MSK

Question 1

Osteoarthritis signs and symptoms

Answer 1

Asymmetrical joint stiffness(morning)
Joint pain, worse on activity
Weight bearing joint(hip/knee)

Obese, female, occupation

Question 2

Osteoarthritis investigations

Answer 2

Joint crepitus
Bouchard’s, Heberden’s nodes
Squaring of thumb
Varus deformity

X ray:
Loss of joint space
Ostéophytes
Subchondral sclerosis
Subchondral cysts

Joint aspiration: straw coloured, viscous

Question 3

Osteoarthritis management

Answer 3

Lifestyle
Physio
Occupational therapy
Topical capsaicin
Analgesia: oral paracetamol/topical NSAID, oral NSAID + PPI, opiate
Intra articular steroids
Joint replacement

Question 4

RA signs and symptoms

Answer 4

Symmetrical poly arthritis
Joint stiffness, better with activity
Wrist, ankle, MCP, PIP, MTP swelling/tenderness
DIP joints spared

Question 5

RA investigations

Answer 5

Swan neck deformity, Boutonnières deformity
ACD

Bloods: Rh factor, anti-CCP(specific), ESR
X ray:
Periarticular osteopenia and erosions
Soft tissue swelling
Subchondral cysts

Question 6

RA management

Answer 6

Bridging prednisolone

1: Methotrexate
2: 2x DMARDs
3: 2x DMARDs + TNFi

DMARDs: Methotrexate, leflunomide, sulfasalazine

TNFi: etanercept, infliximab, adalimumab

anti CD20: rituximab

Surgery

Question 7

Ankylosing spondylitis signs and symptoms

Answer 7

Lower back/hip pain/stiffness
AAA
Ulcerative colitis
Male

Question 8

Ankylosing spondylitis investigations

Answer 8

Schober’s test(lumbar stiffness)
Tragus to wall
Stress test
HLA B27
X ray: sacroiliac joint fusion, spinous ligament fusion(bamboo spine)
MRI

Question 9

Reactive arthritis signs and symptoms

Answer 9

Recent extra-articular infection
Urethritis
Conjunctivitis
Sero-negative arthritis

Question 10

Septic arthritis investigations

Answer 10

Non weight bearing
ESR>40
WCC>12
Temp>38

Joint aspiration: positive culture

Question 11

Septic arthritis management

Answer 11

Antibiotics
Joint lavage

Question 12

Crystal arthritis investigations

Answer 12

X ray:
PG->chondrocalcinosis
G->bony erosion, soft tissue swelling
Joint aspiration:
PG: +ve biréfringence, rhombus shaped
Gout: -ve biréfringence, needle shaped

Question 13

Gout management

Answer 13

Flare up:
Colchicine
NSAIDs
Steroids

Prophylaxis:
Allopurinol

Question 14

Pseudogout management

Answer 14

Mono/oligoarthritis:
Paracetamol
Intra articular steroids

Poly arthritis:
NSAIDs or colchicine
Paracetamol
Steroids

Surgery:
Joint replacement

Question 15

SLE signs and symptoms

Answer 15

Joint pain/inflammation
Malar rash

Young female

Question 16

SLE investigations

Answer 16

ANA: sensitive but not specific
Anti-dsDNA antibody: specific

Question 17

Sjögren’s syndrome signs and symptoms

Answer 17

Dry eyes
Dry mouth
Parotid gland enlargement
Arthritis
Raynaud’s phenomenon

Question 18

Sjögren’s syndrome management

Answer 18

Eye drops
Sugar free gum
Steroids

Question 19

Scleroderma signs and symptoms

Answer 19

CREST syndrome:
Calcinosis cutis
Raynaud’s phenomenon
Oesophageal dysmotility
Sclerodactyly(thickened skin)
Telangiectasia

Question 20

Dermato/polymyositis signs and symptoms

Answer 20

Dermatomyositis: heliotrope rash
Polymyositis: no rash

Gottron’s papules
Subcutaneous calcinosis
Mechanic’s hands

Associated with malignancy and pulmonary fibrosis

Question 21

Osteoporosis management

Answer 21

Bisphosphonates
Calcium and vit D
HRT

Question 22

Osteoporosis signs and symptoms

Answer 22

Multiple fractures
Steroid use, excess alcohol, premature menopause, RA

Question 23

Osteoporosis investigations

Answer 23

DEXA scan
X ray

Question 24

Scleroderma investigations

Answer 24

CXR: lung fibrosis
Lung function test: restrictive, reduced gas transfer
High resolution CT thorax: lung fibrosis
ANA, ENA antibodies

Question 25

Connective tissue disorder management

Answer 25

Steroids
Azathioprine(immuno suppression)

Question 26

Poly myalgia rheumatica signs and symptoms

Answer 26

Stiffness and pain, worse in early morning
Shoulders and hips
NO WEAKNESS

Question 27

Polymyalgia rheumatica/giant cell arteritis investigations

Answer 27

ESR: >40mm/h
Raised CRP

GCA:
Temporal artery biopsy

Question 28

Polymyalgia rheumatica/giant cell arteritis management

Answer 28

1st line: Oral prednisolone 1-2 years
2nd line: Azathioprine if needed
Tocilizumab (GCA)

Question 29

Osteomyelitis signs and symptoms

Answer 29

Pain and swelling around joint
Fever

Question 30

Osteomyelitis investigations

Answer 30

X ray: lytic bony destruction, soft tissue swelling
MRI
FBC, CRP

Question 31

Osteomyelitis management

Answer 31

Flucloxacillin 6/52 (clindamycin if allergic)
Analgesia
Surgical drainage

Question 32

Osteomalacia/osteoporosis signs and symptoms

Answer 32

OM:
Muscle weakness
Joint/bone pain
Hypocalcaemia: Chvostek’ sign, Trosseau sign

OP:
Fragility fractures
Post menopausal women

Question 33

Osteomalacia/osteoporosis investigations

Answer 33

OM:
Low vit D
Low Ca
High ALP
High PTH

OP:
DEXA scan: <-2.5
X ray: cortical thinning, increased radiolucency

Question 34

Osteomalacia/osteoporosis management

Answer 34

OM:
Daily vit D3 supplement

OP:
Vit supplements
Physical therapy, exercise
Bisphosphonate
Strontium ranelate
HRT

Question 35

SLE management

Answer 35

Hydroxychloroquine

Moderate/severe:
Prednisolone
Methotrexate
Rituximab

Question 36

Small vessel vasculitis

Answer 36

ANCA associated vasculitis:
Saddle nose, lung/kidney involvement

Immune complex vasculitis:
Purpuric rash, arthritis, kidney involvement