MSK Flashcards
25M with swollen left knee. Recent holiday in Spain. Swollen, warm L knee with full ROM. Pain on ankle movement but no swelling. Waxy yellow rash on soles of both feet. Diagnosis?
Reactive arthritis (rash is keratoderma blenorrhagica)
24F with recurrent DVT, present with SOB. APTT is prolonged. Diagnosis?
Antiphospholipid syndrome
Initially intermittent tingling of the 4th and 5th finger, worse when the elbow is flexed for prolonged periods. Diagnosis?
Cubital tunnel syndrome
What food precipitate an attack of gout?
Liver, kidneys, seafood, oily fish and yeast products
58M presents with painful, swollen L knee. O/E there is a moderate sized effusion. XR: loss of joint space and linear calcification of the articular cartilage. Diagnosis?
Pseudogout
32F with joint pain. BMI 30. Large effusion of L knee with reduced ROM. MCP joints of R hand are swollen with sausage-like fingers. L hand if normal. HLA-B27 positive. Diagnosis?
Psoriatic arthritis
Asymmetrical presentation suggests psoriatic arthritis rather than rheumatoid
54F with new OA that has not improved with regular paracetamol. What is the next step in management?
Add in topical NSAID
65M with bilateral leg pain brought on by walking. PMH peptic ulcer disease and OA. He can walk for 5 minutes before it develops and it’s relieved by sitting down. Leaning forwards or crouching improves the pain. Diagnosis?
Spinal stenosis
52M with 3 year history of progressively worsening hip and back pain. Worse on weight bearing and improves with rest. O/E frontal bossing and bowing of the legs. What is the appropriate first-line treatment?
Alendronate
Paget’s disease of the bone is treated with bisphosphonates
Which skin disorder is most associated with antiphospholipid syndrome?
Livedo reticularis
+ arterial/venous thrombosis + miscarriage
Patient with severe flare of UC who has an anaphylactic reaction to aspirin. What UC medication presents a significant safety concern?
Sulfasalzine is cross reactive with aspirin
What medication has a side effect of Dupuytren’s contracture?
Phenytoin
What are the Ottowa ankle rules?
X-ray if:
1. Point tenderness over the distal 6cm of the lateral malleolus
2. Point tenderness over the distal 6cm of the medial malleolus
3. Inability to weight bear by at least 4 steps immediately post-trauma and in ED
Sudden onset back pain after tying shoelaces. Tenderness over lumbar spine and leaning back worsens the pain. Neuro exam and SLR is normal?
Facet joint pain
Straight leg raise makes disc prolapse less likely
What risk factors are associated with Dupuytren’s contracture?
Phenytoin treatment, manual labour, ALD and family history
What bloods would you expect in someone with polycystic kidney disease who has been found to have hypocalcaemia?
High phosphate
High ALP
High PTH
Disc prolapse causing reduced sensation on the dorsum of the right foot, particularly around the big toe with weak foot dorsiflexion. Intact ankle and knee reflexes. Which nerve root is affected?
L5
Three episodes of gout with high uric acid. What is the appropriate management?
Allopurinol 100mg OD + diclofenac 50mg TDS
73F with a stable, complete, intertrochanteric proximal femur fracture. What procedure will be recommended?
Dynamic hip screw is preferred for intertrochanteric (extracapsular) femur fractures
35M dancer with anterior groin pain with snapping of the hip. Sharp pain after prolonged sitting. Restricted ROM with pain on adduction and internal rotation of the hip whilst flexed to 90 degrees. Diagnosis?
Femeroacetabular impingement
Antibiotic associated with Achilles tendon rupture?
Ciprofloxacin
Keen runner with pain after exercise. No redness/swelling/locking of the joint. Full ROM. Sharp pain over the lateral epicondyle of the femur on palpation, particularly with the knee at 30 degrees of flexion. Diagnosis?
Iliotibial band syndrome
What rheumatology medication has a side effect of hypertension?
Leflunomide
(causes GI upset, hepatitis and hypertension)
What medication for RA has a side effect of low sperm count?
Sulfasalazine
