Formative Assessments Flashcards
1
Q
Name 3 blood tests to Dx osteomyelitis
A
FBC + diff WCC ESR CRP Blood cultures x3 U&E's
2
Q
Name 3 types of imaging which can be used to Dx osteomyelitis
A
X-ray USS Labelled white cell scan Aspiration MRI
3
Q
Name 3 DDx of acute osteomyelitis
A
Acute septic arthritis
Trauma (fracture, dislocation)
Transient synovitis
Acute inflammatory arthritis
Soft tissue infection:
Cellulitis
Erysipelas
Necrotising Fasciits
4
Q
Name 2 likeliest organisms responsible for acute osteomyelitis
A
Staph. aureus
Strep. Pyogenes
Haemophilus influenzar
5
Q
Which organism would be suspected to cause acute osteomyelitis in sickle cell disease
A
Salmonella
6
Q
Name 2 Rx for acute osteomyelitis
A
Analgesia Rehydration Rest Spintage IV abx
7
Q
Name 3 potential complications of acute osteomyelitis
A
Pathological fracture Chronic osteomyelitis Septicaemia Death Metastatic infection Septic artritis Altered bone growth (esp since young)
8
Q
True or false:
Congenital clubfoot is a rare birth defect
A
False
It is a common one
9
Q
True or false:
Congenital clubfoot is caused by a single gene defect
A
Fale
10
Q
True of false:
Congenital clubfoot the sole of the foot turns laterally and the foot is everted
A
False
Turned medially and is inverted
11
Q
Name 3 different types of synovial joints and where they are found
A
Plane (wrist) Hinge (elbow, knee) Condyloid/Ellipsoid Picot (atlas and axis) Saddle (thumb) Ball and socket (hip and shoulder)
12
Q
Name 3 components of synovial fluid
A
Lubricin
Hyaluronic acid
Fluid component
13
Q
Name 1 function of synovial fluid
A
Lubrication
Nutrition of cartilage
Removal of waste products
14
Q
Name 2 anatomical features that aid in the stability of a joint
A
Ligaments
Muscles
Shape of articulating surface
Capsule
15
Q
Name 3 groups of individual involved in the management of OA
A
GP Consultant Patient Physio OT
16
Q
Name 2 non-pharmacological Rx for patients with OA
A
Thermotherapy
Electrotherapy
Manual therapy
Aids and devices
17
Q
What non-pharmacological Rx do NICE NOT recommend for OA
A
Acupuncture
Nutraceuticals
18
Q
Name 2 pharmacological Rx for OA
A
Analgesia Paracetamol NSAIDS Topical NSAIDS (Capsaicin) Steroid injections
19
Q
Name 4 potential causes of a fracture slow healing
A
Infection Age Steroid use Metabolic disorder Smoking Malnutrition Radiotherapy Warfarin Immune suppressants
20
Q
Describe strength in UMN lesions
A
Decreased
21
Q
Describe strength in LMN lesions
A
Decreased
22
Q
Describe tone in UMN lesions
A
Increased/hypertonia
23
Q
Describe tone in LMN Lesions
A
Decreased/hypotonia
24
Q
Describe reflexes in UMN lesions
A
Increased/hyperreflexia
25
Describe reflexes in LMN lesins
Decreased/hyporeflexia
26
Describe clonus in UMN lesions
Present
27
Describe clonus in LMN lesons
Absent
28
Describe babinskis in UMN lesions
Present
29
Describe Babinskis in LMN lesons
Absent
30
Is atrophy present in UMN lesions
No
31
Is atrophy present in LMN lesions
Yes
32
50yr F presents with sensation of painful clicking in volar aspect of her ring finger when bending it. Most likely diagnosis?
a. OA of MCJ
b. Duputryens disease
c. Flexor ganglion
d. Trigger finger
e. Ruptures flexor tenson
d. Trigger Finger
33
Name 4 muscles of the thenar eminence of the hand
Abductor pollicis brevis
Flexor pollivis brevis
Opponent pollicis
Adductor pollicis
34
60yr F attends surgery complaining of pain at base of thumb when putting on clothes and using it. Suspect OA of thumb. Name 2 operative and non-operative management of this lady
```
Non-operative:
Analgesia (NSAIDs)
Splinting
Steroid injection
Lifestyle modifications
```
Operative:
Fusion
Trapezioectomy
Replacement
35
Name 3 non-operative managements for painful foot conditions
```
Orthotics
Weight loss
Activity modification
Footwear assessment/modification
Physio
```
36
40yr old woman complains of shooting pains in 3rd web space of her foot made worse by wearing high heels. You suspect Mortons Neuroma. Name 2 clinical signs you might elicit. Name 2 Rx for this condition?
Signs:
Mulder click
Altered sensation in 3rd webspace
Palpable swelling of the nerve
Rx:
Excision
Steroid injection
37
50yr old DM attends clinical complaining of heel pain first thing in morning and on walking. You suspect plantar fasciitis. Give one differential diagnosis.
OA
Nerve entrapment syndrome
Calcaneal pathology
38
Name 4 traditional treatments used to treat plantar fasciitis
```
Weight loss
Activity limitation
Rest
Steroid injections
Stretching
ICE
NSAIDs
```
39
Name2 newer/third line rx for plantar fasciitis
```
Extracorpeal Shock Wave Therapy
Nitric Oxide
Platelet rich plasma
Topaz Plasma Coblation
Endoscopic/Open surgery
```
40
Name 3 muscles that attach to the clavicle
```
Trapezius
Sternocleidomastoid
Omohyoid
Deltoid
Stenohyoid
Subclavius
Pectoralis major
```
41
Name 3 directions in which the shoulder can dislocated
Anterior
Inferior
Posterior
42
What is the most common direction of shoulder dislocation
Anterior
43
Name 2 treatments for shoulder dislocation
Analgesia
Manipulation
Immobilisation
Physio.
44
Name 2 injuries where the axillary nerve is at risk
Shoulder dislocation
| Fracture of surgical neck of humerus
45
What is the motor deficit of axillary nerve palsy
Loss of deltoid and trees minor
| Cannot bend arm at elbow
46
Sensory deficit of axillary nerve palsy
Lateral arm sensation loss
| Regimental badge area
47
Name 2 injuries where the radial nerve is at risk
Entrapment
Compression
Trauma
48
What is the motor deficit of radial nerve palsy
Wrist drop
49
Name 2 static constraints of the knee
```
Collateral ligaments (medial and lateral)
Anterior cruciate ligament
Posterior cruciate ligament
Capsule
ITB
Meniscii
```
50
Name 2 dynamic constraints of the knee
Quadriceps
Hamsrings
Medial and lateral gastric.
Popliteus
51
Name 2 flexors of the knee
Biceps femoris
Semimembranosus
Semitendinosis
Gastrocnemius
52
Name 2 extensors of the knee
Rectus femoris
Vastus medialis
Vastus lateralis
Vastus intermedialis
53
Name 3 causes of caudal equine syndrome
```
Tumours
Central lunar disc prolapse
Trauma
Infection
Iatrogenic (spinal surgery or manipulation)
```
54
Name 2 clinical features of caudal equine
```
Bilateral sciatica
Saddle anaesthesia
Bladder incontinence
Bowel incontinence
Urinary retention
```
55
What is the Rx for caudal equine
Urgent surgical decompression
56
Name 3 types of blunt force injury
Contusions/Bruising
Abrasions
Lacerations
57
Names 2 types of sharp force injury
Incision
| Stab wounds
58
What is the clinical term used for diffuse brain injury
Diffus axonal injury
59
What is the pathological term used for diffuse brain injury
Traumatic Axonal Injury
60
60yr M falls whilst working in his garden fracturing his left hip once he has recovered from the fracture which of the following would be the next step in his management?
a. Reassure him that it was simply bad luck as men of his age not at risk of osteoporosis
b. Commence him on bisphosphonate therapy
c. Refer for a bone density scan
d. Advise him to avoid working in the garden
e. Commence calcium and Vitamin D tablets
C. refer for a bone density scan
61
75yr M presents acute onset unilateral headaches, scalp tenderness and pain in his jaw on eating on a background of 2 month history of pain and stiffness of the shoulder what is the next best investigation?
a. ESR
b. RF
c. CT head
d. Temporal artery biopsy
e. ANA
d. temporal artery biopsy
Suspected GCA
62
50rs M attends GP complaining of swelling of his toes. He has just returned from a holiday. He has hypertension and his BMI is 32
What test wold be the most helpful to establish a Dx
Aspirate joint
63
22yr F presents 3mnth history of stiffness of hand joints and new onset right sides sharp chest pain on inspiration. Urinanalysis shows microscopic haematuria and proteinuria
What is the suspected Dx?
Which antibody should be tested
Lupus
| Anti double stranded DNA Ab (dsANA)
64
Which cells are directly responsible for loss of articular cartilage
a. Macrophages
b. Synovial fibroblasts
c. T cells
d. B cells
e. Osteoclasts
Osteoclasts
65
78yr healthy woman on no medications presents acutely with a hot swollen left knee. She was previously well with only mild knee pain on coming down the stairs no other joint involvement. She is struggling to weight bear on the knee. What is the most likely Dx?
a. RA
b. Psoriatic arthritis
c. Pseudogout
d. Trauma
e. OA
Pseudogout (knee is what gout is to the big toe)
66
50yr lady attends GP concerned about osteoporosis as her mother had it. How should GP proceed
a. Perform a fracture risk assessment
b. Refer bone density scan
c. Explain she is too young and return in 5yrs time
d. Comment therapy HRT
e. Commence calcium and Vit D supplements
A. Perform a fracture risk assessment
67
23yr student sees his GP with a several year history back pain and stiffness. Pain is worse at night, first thing in morning and if he has been sitting for long periods of time. Otherwise well apart from previous episode of red painful eye which he received steroid eye drops for. O/E reduced Schobers test and is tender over his right sacroiliac joint. Which Ix would be most helpful in reaching a Dx
```
CRP
HLA-B27
MRI whole spine
Anti-CC antibody
Trial of NSAIDs
```
c. MRI whole spine
Likely Dx = ankylosing spondylitis
HLA-B27 will be useful but not give whole Dx
68
67yr F presents with 3mnth history of proximal weakness of the upper and lower limbs. She struggles to lift her arms above the shoulder level and to stand from sitting unaided. Her blood tests show ESR at 80 and creatinine kinase at 5x the upper limit of normal range. What is the most likely Dx?
Polymyositis
69
1. 30yr F newly diagnose with RA. 2yr old daughter currently trying for another baby. She has synovitis across the MCPs in both hands and has evidence of erosions and joint damage on x-ray
Which Rx should she receive?
a. NSAIDs
b. Methotrexate
C. Sulfasalazine
d. Leflunomide
e. Paracetemol
Sulfasalazine
a. NSAIDS (not strong enough)
b. Methotrexate - Not safe for pregnancy
c. Sulfasalazine - Safe for pregnancy
d. Leflunomide- Not safe for pregnancy
e. Paracetemol - Does not treat the disease
