MSK Formative Review Flashcards
A complex fracture of the proximal fibula is likely to be associated with which clinical signs in the same lower limb?
a. Numbness of the medial calf
b. Numbness of the sole of the foot
c. Numbness of the medial border of the foot
d.
Numbness between the big and second toe on the dorsum of the foot
e. Numbness of the lateral border of the foot
d. Numbness between the big and second toe on the dorsum of the foot
Which clinical finding is most consistently seen in patients suffering from carpal tunnel syndrome?
a. Reduced sensation in the palm of the affected hand
b. Numbness of the tip of the little finger on the volar aspect of the affected hand
c. Weakness in the power of finger abduction in the affected hand
d. Weakness in the power of thumb abduction in the affected hand
e. Weakness of power of DIPJ flexion of the little finger of the affected hand
d. Weakness in the power of thumb abduction in the affected hand
* Carpal tunnel syndrome is caused by pressure on the median nerve. = thumb abduction
Which radiological feature is not characteristic of the presence of osteoarthritis affecting a joint?
a. Congruent joint surfaces
b. Presence of peripheral osteophytes
c. Joint space narrowing
d. Sub-chondral sclerosis
e. Sub-chondral cysts
a. Congruent joint surfaces
Which clinical history is least likely to predispose to osteoarthritis of the knee?
a. A displaced intra-articular fracture of the distal femur on the same side
b. A mal-united tibial fracture of the tibial shaft on the same side
c. Competition in ultra-marathons over a 20 year period
d. A combined ligamentous injury to the knee with instability
e. A body mass index (BMI) of 23
e. A body mass index (BMI) of 23
Which findings might you identify on the same side as compression of the lateral femoral cutaneous nerve?
a. Numbness of the lateral calf
b. Absent knee reflex
c. Weakness of power of extension of the knee
d. Diminished skin sensation on the medial aspect of the thigh
e. Reproduction of symptoms pressing medial to the antero-superior iliac spine (ASIS)
e. Reproduction of symptoms pressing medial to the antero-superior iliac spine (ASIS)
* a
Where should an intra-muscular covid vaccination be sited in the buttock in order to minimise the risk of damage to the sciatic nerve?
a. Centrally
b. Supero-lateral
c. Infero-medial
d. Supero-medial
e. Infero-lateral
b. Supero-lateral
Which of the following scenarios is least likely to be associated with an isolated axillary nerve palsy?
a. A comminuted fracture of the proximal humerus on the same side
b. An anterior dislocation of the humeral head on the same side
c. Inability to abduct the shoulder on the same side
d. Reduced skin sensation on the same side at the level of the deltoid insertion
e. Normal power of elbow flexion on the same side
e. Normal power of elbow flexion on the same side
Which individual is least likely to develop septic arthritis?
a. A neonate following a normal vaginal delivery
b. A healthy 30 year old adult on no medications
c. A patient with rheumatoid disease on disease modifying therapy injections
d. A 70 year old who requires regular courses of oral steroids for asthma exacerbations
e. An 8 year old who has recently had chicken pox
b. A healthy 30 year old adult on no medications
Which clinical finding makes you suspect osteomyelitis or septic arthritis in a neonate?
a. Sleeping between feeds
b. Maternal difficulty with initiating breast feeding
c. Not moving a limb (pseudo-paralysis) and wincing when it is moved passively
d. Waking during the night crying
e. Frequent loose stools
c. Not moving a limb (pseudo-paralysis) and wincing when it is moved passively
Identify which statement about acute osteomyelitis is incorrect.
a. It is more frequently seen in children than adults
b. If diagnosed early, it is usually treated surgically
c. The infection often has spread from a different site (Haematogenous spread)
d. Often it initially presents with localised pain and few clinical signs
e. Staphylococcus aureus is the most frequent causative organism
b. If diagnosed early, it is usually treated surgically
Which feature is most common with an osetoid osteoma?
a. Pain made worse during exercise
b. A strong family history of similar problems
c. Relief of symptoms after administration of Ibuprofen
d. A normal MRI scan of the affected area
e. Continued long-term symptoms after resection
c. Relief of symptoms after administration of Ibuprofen
It isn’t cancer (benign). It remains in the same place it starts. It won’t spread to other bones or parts of your body. The center of an osteoid osteoma is the nidus.
> NSAIDs
-> will resolve
Which statement about hip joint anatomy is most accurate?
a. Articular cartilage, if damaged, will slowly regenerate
b. Gluteus medius is inserted into the greater trochanter and is a major hip abductor
c. Short external rotators are the main external rotators of the hip
d. Labrum deepens the acetabulum but does not contribute to stability of the hip joint
e. Ligamentum teres has an important role in hip stability
Gluteus medius is inserted into the greater trochanter and is a major hip abductor
Which condition does not increase the risk for AVN of the hip?
a. Alcoholism
b. Systemic steroid use
c. Osteoporosis
d. Irradiation
e. Fracture of the femoral neck
c. Osteoporosis
alcohol = fat deposits, disrupts supply to bone
If cauda equina syndrome is diagnosed and surgically treated within 48 hours of onset, which residual symptoms are most unlikely?
a. Ongoing urinary continence issues
b. Persistent numbness in parts of the feet
c. Altered sexual function
d. Persistent weakness of foot and ankle muscles
e. Unresolved sciatica
e. Unresolved sciatica
Which structures contribute least to the development of lumbar spinal stenosis?
a. The pre-existing shape of the spinal canal
b. Hypertrophy of the facet joints
c. Calcification of the Anterior longitudinal ligament
d. Hypertrophy of the ligamentum flavum
e. Posterior disc bulging
c. Calcification of the Anterior longitudinal ligament
For an adult with an open fracture, which statement is most likely to be correct?
a. The presence of intact dermis excludes this injury
b. This is likely to be the result of a low energy injury
c. If systemic antibiotics are given, complications are unlikely
d. The environment the injury occurs in alters the prognosis for the injury
e. Internal fixation of the fracture is contra-indicated
d. The environment the injury occurs in alters the prognosis for the injury
Indicate the single answer that is most likely to be correct. After reducing a forearm fracture a cast, curved in the sagittal plane is applied because:
a. It reduces tension on the intact periosteum more than a straight cast
b. It is less likely to crack than a straight cast
c. It is much easier to apply than a straight cast
d. The peripheral circulation to the limb is improved relative to a straight cast
e. The fracture reduction is more likely to be maintained than in a straight cast
e. The fracture reduction is more likely to be maintained than in a straight cast
Which of the following statements is most appropriate to the management of open fractures?
a. They require surgical internal fixation immediately
b. Prompt, appropriate, surgical debridement in theatre is strongly advised
c. In young adults these injuries are often caused by a simple trip indoors
d. Knowledge of previous immunization for tetanus is irrelevant
e. IV antibiotics should be avoided because of C. difficile risk
b. Prompt, appropriate, surgical debridement in theatre is strongly advised
An otherwise fit 40 year old man has right, posterior lower limb radicular pain and has undergone an MRI confirming a L5/S1 disc proplapse. Which signs are you most likely to find on examination?
a. A positive femoral stretch test
b. Numbness in the L3 dermatome of the right leg
c. A diminished right knee reflex
d. A positive right sciatic stretch test
e. Grade 4/5 weakness of right knee extension
d. A positive right sciatic stretch test
If the patient experiences sciatic pain, and more specifically pain radiating down the leg (radiculopathy), when the straight leg is at an angle of between 30 and 70 degrees, then the test is positive and a herniated disk is a possible cause of the pain. A negative test suggests a likely different cause for back pain.
If you were a GP evaluating a patient with symptoms consistent with acute cauda equina compression, which response is least appropriate?
a. A careful focused examination of lower limb neurology
b. Obtaining an accurate history of the timing of symptom onset
c. Question the patient specifically about perineal and bladder function
d. Examining for altered perineal sensation
e. Making a routine referral to the local spinal service
e. Making a routine referral to the local spinal service
A 75 year old man presents with acute sudden onset unilateral headache, scalp tenderness and pain in his jaw on eating on a background of 2-month history of pain and stiffness of the shoulder girdle.
Which of the following investigations would be the most likely to help towards a diagnosis?
a. ESR
b. Rheumatoid factor (RF)
c. CT head
d. Temporal artery biopsy
e. Anti-neutrophil cytoplasmic antibodies (ANCA)
d. Temporal artery biopsy
The clinical hallmarks of polymyalgia rheumatica are pain and stiffness in the shoulder and pelvic girdle.
A 50 year old man attends his GP complaining of swelling of his toes. He has just returned from a holiday to celebrate his birthday. He has high blood pressure and his BMI is 32. This is a picture of his foot.
a. Serum urate
b. HLA-B27 status
c. CRP
d. Aspirate joint
e. X-ray foot
d. Aspirate joint
A 78 year old healthy woman on no medications, presents acutely with a hot, swollen left knee. She was previously well with only mild knee pain on descending stairs. No other joints are involved. She is struggling to weight bear on her knee.
a. Rheumatoid arthritis
b. Psoriatic arthritis
c. Pseudogout
d. Trauma
e. Osteoarthritis
c. Pseudogout
form of arthritis characterized by sudden, painful swelling in one or more of your joints. These episodes can last for days or weeks. The most commonly affected joint is the knee.
A 35 year old Asian computer programmer presented to his GP with widespread muscle pain and weakness, and difficulty rising from his chair. His alkaline phosphatase is elevated at 2000 and serum calcium is just below the reference range.
Which of the following tests would be diagnostic for the underlying cause of his problems?
d. Vitamin D status
