passmed questions

Question 1

what is the best investigation for a suspected meniscal tear

Answer 1

MRI

-ultrasound not so great as difficult tell if there is a tear when there is a high degree of swelling

Question 2

features of a meniscal tear in knee

Answer 2

typically result from a twisting injury
pain worse on straightening the knee
knee can give way
knee locking = displaced meniscal tears
tenderness along the joint
Thessaly’s test - weight bearing at 20 degrees of knee flexion - positive if pain on twisting knee

Question 3

investigation for suspected osteomyelitis

Answer 3

MRI

Question 4

what is osteomyelitis

Answer 4

infection of the bone

Question 5

what is haematogenous osteomyelitis

Answer 5

results from bacteraemia
usually mono microbial
most common in children
vertebral haematogenous osteomyelitis is most common in adults

risk factors:
sickle cell anaemia
IVdu
immunosuppression
infective endocarditis

Question 6

what is non-haematogenous osteomyelitis

Answer 6

results from the contiguous spread of infection from adjacent soft tissues to the bone or from direct injury/trauma to bone
often polymicrobial
most common form in adults

risk factors:
diabetic foot ulcers/pressure sores, DM, peripheral arterial disease

Question 7

what is the most common organism found to cause osteomyelitis

Answer 7

staph aureus

Question 8

what is the most common organism found to cause osteomyelitis in patients with sickle cell anaemia

Answer 8

salmonella species

Question 9

management of osteomyelitis

Answer 9

flucloxacillin for 6 weeks
>clindamycin if penicillin allergic

Question 10

what is FRAX

Answer 10

acronym for Fracture Risk Assessment tool

> fracture risk in patients can be used in people between 40years and 90 with or without bone mineral density value
estimates the 10 year risk of fragility fracture

Question 11

what is DEXA

Answer 11

Dual energy x-ray absorpimetry

> used to measure bone mineral density

Question 12

when should you be worries about osteoporosis in younger patients

Answer 12

previous fragility fracture
current use of frequent recent use of oral or systemic glucocorticoid
history of falls
family history of hip fracture
low BMI > 18.5kg/m2
smoking
alcohol intake of more than 14 units per week

Question 13

squaring of the thumbs, chronic pain and worsening stiffness, morning stiffness in a 75 yr old woman

what is going on here?

Answer 13

OA
-squaring of the thumbs is a characteristic feature of hand OA

Question 14

what is Reiter’s syndrome

Answer 14

aka reactive arthritis
presents with the classic triad of conjunctivitis, urethritis and oligoarthritis
>can’t see can’t pee can’t bend the knee

Question 15

what are some characteristic features of rheumatoid arthritis

Answer 15

swan - neck deformity
Boutonierres
ulnar deviation
subluxation of the carpal bones

Question 16

how does OA present

Answer 16

typically presents with worsening stiffness following long periods of inactivity (sleep)
stiffness tends to last a few minutes (in RhA stiffness lasts about an hour)
pain tends to be worse with activity and is relieved by rest

Question 17

what is OA

Answer 17

results from the loss of cartilage at synovial joints ‘wear and tear’ and is often accompanied by the degeneration of underlying bone

Question 18

who gets OA

Answer 18

women
positive family history
the presence of hand OA increases the risk of future hip and knee OA

Question 19

risk factors for OA

Answer 19

previous trauma of joint > increases chance for that joint
obesity
hypermobility of a joint
occupation eg farmers/pianists
osteoporosis reduces the risk of OA

Question 20

what are some features of OA

Answer 20

it is usually bilateral
episodic joint pain - an intermittent ache , provoked by movement and relieved by resting the joint
stiffness - worse after long periods of inactivity and only lasts a few minutes
painless nodes - Heberden nodes (DIP joints) Bouchards nodes (PIP joints)

Question 21

investigations for OA

Answer 21

x-ray
radiologically there are osteophytes and joint space narrowing

Question 22

You are a doctor working in the emergency department. A 41-year-old man attends complaining of new left leg tingling and weakness. Three days ago he reports he was independent and walking normally. He has a past medical history of type 2 diabetes mellitus for which he takes insulin.

On examination he has a heart rate of 121 beats per minute, a blood pressure of 101/72 mmHg and a temperature of 38.3ºC. He has 4/5 power throughout the right leg. Sensation is altered over the right anterior thigh and knee. The left leg has 4/5 power in hip flexion and extension, 3/5 power in knee flexion, knee extension and ankle dorsiflexion and there is 0/5 power in great toe extension and plantarflexion. Sensation is altered on the left over the thigh and knee but absent to both light touch and pin prick in the left foot.

What is the most likely diagnosis?

Answer 22

lumbar epidural abscess

signs of systemic sepsis with changing lower limb neurology = possible epidural abscess

the epidural abscess causing compression of the cauda equina

diabetes mellitus is a risk factor for developing an epidural abscess

Question 23

what is discitis

Answer 23

an infection in the intervertebral disc space
can lead to serious complications such as sepsis or an epidural abscess

Question 24

features of discitis

Answer 24

back pain
general = pyrexia, rigors, sepsis
neurological features

Question 25

causes of discitis

Answer 25

bacterial = staphylococcus aureus
viral
TB
aseptic

Question 26

investigation for discitis

Answer 26

MRI

Question 27

treatment for discitis

Answer 27

6-8 weeks of antibiotic therapy
>depends on culture

Question 28

A 35-year-old runner presents with heel pain. On examination, there is diffuse tenderness which is worse on the medial aspect of the heel bed. Although the patient has stopped running for the past week, the pain is aggravated by being on their feet at work all day. Pain is worse when you ask them to walk on their toes.
What is the most likely diagnosis?

Answer 28

plantar fasciitis

exacerbated by walking on tip toes is the take away message