MSK

Question 1

Falling onto an outstretched hand (FOOSH)

pain increased if pressure was applied over the anatomical snuffbox or during ulnar deviation of the wrist.

Answer 1

scaphoid fracture

Question 2

Majority of clavicle fractures occur in

Answer 2

middle clavicle

Question 3

femoral head blood supply

Answer 3

Medial circumflex femoral and lateral circumflex femoral arteries anastomose

Question 4

A patient develops foot drop following a fibular neck fracture- nerve affected?

Answer 4

common peroneal nerve

Question 5

Damage to the ulnar nerve

Answer 5

cause weakness of the lateral two fingers, producing a ‘claw-like’ appearance.§

Question 6

Damage to the axillary nerve

Answer 6

deltoid muscle dysfunction, affecting arm abduction.

Question 7

inability to extend his wrist. Examination confirms this and is consistent with a ‘wrist drop’.

which nerve affected

Answer 7

radial nerve

Question 8

Damage to the musculocutaneous nerve

Answer 8

cause impaired biceps brachii muscle dysfunction, affecting arm flexion.

Question 9

Damage to the median nerve

Answer 9

cause an inability to abduct and oppose the thumb due to paralysis of the thenar muscles.

Question 10

RANKL inhibitors

Answer 10

denosumab. It is a RANKL inhibitor and works by preventing the development of osteoclasts (bone resorption cells).

used for oesteoperosis

Question 11

Sjogren’s Syndrome

Answer 11

condition that affects parts of the body that produce fluids, like tears and spit (saliva). It usually starts in people aged 40 to 60 and is much more common in women than men.

symptoms- dryness

Question 12

what type of muscle do Sarcomeres give rise to

Answer 12

cardiac and skeletal

Question 13

Raynaud’s phenomenon

Answer 13

exaggerated vasoconstrictive response to the cold

Question 14

plaque Psoriasis

Answer 14

damaged skin is replaced with psoriatic plaques. Plaque psoriasis is an autoimmune condition characterised by scaly red plaques with a silver scale. Psoriatic plaques classically appear on the extensor surfaces, as is the case with this patient.

Question 15

Psoriatic arthritis

Answer 15

only arthritis to be associated with skin and nail changes, including pitting and onycholysis. It can also be associated with a ‘rheumatoid-like’ symmetrical pattern affecting the small joints of the hands and feet, however, it typically affects the distal interphalangeal joints rather than the metacarpophalangeal joints which are usually affected in rheumatoid arthritis

Question 16

Caplan’s syndrome

Answer 16

This is a rare syndrome. Also known as rheumatoid pneumoconiosis and is characterised by intrapulmonary nodules in people with rheumatoid arthritis and a known exposure to dust particles (e.g. coal [anthracite], asbestos and silica). It can cause shortness of breath. The patient used to work in the construction industry and thus may have been exposed to asbestos. The symmetrical pain and stiffness in the hands is suggestive of rheumatoid arthritis

Question 17

SLE tests

Answer 17

All patients with SLE needs to have a urine dipstick test to look for proteinuria (evidence of Lupus Glomerulonephritis)

Question 18

DAS28 tests

Answer 18

test done in Rheumatoid Arthritis to assess the number of joints that are affected as a measure of the severity of the condition at a particular point in time

Question 19

dermatomyositis

Answer 19

here is new onset bilateral proximal muscle weakness in an elderly person and he appears to have a heliotrope rash (purple discolouration over the eyelids ± periorbital swelling). Dermatomyositis is highly associated with malignancy and may present before the malignancy does. Lung cancer is one of the malignancies most highly associated with dermatomyositis, and his progressive breathlessness with a lack of chest signs and an extensive smoking history point towards this.

Question 20

RA tests

Answer 20

anti CCP

Question 21

Polymyalgia Rheumatica

Answer 21

Shoulder/ hip girdle stiffness (usually in the mornings) for >1 hour with associated inflammatory pain. Typically, these symptoms respond to treatment with corticosteroids within 72 hours and a therapeutic trial can be useful in diagnosis.

Systemic symptoms including low grade fever, reduced appetite and weight loss, malaise

old

Question 22

autoimmune hepatitis test

Answer 22

Anti-smooth muscle antibodies

Question 23

alendronic acid

Answer 23

osteoperosis

bisphosphonate

ci- oesophageal stricture

Question 24

methotrexate - which vaccine ci ?

Answer 24

yellow fever as is live

Question 25

NSAIDS

Answer 25

naproxen, Diclofenac, Piroxicam

ci- renal disease

Question 26

Wegener’s granulomatosis

Answer 26

also known as granulomatosis with polyangiitis or GPA) is an example of a small vessel vasculitis. It is classically cANCA-positive. It classically presents with a triad of upper respiratory tract symptoms, lower respiratory tract symptoms and renal symptoms

Question 27

Giant cell arteritis

Answer 27

Giant cell arteritis a large-vessel vasculitis which tends to affect older women. Common symptoms include temporal headache, scalp sensitivity, jaw claudication, visual disturbance and systemic symptoms such as malaise and fever

Question 28

gout treatment

Answer 28

steroids

Question 29

Reactive arthritis

Answer 29

Patients with reactive arthritis tend to present with dysuria, iritis/conjunctivits, arthralgia