MSK Flashcards
What condition is caused by antibodies against post synaptic nicotinic acetylcholine receptors?
Myasthenia gravis
What antibodies are involved in guillain barre syndrome?
Anti ganglioside antibodies
note: these antibodies are seen in other immunologically mediated peripheral neuropathies
Which of the following investigation findings is consistent with lambert Eaton myasthenic syndrome?
Positive voltage gated calcium channel antibodies
LEMS is an autoimmune disorder that attacks the neuromuscular junction and is typically a paraneoplastic syndrome associated with small cell lung cancer
D
The patient has carpal tunnel syndrome
Tinel’s test is tapping over the median nerve at the flexor retinaculum eliciting tingling in the nerve distribution.
Phalen’s test- putting hands together, 90 degree flexion at the wrist
The median nerve supplies opponens pollicis, abductor pollicis brevis, flexor pollicis brevis in the hand
A 28 year old man presents with unilateral facial weakness.
The symptoms appeared over 24-48 hours and was associated with prodromal ear pain and an altered sensation of taste. He denies systemic upset, meningism and changes in his hearing.
Examination reveals unilateral facial weakness as described, with involvement of the upper and lower face. The is no evidence of rash and otoscopy is normal.
What is the single most likely underlying diagnosis?
-Bell’s palsy
-acoustic neuroma
-space occupying lesion
-Ramsay hunt syndrome
-sarcoidosis
Bell’s palsy
What is Bell’s palsy? And why does it cause hyperacusis?
Inflammation of the facial nerve causing episode of facial muscle weakness or paralysis. It begins suddenly and worsens over 48 hours.
The facial nerve supplies the stapedius muscle which is why it affects hearing.
A 60 year old female presents to the GP with back pain. Her GP suspects multiple myeloma as the cause.
Which of the following is the best investigation to confirm this diagnosis?
-serum calcium levels
-serum protein electrophoresis
-JAK2 mutation screen
-peripheral blood film
-ALP levels
A 60 year old female is referred to the haematology clinic by the general practitioner. The referral letter is incomplete and the only information you have about the patient is that she was referred after serum electrophoresis revealed an IgG paraprotein spike (IgG 45 g/L).
Which of the following examination findings is consistent with the most likely underlying diagnosis?
-Erythromelalgia
-splenomegaly
-chovstek’s sign positive
-conjunctival pallor
-macroglossia
Remember: multiple myeloma is a cancer of plasma cells so it makes sense why it would present with anaemia!
A 65-year-old man with a background of multiple myeloma attends the emergency department with pain in his back, legs and arms. After investigation, it is suspected that his symptoms are being caused by metastases to the bones. He reports that he has tried paracetamol, ibuprofen and codeine without relief.
Which medication may be added to relieve the pain?
-Hyoscine butylbromide (Buscopan)
-Gabapentin
-Amitriptyline
-Baclofen
-Zoledronic acid (a bisphosphonate)
What condition is being described: This condition is often found young adults and teenagers. Classically described as sun-burst on x-ray it tends to have an affinity for the knee or hip joint.
Osteosarcoma
A 63 year old man has a five-month history of progressive bilateral thigh muscle weakness. He is receiving treatment for small cell lung cancer. Neurological examination reveals absent upper and lower limb reflexes. Blood tests confirm the presence of anti-voltage-gated calcium channel antibodies. What’s the most appropriate first line management option?
3,4 diaminopyradine
What condition is anti CCP antibodies associated with?
Rheumatoid arthritis
What condition are anti-centromere antibodies and antinuclear antibodies associated with?
Limited cutaneous systemic sclerosis a.k.a CREST syndrome
In CREST syndrome, what does CREST stand for?
Calcinosis
Reynaud’s
Eosophageal dysmotility
Sclerodactyly- thickening and tightness of skin on fingers and toes, they look very shiny
Telengiectasia
What antibodies are associated with Sjögren’s syndrome?
Anti- Ro and Anti-La antibodies
What condition is associated with anticardiolipin antibodies?
Antiphospholipid syndrome
note: lupus anticoagulant and anti-beta-2-glycoprotein-1 antibodies are also likely to be positive
Anti-Jo-1 antibodies are associated with which condition? How is this condition normally diagnosed?
Polymyositis
Raised creatinine kinase level, electromyography and muscle biopsy muscle biopsy is the definitive test
Describe Boutonnière’s deformity and state what condition it is associated with
Flexion at the PIP and extension at the DIP and MCP joints
This is typically associated with rheumatoid arthritis
71 year old man complained of progressive weakness and double vision that was more pronounced in the evenings. On examination, he had fatiguable weakness of gaze and shoulder abduction. Initial tests showed his acetylcholine receptor antibodies were positive. Which of the following tests would you also like to consider?
-ABGs
-CT chest
-MRI brain and spine
-anti muscle specific kinase antibodies
-MRI of brain and spine is useless as myasthenia gravis doesn’t have CNS involvement (it is an NMJ disorder)
-Anti muscle specific kinase antibodies can be present in myasthenia gravis but acetylcholine receptor antibodies were positive so you already have the diagnosis
A 28 year old male presents to his GP with blurry vision in his right eye. Examination reveals a cataract, and he is referred to ophthalmology. Upon further questioning, he reveals he has had four months of increasing weakness in his hands and feet. As a child he suffered from talipes equinovarus, but this resolved with physiotherapy and braces. Finally, upon shaking the GP’s hand, he finds it difficult to release his grip.
Given his symptoms, what is the mechanism and inheritance pattern of the condition he suffers from?
What is edrophonium test used for?
Diagnosing myasthenia gravis- it is very responsive as there is more acetylcholine available which increases muscle strength
A 25 year old male is tackled while playing football. He falls on his outstretched arm and experiences immediate pain associated with a ‘popping’ sensation. His friends quickly drive him to the nearest emergency department. He has reduced range of motion on the right side and is extremely tender to palpation over the right shoulder region. His x-ray is shown below. The appearance shown on x-ray is most associated with which of the following:
A Bankart lesion is an injury of the antero-inferior glenoid labrum. It is caused by anterior dislocation of the humeral head. It is an indication for surgical, as Bankart lesions can cause recurrent shoulder dislocation. They are most commonly diagnosed on MRI. A bony Bankart lesion, is one that includes a fracture of the glenoid of the scapula and these case often be seen on x-ray. Bankart lesions are frequently accompanied by a Hill-Sachs lesion, which is a cortical injury of the posterolateral humeral head when it is forcefully impacted against the antero-inferior glenoid
Reassurance and RICE
The x-ray shows a bipartite patella which can be mistaken for a displaced fracture. The location (75% superolateral quadrant) and well corticated smooth edges distinguish it from a fracture. Conservative management with RICE (Rest, ice, compression, elevation) is appropriate in the first instance
What is the most likely diagnosis:
-left middle lobe pneumonia
-left sided simple pneumothorax
-left lower lobe pneumonia
-left lower lobe collapse
-left middle lobe collapse
In this x ray what pathology are the arrows pointing to ?
Chondrocalcinosis (a.k.a pseudogout) calcium deposits in articular cartilage
What is the name of this injury?
What is the most likely location of pathology?
An 11 year old is brought to the children’s ED following a fall on to his right arm while playing basketball at school. He’s accompanied by his father. According to his father he has no past medical history and is usually fit and well. He’s had no previous hospital admissions. He describes crashing into another player while holding the air holding the ball. He fell onto his right arm and is now unable to move it. On examination, there is visible deformity of his right wrist; the medial dorsal surface appears swollen. There’s significant tenderness along the lateral aspect of his right arm and right wrist. He is unable to move his right arm because of the pain. An x ray of his right arm is shown below;
What condition is this image describing?
Henoch Schoenlein purpura/IgA nephropathy- palpable purpuric rash mostly on extensor surfaces of lower limbs associated with abdominal pain, polyarthritis and IgA nephropathy
A 55-year old man presents to his GP complaining of persistently aching legs. The ache is localised to both his thighs and he finds it increasingly difficult to walk. Over the past 6 months his relatives have noticed a progressive hearing loss on the left side as well as some changes in his head size. He has noticed that he can no longer fit into his favourite hat.
There is suspicion of a diagnosis of Paget’s disease of the bone. Which of the following blood test results fit with a diagnosis of Paget’s disease?
A 23-year-old woman is seen in the trauma outpatient clinic 6 weeks after being involved in a car crash that caused several injuries to her arms, legs, and foot. After undergoing extensive physiotherapy and surgical management, she is now able to mobilise using crutches, but she has noticed some weakness in her left leg.
Nerve conduction studies are performed, which show significant neuropraxia of her left deep peroneal nerve.
Given the most likely diagnosis, which muscles will be affected?
-Flexor digitorum longus, flexor hallucis longus, tibialis posterior
-Peroneus longus, peroneus brevis
-Semitendinosus, semimembranosus, biceps femoris
-Soleus, gastrocnemius
-Tibialis anterior, extensor digitorum longus, extensor hallucis longus
An 80-year-old patient has been housebound for the last few years. His carer became concerned as the patient has been experiencing widespread tenderness and bone pain over the last few months. His past medical history includes heart failure and atrial fibrillation.
Due to the patient’s lack of sunlight, it is suspected he may be suffering from osteomalacia.
What blood results would support this diagnosis?
Low serum calcium, low serum phosphate, raised ALP and raised PTH - osteomalacia
A 73-year-old lady suffers a fracture at the surgical neck of the humerus. The decision is made to operate. There are difficulties in reducing the fracture and a vessel lying posterior to the surgical neck is injured. Which one of the following is this vessel most likely to be?
-Axillary artery
-Brachial artery
-Thoracoacromial artery
-Transverse scapular artery
-Posterior circumflex humeral artery
The circumflex humeral arteries lie at the surgical neck and is this scenario the posterior circumflex is likely to be injured. The thoracoacromial and transverse scapular arteries lie more superomedially. The posterior circumflex humeral artery is a branch of the axillary artery.
