MSK

Question 1

Swollen knee - aspiration shows weakly positive bifringent crystals. Dx?

Answer 1

Pseudogout = Positive bifringent crystals
-rhomboid shaped

Gout is negative bifringent crystals, and needle shaped

Question 2

35-55 y/o man, lateral elbow/forearm pain, wrist extension or supination worsens pain, but not flexion or pronation. Point of tenderness distal to lateral epicondyle. Dx?

Answer 2

Tennis elbow
-lateral epicondyle
-wrist extension/supination against resistance provokes symptoms, but not flexion/pronation

Question 3

Drug tx for Raynaud’s?

Answer 3

CCBs - nifedipine

Question 4

Colles’ fracture is what?

Answer 4

DDD - dorsally displaced distal radius fracture
-from fall on an outstretched hand
-common in older postmenopausal women
-‘dinner fork’ deformity

Question 5

Low vitamin D leads to?

Answer 5

Osteomalacia (adults)
Rickets (children)
-inadequate mineralisation of bone cortex

Question 6

How does polymyalgia rheumatica present and how is it diagnosed? Treatment?

Answer 6

-bilateral pain and morning stiffness of shoulders, neck, pelvic girdle (muscle tenderness rather than joints)

-raised inflammatory markers - ESR

-STEROIDS

Question 7

What is Osgood-Schlatter disease?
Symptoms?
Treatment?

Answer 7

Small avulsion fractures within the tibial tuberosity occur in growing children

Pain and swellings below knee

REST

Question 8

Treatment for SUFE?

Answer 8

Surgical pinning

Question 9

Ottowa rules for ankle X-rays?

Answer 9

X-rays only required if bony pain in malleolar zone PLUS
-tenderness along distal 6cm posterior edge of tibia/tip of medial or lateral malleolus
-inability to weight bear immediately and in ED for 4 steps

Question 10

Ottowa rules for foot xray

Answer 10

Indicated if
-bone tenderness at BASE of 5TH metatarsal
-bone tenderness at navicular bone
-inability to weight bear both immediately and in ED for 4 steps

Question 11

Barlow’s vs Ortolani’s?

Answer 11

Barlow’s - aDDuct hip whilst applying pressure to knee (posterior force) - palpable subluxation = +ve test
‘Barlow’s = Bad, as dislocates’

Ortolani’s - relocation, with hips and knees flexed, anterior pressure given to greater troxhanters, legs abducted- clunk as relocates =+ve test
‘Ortolani’s = OK again, relocates’

Question 12

Test to assess ACL injury to knee?

Answer 12

Lachman test

Question 13

Adult hit by car bumper from side, now has very swollen deformed knee. Likely Dx?

Answer 13

Tibial plateau fracture
-fall from height or struck violently from side ie car bumper
-badly swollen, deformed knee

Question 14

30 y/o Japanese man with oral & genital ulcers, iritis, and knee/ankle joint pain. Erythema nodosum on shins. Dx?

Answer 14

BEHCET’s disease
-chronic multisystem vasculitis

Question 15

What may happen if you give allopurinol in acute gout?

Answer 15

Risk of precipitating acute gout!
Should be started after acute attack has resolved

Question 16

Test for ruprtured Achilles tendon?

Answer 16

Simmonds/Thompson test
-patient lies prone
-squeeze calf muscle - should cause plantar flexion. If reduced or absent, it is a positive test

Question 17

What is a Smith’s fracture?

Answer 17

Volar displacement of distal radius fracture
-fall on to back of hand (‘reverse Colles’ fracture’)

Question 18

Gamekeeper’s thumb?

Answer 18

Injury to ulnar collateral ligament (UCL) of 1st MCP (thumb.) May see avulsion fracture at ulnar corner at base of PP.
-also called skier’s thumb or UCL tear

Question 19

Barton’s fracture?

Answer 19

INTRAARTICULAR fractures of distal radius.
-Can be dorsal or volar
-caused by fall on to extended and pronated wrist
-INTRA-ARTICULAR component distinguishes from Smith’s or Colles’

Question 20

6 y/o, thigh pain and limp, systemically well. Reduced ROM, xray shows patchy avascular necrosis. Dx?

Answer 20

PERTHE’S DISEASE
-idiopathic avascular necrosis of femoral head
-most commonly boys aged 5-12
-atraumatic pain and limp, unusually unilateral

Question 21

Treatment of Perthe’s?

Answer 21

Non-operative:
Rest
Physio
NSAIDs

Operative

Question 22

1st line Tx for Rheumatoid arthritis?

Answer 22

METHOTREXATE (DMARD)