MSK

Question 1

Features of carpal tunnel

Answer 1

arm pain and hand tingling

most commonly middle aged women

Tinel’s and Phalens tests

motor signs- weakness of thenar eminence

Question 2

Causes of carpal tunnel

Answer 2

MEDIAN TRAP

Myxoedema (hyopthyroidism)

ETOH (alcohol)

Diabetes mellitus

Idiopathic

Amyloidosis

Neoplasia

Trauma

Rheumatoid arthritis

Acromegaly

Pregnancy

Question 3

Management of carpal tunnel

Answer 3

The three S‘s

Splinting

Steroids – local injection

Surgery – decompression

Question 4

Four signs or ulnar nerve palsy

Answer 4

• sensory loss over 5th finger and ulnar half of 4th
• weakness and wasting of the first dorsal interosseous
• weakness of pincer grip
• partial claw hand (weakness of medial lubricants)

Question 5

T1 nerve lesion

Answer 5

Question 6

Lower limb nerve roots

Answer 6

L2- hip flexion

L3- knee extension

L4- inversion and Dorsiflexion of foot

L5- dorsiflexion of big toe

S1- ever sign of foot

Question 7

Movements of upper limb, with nerve root and peripheral nerve

Answer 7

Question 8

How to test hand function?

Answer 8

• grip- squeeze my fingers- c8 root
• pincer grip
• prayer sign
• fine movement- pyramidal function

Question 9

What conditions have a +ve prayer sign?

Answer 9

• RA
• scleroderma
• diabetes (cheiro-arthropathy)
• ulnar nerve palsy (partial claw hand)
• T1 palsy (complete claw hand)
• dupuytren’s Contracture

Question 13

Causes of peripheral neuropathy

Answer 13

ABCDEP

Alcohol

B12

CKD

Diabetes and drugs

Every vasculitis

Plus:Cancer (para-neoplastic), Lyme disease, and Charcot Marie tooth

Question 14

symptoms of acute hypercalcaemia

Answer 14

thirst and polyuria

constipation, vomiting

confusion

muscle weakness

bradycardia, heart block, cardiac arrest

Question 15

tumours that typically metastasise to bone

Answer 15

Breast, bronchus, thyroid, kidney, prostate

Question 16

acute managment of hypercalcaemia

Answer 16

rehydration- dilution

furosemide- inhibits tubular reabsorption of calcium

bisphosphonates- inhibits osteoclasts

dialysis

Question 17

causes of hypercalcaemia

Answer 17

facticious: tourniquet, high serum albumin

hyperparathyroidism

bone secondaries

paraneoplastic e.g. carcinoma of the bronchus

others:myeloma, thyrotoxicosis, sarcoidosis, vitamin D toxicity, thiazides

Question 18

symptoms of hyperparathyroidism

Answer 18

sones

bones

groans

moans

psychiactric overtones

Question 19

what is dupuytren’s contracture?

Answer 19

fibroproliferative disease of palmar and digital fascia

thickening of palmar aponeurosis

doesn’t involve the tendons

prevents flexor tendons functioning

not painful- functional impairment

Question 20

associations with dupuytren’s

Answer 20

white

FHx

alcohol

cigarette

diabetes

peyronie’s

phenytoin

trauma

Question 21

dupuytrens contracture

Answer 21

prevent functional impairment

many don’t require treatment

zig-zag inscision to prevent volar contracture

post-op sling and splint

complications: haematoma, recurrence (significant), damage to neurovascualr bundle