MSK

Question 1

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?

Answer 1

Reactive arthritis (rash is keratoderma blenorrhagica)

Question 2

24F with recurrent DVT, present with SOB. APTT is prolonged. Diagnosis?

Answer 2

Antiphospholipid syndrome

Question 3

Initially intermittent tingling of the 4th and 5th finger, worse when the elbow is flexed for prolonged periods. Diagnosis?

Answer 3

Cubital tunnel syndrome

Question 4

What food precipitate an attack of gout?

Answer 4

Liver, kidneys, seafood, oily fish and yeast products

Question 5

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?

Answer 5

Pseudogout

Question 6

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?

Answer 6

Psoriatic arthritis
Asymmetrical presentation suggests psoriatic arthritis rather than rheumatoid

Question 7

54F with new OA that has not improved with regular paracetamol. What is the next step in management?

Answer 7

Add in topical NSAID

Question 8

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?

Answer 8

Spinal stenosis

Question 9

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?

Answer 9

Alendronate
Paget’s disease of the bone is treated with bisphosphonates

Question 10

Which skin disorder is most associated with antiphospholipid syndrome?

Answer 10

Livedo reticularis
+ arterial/venous thrombosis + miscarriage

Question 11

Patient with severe flare of UC who has an anaphylactic reaction to aspirin. What UC medication presents a significant safety concern?

Answer 11

Sulfasalzine is cross reactive with aspirin

Question 12

What medication has a side effect of Dupuytren’s contracture?

Answer 12

Phenytoin

Question 13

What are the Ottowa ankle rules?

Answer 13

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

Question 14

Sudden onset back pain after tying shoelaces. Tenderness over lumbar spine and leaning back worsens the pain. Neuro exam and SLR is normal?

Answer 14

Facet joint pain
Straight leg raise makes disc prolapse less likely

Question 15

What risk factors are associated with Dupuytren’s contracture?

Answer 15

Phenytoin treatment, manual labour, ALD and family history

Question 16

What bloods would you expect in someone with polycystic kidney disease who has been found to have hypocalcaemia?

Answer 16

High phosphate
High ALP
High PTH

Question 17

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?

Answer 17

L5

Question 18

Three episodes of gout with high uric acid. What is the appropriate management?

Answer 18

Allopurinol 100mg OD + diclofenac 50mg TDS

Question 19

73F with a stable, complete, intertrochanteric proximal femur fracture. What procedure will be recommended?

Answer 19

Dynamic hip screw is preferred for intertrochanteric (extracapsular) femur fractures

Question 19

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?

Answer 19

Femeroacetabular impingement

Question 20

Antibiotic associated with Achilles tendon rupture?

Answer 20

Ciprofloxacin

Question 21

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?

Answer 21

Iliotibial band syndrome

Question 22

What rheumatology medication has a side effect of hypertension?

Answer 22

Leflunomide
(causes GI upset, hepatitis and hypertension)

Question 23

What medication for RA has a side effect of low sperm count?

Answer 23

Sulfasalazine

Question 24

What are the age-independent risk factors for osteoporosis?

Answer 24

Low BMI <19
Height loss >3cm
FH of maternal hip fracture >75
Any condition associated with prolonged immobility
Chronic conditions associated with bone loss (coeliac disease, T1DM, RA)

Question 25

What is Felty’s syndrome?

Answer 25

A rare complication of RA
RA, splenomegaly and neutropenia

Question 26

Antibodies in Sjogren’s syndrome?

Answer 26

Anti Ro/La

Question 27

Antibodies in antiphospholipid syndrome?

Answer 27

Anti-cardiolipin antibodies

Question 28

Antibodies associated with Limited Systemic Sclerosis (CREST)?

Answer 28

Anti-centromere antibodies

Question 29

What drugs cause drug-induced lupus?

Answer 29

Chlorpromazine
Methyldopa
Hydralazine
Isoniazid
d-penicillamine
Minocycline

Question 30

What is the most appropriate investigation for renal stones?

Answer 30

Non-enhanced CT scan

Question 31

2 month boy with UTI and impaired renal function. USS shows bilateral hydronephrosis. What is the most appropriate next investigation?

Answer 31

Micturating cystogram

Question 32

What antibodies are associated with Goodpasteur’s syndrome?

Answer 32

Anti-GBM antibodies