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Focused 3 > MSK (MCQBank) > Flashcards

MSK (MCQBank) Flashcards

1
Q

Ottawa’s knee rules

A

Knee X-ray is needed if there are any of the following:
- >=55y/o
- isolated tenderness of patella
- tenderness of head of fibula
- inability to flex to 90 degrees
- inability to weight bear both immediately and in ED (not more than 4 steps)

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2
Q

Treatments NOT advocated by NICE osteoarthritis guidance

A

Electro-acupuncture
Glucosamine or chondoitin
Rubefacients (substance that causes vasodilation/increase blood circulation)
Intra-articular hyaluronan injections

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3
Q

Tennis elbow VS Golfer’s elbow

A

Lateral epicondylitis - tennis
Medial epicondylitis - golfer

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4
Q

Simmonds calf squeeze test is positive - what does this mean?

A

When squeezed calf, there is NO plantarflexion of foot. Indicating rupture of Achilles tendon.

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5
Q

Arm VS Forearm

A

Upper part of the upper limb - ARM
Lower part of the upper limb - FOREARM

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6
Q

Organism causing reactive arthritis

A

Chlamydia trachomatis
Neisseria gonorrhoea
Ureaplasma urealyticum
Salmonella
Shigella
Yersinia
Campylobacter

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7
Q

Treatment of piriformis syndrome

A

Avoid the movement that causes irritation to the sciatic nerve (it runs through the greater sciatic foramen below the piriformis muscle)

Corticosteroid injection near the site where the piriformis muscle crosses the sciatic nerve

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8
Q

What test to check function of anterior cruciate ligament?

A

Lachman test (anterior drawers test)

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9
Q

Pain on shoulder abduction
- WITH pain on passive external rotation
- WITHOUT pain on passive external rotation

List of diagnosis?

A

WITH pain - adhesive capsulitis (ie frozen shoulder)

WITHOUT pain - shoulder impingement syndrome, subacromial bursitis, rotator cuff tear

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10
Q

Most common bacteria causing septic arthritis

A

Staph aureus

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11
Q

What position of the joint might you see for someone with septic arthritis? (think of baby with hip septic arthritis)

A

position that increases its intracapsular volume
- abducted
- flexed
- externally rotated

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12
Q

what is Morton’s neuroma?

A

irritation of interdigital digit by compression between metatarsal heads often in tight fitting footwear

occassionally accompanied by inflammed bursa of the same site

commonest site - 3rd & 4th metatarsal heads

squeezing the metatarsal head may elicit a painful click - mulder’s click

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13
Q

Gout VS Pseudogout

A

Gout : negatively birefringent crystals, needle shaped, monosodium urate crystals, appear YELLOW when aligned parallel to slow axis of compensator and BLUE when perpendicular

Pseudogout: positively birefringent crystals, rhomboid shaped, calcium pyrophosphate crystals, appear BLUE when aligned parallel to slow axis of compensator and YELLOW when perpendcular.

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14
Q

Dorsal VS Ventral

A

Ventral - anterior
Dorsal - posterior

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15
Q

Common cancer to metastasise to bone (in order to frequency)

A

Breast
Prostate
Lung
Colon
Stomach
Bladder
Uterus
Rectum
Thyroid
Kidney

Common site of metastasis: SPINE

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16
Q

What is Still’s disease?

A

Rare systemic form of arthritis before onset of 7y/o.
PC: spiking fever, systemic symptoms BEFORE arthritis. Associated with morbiliform rash, hepatosplenomegaly, serositis, anaemia, leococytosis.

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17
Q

X-ray findings of RA

A

early: soft tissue swelling, juxta-articular demineralisation/osteopororis/osteopenia

late: joint space narrowing, periarticular erosions, joint deformation, subluxations

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18
Q

what is the Mondor sign?

A

bruise found in the sole of the foot - a sign of calcaneal fracture

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19
Q

Spondylosis VS spondylolithesis

A

Spondylosis - degenerative changes of vertebrae and disk

Spondylolithesis - slippage of the vertebrae body (ie displacement). Causes: congenital anomalies of vertebrae, damage of ligaments or joints secondary to degeneration, inflammation or trauma

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20
Q

Examination findings of scaphoid fracture

A

Tenderness of palmar and dorsal aspect of the scaphoid - anatomical snuff box.
wrist joint effusion.
Pain on compressing the thumb longitudinally.
Pain on general flexion and ulnar deviation of wrist.

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21
Q

What rheumatological condition is strongly associated with GCA?

A

Polymyalgia rheumatica

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22
Q

which antibody is highly SPECIFIC for rheumatoid arthritis

A

Anti-CCP

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23
Q

what are the systemic features of rheumatoid arthritis?

A

Eyes - Sjogren’s, scleritis, episcleritis
Skin - leg ulcers, rash, nail fold infarcts
Rheumatoid nodules
Polyneuropathy, mononeuritis multiplex
Respiratory: pulmonary fibrosis, obliterative bronchiolitis, Caplan’s syndrome
Pericardial involvement, valvulitis, myocardial fibrosis, immune complex vasculitis
Kidney: analgesic nephropathy, amyloidosis
Liver: mild hepatomegaly
Thyroid disorders, osteoporosis, depression, splenomegaly

24
Q

Colchicine should be avoided if patients have..?

A

Blood disorders
eGFR<10 (colchicine is excreted via kidneys)
Renal impairment
Severe hepatic impairment
Pregnancy/breastfeeding
Taking p-glycoprotein inhibitors (increase colchicine levels) eg clarithromycin, erythromycin, ritonavir, verapamil or strong CYP3A4 inhibitors

25
Q

Indication for DEXA bone scan

A

<75y/o of low trauma fracture
x-ray finding of incidental or vertebrae collapse
postmenopausal women with history of hip fracture
low BMI <19
Long term steroid tx
Oestrogen deficiency
Conditions that predispose to osteoporosis:
- malabsortion
- dermatomyositis
- RA
- anorexia
- CKD
- HYperthyroidism
Cushing;s

26
Q

treatment of polymyalgia rheumatica

A

steroids

27
Q

Bennet VS gamekeeper’s thumb

A

Bennet -carpo-metacarpal area fracture & dislocation of 1st thumb. Swelling, bruising and cannot move thumb. Can damage flexor pollicis longus.

Gamekeeper (aka skier’s thumb or UCL tear)- at the level of metacarpo-phalangeal level. small avulsion fracture of ulnar corner at base of proximal 1st phalanx. Chronic ulnar collateral ligament rupture.

28
Q

Osgood schlatter

A

Pain in the upper part of tibia - due to overuse in sports.
Age: 10-13males8-12female

29
Q

7yo from Ghana with pain of left knee worse on movement. Pyrexial, with warm upper shin and small knee effusion ? Diagnosis

A

Osteomyelitis

30
Q

8 yo with painful right hip and limp. X-ray showed sclerotic hip. ?diagnosis

A

Avascular necrosis (sure to the sclerotic femur)

31
Q

15yo girl, anterior knee pain worse on going downstairs, valgus knee deformity, shrug test positive

A

Chondromalacia patella/ runner’s knee/ patellofemoral pain syndrome (softening of cartilage around patella)

32
Q

which hepatitis is linked with polyarteritis nodosa?

A

hep B

PAN is a necrotising vasculitis.

33
Q

x-ray findings of osteoarthritis VS rheumatoid arthritis

A

OA: joint space narrowing, osteophytes, subchondral cysts, subchondral sclerosis

RA: soft tissue swelling, juxta-articular demineralisation, joint space narrowing, erosions, joint deformation

34
Q

difference between osteoporosis, osteomalacia, rickets, Paget’s disease in terms of Ca, PO, Alkphos

A

Ca - PO - ALP
osteoporosis: N, N, N
osteomalacia: Low/n, N/low, Raised
Rickets: ?, Low, Raised
paget’s disease: N/raised, N, Raised

35
Q

x-ray findings of osteomalacia

A

linear areas of low density

36
Q

mechanism of injury for acromioclavicular dislocation

A

fall onto shoulder tip

37
Q

fall on outstretched arm - ? causes what type of injury

A

young child: posterior displacement of distal radial epiphysis, greenstick fracture of forearm bone, supracondylar fracture of humerus

teenager: fracture of clavicle

young adult: fracture of scaphoid

elderly: colles’ fracture

38
Q

what test to do for Behcet’s disease?

A

Pathergy test
- inserting a small needle under the skin and evaluating the site 24-48hrs later
- if there is a papule at the site of puncture - this means it is positive

39
Q

what is auspitz sign?

A

bleeding when the scales are taken off - seen in psoriasis

40
Q

osteochondritis dissecans -?PC

A

separation of subchondral bone articular cartilage from joint surface
vague and achy joint pain worse by activity and accompanied by swelling.
locking, catching, giving way are common features - due to intra-=articular loose bodies

41
Q

knee pain worse in sports
flexion of hips cause external rotation

A

SUFE

42
Q

x-ray finding for vit D deficiency

A

Looser’s zones (translucent bands)

43
Q

elderly patient with muscle weakness and tenderness ?diagnosis

generalised muscle stiffness, weight loss, bilateral tenderness/pain of upper arms ?diagnosis

proximal muscle weakness more in the lower limb & linked with malignancy ?diagnosis

widespread pain for 3 months and multiple localised tenderness ?diagnosis

bilateral shoulder pain and tenderness of acute or subacute onset with bilateral upper arm tenderness. can also involve pelvic girdle and neck.

A

polymyositis

polymyalgia rheumatics (if 3 or more of criteria met: bilateral shoulder/neck stiffness, onset of illness<2weeks, ESR>40, morning stiffness >1hr, age >65, depression or weight loss, bilateral tenderness of upper arms)

polymyositis

fibromyalgia

polymyalgia rheumatica

44
Q

Monteggia VS Galeazzi fracture

A

MugGeR

Monteggia Ulnar Fracture (Radial Head dislocation) - proximal (monteggiA - A is at the start)

Galeazzi Radial Fracture (Ulnar dislocation) - distal (galeazZi - Z is at the end/distal)

45
Q

chronic pain and tingling of buttocks & worse when sitting in toilet seat or chair for too long. no lumbar pain. can elicit pain by internally rotating hip.

?diagnosis

A

piriformis syndrome

46
Q

3yo hip pain and limp. recent URTI.

?diagnosis

A

transient synovitis of hip

47
Q

what can be found to diagnose felty syndrome?

A

RA
splenomegaly
neutropenia

But - can also remember by: SANTA
splenomegaly
anaemia
neutropenia
thrombocytopenia
arthritis

48
Q

what is Freiberg’s disease?

A

osteochondrosis/avascular necrosis of toes- articular surfaces of second or third metatarsal head collapse
- common in girls 12-15yo
- pain on weight bearing and restricts physical activity
- Tx: rest and use a metatarsal head-> surgery to remove the fragments of articular cartilage and resectioning the dorsal aspect of metatarsal head to allow the joint to move freely and painlessly.

49
Q

Ottawa’s ankle rules VS Ottawa’s foot rules

A

ANkle x-rays required only if there is bony pain in the malleolar zone AND any 1 of the following:
- tenderness along distal 6cm of the posterior edge of the tibia or tip of medial malleolus
- tenderness along distal 6cm of posterior edge of fibula or tip of lateral malleolus
- inability to weight bear both immediately and in ED for 4 steps.

Foot x-rays required if there is bony pain in the midfoot zone and any 1 of the following:
- tenderness of base of 5th metatarsal
- tenderness of navicular bone
- inability to weight bear both immediately and in ED for 4 steps

50
Q

Maisonneuve fracture - what is it?

A

spiral fracture of the upper third of fibula and tear of distal tibiofibular syndesmosis and the interosseous membrane.
- usually involving pronation-external rotation force.
- associated fracture of medial malleolus or rupture of deep deltoid ligament

51
Q

March fracture - what is it?

A

stress fracture of metatarsals
- for repetitive walking or running - ie in the army/runners etc
- commonest site is 2nd metatarsal shaft (or 3rd or rarely navicular)
- tender lump on dorsum of foot that is palpable from distal to mid-shaft of foot
- tx: analgesia, elevation, rest and modified daily activity.

52
Q

treatment of rheumatoid arthritis

A

DMARDS
- methotrexate and sulfasalazine - efficacy
- can also use axathioprine, cyclophosphamide, ciclosporin

Can also consider glucocorticoid steroids or monoclonal antibodies that block TNF-alpha (infliximab or etanercept).

53
Q

risk factors for chronic back pain

A

smoking
psychological morbidity - anxiety/depression
low income / social class
co-existing CVS disease
poor work conditions
large numbers of children

54
Q

what injury occurs in a bumper fracture or fall from height?

A

tibial plateau fracture - fracture of the tibial condyles
- occur in 50-60yo
- badly swokken and deformed knee but cannot find an acual positive examination due to pain and haemarthrosis

55
Q
A

Focused 3 (21 decks)

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