All MSK and Arthritis

Question 1

DIP

PIP

MCP

MTP

Answer 1

Distal Interphalangeal Joint

Proximal Interphagangeal Joint

MCP (knuckle) MetoCarpoPhalangeal

MTP (foot) MetaTarsoPhalangeal

Question 2

Small bony nodules (osteophytes) at the DIP and PIP joints are characteristic of what?

Answer 2

OA

DIP - Herberden’s nodes

PIP - Bouchard’s nodes

Question 3

Where do you find Rhematoid nodules on the hands?

Answer 3

MCP

(knuckles)

Question 4

Deformities of the finger in RhA

(diagram)

Answer 4

Question 5

Diagram of Tophi (white subcutaneous nodes)

in Gout

• uric acid crystals

Answer 5

Question 6

Two main features of carpal tunnel syndrome

Answer 6

Median nerve compression

Thenar muscle wasting

rem. flexor retinaculum

Question 7

Subluxation in the hand and ulnar deviation of the the MCP joints are characteristic of what?

Answer 7

RhA

Question 8

What is a pannus?

Answer 8

hypertrophied synovium,

containing inflammatory cells that release collagenolytic enzymes

causing loss of bone and cartilage (chronic RhA)

Question 9

General facts about RhA

Men or Women?

Geographically areas

Answer 9

Low incidence in Afria, high incidence in North America.

3:1 ratio (females >>)

Can disappear in pregnancy due to immune system adaptations to foreign matter.

symmetrical

HLA-DR4 antigen identified.

Hormonal & viral links

Question 10

RhA nodules characteristics

Answer 10

Made from fibroblasts.

Pinky colour.

Blood supply on the outside only; can become necrotic.

Locations; extensor surfaces of elbows, forearms and hands

Question 11

RhA on XR - characteristics

Answer 11

White sclerotic changes - spongy bone looks whiter.

Subluxation of MCP

Wrist/ hand displacement

Thumb - Z deformity

Question 12

RhA diagnostic criteria

Answer 12

morning stiffness >> 60 mins

stiffness after rest

>> six weeks duration

DIP joints spared

Volar subluxation

Swan neck/ boutonniere, guttering between bones

RhA attacks connective tissue (therefore tendinous sheaths); fingers stay in flexion/ extension

Question 13

Felty’s syndrome (important)

Answer 13

Rare autoimmune disease

Splenomegaly

neutropenia

RhA

Question 14

Early sign of RhA?

Answer 14

boggy metacarpal joints

Question 15

Learn the Gold star slide (differences between RhA, OA, and gout)

Answer 15

need image

Question 16

Tx of gout

Answer 16

Acute; NSAIDs, (+PPIs) or if can’t tolerate then colchicine or steroids.

Chronic; allopurinol or if not tolerated, try febuxostat

Question 17

Diagram showing MTP joint

Answer 17

Question 18

What does DAS28 measure?

Answer 18

Disease Activity Scores for RhA

Question 19

MKD pain of the hip needs to be distinguished from:

Answer 19

lumbar nerve roor irritation

spinal or arterial claudication

abdominal causes, e.g. hernias

Question 20

What is the classical appearance of a hip fracture?

Answer 20

affected side; shortened leg, externally rotated.

NB> fracture of the hip in the elderly can occur with minimum trauma and present atypically, px even may be able to weight bear.

Question 21

What is a subcapital fracture, and it’s treatment?

Answer 21

A subcapital fracture is the commonest type of intracapsular fracture of the proximal femur.

hemiarthroplasty

Question 22

Local knee joint line tenderness could indicate….?

Answer 22

Meniscal tears

Question 23

Meniscal provocation test

Answer 23

Question 24

Answer 24

Question 25

Trendelenberg sign

Answer 25

Question 26

Answer 26

Question 27

varus and valgus knees

Answer 27

Question 29

ankle anatomy diagram

Answer 29

Question 34

What tests are useful for checking knee stability?

Answer 34

* **Collateral test** (knee fully extended between body and elbow and varus/ valgus forces applied). Feel the joint margin. Repeat with knee at 30 degrees. * **Anterior drawer test** (NB. check no posterior subluxation of tibia on femur) * **Posterior drawer test** * **Patellar apprehension test** (for patellar dislocation/ instability) * **medial/ lateral meniscus** tests * **Squat test** (menisci)

Question 35

Which shoulder dislocation is most common?

Answer 35

**Anterior** - 95% Usually caused by a direct blow to, or **fall on, an outstretched arm.** The patient typically holds his/her arm externally rotated and slightly abducted.

Question 36

Dermatome to little finger?

Answer 36

Question 37

Dermatome to middle finger

Answer 37

Question 38

Dermatome to the thumb

Answer 38

Question 39

Dermatome to Inner Forearm

Answer 39

Question 40

Dermatome to Upper inner arm

Answer 40

Question 41

Dermatome to knee

Answer 41

Question 42

Dermatome to medial malleolus

Answer 42

Question 43

Dermatome to dorsum of foot

Answer 43

Question 44

Dermatome to Toes 1-3

Answer 44

Question 45

Dermatome to Toes 4 and 5; lateral malleolus

Answer 45

Question 46

Footpain after walking, often in the 2nd metatarsal, can suggest what?

Answer 46

Forefoot pain, often localised to the second metatarsal, after excessive activity such as trekking, marching or dancing, **suggests a stress fracture.** Symptoms are relieved by rest and aggravated by weight bearing.

Question 47

Pain between the 3rd and 4th toes in a middle-aged woman wearing tight shoes is suggestive of?

Answer 47

**Spontaneous lancinating pain** in the forefoot radiating to contiguous sides of adjacent toes occurs with **Morton’s neuroma**. A common site is between the third and fourth toes.