MSK

Question 1

Rheumatoid Arthritis deformities

Answer 1

Boutonniere
Ulnar deviation
Swan-neck
Z thumb

Question 2

Osteoarthritis deformities

Answer 2

Bouchard - (PIP)

Question 3

Osteoporosis mx:

1L, 2L

Answer 3

1L: Alendronic acid (bisphosphonate) + AdCal (vitD + Ca)

2: DMARD - Denosumab (monoclonal Ab to RANK > inhibit osteoclasts)

Question 4

Gout Mx

+ brief pharmacology

Answer 4

Flare-up: COLCHICINE

Prophylaxis: Allopurinol + Febuxostat

Allopurinol = xanthine-oxidase inhibitor)

Question 5

Osteoarthritis X-ray px

Answer 5

LOSS

Loss joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

Question 6

Rheumatoid arthritis X-ray

Answer 6

Bony erosions
Joint subluxation 
Reduced joint space 
Osteopenia 
Soft tissue swelling

Question 7

Bisphosphonate Pharmacology

Answer 7

Inhibit Farnesyl Pyrophosphate Synthase > inhibit osteoclasts

Question 8

Denosumab Pharmacology

Answer 8

Monoclonal Ab to RANK Ligand > inhibit osteoclasts

Question 9

Osteoporosis Mx + pharmacology

Include tx option for someone post-menopausal or on a glucocorticoid

Answer 9

1L] Bisphosphonate - Alendronate; inhibit cholesterol synthesis > slows osteoclasts

2L] Denosumab; RANK Ligand Ab > matures osteoclasts
(Deno DINO BONES + -mAB = Ab)

Raloxifene; (post-menopause/ on glucocorticoid) - binds estrogen receptor, inhibits osteoclasts

Teriparatide; PTH analogue

Question 10

Side effects of Bisphosphonates

Answer 10

Oesopagheal ulcers

Take with big glass of water, once weekly. Sit upright for 30 minutes after.

Question 11

What is a DEXA scan?

Answer 11

DEXA Scan - T-score; compares bone density to younger pt of same sex

Used to diagnose osteoporosis

Question 12

Osteoarthritis joints affected + X-ray findings

Answer 12

Wt-bearing, DIP, PIP

Weight-bearing joints = knee, hip, lumbar spine.

DIP - Heberden’s
PIP - Bouchard’s

X-RAY: 
Lost joint space
Osteophytes 
Subchondral sclerosis
Subchondral cysts

Question 13

Rheumatoid Arthritis joints affected + deformities + other presentations

Answer 13

Symmetrical. MCP, PIP

Swan-neck
Boutonniere
Ulnar deviation
Rheumatoid nodules + factor

Dry cough (pleural effusion/ fibrosis). 
Neck pain. Splenomegaly.

Question 14

Rheumatoid arthritis GOLD investigation

Answer 14

Anti-cyclic citrullinated peptide Ab (Anti-CCP/ ANCPA)

Question 15

Rheumatoid arthritis management

Answer 15

DAS28 score.

NSAIDs, paracetamol

DMARDs - Methotrexate (Sulfasalazine/ hydroxychloroquine). Prednisolone.

TNF-a inhibitors - Infliximab

Question 16

RA risk factors

Answer 16

F, HLA-DR4, 40-60, Rheumatoid Factor, smoking

Question 17

Osteoarthritis management

Answer 17

Physio, wt loss, aerobics.

Paracetamol, NSAIDs.

Short-term intra-articular steroids.

Curative = joint replacement

Question 18

Most common overall cause of osteomyelitis and septic arthritis

Answer 18

Staphylococcus aureus

Question 19

Moat common cause of osteomyelitis in IVD users

Answer 19

Pseudomonas

E coli

Question 20

Most common cause of osteomyelitis in Sickle Cell patients

Answer 20

Salmonella

Question 21

Most common cause of osteomyelitis/ septic arthritis following a joint-replacement

Answer 21

Staphylococcus epidermis

Question 22

Treatment of osteomyelitis

Answer 22

Flucloxacillin + Fusidic Acid

or

Vancomycin + Cefotaxime

Question 23

Most common cause of septic arthritis in young sexually-active adults

Answer 23

Neisseria gonorrhoea

Question 24

Most common cause of septic arthritis in IVD users

Answer 24

Pseudomonas aeruginosa

Question 25

Treatment of septic arthritis

Answer 25

1. Drainage of joint 2. Remove prosthetic 3. EMPIRICAL - Flucloxacillin + Vancomycin 4. S. aureus - vancomycin N. gonorrhoea - Ceftriaxone

Question 26

Most common bacterial STI? Second most common bacterial STI? Investigations?

Answer 26

Most common: Chlamydia Trachomatis Second most common: Neisseria gonorrhoea 1L: NAAT Gold: Microscopy: N. gonorrhoea: Gram-negative diplococci with polymorphs

Question 27

Management of Chlamydia Trachomatis

Answer 27

Avoid sex until course finished Doxycycline/ azithromycin Contact trace

Question 28

Management of Neisseria gonorrhoea

Answer 28

Ceftriaxone + Azithromycin

Question 29

Sjorgren syndrome investigations

Answer 29

Salivary Gland Biopsy - ANA, Anti-Ro, Anti-La Schirmer's Test, Rose Bengal Stain

Question 30

Sjorgren syndrome shows a ____ __ _________ of minor glands

Answer 30

Type 4 Hypersensitivity

Question 31

Significantly raised ALP indicates...

Answer 31

Paget's Disease of Bone

Question 32

Methotrexate uses

Answer 32

= anti-metabolite + immunosuppressant - breast, skin, head, neck cancers Autoimmune disorders: - Inflammatory arthritis - Psoriasis - Crohn's

Question 33

DEXA T-scores

Answer 33

Normal: T >-1 Osteopenia: -1> T >-2.5 Osteoporosis: T < -2.5

Question 34

Classical symptoms of Reactive Arthritis

Answer 34

Classic triad: 1. Conjunctivitis 2. Urethritis 3. Arthritis CAN'T SEE CAN'T PEE CAN'T CLIMB A TREE

Question 35

Pt cannot flex ring finger. He has a Hx of alcohol abuse. Likely diagnosis?

Answer 35

Dupuytren contracture - affected palma fascia of 4th and 5th fingers - RF: alcohol, liver disease

Question 36

30yr old pt presents with joint pain. He describes <30 minutes of morning stiffness. Likely diagnosis? Initial management?

Answer 36

Osteoarthritis Arthroscopy because he is UNDER 45 so may be more sinister

Question 37

Young Pt uses his arms to move forward in a seated position. Name of sign? Indicates?

Answer 37

Gower's sign Suggests Duchenne Muscular Dystrophy

Question 38

Gorlin sign. Suggests?

Answer 38

Ability to touch tip of nose with tongue Ehlers Danlos Syndrome

Question 39

Lasegue Sign. Suggests?

Answer 39

Pain when lying flat on back, with leg raised vertically, and ipsilateral knee is straight. Herniated disk.

Question 40

Tinnel's sign. Suggests

Answer 40

Pins and needles in area innervated by nerve, when nerve is tapped. Carpal tunnel - median nerve

Question 41

ADPKD presentations, investigations, management

Answer 41

Px: 30-40yrs - renal dysfunction - side/back pain - renal enlargement - Bulging abdomen + GI symptoms - Uremic encephalopathy (confusion, unstable) Screen for: - liver cysts - heart valve prolapse - brain aneurysmys