MSK

Question 1

5 year old boy in ED, fall onto outstretched hand, pain and swelling around elbow and bruising of antecubital fossa. Cannot flex the IP of thumb or DIP of index finger. What fracture?

Answer 1

Supracondylar fracture of the humerus (features of anterior interosseous nerve neuropraxia = most common type of neuropraxia associated with this injury)

Question 2

22 year old in ED, hit on elbow during baseball with bat. Swollen painful elbow, cannot extend arm.

Answer 2

Olecranon fracture

Question 3

3 year old in ED, started screaming when mum took off vest. Not moving left arm, Elbow is extended and forearm pronated, no bruising/tenderness or swelling over elbow. What fracture?

Answer 3

Subluxation of radial head (also known as pulled elbow)

Question 4

Examination finding best support a diagnosis of de Quervain’s tenosynovitis?

Answer 4

Positive Finkelstein’s test

Question 5

Features of RA on x-ray?

Answer 5

Periarticular osteoporosis, Narrowing of joint space, Juxta-articular bony erosions, Subluxtion and gross deformity, Periarticular soft tissue swelling.
Clinical features: Swan neck deformity, ulnar deviation of MCP, Boutonniere’s deformity of thumb, Bouchard’s nodes

Question 6

Features of OA on x-ray?

Answer 6

Subchondral bone cysts, Osteophytes, Narrowing of joint space, Subchondral sclerosis

Question 7

What fracture are the following:
a) Dorsal displacement of the distal radius
b) Volar displacement of the distal radius
c) Thenar eminence swelling, palmar bruising and inability to move thumb
d) Subluxtion of MCP joint of thumb with abduction

Answer 7

a) Colles fracture
b) Smith fracture (fall onto back of hand)
c) Bennet fracture (fracture of the base of the metacarpal of the thumb)
d) Gamekeeper’s thumb (chronic ulnar collateral repture of thumb)

Question 8

Triad of reactive arthritis

Answer 8

Urethritis, seronegative arthritis, conjunctivitis

Question 9

What might occur if treating an acute attack of gout with allopurinol?

Answer 9

Exacerbation and prolongation of the attack

Question 10

15 year old girl, anterior knee pain for several weeks, worse when walking downstairs?

Answer 10

Chondomalacia patellae (abnormal softening of the cartilage on the underside of the patella)

Question 11

12 year old boy, gradually increasing pain in the right hip and a limp. Reduced ROM in the hip. X-ray shows scelortic femoral head

Answer 11

Avascular necrosis

Question 12

Middle aged woman presents with right foot drop, numbness in right hand, thenar eminence wasting and sensory loss over the radial half of her hand?

Answer 12

Mononeuritis multiplex (neuropathy of two or more non-anatomically related peripheral nerves)

Question 13

Most likely injury to cause anterior shoulder dislocation?

Answer 13

Rugby injury causing deformity and sensory loss over the lateral shoulder

Question 14

Most likely injury to cause posterior shoulder dislocation?

Answer 14

Tonic clonic seizure

Question 15

Indication to refer to orthopaedic surgeon for lateral epicondylitis?

Answer 15

Loss of sensation over the dorsum of the hand

Question 16

Positive pathergy test a sign of?

Answer 16

Behcet’s disease (insert a needle and papule will form later)

Question 17

Over the age of 65 with clinical features of OA. What investigations?

Answer 17

None needed