PACES - Musc

Question 1

Answer 1

Gottron’s Papules

Dermatomyositis

Question 2

Answer 2

Nail Telangiectasia

Systemis Sclerosis

Question 3

Answer 3

Onycholysis

PA

Question 4

Answer 4

Pitting

PA

Question 5

Answer 5

Longitudinal Ridging

PA

Question 6

Answer 6

Nail Fold Infarct

Vasculitis

Question 7

Answer 7

Subcutaenous Deposits

CREST

Question 8

Answer 8

Dactylitis

Question 9

DX?

Answer 9

PA with dactylitis

Question 10

Answer 10

Heberden’s Nodes

Question 11

Answer 11

Bouchard Nodes

Question 12

How to conclude a hand exam

Answer 12

I would like to..
Examine other joints
Resp exam (fibrosis)
Abdo if RA (Felty’s Syndrome, splenomegaly)

Investigations:
FBC primarily to check for anaemia
U&Es, Vasculitic renal impairment and for drug dosing
LFT, baseline for meds
ESR/CRP, correlate with disease activity
TFT, Autoimmune concern

Immuno tests (Antibodies related to symptoms/signs identified)

Hand XR

Aspirate if effusion

Question 13

What is a trendelenburg gait?

Answer 13

Waddling, body swings side to side due to hip abductor weakness, forcing the pt to use trunk muscles to lift the hip high enough to walk

Question 14

What is an antalgic gait?

Answer 14

Hip pain = short stance phase on the painful side

Question 15

How would you perform the trendelenburg test?

Answer 15

Ask the patient to stand facing you with hands out palms on top of yours

Stand on one leg then the other.

+ve test if pressure on contralateral palm, due to hip abductor weakness.

Question 16

What is the modified thomas’s test

Answer 16

Hand under lumbar spine, ask pt to bring both knees up to chest

Passively push each hip into further flexion whilst watching pt’s face.

Ask pt to hold affected hip flexed whilst extending the other leg. Pressure should be felt on the examiner’s hand. Repeat on the other side whilst watching pt’s face. Fixed flexion deformity if pressure off hand lessens due to extension of lumbar spine as compensation.

Question 17

What is reduced internal rotation of the hip a sign of?

Answer 17

Early OA

Question 18

Answer 18

FAbER test

Hip pain & movement restriction = intraarticular dysfunction such as OA

Question 19

Answer 19

FAdIR test

Femoroacetabular Impingement Syndrome
Anterior Labral Tear

Question 20

How would you perform a hip exam

Answer 20

Intro

Inspect

Gait

Feel (Temperature, pulses,greater trochanter, leg length)

Move - Active hip flexion/extension with hand under lumbar spine
Passive extension, flexion, IR, ER, abduction, adduction

Special - Thomas’
Trendelenburg’s

Question 21

How would you perform a knee exam?

Answer 21

Intro

Inspection

Gait

Feel - Temperature, measure quads size, palpate extended knee (joint lines, patella, offer patellar apprehension test, effusion, patellar tap), Palpate flexed knee and popilteal fossa

Move - Active flexion extension
Passive flexion extension

Posterior Sag
Anterior Drawer
Posterior Draw
LCL
MCL
McMurray’s

Question 22

Hand exam

Answer 22

Intro

Inspection

Feel - temperature, radial/ulnar pulse,

Palms up - thenar/hypothenar bulk, palmar thickening,

Palms down - Radial Nerve (first dorsal webspace), bimanual joint palpation, snuffbox

Wrist palpation

Elbow - elbow palpation along ulnar

Active movement - Splay fingers
Make fist
Palms together and extend wrists
Back of hands together and flex wrists

Passive movement

Motor ->
Wrist/finger extension
Index finger abduction
Thumb abduction

Squeeze fingers, squeeze finger between thumb and index finger
Pick up coin

Tinel’s (Tap over the carpal tunnel)
Phalen’s (Hold wrist in maximum forced flexion for 60s, sx?)

Question 23

What are the main principles of trauma management?

Answer 23

ATLS
Reduce Close -> Open
Repair
Rehab

Question 24

Answer 24

Normal
Varus
Valgus

Question 25

Answer 25

L = Volar R = Dorsal

Question 26

Answer 26

Question 27

What are the main complications of fractures?

Answer 27

Pain, bleeding, infection Compartment syndrome, fat embolus syndrome, DVT

Question 28

Answer 28

Hip Arthroplasty Scar

Question 29

Answer 29

Gluteal Wasting

Question 30

Answer 30

Leg shortened and externally rotated

Question 31

Answer 31

Quadriceps wasting

Question 32

Answer 32

Trendelenburg test Sound side sags OA, Superior gluteal injury DDH

Question 33

Apparent shortening of leg?

Answer 33

Scoliosis

Question 34

True shortening of the leg?

Answer 34

NOF Hip dislocation

Question 35

OA Hip Signs/Mx

Answer 35

Loss of IR first, loss of other movements later Arthroscopic washout Realignment OSteotomy

Question 36

Complications of hip arthroplasty

Answer 36

Nerve Injury Fracture DVT Dislocation

Question 37

Which x ray views do you need to examine a knee?

Answer 37

Skyline Lateral Medial

Question 38

Answer 38

Lap ports knee

Question 39

Answer 39

TKR scar

Question 40

Answer 40

Unicompartmental replacement scar

Question 41

Answer 41

ACL repair scar with graft harvest scar

Question 42

Answer 42

Open Menisciotomy

Question 43

Answer 43

Baker's Cyst

Question 44

Answer 44

Varus Thrust MCL Instability

Question 45

Answer 45

Valgus Thrust LCL Instability

Question 46

Complications of TKR

Answer 46

Immediate- Fracture, Nerve Injury Early - DVT, Infection Late - Loosening, Reduced ROM

Question 47

Answer 47

Gouty Tophi

Question 48

Answer 48

CREST

Question 49

Answer 49

Trigger Finger Stenosing Tenosynovitis

Question 50

Answer 50

Ulnar Claw, T1+C8

Question 51

Answer 51

RA Hands Ulnar deviation of MCPs Boutonniere of thumb (PIP flexion, DIP hyperextension) Swan Neck deformity (hyperextended PIP, flexed DIP)

Question 52

Answer 52

Question 53

Answer 53

Squaring of thumb - OA

Question 54

Answer 54

Dupuytren's Idiopathic, Chronic liver disease

Question 55

Answer 55

Thenar Wasting (median nerve)

Question 56

Answer 56

Hypothenar wasting Ulnar

Question 57

Monteggia vs galeazzi?

Answer 57

MU MonteggiA A is proximal GR GaleaZzi Z is distal

Question 58

Answer 58

Deltoid Atrophy

Question 59

Kennedy HAwkins test?

Answer 59

Impingement

Question 60

Jobe's Empty can test?

Answer 60

Supraspinatus damage

Question 61

Belly Press

Answer 61

Subscapularis

Question 62

Answer 62

Winging of the scapula Axillary surgery Upper brachial plexus injury Test by getting pt to press against the wall

Question 63

Scarf Test?

Answer 63

Push medially ACJ OA