MSK Presentations

Question 1

A 45 year old lady presents with pain in her DIPJs. She has an XR of the affected joints. The XR shows erosions in the centre of the joint which are described as having a ‘pencil in cup appearance

Answer 1

Psoriatic arthritis

Question 2

A 36 year old gentleman presents with stiffness of his neck and an abnormal posture. He complains of episodes of back pain that improve on movement. He has previously had episodes of severe eye pain with photophobia.

Answer 2

Ankylosing spondylitis

Question 3

A 57 year old female patient presents with an acutely painful and swollen first metatarsal-phalangeal joint.

Answer 3

Gout

Question 4

A 64 year old retired gamekeeper presents with pain in both knees. He has has the pain for a number of years and finds that it is worse towards the end of the day

Answer 4

Osteoarthritis

Question 5

A 28 year old gentleman presents with an acutely painful left foot. He has tenderness over his metatarsal-phalangeal joints on his left foot as well as discomfort affecting his Achilles tendon. He states that he had an episode of diarrhoea and vomiting about 2 weeks ago.

Answer 5

Reactive arthritis

Question 6

A 41 year old mother presents with painful hands. She has swelling and pain in her MCP joints and stiffness in both of her wrists. She is also found to have cubcutaneous nodules over both elbows.

Answer 6

Rheumatoid arthrits

Question 7

A 50 year old woman presents with a unilateral acutely painful, swollen, hot knee. She is febrile, unwell and has raised inflammatory markers. On aspiration synovial fluid appears yellow and opaque and has an elevated white cell count.

Answer 7

Septic arthritis

Question 8

A 16 year old keen runner presents to his GP with pain and tenderness in his right knee. He denies any acute injury but says the pain is worse after exercise. On examination his knee joint appears normal but he has a large tender lump over his tibial tuberosity.

Answer 8

Osgood-Schlatter’s disease

Question 9

A 32 year old women presents with a lump in the popliteal area. She is asymptomatic but is concerned about the swelling.

Answer 9

Baker’s cyst

Question 10

A 68 year old alcoholic presents with a hot tender knee. On aspiration negatively birefringent crystals were identified.

Answer 10

Gout

Question 11

An 18 year old female student nurse presents with forefoot pain that has been present for 4 days. She has recently started clinical placement.

Answer 11

2 metatarsal stress fracture

Question 12

A 65 year old woman presents following a fall on an outstretched hand. There is evidence of displacement.

Answer 12

Colles fractures

Question 13

A 26 year old ruby player presents to you with difficulty walking and pain in his right knee. That morning he was playing and was tackled, twisting his knees as he fell. He says that his knee became swollen very quickly and that he feels ‘as if something is catching in his knee’. On examination his knee is swollen with an effusion identifiable and there is tenderness along the joint line. With the knee flexed the tibia can be pulled forward easily on the femur and with his knee at 90degrees internal rotation & extension causes pain.

Answer 13

Acute meniscal tear and ACL rupture.

Question 14

A 64 year old patient with a painful left hip. She has had pain in both hips for 12 years. Over the past few months it has got much worse with the left hip being the worst affected. She experiences pain on movement and her pain gets worse throughout the day. She feels that she is constantly stiff. She has a BMI of 31, walks with antalgic gait and had reduced range of movement

Answer 14

Hip OA

Question 15

Mrs Macleod is a 42 year old female patient who presents with pain and swelling of both of her hands for the past 18 months. The pain is worse in the morning and improves throughout the day.

Answer 15

Rheumatoid arthritis

Question 16

A 83 year old female presents to A&E with a very painful left hip following a fall. On examination you find that her left leg is shorter than he right and externally rotated.

Answer 16

Hip fracture

Question 17

A 56 year old plumber presents with lumbar back pain for 3 weeks. It is worse with activity.

Answer 17

Mechanical back pain

Question 18

Elderly patient with recognised osteoporosis has acute back pain and kyphosis

Answer 18

Crush fracture

Question 19

A 39 year old man has leg pain in a dermatomal pattern. He states he previously had episodic back pain before the leg pain.

Answer 19

Lumbar disc prolapse

Question 20

A 52 year old overweight male has burning lower leg pain when walking downhill. It radiates to his buttocks. The pain is relieved when walking up hill.

Answer 20

Spinal stenosis with neurogenic claudication

Question 21

A 60 year old woman has bilateral leg pain and is experiencing bladder dysfunction. She recently was diagnosed with a lumbar disc prolapse.

Answer 21

Cauda equina syndrome

Question 22

A 76 year old man is admitted with suspected thoracic vertebral fracture. There is no history of trauma

Answer 22

Pathological fracture; tumour

Question 23

A 43 year old weightlifter has anterior shoulder pain on elbow/shoulder flexion and pronation of the forearm. On examination the popeye deformity is seen

Answer 23

Bicep long head tendon tear

Question 24

A 22 year old woman playing sports fell backwards onto her arms. She has numbness is the regimental badge area and can’t bend her arm at the elbow or raise her arm at her shoulder.

Answer 24

Anterior shoulder dislocation with axillary nerve injury

Question 25

A 55 year old woman reports pain and weakness on abduction, internal and external rotation of her shoulder. She had a ‘sudden jerk’ and has had symptoms since.

Answer 25

Rotator cuff tear

Question 26

A 36 year old man has shoulder pain between 60 and 120 degrees of abduction of the shoulder which radiates to the deltoid. On examination the Hawkin’s Kennedy test is positive

Answer 26

Impingement syndrome aka painful arc

Question 27

A 48 year old woman presents with a progressively pain and stiff shoulder. She is diabetic. On examination you note a decreased range of external rotation.

Answer 27

Adhesive capsulitis aka frozen shoulder

Question 28

A 18 year old man presents to A&E after having an epileptic fit. He has had severe shoulder pain since. On examination there is a positive sulcus sign

Answer 28

Posterior shoulder dislocation

Question 29

A RTA patient has a severe arm pain and a wrist drop

Answer 29

Humeral shaft fracture with radial nerve injury

Question 30

A 62 year old woman has a fall on an outstretch hand and has had severe shoulder pain since

Answer 30

Surgical neck of the humerus impaction fracture

Question 31

An 8 year old girl had a fall on an outstretched hand and has since had severe arm pain. On examination you note abnormal humerocapitellar alignment

Answer 31

Supracondylar humerus fracture

Question 32

An 83 year old woman had a fall onto a hyperflexed wrist and has since has severe wrist pain

Answer 32

Smith’s fracture

Question 33

A 20 year old male had a fall on an outstretched hand. He has pain in the anatomical snuffbox and particularly when you press on the thumb metacarpal

Answer 33

Scaphoid fracture

Question 34

A 28 year old office worker has pain on the lateral side of her wrist. She has a painful, swollen and red styloid process. She has a positive Finklestein’s test.

Answer 34

De Quervain’s tenosynovitis

Question 35

A 6 year old child has an abscess around their nail fold. Their mum says they bite their nails frequently.

Answer 35

Paronychia

Question 36

A 23 year old man has a pigmented mass on the palmar surface of his finger near his PIPJ. It is slightly painful.

Answer 36

Giant cell tumour of tendon sheath

Question 37

A 52 year old man has an acutely swollen and red hand around his middle finger. It is extremely painful.

Answer 37

Flexor tendon sheath infection

Question 38

A 6 year old girl in by her mum in general practice, she is concerned about the alignment of her daughter’s fingers. On examination you see hyperflexion at the DIPJ and hyperextension at the PIPJ.

Answer 38

Swan neck deformity

Question 39

A 47 year old woman has had pain and stiffness in her hands for several months. On examination you see hyperflexion at the PIPJ and hyperextension at the DIPJ.

Answer 39

Boutonniere’s deformity in rheumatoid arthritis

Question 40

A 52 year old man has recurrent paraesthesiae in his left pinky finger. He also has weakness in his left forearm and hand. On examination you find a positive Tinel’s and Froment’s test.

Answer 40

Cubital tunnel syndrome

Question 41

A 56 year old man has a fixed flexion deformity of his ring finger. The skin on his hand is puckered and you palpate nodules. There is a positive table top test on examination.

Answer 41

Dupuytren’s contracture

Question 42

incorrect punch, fingers can’t bend in same direction

Answer 42

Boxer’s fracture

Question 43

articular surface of 1st metacarpal thumb displacement

Answer 43

Bennett’s fracture

Question 44

women, >30, thumb + 2 1/2 finger paraesthesia, worse at night,

Answer 44

Carpal tunnel syndrome

Question 45

avulsion finger# on extensor tendon, from forced extension, can’t extend at DIPJ

Answer 45

Mallet finger

Question 46

severe mutilating injury, skin removed

Answer 46

Degloving

Question 47

bleeding under nail, v painful, part of nail black

Answer 47

Subungual hematoma

Question 48

pain/tender at greater trochanter & on abduction, abductor gluteus medius tendonitis, women

Answer 48

Trochanteric bursitis

Question 49

fall from height, 1 leg shorter, hemipelvis displaces superiorly, >nerve injury

Answer 49

vertical shear pelvic fracture

Question 50

2-5yr, boy, insidious onset, after URT infection, can’t bear weight, pyrexic,

Answer 50

Transient synovitis aka irritable hip

Question 51

A 12 male of African descent has knee and distal thigh pain. He is currently having a growth spurt. On examination there is a loss of internal rotation and a positive Trethowan’s sign.

Answer 51

SUFE

Question 52

4-8yr short hyperactive boy, unilateral hip pain

Answer 52

Perthes

Question 53

Child sits in W position

Answer 53

Femoral neck anteversion

Question 54

asymptomatic area of sclerosis found on x ray at long bone epiphysis

Answer 54

osteochondroma

Question 55

teenage boy with pain mid thigh which is worse at night, warm swelling, fatigue and weight loss

Answer 55

ewing’s sarcoma

Question 56

painless well defined firm mass at the base of the thumb

Answer 56

mucous cyst

Question 57

rheumatoid arthritis patient in for review clinic recently been experiencing mouth uclers

Answer 57

methotrexate side effect