Musculoskeletal

Question 1

Duputryen’s causes

Answer 1

Alcohol
Family history
Diabetes
Epileptic drugs (phenytoin)

Question 2

JIA/Still’s disease

Answer 2

Still’s = systemic JIA = salmon pink rash

Type of inflammatory arthritis

Salmon pink rash on trunk, arms and legs

Tx: same for rheumatoid

Question 3

Recovery after knee replacement vs hip

Answer 3

ERAS

Knee: Bend knee after 2-3 days, approx 10 days in hospital

Hip: mobilise and stand as early as possible, even next day

Question 4

Damage to what vessels during knee replacement

Answer 4

SFA

Popliteal

Question 5

What is ERAS

Answer 5

is a multimodal, multidisciplinary approach to the care of the surgical patient

minimally invasive approaches instead of large incisions

management of fluids to seek balance rather than large volumes of intravenous fluids

avoidance of or early removal of drains and tubes, early mobilization

and serving of drinks and food the day of the operation

Question 6

Haemoarthrosis

Answer 6

Primary spontaneous (coagulopathy e.g. Haemophilia, no major trauma necessarily)

Secondary (trauma)

ACL classically

Question 7

Hallux valgus causes and treatment

Answer 7

Familial
Bad shoes
Assoc with RA

Management

Non surgical: appropriate footwear, physio, splints

Surgery: Bunionectomy, excision arthroplasty

Question 8

Hammer/claw/mallet toe causes

Answer 8

Imbalance between intrinsic and extrinsic toe muscles

Commoner in females, elderly

Question 9

Weber classification of ankle injuries

Answer 9

Fibula; determines stability

A: below syndesmosis

B: above syndesmosis

C: highest above syndesmosis

Question 10

What is a charcot joint?

Answer 10

Progressive, destructive joint arthropathy secondary to peripheral neuropathy

Question 11

Phases of gait

Answer 11

4 phases:

Heel strike
Stance phase
Toe-off
Swing phase

Question 12

Baker’s cyst

Answer 12

Posterior herniation of knee joint capsule

Associated with degenerative knee disease

Question 13

Ix for popliteal aneurysm

Answer 13

Duplex scan

Question 14

Shoulder dislocation and complications

Answer 14

Anterior (most common)
Posterior (seizure/electrocution)

Axillary nerve damage

Question 15

Carpal tunnel syndrome on examination? What will they complain of?

Answer 15

Wasting of thenar eminence
Scar over flexor retinaculum

Parasthesia/anaesthesia in thumb, index, middle fingers
Worse at night or repetitive actions

Question 16

Causes of carpal tunnel syndrome?

Answer 16

Idiopathic
RA
Pregnancy 
DM
Acromegaly

Question 17

What runs through carpal tunnel?

Answer 17

The tendon of flexor pollicis longus
Four tendons of flexor digitorum profundus
Four tendons of flexor digitorum superficialis
Median nerve

Question 18

Ulnar palsy on examination? How can you test for it?

Answer 18

Hypothenar eminence wasting
Ulnar claw
Loss of sensation in ulnar distribution

Examine the hand
Examine the brachial plexus/neck

Question 19

Blood supply to the femoral head

Answer 19

Lateral circumflex arteries giving rise to retinacular vessels

Intramedullary vessels

Artery of ligamentum teres

Question 20

Nerve supply to:
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Deltoid

Answer 20

Supraspinatus & Infraspinatus - suprascapular nerve
Deltoid & Teres Minor - axillary nerve
Subscapularis - subscapular nerve

Question 21

Fracture management

Answer 21

Resuscitation (ATLS guidelines)
Reduction (closed or open)
Restriction (non-rigid, plaster, ex-fix or int-fix)
Rehabilitation (physio, OT)

Question 22

Mortality of hip replacement

Answer 22

30% at 1 year

Question 23

Cauda equina red flags

Answer 23

Saddle anaesthesia
Loss of anal tone
Bladder/bowel incontinence
Leg pain

Question 24

Klumpke’s paralysis? Erb’s palsy?

Answer 24

KP: C8/T1 of brachial plexus
Erbs: C5/C6 of brachial plexus