Muscoskeletal

Question 1

What are the side effects of the following drugs?

a) methotrexate
b) gold
c) penicillamine
d) biologics (e.g. infliximab)

Answer 1

a) myelosuppression, liver damage, pneumonitis (the latter presents with fever, dry cough, SOB - must spot to prevent irreversible fibrosis developing!)

b) proteinuria

c) proteinuria, exacerbation of myasthenia gravis

d) reactivation of TB (hence why CXR mandatory)

Question 2

Which enzyme must be measured prior to starting azathioprine and why?

Answer 2

TMPT

if deficient, higher risk of severe myelosuppression from azathioprine

Question 3

Treatment for PMR?

Answer 3

Oral prednisolone 15mg/day long term

Question 4

What do you give for bone protection in steroid use 3 months and longer?

Answer 4

ALWAYS give bisphosphonates

Question 5

Which haematological disease makes you more suspectible to osteomyelitis? Why?

Answer 5

Sickle cell

RBC breakdown and increased iron assist siderophilic bacteria

Question 6

Organism(s) responsible for osteomyelitis most commonly?

Answer 6

S.aureus

Except in Sickle cell patients, where it is salmonella

Question 7

In hypocalcaemia secondary to CKD, what would levels of Ca, Ph, ALP and PTH be?

Answer 7

Ca - low
Ph - high
PTH - high
ALP - high

Question 8

For achilles tendon rupture, what clinical examination would you do?

What is 1st line imaging?

Answer 8

Thompson test (patient prone, feet hanging off bed, squeeze calf muscle, if positive would see absence of foot plantar flexion)

USS

Question 9

Which forearm/wrist movements are painful in tennis elbow (lateral epicondylitis)?

Answer 9

wrist extension
forearm supination

Question 10

What are the 4 spondylarthropathies?

Answer 10

PEAR

Ank Spon
Reactive arthritis

Psoriatic arthritis
Enteropathic arthritis

Question 11

What demographic does Ankylosing spondylitis affect?

Answer 11

Tends to be young males 20-30 yrs

Question 12

Which diseases cause the following?

a) Bouchard nodes
b) Herbeden nodes
c) Gottron’s papules
d) Janeway lesions
e) Osler nodes

Answer 12

a) OA (painless)
b) OA (painless)
c) Dermatomyositis (painful red plaques on dorsal hand)
d) IE (Jane is painless)
e) IE (Osler - bad bloke - painful)

Question 13

Blood test findings in antiphospholid syndrome? (antibodies, FBC, Clotting)

Answer 13

Anti-cardiolipin antibodies

Thrombocytopenia

Paradoxically raised APTT

Question 14

Features of anti phospholipid syndrome?

Answer 14

Arterial and venous thrombosis
Recurrent miscarriages
Low platelets
High APTT

Question 15

How do you manage Achilles tendonitis/rupture?

Answer 15

Rest + simple analgesia (NSAIDs)

If symptoms persist beyond 7 days, refer physio

Question 16

Management of hip fracture?

Answer 16

Intracapsular (i.e. femoral neck/NOF):
displaced - hip replacement
undisplayed - internal fixation

Extracapsular (i.e. below femoral neck/trochanter and below)
intertrochanteric - DHS
subtrochanteric - intermedullary nail

Question 17

Most common reason for hip replacement revision?

Answer 17

Aseptic loosening of hip prosthesis

Question 18

Symptoms of dermatomysitis? Which antibody? What might underlying cause be?

Answer 18

Muscle weakness + skin changes
Gottron’s papules
Anti-Jo antibody

Malignancy
(also can be idiopathic or associated with CTD)

Question 19

How to diagnose Chronic Fatigue Syndrome?

Answer 19

Tiredness screen first

Symptoms must persist 3 months and affect patient more than 50% of time

Question 20

Incomplete fracture which involves bulging of cortex?

Answer 20

Buckle fracture

Question 21

Treatment for Ankylosing Spondylitis?

Answer 21

NSAIDs

(it is inflammatory duh!)

Question 22

Which bones does Paget’s affect?

Answer 22

Skull, spine, pelvis, femur, tibia

Question 23

Levels of Ca, Ph, ALP, PTH in Paget’s?

Answer 23

High ALP, rest normal

Question 24

Levels of Ca, Ph, ALP, PTH in osteomalacia?

Answer 24

Ca - low
PTH - high
ALP - high
Ph - low

Question 25

How does osteomalacia affect muscles?

Answer 25

The lack of Vit D reduces muscle synthesis, causing proximal myopathy and therefore a ‘waddling gait’

Question 26

Should all gout patients receive allopurinol? What must you ensure you also give them when commencing it, and for how long?

Answer 26

All patients should start allopurinol (urate lowering therapy) after their first attack, starting 100mg/day. And uptitrate later to aim for serum rate <360

YOU MUST ALSO GIVE COLCHICINE, otherwise risk precipitating gout (lowering serum urate mobilised rate crystals from joints which precipitates an inflammatory reaction)

Question 27

Most common cause of septic arthritis in young adults?

Answer 27

Gonorrhoea!

Question 28

What is carpal tunnel syndrome caused by? What are the 2 tests

Answer 28

Median nerve compression

Tinels (tap) test
Phalens (flexion) test