MSK

Question 1

what are the key x-ray changes seen in osteoarthritis ?

Answer 1

LOSS
Loss of Joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

Question 2

what is the presentation of osteoarthritis ?

Answer 2

joint pain and stiffness that worsens with activity
worsens at the end of the day
morning stiffness lasting < 30 minutes

Question 3

what are the signs of osteoarthritis ?

Answer 3

Heberden’s nodes : DIP
Bouchard’s nodes : PIP

Question 4

what is the criteria for diagnosis for Osteoarthritis

Answer 4

> 45
typical pain
no morning stiffness

Question 5

what is the management of osteoarthritis

Answer 5

lifestyle changes
topical NSAID’s Followed by oral NSAID’s
weak opiates and paracetamol
infrequently
intra-articular steroid injections

Question 6

what are the 2 major risk factors for hip fractures

Answer 6

age
osteoporosis

Question 7

what is the difference between intra-capsular and extra-capsular fractures of the hip?
what system is used to classify hip fractures?

Answer 7

Intra-capsular fractures : they are from the edge of the femoral head to the insertion of the capsule.
Non displaced : Have an intact blood supply
Displaced : disrupt blood supply

Extra-capsular : can be trochanteric or subtrochanteric

Garden system used in the classification of hip fractures.

Question 8

how does a hip fracture present?

Answer 8

hip/ groin pain
unable to weight bear
short, abducted and externally rotated leg

Question 9

what is the investigation used in the diagnosis of hip fracture?
how is it managed ?

Answer 9

X-ray : AP view and lateral view

Intra-capsular fractures :

Non displaced : internal fixation ( as blood supply may be intact)

Displaced: total hip replacement or hemiarthroplasty

Extra-capsular fractures :
Stable intertrochanteric fracture : dynamic hip screw
Reverse oblique, transverse or sub trochanteric : Inter-medullary device

Question 10

what is compartment syndrome ? how does it present ?
which fractures carry this complication?
how is it diagnosed and managed ?

Answer 10

A complication of fractures characterised by raised pressure within a closed anatomical space eventually compromising tissue perfusion causing necrosis.

features include :
Pain on movement with excessive use of breakthrough analgesia
paraesthesia
pallor
arterial pulsation
paralysis

Supracondylar and tibial shaft fractures carry the highest risk

diagnosis :
made by measurement of intra-compartmental pressure ( > 20 mm is abnormal and > 40 mm Hg is diagnostic)

management involves fasciotomies

Question 11

what is the cause of greater trochanteric pain syndrome?

Answer 11

repeated movement of fibro-elastic iliotibial band.
features include :
pain on lateral side of hip/ thigh
tenderness on palpation of the greater trochanter

Question 12

what are the risk factors for tendon disorders?
What are the most common tendon disorders?

Answer 12

quinolone use ( Ciprofloxacin)
Hypercholesterolaemia

Achilles tendinopathy ( tendinitis)
Achilles tendon rupture

Question 13

what are the features and management of Achilles tendinopathy

Answer 13

gradual onset of posterior heel pain worse following activity
morning stiffness and pain

managed with simple analgesia and rest

Question 14

how does Achilles tendon rupture present? How is it managed?

Answer 14

Should be suspected if person described a sudden ‘‘pop’’ while playing a sport and sudden onset significant pain.

Simmonds triad can be used to examine and ultrasound is used for imaging.

referral to orthopaedic specialist should be managed.

Question 15

which is the most commonly injured knee ligament

Answer 15

Anterior cruciate ligament

Question 16

what are the features of ACL injury?

Answer 16

Sudden ‘‘popping’’ sound
knee swelling
instability

typically occurs from twisting injuries

anterior draw test and Lachman’s test

Question 17

most common cause of heel pain in adults ?

Answer 17

Plantar fasciitis

Question 18

describe osteomalacia. What is it known as in children’s?

Answer 18

softening of the bones secondary to low vitamin D levels. Known as rickets if it occurs in growing children.

Question 19

what are the causes of osteomalacia ?

Answer 19

Vitamin D deficiency
(malabsorption, lack of sunlight and diet )
CKD

Question 20

what are the features of osteomalacia ?

Answer 20

Bone pain
bone / muscle tenderness
fractures ( femoral neck)
proximal myopathy leading to a waddling gait

Question 21

How is osteomalacia investigated and managed?

Answer 21

Bloods ( low vitamin D, low calcium ,phosphate, raised ALP)

x-ray shows translucent bands

management :
vitamin D supplementation

Question 22

what is the difference between haematogenous and non haematogenous osteomyelitis ?

Answer 22

haematogenous : pathogen is carried through the blood and seeded in bone ( most common)

Non-haematogenous : direct contamination ( fracture site, operation)

Question 23

what is the most common cause of osteomyelitis ?

Answer 23

Staph. Aureus
salmonella - most common in sickle cell disease

Question 24

how is osteomyelitis investigated and managed

Answer 24

MRI
blood tests, bone cultures and blood cultures.
surgical debridement

flucloxacillin for 6 weeks with rifampicin or fusidic acid added for the 1st 2 weeks ( clindamycin if penicillin allergic)

Question 25

what is the Boxer fracture?

Answer 25

minimally displaced fracture of the 5th metacarpal that generally occurs after a patient punching a hard surface

Question 26

what is Colle's fracture? How does it present ? what are its complications?

Answer 26

follows Fall onto an outstretched hand Dorsally Displaced Distal radius leading to Dinner fork Deformity. complications : median nerve injury ( acute carpal tunnel injury)

Question 27

what is smith's fracture and how does it present?

Answer 27

Reverse Colle's fracture Caused by falling backwards onto the palm of an outstretched hand / falling with wrists flexed

Question 28

How does carpal tunnel syndrome present ?

Answer 28

pain + pins and needles in the thumb, index finger and middle finger

Question 29

what does examination show in carpal tunnel syndrome

Answer 29

weakness of thumb abduction wasting of thenar eminence Tinel's and Phalen's sign

Question 30

How is carpal tunnel syndromemanaged?

Answer 30

6 week trial of conservative measures mild-moderate : corticosteroids wrist splints at night ( esp. if pregnant / transient factors) surgical decompression of flexor retinaculum division

Question 31

what are the causes of carpal tunnel syndrome

Answer 31

idiopathic pregnancy oedema e.g. heart failure lunate fracture rheumatoid arthritis

Question 32

what is discitis ? what are its complications?

Answer 32

It is an infection in the intervertebral disc space that can lead to serious complications such as sepsis / epidural abscess.

Question 33

what are the causes of discitis ?

Answer 33

Bacterial : Staph. Aureus viral TB Aseptic

Question 34

What are the features of discitis ?

Answer 34

Back pain general features : pyrexia, rigors, sepsis neurological features : changing lower limb neurology

Question 35

what is the investigation and management of discitis?

Answer 35

MRI : highest sensitivity treatment : 6-8 weeks of IV Abx therapy assess for endocarditis

Question 36

what is De quervain's tenosynovitis ? What are its features and management ?

Answer 36

Condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendon is inflamed. features include : pain on radial side of the wrist tenderness over the radial styloid process abduction of thumb against resistance is painful management : analgesia steroid injection immobilisation surgical treatment

Question 37

what test can aid the diagnosis of De Quervain's tenosynovitis ?

Answer 37

Finkelstein's test

Question 38

what is a scaphoid fracture a complication of ?

Answer 38

FOOSH - fall on outstretched hand Contact sports

Question 39

what is a complication of scaphoid fractures?

Answer 39

avascular necrosis of the scaphoid

Question 40

what are the signs and symptoms of scaphoid fractures

Answer 40

Pain along the radial aspect of the wrist - at the base of the thumb loss of grip / pinch strength signs include : Point of maximal tenderness is over the anatomical snuffbox wrist joint effusion pain elicited by telescoping of the thumb

Question 40

how are scaphoid fractures investigated and managed?

Answer 40

Plain film radiographs MRI- definitive Management Immobilisation with Futuro Splint referral to orthopaedics

Question 40

what are the patterns of disease in systemic sclerosis ?

Answer 40

Limited cutaneous systemic sclerosis Diffuse cutaneous systemic sclerosis Scleroderma

Question 41

what are the features of limited cutaneous systemic sclerosis

Answer 41

CREST syndrome Calcinosis Raynaud's oesophageal dysmotility Sclerodactyly Telangiectasia Associated with anti-centromeric antibodies Scleroderma affects face and distal limbs predominantly

Question 42

what are the features of diffuse cutaneous systemic sclerosis ?

Answer 42

affects trunk and proximal limbs respiratory involvement : ILD, PAH can cause renal disease and HTN Anti scl-70 antibodies

Question 43

what is the nature of inheritance of Marfan's syndrome? What are its features ?

Answer 43

Autosomal dominant connective tissue disorder. Features include : tall stature high arch plate pectus excavatum pes planus scoliosis mitral valve prolapse and dilation of the aortic sinuses repeat pneumothoraces lens dislocation dural ectasia

Question 44

what is an iliopsoas abscess? what is it caused ( primary and secondary)? What are its clinical features? How is it investigated and managed?

Answer 44

Collection of pus in the iliopsoas compartment. Caused by : Haematogenous spread Staph aureus Secondary causes include: Crohn's diverticulitis, colorectal cancer UTI's, GU cancer vertebral osteomyelitis endocarditis IVDU features include : fever, back/flank pain, limp and weight loss hyperextension of the effected hip will cause pain. Investigation : CT abdomen Management : ABx Percutaneous drainage