MSK

Question 1

How does temporal arteritis present?

Answer 1

Temporal arteritis: usually rapid onset unilateral headache with jaw claudication and raised ESR

Question 2

What is ankylosing spondylitis?

Answer 2

a HLA-B27-associated spondyloarthropathy typically presenting in men aged 20-30

Question 3

How do we manage ankylosing spondylitis?

Answer 3

First-line management involves the use of an NSAID, such as ibuprofen, along with extensive physiotherapy.

Question 4

How does ankylosing spondylitis present on XR?

Answer 4

X-ray of the pelvis is particularly useful as the sacroiliac joints are commonly affected, demonstrating subchondral erosions and sclerosis.

Question 5

Where do you see a positive Simmon’s sign?

Answer 5

Achilles tendon rupture

Question 6

How does De Quervain’s tenosynovitis present?

Answer 6

De Quervain’s tenosynovitis is an idiopathic pain syndrome involving the tendons of extensor pollicis brevis and abductor pollicis longus at the radial wrist.

Question 7

What is Finkelstein’s test?

Answer 7

Finkelstein’s test, which is performed by pulling the patient’s thumb with ulnar deviation and longitudinal traction, can aid the diagnosis of De Quervain’s tenosynovitis. Finkelstein’s test is positive if the manoeuvre reproduces pain.

Question 8

What is CREST syndrome?

Answer 8

This patient has Sclerodactyly and Raynaud’s phenomenon. Telangiectasia can also be seen on the hands. She therefore has the RST of CREST syndrome, or more accurately limited cutaneous systemic sclerosis.

Question 9

What is bamboo spine?

Answer 9

bamboo spine with a single central radiodense line related to ossification of supraspinous and interspinous ligaments which is called dagger sign. Ankylosing is detectable in both sacroiliac joints.

Question 10

What is the other name for tennis elbow?

Answer 10

lateral epicondylitis, also known as tennis elbow. This condition is characterized by pain and tenderness over the lateral epicondyle of the humerus, which is aggravated by wrist extension against resistance with the elbow extended.

Question 11

What is trochanteric bursitis?

Answer 11

Due to repeated movement of the fibroelastic iliotibial band
Pain and tenderness over the lateral side of thigh
Most common in women aged 50-70 years

Question 12

What are Gottron’s papules?

Answer 12

Gottron’s papules are roughened red papules over the extensor surfaces and are seen in dermatomyositis

Question 13

How can we treat Raynaud’s phenomenon pharmacologically?

Answer 13

Oral nifedipine

Question 14

Which movement temporarily causes the pain in lateral epicondylitis?

Answer 14

Lateral epicondylitis: worse on resisted wrist extension/suppination whilst elbow extended

Question 15

Cipro stops you from going pro

Answer 15

Cipro causes achilles tendon rupture

Question 16

How does reactive arthritis present?

Answer 16

Urethritis + arthritis +/- conjunctivitis = reactive arthritis

Question 17

What is the McMurray’s test?

Answer 17

A meniscal tear is usually caused by twisting of the knee and on examination, McMurrays test will be positive. To perform McMurrays test, the knee is held in one hand, which is placed along the joint line, and flexed while the sole of the foot is held with the other hand. One hand is placed on the medial side of the knee to pull the knee towards a varus position. The other hand is used to rotate the leg internally whilst extending the knee. If pain or a ‘click’ is felt, this constitutes a ‘positive McMurray test’.

Question 18

What is the most common reason THRs need revising?

Answer 18

Aseptic loosening is the most common reason for total hip replacement revision. This often presents with pain in the hip or groin region radiating down to the knee.

Question 19

How does PMR present?

Answer 19

Features
typically patient > 60 years old
usually rapid onset (e.g. < 1 month)
also mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats

Question 20

What is olecranon bursitis?

Answer 20

Olecranon bursitis (‘student’s elbow’) is a common cause for elbow swelling and may be caused by prolonged pressure, trauma or rheumatoid arthritis

Question 21

Where would you see anti-Ro antigen?

Answer 21

Primary Sjogren’s syndrome is an autoimmune disorder characterised by lymphocytic infiltration of the exocrine glands, particularly the salivary and lacrimal glands, leading to symptoms such as dry mouth (xerostomia) and dry eyes (keratoconjunctivitis sicca). Anti-Ro (also known as SS-A) autoantibodies are found in approximately 60-70% of patients with primary Sjogren’s syndrome, making it the most associated autoantibody for this condition.

Question 22

How does lateral epicondylitis present?

Answer 22

Sometimes referred to as ‘tennis’ elbow, but remember other activities can also trigger it.

Worse on resisted wrist extension/suppination whilst elbow extended

Question 23

How does medial epicondylitis present?

Answer 23

This condition is commonly referred to as ‘golfer’s’ elbow. The pain is aggravated by wrist flexion and pronation. Sometimes it is associated with ulnar nerve compression. The symptoms in the question do not suggest medial epicondylitis as the pain is worsened on resisted extension and there are no other associated features.

Question 24

Who must we refer to when starting hydroxychloroquine?

Answer 24

H-eye-droxychloroquine

Recent data suggest that retinopathy caused by hydroxychloroquine is more common than previously thought and the most recent RCOphth guidelines (March 2018) suggest colour retinal photography and spectral domain optical coherence tomography scanning of the macula for patients likely to be taking the drug for more than 5 years.

Question 25

Which nerve is most likely to be damaged in knee arthroplasty?

Answer 25

Common peroneal nerve

Question 26

How does SLE present?

Answer 26

The malar rash, arthralgia, lethargy and history of mental health points towards a diagnosis of SLE. Remember that the CRP (in contrast to the ESR) is typically normal in SLE.

Question 27

Name an important SE of alendronate

Answer 27

Bisphosphonates can cause a variety of oesophageal problems

Question 28

How should oral bisphosphonates be taken?

Answer 28

Oral bisphosphonates should be swallowed with plenty of water while sitting or standing on an empty stomach at least 30 minutes before breakfast (or another oral medication); the patient should stand or sit upright for at least 30 minutes after taking

Question 29

Give a common SE of methotrexate

Answer 29

Methotrexate may cause pneumonitis - typically presents with cough, dyspnoea and fever