MSK

Question 1

IT band sx and mx

Answer 1

tenderness 2-3cm above the lateral joint line
Common in runners

Management
activity modification and iliotibial band stretches
if not improving then physiotherapy referral

Question 2

Red flags back pain

Answer 2

age < 20 years or > 50 years
history of previous malignancy
night pain
history of trauma
systemically unwell e.g. weight loss, fever
Thoracic back pain

Question 3

Hip disclocation sx

Answer 3

shortened and internally rotated leg

Question 4

Mx and complications of hip dislocation

Answer 4

A reduction under general anaesthetic within 4 hours to reduce the risk of avascular necrosis.

Sciatic or femoral nerve injury
Avascular necrosis
Osteoarthritis: more common in older patients.
Recurrent dislocation: due to damage of supporting ligaments

Question 5

calcification of the articular cartilage dx

Answer 5

Pseudogout

Chondrocalcinosis

Question 6

Spinal stenosis

Answer 6

Usually gradual onset
Unilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking. Resolves when sits down. Pain may be described as ‘aching’, ‘crawling’.
Relieved by sitting down, leaning forwards and crouching down

Clinical examination is often normal

Requires MRI to confirm diagnosis

Question 7

Signs of scaphoid fracture

Answer 7

Point of maximal tenderness over the anatomical snuffbox
This is a highly sensitive (around 90-95%), but poorly specific test (<40%) in isolation
2. Wrist joint effusion
Hyperacute injuries (<4hrs old), and delayed presentations (>4days old) may not present with joint effusions.
3. Pain elicited by telescoping of the thumb (pain on longitudinal compression)

Question 8

Infrapatella bursitis

Answer 8

associated with kneeling as seen in clergymen
Swelling and tenderness

Question 9

Psoriatic arthritis sx

Answer 9

symmetric polyarthritis
very similar to rheumatoid arthritis
30-40% of cases, most common type
asymmetrical oligoarthritis: typically affects hands and feet (20-30%)

periarticular disease - tenosynovitis and soft tissue inflammation resulting in:
enthesitis: inflammation at the site of tendon and ligament insertion e.g. Achilles tendonitis, plantar fascitis
tenosynovitis: typically of the flexor tendons of the hands
dactylitis: diffuse swelling of a finger or toe
nail changes
pitting
onycholysis

Question 10

X ray psoriatic arthritis

Answer 10

‘pencil-in-cup’ appearance

Question 11

Dermatomyositis sx

Answer 11

Skin features
photosensitive
macular rash over back and shoulder
heliotrope rash in the periorbital region
Gottron’s papules - roughened red papules over extensor surfaces of fingers

proximal muscle weakness +/- tenderness

ANA+
Anti Jo

Question 12

Right-sided hip pain radiating to knee and joint instability, post THR

Answer 12

Aseptic loosening

Question 13

If UGI SE from alendronate

Answer 13

Change to risedronate

Question 14

Acute mx of gout

Answer 14

NSAID
Colchicine - avoid if GFR <10
Oral steroids if others CI

Question 15

SE of entanjrcept

Answer 15

Reactivation of TB

Question 16

AS mx

Answer 16

Ibuprofen

Question 17

AS XR

Answer 17

sacroiliitis: subchondral erosions, sclerosis
squaring of lumbar vertebrae
‘bamboo spine’ (late & uncommon)
syndesmophytes: due to ossification of outer fibers of annulus fibrosus

Question 18

Clubfoot findings

Answer 18

Inverted + plantar flexed foot which is not passively correctable.

Question 19

PMR sx and mx

Answer 19

typically patient > 60 years old
usually rapid onset (e.g. < 1 month)
aching, morning stiffness in proximal limb muscles
ESR>40

Pred 15mg- 1 week then reassess

Question 20

Sjogren AB

Answer 20

Positive anti-Ro and anti-La antibodies

Question 21

Sjogren’s syndrome sx

Answer 21

dry eyes: keratoconjunctivitis sicca
dry mouth
vaginal dryness
arthralgia
Raynaud’s, myalgia
sensory polyneuropathy
recurrent episodes of parotitis

positive Schirmer’s test

Question 22

Mx of hip fracture

Answer 22

Undisplaced Fracture:
internal fixation, or hemiarthroplasty if unfit.

Displaced Fracture:
arthroplasty (total hip replacement or hemiarthroplasty) to all patients with a displaced intracapsular hip fracture
total hip replacement is favoured to hemiarthroplasty if patients:
were able to walk independently out of doors with no more than the use of a stick and
are not cognitively impaired and
are medically fit for anaesthesia and the procedure.

stable intertrochanteric fractures: dynamic hip screw

if reverse oblique, transverse or subtrochanteric fractures: intramedullary device

Question 23

AS features

Answer 23

reduced lateral flexion
reduced forward flexion - Schober’s test
Pain at night

Anterior uveitis
Aortic regurgitation
Achilles tendonitis

Question 24

Prepatellar bursitis

Answer 24

Associated with more upright kneeling