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msk > pastest > Flashcards

pastest Flashcards

1
Q

patient presents after a car accident with nasal bleeding with a clear fluid, orbital haematoma, glasgow coma scale 3/15

which type of fracture do they most likely have?

A

anterior fossa skull fracture

-clear fluid is CSF which is only possible with an anterior skull fracture

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2
Q

a patient has hyperextended PIP joints and flexed DIP joints, subcutaneous nodules near her elbows, joint stiffness lasting more than an hour in the morning

what is the diagnosis

A

rheumatoid arthritis

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3
Q

what is the histological composition of subcutaneous nodules in rheumatoid arthritis

A

areas of fibrinoid necrosis surrounded by palisading epithelioid cells

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4
Q

specific test for rheumatoid arthritis

A

anti-CCP

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5
Q

is glucosamine recommended by NICE for treatment for osteoarthritis

A

no

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6
Q

which test do you do for SLE

A

anti-double stranded DNA

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7
Q

a patient has pain and swelling of the knees, ankles, elbows and metacarpophalangeal joints. She is sensitive to sunlight and she has a butterfly-shaped erythematous rash on her face

most likely diagnosis?

A

SLE

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8
Q

how would you treat a 78 year old woman, fall and sustained a right-sided intertrochanteric neck of femur fracture

A

dynamic hip screw

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9
Q

how would you treat a 84 year old man with left inferior and superior pubic rami fracture

no femoral neck fracture
PMH hypertension

A

analgesia and physio

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10
Q

how would you treat a woman with right ankle injury, x-ray shows bimalleolar fracture

A

open reduction and internal fixation

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11
Q

how would you treat a 64 year old woman with a history of osteoporosis with a displaced sub-capital fracture of the right femoral neck

A

total hip replacement

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12
Q

what is an effective method of analgesia for patients with a neck of femur fracture

A

iliofascial nerve block

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13
Q

which drug has an interaction with azathioprine that causes bone marrow suppression

A

allopurinol

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14
Q

patient has unilateral leg pain, progressing over the last 6 months, associated with mild weakness of the left leg on any activity. Pain radiates posteriorly down patients left leg and is worse on walking
back and neuro exam are normal
no smoking of cardiovascular disease history

what is the diagnosis

A

lumbar canal spinal stenosis

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15
Q

if a patient suffers upper GI side effects from alendronate (for osteoporosis) what should it be changed to

A

risedronate or etidronate

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16
Q

pharmacological treatment for osteoarthritis

A

first line - oral paracetamol
second line - oral paracetamol + topical NSAIDS
third line - addition of opioid analgesics

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17
Q

a 63 year old lady undergoes an axillary clearance for breast cancer.
8 weeks post op she suffers severe shoulder pain, on examination she had reduced active movements in all planes and loss of passive external rotation

what is the diagnosis

A

adhesive capsulitis (frozen shoulder)

18
Q

28 year old man has pain and weakness in his shoulder. Recently been unwell with glandular fever but has fully recovered. On examination there is muscle wasting and a degree of winging of the scapula. Power during active movements is impaired

what is the diagnosis

A

Parsonage - turner’s syndrome

19
Q

a 32 year old rugby player presents to emergency department with a painful knee, she describes feeling a popping sensation in her right knee during the match, knee is swollen and the patient is unable to fully extend her knee

diagnosis?

A

meniscal tear

20
Q

what is the most appropriate form of investigation for a meniscal tear

A

MRI

21
Q

if a patient has sensory loss of posterolateral aspect of the leg, and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex and a positive sciatic nerve stretch, what root compression has this patient experienced

A

S1

22
Q

if a patient has discomfort over the groin and upper thigh region with associated weakness of the pelvic and psoas muscles, difficulty lifting the affected leg and walking upstairs, what nerve root compression is this?

A

L1-2

23
Q

if a patient has sensory loss of the anterior aspect of the thigh, weakness of the quadriceps with a reduction of knee flexion on the affected side and pain in the anterior thigh when performing femoral stretch test, what nerve root compression is this?

A

L3

24
Q

if a patient presents with similar symptoms as a L3 nerve root compression but instead of sensory loss of anterior aspect of thigh, there is sensory loss over anterior aspect of the knee, what nerve root compression is this?

A

L4

25
Q

if a patient has evidence of sensory loss on the dorsum aspect of the foot with weakness of the foot and big toe dorsiflexion, positive sciatic nerve stretch, which nerve root compression is this?

A

L5

26
Q

a woman has SLE, no joint pain, malar rash, she’s anaemic and her dsDNA antibody titres were markedly raised, what bedside test needs to be done for her in clinic?

A

urine dipstick test

-look for proteinuria which is evidence of lupus glomerulonephritis

27
Q

if a patient presents with swollen red tender knee and the joint fluid aspiration reveals positively befringent, rhomboid shaped crystals and gram stain is negative, what is the diagnosis?

A

pseudogout

28
Q

which antibodies are associated with systemic sclerosis

A

Scl-70, anticentromere and anti-RNA polymerase III

29
Q

if a 22 year old patient has swollen, red, tender knee but also has tender pustular lesions on the dorsum of his left hand, what bacteria most likely caused this?

A

neisseria gonorrhoea

30
Q

how often should methotrexate always be given

A

once weekly

31
Q

a 58 year old female with longstanding diffuse cutaneous systemic sclerosis presents to A&E with severe headache, on examination her observations are:
T 37.6, BP 200/120, HR 89, SaO2 98% on air.
U&Es show urea 9.1, creatine 201

what is the diagnosis

A

scleroderma renal crisis

32
Q

what is first line treatment for a scleroderma renal crisis

A

captopril (ACEi)

33
Q

what antibodies are associated with psoriatic arthritis

A

none

-its seronegative

34
Q

which drug makes raynaud’s phenomenon worse?

A

propanolol

35
Q

a patient has pain in his right knee and he has recently had a total knee replacement
there are no systemic symptoms and his observations are stable, there is swelling and erythema over the joint
what is next best investigation?

A

joint arthrocentesis in theatre

-rule out septic arthritis

36
Q

what is the result of joint aspiration in gout

A

negatively birefringent needle-shaped crystals

37
Q

a 60 year old man has excruciating pain in his left toe, passive movement hurts his toe and even putting a blanket on it hurts. No trauma. Recently diagnosed with diffuse large B cell lymphoma and was started on chemo. His bloods show hyperkalaemia and he is being managed on the acute kidney injury protocol

most likely diagnosis?

A

gout

38
Q

which drug is eosinophilic granulomatosis with polyangiitis stongly associated with

A

leukotriene receptor antagonists (montelukast)

39
Q

clinical diagnosis of osteoporosis

A
  • patient is aged over 45 years AND
  • patient has activity-related joint pain AND
  • patient has no morning stiffness or morning stiffness lasts less than 30 mins
40
Q

which virus is associated with polyarteritis nodosa

A

hep B

41
Q

75 year old woman presents to A&E with pain in her wrist over past two weeks, she has a history of haemochromatosis, her wrist is swollen warm and tender

what is the diagnosis?

A

pseudogout

42
Q

should joint aspiration be attempted before starting antibiotics in a potential septic arthritis or should IV antibiotics be started straight away?

A

joint aspiration first

msk (45 decks)

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