MSK

Question 1

Which drug causes reactivation of TB

Answer 1

TNF alpha inhibitor (etanercept and infliximab)

Question 2

What are the symptoms of cubital tunnel syndrome and what nerve is compressed

Answer 2

Tingling in the ring and middle finger. The ulnar nerve is trapped in the cubital fossa

Question 3

How do you treat necrotising fasciitis

Answer 3

Debridement, penicillin and clindamycin

Question 4

What DMARD causes interstitial pneuomonitis

Answer 4

Methotrexate

Question 5

What rheumatic drug causes tarry black stool

Answer 5

NSAIDs

Question 6

What rheumatic drug is a nephrotoxic

Answer 6

Gold and penicillamine

Question 7

What is another side effect of penicillamine (other than nephrotoxicity)

Answer 7

Pneumonitis

Question 8

What are symptoms of bechet’s syndrome

Answer 8

Visual loss, mouth ulcers and genital ulcers.

Question 9

What bloods are raised in bechet’s syndrome and what other conditions is it related to?

Answer 9

It’s associated with IBD, arthritis and is from a HLA-B51 lineage. CRP and ESR are raised

Question 10

What DMARD caused bone symptoms (osteoporosis)

Answer 10

Predinsolone

Question 11

Describe rheumatoid arthritis

Answer 11

A chronic inflammatory disease (type IV hypersensitivity) causing symmetrical deforming, polyarthritis and systemic disease.

Question 12

What is the synovial full of in rheumatoid

Answer 12

Macrophages, fibroblasts and giant cells

Question 13

Tests for RA

Answer 13

High inflammatory markers, and positive rheumatoid factor. Anti CCP antibodies

Question 14

What are the differences between OA and RF

Answer 14

OA is asymmetrical, non inflammatory and usually involved in older patients

Question 15

What are the 4 x-ray signs of OA

Answer 15

LOSS: 
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

Question 16

What are nodes on the DIP and PIP caused

Answer 16

DIP: Herberden’s nodes
PIP: Bouchard’s nodes

Question 17

Treatment of OA

Answer 17

Physio, topical NSAIDs, paracetamol and joint replacement

Question 18

What are symptoms of a simple backache

Answer 18

20-55 years old, well patient, back/buttock/thigh pain, normal neurology, pain changes with position or movement

Question 19

What are symptoms of nerve root pain

Answer 19

unilateral leg pain, paraesthesia in same distribution, leg>back pain, abnormal neurology, weakness, reflex/sensory changes, nerve stretch pain),

Question 20

What symptoms are of a serious spinal pathology

Answer 20

osteoporosis/long term steroid use/premature menopause/cancer/TB/HIV/IV drug history, weight loss, unremitting pain, sleep loss, under 20 or over 55, recent trauma, marked morning stiffness

Question 21

Symptoms of cauda equina

Answer 21

saddle anaesthesia, altered bladder control, bowel incontinence, gait disturbance

Question 22

What is the treatment of carpal tunnel

Answer 22

corticosteroid injection, splint, workplace task modification, standard open carpal tunnel release, arthroscopic

Question 23

What is the treatment of cubital tunnel

Answer 23

splint, neurolysis, anterior transposition

Question 24

What is the treatment of dupuytren

Answer 24

radiation therapy, needle aponeurotomy, collagenase injection, surgery

Question 25

What is the treatment of trigger finger

Answer 25

Corticosteroid injection, surgery

Question 26

What is the treatment of swan neck

Answer 26

splintage, volar tenodesis, dorsal release

Question 27

What is the treatment of boutonniere

Answer 27

splintage, steroid injection, joint release surgery, extensor mechanism reconstruction

Question 28

What is the treatment of ganglion cyst

Answer 28

ignore, needle aspiration, corticosteroid injection

Question 29

What is the treatment of wrist drop

Answer 29

splinting, osteopathy, physio, OT, surgical removal of bone spurs

Question 30

What is the treatment of de quervians tenosynovitis

Answer 30

splint, physio, OT

Question 31

What is the treatment of a tendon sheath infection

Answer 31

NSAID, brace, physio, OT, steroid injection

Question 32

What is the treatment of mallet finger

Answer 32

Ice, splint and surgery

Question 33

Name the different nerves damaged in these arm pathologies (cubital tunnel, humerous shaft fracture, supracondylar fracture of distal humerous and carpal tunnel syndrome

Answer 33

Cubital: Ulnar Humerous shaft fracture: Radial Distal humerous and carpal tunnel: Median nerve damage

Question 34

What is dupuytren's contracture

Answer 34

non-painful flexion contracture which is not correctable in an elderly patient

Question 35

What is the first stage of dupytrens

Answer 35

Nodules develop

Question 36

What occurs during the active contractile phase

Answer 36

the contraction forms because of contractile myofibroblasts within the lesion

Question 37

What is a major side effect of hydroxyquinolone

Answer 37

Retinopathy

Question 38

What are typical x-ray features of seronegative arthritis

Answer 38

sacro-iliac joint erosions, soft tissue swelling, irregular peri-articular new bone formation, pencil-in-cup deformity and spinal ligament ossification (syndesmophytes)

Question 39

Systemic sclerosis symptoms and antibodies

Answer 39

characterised by fibrosis, vascular alterations (Raynaud's) and autoantibodies, is investigated with anti-centromere antibodies

Question 40

Common peroneal nerve injury symptoms

Answer 40

severe lateral knee pain with inability to move ipsilateral foot and generalised numbness following total knee replacement

Question 41

Some information on ankylosing spondylitis

Answer 41

commonly occurs at ~55 years old with acute pain and stiffness of cervical spine, bilateral foot pain and trouble breathing

Question 42

Prolapse disc summaries and investigations

Answer 42

pain and numbness in spinal nerve distribution with foot drop – MRI

Question 43

Burst fracture symptoms and investigations

Answer 43

severe lumbar pain following a fall from height or severe axial loading – CT

Question 44

What does FOOSH stand for

Answer 44

Fall on out stretched hand

Question 45

Describe colles fracture

Answer 45

FOOSH (fall onto out stretched hand)  extra-articular # of distal radius, dorsal angulation, dorsal displacement. Dinner fork deformity. Complications – median nerve compression, EPL rupture, CRPS, loss grip strength

Question 46

What would suggest bone metastasis

Answer 46

High calcium, osteoclast proliferation, bone pain

Question 47

Symptoms of polymyositis

Answer 47

inflammation and degeneration of skeletal muscle throughout the body

Question 48

Symptoms of polymyalgia rheumatica

Answer 48

pain or stiffness, usually in the neck, shoulders, upper arms, and hips - Systemic sclerosis pneumonic

Question 49

How to remember systemic sclerosis

Answer 49

C - anti-centromere antibody and calcinosis (calcium deposits in weird places) R - Raynaud’s E - esophageal dysmotility (heartburn, reflux, swallowing problems) S - sclerodactyly (thickening and tightening of the skin) T - telangiectasia P - pulmonary hypertension (important one as that’s what they die of)