MSK + Rheum

Question 1

DDx for 6wks localised right heel pain, no obvious trauma (5)

Answer 1

1. Right plantar fascitis
2. Right achilles tendinopathy
3. Right tender heel pad
4. Right retrocalcaneal bursitis
5. Right tibialis posterior tendinopathy

Question 2

Dislocated shoulder from posterior force. ?exam findings (4)

Answer 2

1. Arm held in slight abduction + external rotation
2. Humeral head can be felt anterior to glenohumeral fossa
3. Reduced global range of motion
4. Loss of normal contour of deltoid

Question 3

Recent traveller with arthritis, also complaining of conjuctivitis and dysuria.
?Condition and common causes (3)

Answer 3

Reactive arthritis
- Urethritis + conjuctivitis+-iritis + arthritis
Urogenital infection - chalmydia trachomatis
GI infections - Shigella + Salmonella

Question 4

Patient noticed one foot feels more flat than the other
?Dx

Answer 4

Posterior tibialis tendon rupture
- often middle aged women
- uncommon for obvious discomfort at moment of rupture -> just note suddenly foot feels flat
- “too many toes” test when standing 3m behind patient

Question 5

Answer 5

Calcaneal apophysitis (SEVER DISEASE)
- increased density of the calacneal apophysis
- typical between 7-14yrs
- loss of fat/soft tissue planes in the region of the retrocalcaneal bursa

Question 6

Answer 6

Lisfranc injury
- plantar echymoses
- displacement of the metatarsals from the tarsus
-> particualry 2nd tarso-metatarsal joint

Question 7

10-20yo, pain in thigh at night
Relief post NSAIDs

Answer 7

Osteoid Osteoma
- benign tumour

Question 8

Features of general OA management (6)

Answer 8

1. Individualised goals (function + QoL)
2. Education (including reassurance)
3. Optimise other co-morbidities
4. Weight reduction (if relevant)
5. Exercise (programs with physio)
6. Medications

Question 9

Dx?

Answer 9

Gout
- discrete punched out lesions
- slightly different to erosions seen in RA
-> also not preserved joint otherwise

Question 10

Mx?

Answer 10

Humerus fracture
- most shaft AND SNOH fractures in GP can be managed with sling OR collar+cuff

Question 11

Child with ulna fracture. What must you check + what is it called when present?

Answer 11

Need to check radial location
Ulna # + dislocated radial head = MONTEGGIA fracture

Question 12

Child with clavicle fracture. Mx?

Answer 12

Broad arm sling for 2-3wks (or until comfortable)
- for mid 1/3 fractures
Acute referral for:
- Off ended
- Open
- Lateral third

Question 13

KFP: Muscle tear or tendinitis management (non acute) - (6)

Answer 13

1. Muscle stretching with specific example
2. Muscle strengthening with specific example
3. Avoid aggravating activity with example
4. Graded return to activity over 4-8wks
5. Refer to physio
6. Apply warmth
   AVOID RICE unless in first 48hrs

Question 14

Mx of distal radius buckle fracture in kid (3)

Answer 14

Plaster back slab (or removable wrist splint) for 3wks
No follow-up required
**If both radius + ulna - likely need ortho advice

Question 15

Kid with sore wrist ?Managment

Answer 15

This is distal radius fracture (NOT BUCKLE)
therefore:
- full below elbow cast for 6wks
- Fracture clinic with XR within 1wk

Question 16

KFP DDx for paediatric hip pain (7)

Answer 16

1. Transient synovitis
2. Truama
3. NAI
4. Septic arthritis or OM
5. <4yo - Toddlers fracture
6. 4-10 - Perthes disease
7. > 10 SUFE

Question 17

2yo has bowed out legs, with intercondylar measurement of 3cm
Management? (3)

Answer 17

Genu Varum
- reassure that most physiological
- advise usually bow legged until 3, most resolve by 3
- Refer if >6cm at 4yrs, asymmetrical or not improving

Question 18

5yo boy has bilateral knocked knees
You’ve measured something important at 5cm
?Management (2), when to Ix+ refer (4)

Answer 18

Genu Valgum
- physiological, often seen 3-5yo, most resolve by 8yo
- Measure intermalleolar distance standing with knees together
Investigate + refer if:
- Unilateral
- IM distance >8cm
- progressing
- lack of spontaneous resolution by 8

Question 19

KFP: Anklylosing spondylitis, worsening symptoms affecting function. What non pharma management options? (3)

Answer 19

1. Refer to rheumatologist for escalation of treatment
2. Refer to physio for tailored exercise program
3. Refer to physio for guided hydrotherapy

Question 20

Child with hip + knee pain. External rotation of lef during passive flexion at hip ?

Answer 20

SUFE
- Drehmans sign

Question 21

Non pharma Mx of fibromyalgia (3)

Answer 21

1. Refer to PT for graded aerobic exercise
2. Refer to psychologist for CBT
3. Refer to Fibromyalgia support group

Question 22

Pharmacological Mx of fibromyalgia (3)

Answer 22

1. Amitriptyline nocte
2. Gabapentanoid (gabapentin nocte)
3. SNRI (duloxetine)

Question 23

Radial nerve assessment - sensation + motor (1+3)

Answer 23

Backward fingerless glove for 3.5
Extension, supination + thumbs Up

Question 24

Ulna nerve assessment - sensation + motor

Answer 24

Sensation: last 1.5
Motor: finger add/abduct

Question 25

Median nerve assessment - sensation + motor

Answer 25

Sensation: palmar 3.5
Motor: pincer OK, pronation

Question 26

45M eversion injury, sore ankle. XR - next step?

Answer 26

Possible Maisonneuve fracture
- combination of proximal fibula fracture PLUS unstable ankle injury (WIDENING of the ankle mortise on XR)

Question 27

2 common knee pains associated with activity

Answer 27

1. Patella tendinopathy - “Jumpers knee”
   - gradual onset, localised below knee
2. Patellofemoral syndrome - “runners or joggers knee”
   - aggravated during activity - stairs, squatting
   - frozen after sitting