Musculoskeletal

Question 1

Typical presentation and initial investigation of Ankylosing spondylitis?

Answer 1

Male (3:1) more common
20-30
Early morning lower back stiffness improved with movement and NSAIDs
Association with HLA-B27 antigen
May have reduced forward and lateral flexion on examination
Mainly affects sacroiliac joints but association with plantar fasciitis and Achilles tendonitis

Question 2

Presenting features of a common peroneal / common fibular nerve injury ?

Answer 2

• Footdrop / weakness of dorsiflexion
• Weakness in everting the foot
• Loss of sensation dorsum of foot

May occur secondary to trauma to the lateral aspect of the upper shin where the nerve wraps around the head of the fibula. Transient trauma to the nerve eg compression will result in more of a neuropraxia with milder and reversible symptoms

Question 3

What is the classic triad of symptoms for reactive arthritis ?

Answer 3

1) urethritis (dysuria)
2) conjunctivitis
3) arthritis

‘Can’t see, pee or climb a tree’

Onset of symptoms a few weeks after either a diarrhoea episode (post dysenteric reactive A) when shigella, salmonella or campylobacter are commonly to blame) OR post contracting an STI (mainly chlamydia )

Mx = NSAIDs plus methotrexate or sulfasalazine if persistent. Symptoms shouldn’t last more than 12 months