msk

Question 1

features of L3 nerve root compression

Answer 1

Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

Question 2

features of L4 nerve root compression

Answer 2

Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

Question 3

features of L5 nerve root compression

Answer 3

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

Question 4

features of S1 nerve root compression

Answer 4

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

Question 5

drug induced lupus:
1. most common causes (2)
2. less common causes (3)

Answer 5

1. procainamide (used to treat SVT)
   hydralazine

2.isoniazid
minocycline (a tetreacycline)
phenytoin

Question 6

clinical features of drug induced lupus (4)

Answer 6

arthralgia
myalgia
skin (malar rash)
pulmonary involvement (e.g. pleurisy)

Question 7

drug induced lupus antibodies:

Answer 7

ANA +ve in 100% (dsDNA -ve)
anti-histone antibodies are found in 80-90%
anti-Ro, anti-Smith positive in around 5%

Question 8

RA poor prognostic features (7)

Answer 8

rheumatoid factor positive
anti-CCP antibodies
poor functional status at presentation
X-ray: early erosions (e.g. after < 2 years)
extra articular features e.g. nodules
HLA DR4
insidious onset

Question 9

azathioprine

1. test prior to starting
2. adverse effects (4)
3. drug interaction (1)
4. is it pregnancy safe?

Answer 9

1. TPMT (thiopurine methyltransferase)
2. bone marrow supression (do FBC if pt develops infection/ bleeding)
   nausa & vomiting
   pancreatitits
   non-melanoma skin cancer
3. allopurinol (use lower dose)
4. yes

Question 10

hip #mgt - intracapsular
i. undisplaced
ii. displaced

Answer 10

i. internal fixation or hemiarthoplasty if fit

ii. THR

Question 11

hip #mgt - extracapsular

Answer 11

DHS (if stable intra-trochaneteric #)

im nail if oblique/ transverse/ subtrochanteric

Question 12

nerve affected by meralgia paraesthetica

Answer 12

lateral cutaneous n. of thigh

Question 13

osteomalacia bloods findings

i. calcium
ii. phosphate
iii. ALP
iv. PTH

Answer 13

i. calcium - low
ii. phosphate - low
iii. ALP - high
iv. PTH - high

Question 14

primary hyperparathyroidism blood results:

i. calcium
ii. phosphate
iii. ALP
iv. PTH

Answer 14

i. calcium - high
ii. phosphate - low
iii. ALP - high
iv. PTH - high

Question 15

CKD (secondary hyperparathyroidism) blood results:

i. calcium
ii. phosphate
iii. ALP
iv. PTH

Answer 15

i. calcium - low
ii. phosphate - high
iii. ALP - high
iv. PTH - high

Question 16

antiphospholipid syndrome features: (3)

Answer 16

• venous/arterial thrombosis
• recurrent miscarriages
• livedo reticularis

other features: pre-eclampsia, pulmonary hypertension

Question 17

antiphospholipid syndrome

i. antibodies (3)

ii. blood tests

Answer 17

i. anticardiolipin antibodies
anti-beta2 glycoprotein I (anti-beta2GPI) antibodies
lupus anticoagulant

ii. FBC - thrombocytopenia
clotting - prolonged APTT

Question 18

hydroxychloroquine

i. key adverse effect

ii. is it pregnancy safe?

Answer 18

i. bull’s eye retinopathy (can also get corneal deposits)

ii. yes

Question 19

reactive arthritis skin features (2) :

Answer 19

circinate balanitis (painless vesicles on the coronal margin of the prepuce)

keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)

Question 20

osteomyelitis:

1. most common causative organism
2. most common causative organism in sickle cell

Answer 20

1. s. aureus
2. non-typhi salmonella

Question 21

methotrexate SE (3)

Answer 21

Myelosuppression
Liver cirrhosis
Pneumonitis

Question 22

sulfasalazine SE (4)

Answer 22

Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease

Question 23

sulfasalazine cautions: (2)

pregnancy safe?

Answer 23

G6PD deficiency
aspirin/ sulphonamide allergy (cross sensitivity)

is pregnancy safe

Question 24

Leflunomide SE (3)

Answer 24

Liver impairment
Interstitial lung disease
Hypertension

Question 25

gold SE (1)

Answer 25

proteinuria

Question 26

penicillamine SE (2)

Answer 26

proteinuria
exacerbation of myaesthenia gravis

Question 27

entanercept SE (2)

Answer 27

demyelination
reactivation of TB

Question 28

infliximab and adalimumab SE

Answer 28

reactivation of TB

Question 29

drug causes of gout (5)

Answer 29

diuretics –> thiazides & furosemide
ciclosporin
alcohol
cytotoxic agents
pyrazinamide
aspirin

Question 30

ankylosing spondylitis examination features:

Answer 30

reduced:
- lateral flexion
- forwards flexion (Schober’s test)
- chest expansion

Question 31

ankylosing spondylitis other features “A” (8)

Answer 31

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
cAuda equina syndrome
peripheral Arthritis (25%, more common if female)

Question 32

RA x-ray features: (5)

Answer 32

loss of joint space
juxta-articular osteoporosis
soft-tissue swelling
periarticular erosions
subluxation