Musculoskeletal

Question 1

Describe the 5 types of psoriatic arthritis

Answer 1

1. Asymmetrical oligoarthritis
2. Symmetrical polyarthritis (similar to RA)
3. Spondylitis
4. DIP arthritis
5. Arthritis mutilans (severely deformed hands, ‘telescoping fingers’)

Question 2

What is the rhyme to remember nerve roots for each reflex?

Answer 2

One, two; buckle my shoe (S1,2 = ankle)
Three four; kick the door (L3,4 = knee)
Five, six; pick up sticks (C5,6 = biceps)
Seven, eight; shut the gate (C7,8 = triceps)

Alternative: “three, four; winks galore” (S3,4 = anal wink reflex)

Question 3

What are the following blood results in osteogenesis imperfecta?

PTH
Calcium
Phosphate
ALP

Answer 3

All are NORMAL

Question 4

Systemic vasculitis sx + hepatitis B signs - pulmonary sx = ?

Answer 4

Polyarteritis nodosa

Polyarteritis nodosa is a medium vessel vasculitis, strongly associated with hepatitis B

Question 5

Sudden popping sound during athletic activity → knee pain. Swelling and instability?

What is the probable diagnosis?

Answer 5

?ACL injury

Question 6

Limited cutaneous systemic sclerosis is associated with which antibody?

Answer 6

Anti-centromere antibodies

LcSSc is aka. CENTRAL sclerosis
Central sclerosis = ‘centro’mere antibodies

Question 7

Diffuse cutaneous systemic sclerosis is associated with which antibody?

Answer 7

Anti-Scl-70 antibodies

Question 8

What condition is being described here?

“An inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions”

Answer 8

Dermatomyositis

Polymyositis is a variation of this diseases where skin lesions are less characteristic

Question 9

Treatment of choice for displaced hip fractures?

Answer 9

Co-morbid, older, less mobile pt = hemiarthroplasty or Younger, active, mobile pt = total hip replacement

Question 10

Non-displaced hip fracture tx vs displaced hip fracture tx?

Answer 10

Non-displaced = blood supply intact = internal fixing
Displaced = risk of avascular necrosis = femoral head needs replacing (+/- acetabulum/socket)

Question 11

What is a Colles’ fracture?

Answer 11

Fracture of the distal radius along the metaphysis with NO articular involvement.

Always associated with osteoporosis, and is therefore a fracture of the elderly

Colles’ - Dorsally Displaced Distal radius → Dinner fork Deformity

Question 12

Bone pain, tenderness and proximal myopathy (→ waddling gait) → ?

Answer 12

? Osteomalacia

Question 13

Malignancy + raised CK = ?

Answer 13

? polymyositis

Question 14

Good test to differentiate between polymyalgia rheumatica and polymyositis?

Answer 14

CK. CK is raised in polymyositis but not in PMR

Question 15

Tenderness over medial joint line of knee + gradual swelling = ?

Answer 15

Medial meniscus tear

Differentiate from ACL injury as ACL injury causes rapid swelling due to haemarthrosis

Pain at the joint line = meniscus tear
Pain above or below (where ligaments insert) = ligament tear

Question 16

What nerve is tested when assessing the ‘regimental badge area’?

What would damage to this nerve cause?

Answer 16

Axillary nerve, from C5+6 nerve root

It would cause sensation loss over regimental badge area, and motor weakness in DELTOID and TERES MINOR

Question 17

Most common causative agent for septic arthritis?

Answer 17

Neisseria gonorrhoeae

Septic = gonorrhoea 
Reactive = chlamydia

Question 18

Lupus features: RASH OR PAIN

Answer 18

Rash (malar or discoid)
Arthritis (polyarthritis)
Serositis (pleuritis or pericarditis)
Haematological disorders (e.g. cytopenias)

Oral / nasopharyngeal ulcers
Renal disease

Photosensitivity
Anti-nuclear antibodies
Immunological disorder (anti-dsDNA, anti-Sm, anti-phospholipid)
Neurological (seizures, psychosis)

Question 19

Maintenance tx and tx of flares in SLE?

Answer 19

Maintenance = NSAIDs for arthralgia, hydroxychloroquine for joint+skin involvement

Mild flares (no organ damage) = hydroxychloroquine + low-dose steroids

Moderate flares = DMARDs or mycophenolate

Severe flares (life or organ-threatening) = high-dose steroids, mycophenolate, rituximab, and cyclophosphamide

Question 20

Describe the use of ALLOPURINOL, COLCHICINE, and FEBUXOSTAT in gout

Answer 20

Colchicine = first line acute management*, particularly if NSAIDs are C/I

Allopurinol = prevention of gout attacks, start 3w after an attack

Febuxostat = second line if allopurinol C/I or not tolerated

• NSAIDs are an alternative first line medication

Question 21

Interaction between azathioprine + allopurinol?

Answer 21

Bone marrow suppression. DO NOT CO-PRESCRIBE.

They are both xanthine oxidase inhibitors

Question 22

Drug-induced lupus causes:

PHIMP

Answer 22

Procainamide
Hydralazine 
Isoniazid
Minocycline
Phenytoin

PH > IMP

Question 23

6 As of ankylosing spondylitis

Answer 23

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis

Question 24

Oral ulcers + genital ulcers + anterior uveitis = ?

Answer 24

Behcet’s disease