MSK

Question 1

What is Perthe’s disease?

Answer 1

Idiopathic avascular necrosis of the femoral head, most commonly seen in 4-8 year olds

Question 2

Describe the Ottowa knee rules

Answer 2

Age of 55 or over
Isolated tenderness of the patella
Isolated tenderness of the fibular head
Inability to flex knee beyond 90 degrees
Inability to bear weight both immediately and in the ED

Question 3

What is the Mondor sign?

Answer 3

Bruising that tracks to the sole of the foot, seen in calcaneal fractures

Question 4

Name some indications for a DEXA scan

Answer 4

Patient <75 with a history of a low trauma fracture
BMI <19
Long term steroid use
Incidental finding of vertebral collapse or osteopaenia
Oestrogen deficiency

Question 5

What does synovial fluid analysis in gout show?

Answer 5

Needle shaped, negatively birefringent crystals

Question 6

What does synovial fluid analysis in pseudogout show?

Answer 6

Weakly positively birefringent, rhomboid or rod shaped

Question 7

Name some ocular features of RA

Answer 7

Scleritis, episcleritis and sicca symptoms

Question 8

What is Freiburg’s disease?

Answer 8

Osteochondrosis affecting the toes - articular surfaces of the second or third metatarsal heads collapse

Question 9

Name the patterns of malunion

Answer 9

Malrotation
Volar angulation
Lateral angulation
Shortening

Question 10

Name a second line preventative drug for gout

Answer 10

Febuxostat

Question 11

Which antibodies are associated with CREST?

Answer 11

Anti-centromere antibodies

Question 12

Which antibodies are associated with systemic slceroderma?

Answer 12

Anti-scl70

Question 13

Which antibodies are associated with SLE?

Answer 13

Anti ds, antinuclear, anti Sm, anti phospholipid

Question 14

Name some extra articular manifestations of ank spond

Answer 14

Anterior uveitis
Aortic valve insufficiency
Restrictive lung disease
Renal amyloid
Cauda equina syndrome
Osteoporosis

Question 15

Where does the mental nerve come off?

Answer 15

Inferior alveolar nerve

Question 16

What is a Maisonneuve fracture?

Answer 16

A spiral fracture of the upper third of the fibula associated with a tear of the distal tibiofibular syndesmosis

Question 17

What is spondylolisthesis?

Answer 17

The proximal vertebra moving forward relative to a distal vertebra

Question 18

In which condition is anti Jo-1 elevated?

Answer 18

Dermatomyositis

Question 19

What is a Bennett’s fracture?

Answer 19

Two part intraartiuclar fracture of the base of the first metacarpal

Question 20

Name some adverse effects of bisphosphonates

Answer 20

Oesophageal reactions: oesophagitis, Oesophageal ulcers (especially alendronate)
Osteonecrosis of the jaw
Increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate
Acute phase response: fever, myalgia and Arthralgia may occur following administration
Hypocalcaemia: due to reduced calcium efflux from bone. Usually clinically unimportant

Question 21

Name an important adverse effect of hydroxychloroquine

Answer 21

Bull’s eye retinopathy - may result in severe and permanent visual loss

Question 22

Name the ‘As’ of Ank Spond

Answer 22

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis

Question 23

Name the skin manifestations of dermatomyositis

Answer 23

photosensitive
macular rash over back and shoulder
heliotrope rash in the periorbital region
Gottron’s papules - roughened red papules over extensor surfaces of fingers
‘mechanic’s hands’: extremely dry and scaly hands with linear ‘cracks’ on the palmar and lateral aspects of the fingers
nail fold capillary dilatation

Question 24

Name some features of osteosarcoma

Answer 24

most common primary malignant bone tumour
seen mainly in children and adolescents
occurs most frequently in the metaphyseal region of long bones prior to epiphyseal closure, with 40% occuring in the femur, 20% in the tibia, and 10% in the humerus
x-ray shows Codman triangle (from periosteal elevation) and ‘sunburst’ pattern
mutation of the Rb gene significantly increases risk of osteosarcoma (hence association with retinoblastoma)
other predisposing factors include Paget’s disease of the bone and radiotherapy

Question 25

Name some features of Ewing’s sarcoma

Answer 25

small round blue cell tumour
seen mainly in children and adolescents
occurs most frequently in the pelvis and long bones. Tends to cause severe pain
associated with t(11;22) translocation which results in an EWS-FLI1 gene product
x-ray shows ‘onion skin’ appearance

Question 26

Name some SEs of etanercept

Answer 26

Demyelination
Reactivation of tuberculosis

Question 27

Name some SEs of sulphasalazine

Answer 27

Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease

Question 28

Name some SEs of leflunomide

Answer 28

Liver impairment
Interstitial lung disease
Hypertension

Question 29

Name some SEs of rituximab

Answer 29

Infusion reactions are common

Question 30

Name some features of drug induced lupus

Answer 30

arthralgia
myalgia
skin (e.g. malar rash) and pulmonary involvement (e.g. pleurisy) are common
ANA positive in 100%, dsDNA negative
anti-histone antibodies are found in 80-90%
anti-Ro, anti-Smith positive in around 5%

Question 31

Name some causes of drug induced lupus

Answer 31

Most common causes
procainamide
hydralazine

Less common causes
isoniazid
minocycline
phenytoin

Question 32

Describe the management of Paget’s disease

Answer 32

indications for treatment include
bone pain
skull or long bone deformity
fracture
periarticular Paget’s
bisphosphonate (either oral risedronate or IV zoledronate)
calcitonin is less commonly used now

Question 33

Name some complications of Paget’s disease

Answer 33

deafness (cranial nerve entrapment)
bone sarcoma (1% if affected for > 10 years)
fractures
skull thickening
high-output cardiac failure

Question 34

Name the biochemical features of secondary hyperparathyroidism

Answer 34

Low Ca
High PO4
High PTH
High ALP

Question 35

At what T score should patients be offered bone protection?

Answer 35

Less than 1.5

Question 36

What are the indications for urate lowering therapy?

Answer 36

Indications for urate-lowering therapy (ULT)
the British Society of Rheumatology Guidelines now advocate offering urate-lowering therapy to all patients after their first attack of gout
ULT is particularly recommended if:
>= 2 attacks in 12 months
tophi
renal disease
uric acid renal stones
prophylaxis if on cytotoxics or diuretics

Question 37

Name some red flags for lower back pain

Answer 37

age < 20 years or > 50 years
history of previous malignancy
night pain
history of trauma
systemically unwell e.g. weight loss, fever

Question 38

Name some associations of club foot

Answer 38

spina bifida
cerebral palsy
Edward’s syndrome (trisomy 18)
oligohydramnios
arthrogryposis

Question 39

Name some adverse effects of sulphasalazine

Answer 39

oligospermia
Stevens-Johnson syndrome
pneumonitis / lung fibrosis
myelosuppression, Heinz body anaemia, megaloblastic anaemia
may colour tears → stained contact lenses

Question 40

What is the MOA of 5-ASA?

Answer 40

works through decreasing neutrophil chemotaxis alongside suppressing proliferation of lymphocytes and pro-inflammatory cytokines.

Question 41

Which antibodies are associated with limited cutaneous systemic sclerosis?

Answer 41

Anti-centromere

Question 42

Which antibodies are associated with diffuse cutaneous systemic sclerosis?

Answer 42

Anti scl-70