MSK

Question 1

Scaphoid fracture commonly presents with

Answer 1

Scaphoid fracture commonly presents with tenderness in the anatomic snuffbox dorsally, or tenderness in the scaphoid scaphoid tubercle volarly

Question 2

highly specific test for SLE

Answer 2

Anti-dsDNA is a highly specific test for SLE

Question 3

common causes of lateral knee pain in runners

Answer 3

Question 4

Rhabdomyolysis will typically feature in the exam as

Answer 4

Rhabdomyolysis will typically feature in the exam as a patient who has had a fall or prolonged epileptic seizure and is found to have an acute kidney injury on admission.

Question 5

rhabdomyalisis causes

Answer 5

• seizure
• collapse/coma (e.g. elderly patient collapses at home, found 8 hours later)
• ecstasy
• crush injury
• McArdle’s syndrome
• drugs: statins (especially if co-prescribed with clarithromycin)

Question 6

rhabdomyalisis features

Answer 6

Question 7

rhabdomyalisis management

Answer 7

• IV fluids to maintain good urine output
• urinary alkalinization is sometimes used

Question 8

the initial imaging modality of choice for suspected Achilles tendon rupture

Answer 8

Ultrasound is the initial imaging modality of choice for suspected Achilles tendon rupture

Question 9

classification system is used to classify neck of femur fractures

Answer 9

The Garden classification system is used to classify neck of femur fractures

Question 10

the treatment of choice for all patients with a displaced hip fracture

Answer 10

Hemiarthroplasty or total hip replacement is the treatment of choice for all patients with a displaced hip fracture

Question 11

the most common mechanism of ankle sprain

Answer 11

Inversion of the foot is the most common mechanism of ankle sprain

Question 12

Trochanteric bursitis presents with

Answer 12

Trochanteric bursitis presents with isolated lateral hip/thigh pain with tenderness over the greater trochanter

no history of trauma

usually gradual onset over weeks

“worse at night lying on that side”

Question 13

A 36-year-old woman presents with a 6 week history of a painful wrist. On examination pain over the radial aspect of the wrist is is elicited by forced adduction and flexion of the thumb.

What is the most likely diagnosis?

Answer 13

Question 14

score used to identify patients at risk of pressure sores and its components

Answer 14

Waterlow score - used to identify patients at risk of pressure sores

Question 15

next step management following fragility fracture

Answer 15

Following a fragility fracture in women ≥ 75 years, a DEXA scan is not necessary to diagnose osteoporosis and hence commence a bisphosphonate

Question 16

Lateral epicondylitis features

Answer 16

• pain and tenderness localised to the lateral epicondyle
• pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended
• episodes typically last between 6 months and 2 years. Patients tend to have acute pain for 6-12 weeks

Question 17

Lateral epicondylitis and demographic

Answer 17

typically follows unaccustomed activity such as house painting or playing tennis (‘tennis elbow’). It is most common in people aged 45-55 years and typically affects the dominant arm.

Question 18

Lateral epicondylitis management

Answer 18

advice on avoiding muscle overload
simple analgesia
steroid injection
physiotherapy

Question 19

Pain on the radial side of the wrist/tenderness over the radial styloid process ?

Answer 19

Pain on the radial side of the wrist/tenderness over the radial styloid process ? De Quervain’s tenosynovitis

Question 20

De Quervain’s tenosynovitis

Answer 20

Sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed.
typically females aged 30 - 50 years old.

Question 21

De Quervain’s tenosynovitis features

Answer 21

• pain on the radial side of the wrist
• tenderness over the radial styloid process
• abduction of the thumb against resistance is painful
• Finkelstein’s test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus

Question 22

De Quervain’s tenosynovitis management

Answer 22

• analgesia
• steroid injection
• immobilisation with a thumb splint (spica) may be effective
• surgical treatment is sometimes required

Question 23

In the emergency department, suspected scaphoid fractures should be managed with

Answer 23

• immobilisation using a Futuro splint or standard below-elbow backslab before specialist review
• orthopeadic review within **7 days **

Question 24

A 28-year-old man presents to his general practitioner with six months of insidious onset lower back pain. The pain is worse in the morning and improves over the course of the day. There is no history of trauma, weight loss or bladder or bowel symptoms. He has no significant past medical history. He takes occasional ibuprofen, which seems to improve the pain. He works as a journalist and has travelled extensively in the last year in South Asia.

On examination, he has lower back tenderness. There are no neurological abnormalities.

Given the likely diagnosis, what is the most appropriate initial investigation to confirm a diagnosis?

Answer 24

Diagnosis of ankylosing spondylitis can be best supported by sacro-ilitis on a pelvic X-ray

Question 25

• He undergoes aspiration and urgent gram stain shows no organisms or crystals but many white blood cells.
• an episode of diarrhoea 3 weeks previously which resolved after 4 days.
• watery discharge of both eyes and he reports dysuria for several days

Answer 25

Reactive arthritis: develops after an infection where the organism cannot be recovered from the joint

Question 26

Complications of total hip replacement

Answer 26

Question 27

A 68-year-old woman presents to the emergency department with right-sided hip pain and joint instability. She tells you that the pain radiates to the knee and is worse on weight-bearing, however it has not prevented her from walking or weight bearing. She had a total hip replacement 18 months ago due to an intracapsular neck of femur fracture.

What is the most likely diagnosis?

Answer 27

Aseptic loosening is the most common reason total hip replacements need to be revised

Question 28

How many different non-steroidal anti-inflammatory drugs must a patient have failed to respond to before he can be started on anti-TNF alpha inhibitors, in someone with predominantly axial disease?

Answer 28

Anti-TNF alpha inhibitors should be used in axial ankylosing spondylitis that has failed on 2 different NSAIDS and meets criteria for active disease on 2 occasions 12 weeks apart

Question 29

management the acute flares of rheumatoid arthritis

Answer 29

Intramuscular steroids such as methylprednisolone are used to manage the acute flares of rheumatoid arthritis

Question 30

A patient with a subtrochanteric femoral fracture fixed with intramedullary nail should weight bear how long after an operation?

Answer 30

A patient with a subtrochanteric femoral fracture fixed with intramedullary nail should weight bear immediately after the operation

Question 31

L5 radiculopathy presentation

Answer 31

L5 radiculopathy: Weakness of hip abduction and foot drop, no specific reflex lost

Nerve root pain can be distinguished from other pain in the leg by the dermatomal distribution and an associated neurological deficit

“He has limited movement of the ankle and it is painful to dorsiflex his foot. He has slightly altered sensation over the dorsum of his foot but sensation in the rest of his leg is normal.”

Question 32

S1 lesion features

Answer 32

S1 lesion features = Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test

Question 33

management for intertrochanteric (extracapsular) proximal femoral fracture

Answer 33

Dynamic hip screws are the preferred surgical management for intertrochanteric (extracapsular) proximal femoral fracture