MSK

Question 1

Which nerve damaged in shoulder dislocation can cause loss of sensation in “reg badge” area?

Answer 1

Axillary (supplying deltoid)

Question 2

Which nerve root do axillary nerve, musculocutaneous nerve and suprascapular nerve originate from?

Answer 2

C5/6

Question 3

What is Klumpke’s paralysis?

Answer 3

Claw-like hand in baby from damage to spinal roots C8 and T1

Question 4

What is a Bennett fracture?

Answer 4

Fracture of base of first metacarapal

Question 5

Which medication can increase risk of hip fracture?

Answer 5

Carbamazepine

Question 6

Clin pres of osteochondritis dissecans

Answer 6

Young adult
Joint stiffness
Worse on activity
Due to overuse and repetitive microtrauma

Question 7

Risk factors for wedge fracture

Answer 7

Steroid use, female, old age, low BMI
History of low-impact trauma

Question 8

First line management of CRPS

Answer 8

Amitryptyline

Question 9

What can be seen on exam of DeQuervain’s tenosynovitis?

Answer 9

Tenderness elicited over the radial styloid upon ulnar flexion of the wrist with thumb clasp in the palm

Question 10

Describe Lisfranc injury

Answer 10

Dislocation of base of second metatarsal and medial cuneiform in midfoot
Usually due to joint rotation of forced plantar flexion

Question 11

Investigation used in polymyalgia rheumatica

Answer 11

DEXA scan
- to determine low bone density

Question 12

Medication to manage RA with little response to DMARDs

Answer 12

Biologics e.g. adalimumab

Question 13

Erb’s palsy is characterised by which deformities of wrist and elbow

Answer 13

Impaired wrist extension
Impaired elbow flexion

Question 14

Nerve supplying sensation over medial aspect of leg an foot which may be injured in placing of IM nails post-hip fracture

Answer 14

Saphenous nerve

Question 15

Fracture in kids involving only one cortex of bone involving bending at fracture site?

Answer 15

Greenstick fracture

Question 16

LFT abnormality assoc with Paget’s disease

Answer 16

High ALP

Question 17

How can you distinguish between trigger finger and Dupuytren’s contracture?

Answer 17

Trigger finger - passively corrected and no skin changes
Dupuytren’s contracture - fixed flexion w fibrotic thickening, assoc with excessive alcohol use

Question 18

Risk factor for frozen shoulder

Answer 18

Diabetes

Question 19

Tenderness elicited over the radial styloid upon ulnar flexion of the wrist with thumb clasp in the palm suggests

Answer 19

DeQuervain’s tenosynovitis
- positive Finkelstein’s test

Question 20

Tennis player with weakness in 4th/5th fingers, decreased grip strength and no history of trauma

Answer 20

Hamate fracture

Question 21

Gradual onset midfoot pain in ballet dancer with amennorhoea

Answer 21

Second metatarsal base stress fracture

Question 22

Describe a Lisfranc fracture

Answer 22

Dislocation of the base of the second metatarsal and the medial cuneiform in the midfoot.
Usually due to direct trauma

Question 23

Management of SCFE

Answer 23

Surgical fixation of femoral head

Question 24

Nerve responsible for elbow and wrist flexion

Answer 24

Radial nerve

Question 25

Medication used in the management of Raynaud's

Answer 25

Calcium channel blockers

Question 26

What anticoag is used in pregnancy with anti-phospholipid?

Answer 26

LMWH

Question 27

Low levels of complement in SLE indicate what?

Answer 27

Active disease

Question 28

Nail changes assoc with psoriatic arthritis

Answer 28

Onycholysis (lifting of the nail from its nailbed) Pitting

Question 29

Is allopurinol used for prevention or management of acute attacks of gout?

Answer 29

Prevention - NSAIDs/steroids/colchicine for management

Question 30

What is Wolff's law?

Answer 30

The idea that extra bone is laid down at areas of stress e.g. extra bone growth at fracture site

Question 31

Gradually worsening instep foot pain (worse on walking) with tenderness over calcaneal tuberosity over post/medial arch?

Answer 31

Plantar fasciitis

Question 32

Common side effects of bisphOsphOnates

Answer 32

Osteonecrosis of jaw Oesophageal ulcers

Question 33

First line investigation for suspected Sjogren's

Answer 33

Schrimer's test

Question 34

Common side effect of colchicine

Answer 34

Diarrhoea

Question 35

Management of delayed presentation of scaphoid fracture

Answer 35

Urgent ortho review

Question 36

Patient with difficulty picking up objects but no reduced sensation after a radial head fracture?

Answer 36

Low radial nerve injury

Question 37

Describe osteochondritis dissecans

Answer 37

Necrosis and displacement of a fragment of bone and cartilage in the joint due to overuse and repetitive microtrauma of the joint Commonly affects young adults and is worsened by physical activity Patients may experience joint locking and stiffness.

Question 38

Which Weber classification requires definitive surgical management?

Answer 38

Type C Fracture above the level of the ankle joint with disruption of the tibiofibular syndesmosis

Question 39

What movements are involved in the pronation and supination of the arm?

Answer 39

Rotation of radius on ulna

Question 40

When would you not choose internal fixation?

Answer 40

Open fractures = dirty wounds

Question 41

Hep B infection with CNIII and ulnar nerve palsy and ulcers with systemic upset suggests?

Answer 41

Polyarteritis nodosa

Question 42

Antibody assoc with systemic sclerosis

Answer 42

Anti-centromere

Question 43

Is lateral epicondylitis assoc with resisted extension or flexion of wrist and digits?

Answer 43

Resisted extension

Question 44

What is a lipohaemarthrosis?

Answer 44

Fat and blood floating mass above patella esp after fracture

Question 45

Signs of Perthes on X-ray

Answer 45

Femoral head collapse and fragmentation suggestive of osteonecrosis

Question 46

Most common arteries damaged in hip fracture and dislocation

Answer 46

Fracture - AVN of medial femoral circumflex artery Dislocation - Artery of ligamentum teres

Question 47

Which muscle is responsible for flexion of DIP joints?

Answer 47

Flexor digitorum profundus

Question 48

Anatomical snuffbox is innervated by?

Answer 48

Radial nerve

Question 49

Damage to which nerve would cause reduced flexion and adduction of the wrist?

Answer 49

Ulnar

Question 50

Abdominal presentation of cauda equina?

Answer 50

Suprapubic mass

Question 51

Ligament injury most assoc with type 4 tibial plateau fracture

Answer 51

ACL tear

Question 52

Which cancers spread to bone?

Answer 52

Prostate Loves To Kill Bone - prostate, lung, thyroid, kidney, breast

Question 53

What lesion can occur after repeated shoulder disloctions/subluxations?

Answer 53

Bankart lesion - seen on MRA

Question 54

Osteoarthritis of the knee can cause what kind of swelling and how would you investigate it?

Answer 54

Baker's cyst - US

Question 55

Management of Achilles tendon rupture

Answer 55

Same-day ref to ortho Urgent ultrasound Venous thromboembolism prophylaxis Plantarflexed cast/Achilles tendon reattachment

Question 56

Which test can rule out Achilles rupture?

Answer 56

Simon's calf squeeze test

Question 57

Sudden pain during walking recently post-op total hip replacement?

Answer 57

Posterior hip displacement

Question 58

Which muscle can cause a fibular head avulsion fracture?

Answer 58

Biceps femoris - sudden contraction of the biceps femoris is a common cause of an avulsion fracture of the fibular head

Question 59

Nerve injury most commonly assoc with fibular fracture

Answer 59

Common peroneal - loss of the ability to dorsiflex and evert the foot causing a foot drop - Sensory functions of this nerve cover the skin on the anterolateral aspect of the leg and the dorsum of the foot

Question 60

Management in septic arthritis of prosthetic joint where broad-spectrum antibiotics have not provided any relief

Answer 60

Surgical washout

Question 61

Back pain which wakes from sleep assoc with raised ESR?

Answer 61

Inflammatory pain e.g. AS - lumbar x-ray

Question 62

Back pain which radiates to buttocks and thigh and improves on sitting down/leaning forward

Answer 62

Lumbar spine stenosis

Question 63

Intrinsic hand muscle wasting suggests a lesion at what site?

Answer 63

T1 nerve root

Question 64

Which test has highest specificity for RA?

Answer 64

Anti-CCP

Question 65

Back pain with leg weakness and minor trauma and PMHx of cancer

Answer 65

Spinal cord compression

Question 66

C8/T1 radiculopathy would cause what type of symptoms in what location?

Answer 66

Sensation synptoms proximal to wrist e.g. paraesthesia or numbness

Question 67

55y/o make with acute back pain, cervical stiffness, foot pain and difficulty breathing?

Answer 67

Ankylosing spondylitis

Question 68

X-ray showing a well healed fracture with a backed out DHS assoc with pain over greater trochanter?

Answer 68

Trochanteric bursitis from prominent metalwork

Question 69

Bilateral parotid swelling assoc with Sjogren's, gradual and assoc lymphadenopathy

Answer 69

MALT lymphoma

Question 70

Diagnostic test for disc herniation

Answer 70

Straight leg raise

Question 71

Swan-neck deformity?

Answer 71

MCP flexion Prox hyperetension Distal hyperflexion

Question 72

Symptoms of S1 nerve root lesion

Answer 72

Foot eversion is weak Ankle jerk is affected

Question 73

Characteristics of IgG4 disease

Answer 73

Recurrent AI pancreatitis Haemodynamic stability, mildly deranged LFTS, and a normal CRP are also characteristic Sausage pancreas = diffuse thickening

Question 74

What investigations should be undertaken before starting methotrexate?

Answer 74

Baseline liver function test, renal function, full blood count, CXR

Question 75

What is first line for lupus?

Answer 75

Hydroxychloroquine Then azathioprine Acyclophosphamide if acute e.g. lupus nephritis

Question 76

Pain on medial heel, worse in the morning, no injury history, runner?

Answer 76

Plantar fasciitis

Question 77

Is paralysis a late or early comp of compartment syndrome?

Answer 77

Late

Question 78

Innervation of thumb adduction

Answer 78

Ulnar

Question 79

Immediate swelling of knee joint after injury would suggest damage to which ligaments?

Answer 79

Cruciate - meniscal is usually 12-24h after

Question 80

In what incidence would you give a septic arthritis patient antibiotics before aspiration?

Answer 80

If there is an unavoidable delay in performing a knee aspiration or the patient is septic

Question 81

How doe pain from talus fracture present?

Answer 81

Ankle pain rather than foot pain

Question 82

Swellings in osteochondritis dissecans and osgood-schlatter's

Answer 82

Tibial tuberosity - osgood Femoral condyle - osteochondritis

Question 83

Most unstable type of ankle fracture

Answer 83

Ones involving tibiofibular syndesmosis - manage ORIF

Question 84

Which head of biceps more commonly ruptures?

Answer 84

Long head

Question 85

What is the female athletic triad and what hip fracture can it cause?

Answer 85

Osteoporosis, eating disorders and amenorrhoea - stress fracture of femoral head due to osteoporosis

Question 86

Achilles tendon rupture inv

Answer 86

US ankle and calf