlying mature organic bone matrix

inadequate levels of calcium, phosphate or vitamin D,

Question 8

What is arthroscopy?

Answer 8

Surgical procedure where thin telescope with light source (arthroscope) to look inside joints.

Diagnostic or Arthroscopic surgery.

Mainly used to investigate or treat knee problems.
Can be used in other joints too.

Question 9

Indications for joint aspiration

Answer 9

any patients with inflamed joints with no established diagnosis.

Question 10

Joint aspiration of gout vs septic arthritis:

Answer 10

Gout: needle shaped negatively-birefringent uric acid crystals

Septic arthritis:
1. joint fluid aspiration appears cloudy or purulent

2. cell count with WBC > 50,000 is considered diagnostic for septic arthritis
3. gram stains only identifies infective organism 1/3 of time

Question 11

Rheumatoid + osteoarthritis inflammatory differences

Answer 11

High ESR + CRP = RA

Normal ESR + CRP = Osteroarthritis

Question 12

When to refer urgently for rheumatoid arthritis?

Answer 12

• Small joints of the hands or feet are affected
• More than one joint is affected
• There has been a delay of 3 months or longer between the onset of
  symptoms and the person seeking medical advice
• Do not delay referral if blood tests are normal or results have not returned from the laboratory.
• Early intervention may help prevent irreversible joint damage

Question 13

Ix for SLE

Answer 13

1. Anti-dsDNA
2. Anti-smith
   antibodies
3. ANA +

–> confirmatory of SLE with symptoms

Question 14

Anti-CCP specific to…

Answer 14

Rheumatoid arthritis

Question 15

Rheumatoid factor

Answer 15

Non- specific marker

Question 16

Rheumatoid arthritis markers

Answer 16

Anti-CCP

RF

Question 17

What is ANA?

Answer 17

Non specific marker for autoimmune disease.

Nearly all patient have +’ve ANA and this is positive in many cases.

Question 18

Acute compartment syndrome symptoms

Answer 18

Mainly PAIN

Late signs (Ischemic Limb):
Pallor
Paraesthesia
Perishingly cold
Pulselessness
Paralysis

Question 19

Ix for Acute compartment syndrome

Answer 19

Clinical diagnosis (early signs/patient at risk)
Compartment pressure monitoring.

Question 20

Symptoms of cauda equina

Answer 20

Back pain
Uni/bilateral leg pain
Bowel and bladder dysfunction
Reduced power lower limb

Question 21

Signs of cauda equina

Answer 21

• Bilateral sciatica
• Urinary retention (50-70%)
• Faecal incontinence
• Saddle anaesthesia
• Loss of anal tone

Question 22

Ix for CES

Answer 22

Urgent MRI

Question 23

Sx for Cervical spine fracture

Answer 23

Neck pain/tenderness
Neck spasm
Reduced range of movement
Occipital headache

Question 24

Indication for imaging for symptoms of cervical spine fracture

Answer 24

Intoxication OR
Altered GCS OR
Neck pain or tenderness OR
Distracting Injury

Question 25

Ix for cervical spin fracture

Answer 25

X-rays (AP, Lateral, Peg view) CT scan Flexion and extension MRI (ligament and disc injuries

Question 26

Symptoms of joint dislocation

Answer 26

``` History of trauma Intense pain Deformity of joint area Swelling Inability to weightbear ```

Question 27

Imaging for join dislocation

Answer 27

X-ray (not ankle) CT +/- angio (if vascular injury suspected) MRI to evaluate soft tissue injury

Question 28

Imaging for suspected fracture

Answer 28

X-ray

Question 29

Presentation of NOF fracture

Answer 29

Hip/groin pain Inability to weight bear May be shortened and externally rotated limb

Question 30

Ix for NOF fracture

Answer 30

Bloods - FBC, U+E, LFTs, TFTs, Vit D, Folate, Vit B12, Clotting X-ray X-ray normal but high suspicion – MRI If MRI not available 24 hrs or contraindicated - CT

Question 31

Examples of distal radius fracture

Answer 31

Colles' | smiths

Question 32

Presentation of distal radius fracture

Answer 32

History of FOOSH Pain + swelling Visible deformity of displaced

Question 33

Ix for distal radius fracture

Answer 33

X-rays AP + Lateral

Question 34

Presentation of scaphoid fracture

Answer 34

Localised pain in the wrist Classical sign – snuffbox tenderness (non specific) Longitudinal thumb compression

Question 35

Imaging for scaphoid fracture

Answer 35

Xrays – AP + Lateral, Scaphoid views (AP with ulnar deviation + 45deg pronation) If negative but high clinical suspicion – repeat in 10 -14 days CT/MRI – most sensitive for diagnosis of occult fracture