MSK

Question 1

What would the clinical picture be of someone with compression of L3 nerve root? (4)

Answer 1

• sensory loss of anterior thigh
• weak quads (knee extension)
• reduced knee reflex
• positive femoral stretch test

Question 2

What would the clinical picture be of someone with compression of L4 nerve root? (4)

Answer 2

• sensory loss anterior aspect of knee
• weak quads (knee extension)
• reduced knee reflex
• positive femoral stretch test

Question 3

What would the clinical picture be of someone with compression of L5 nerve root? (3)

Answer 3

• sensory loss dorsum of foot
• weakness in foot and big toe dorsiflexion
• reflexes intact
• positive sciatic nerve stretch test

Question 4

What would the clinical picture be of someone with compression of S1 nerve root? (4)

Answer 4

• weak foot plantarflexion and eversion
• loss of ankle jerk
• calf pain
• decreased sensation sole of foot/back of calf
• positive sciatic nerve stretch test

Question 5

What is tennis elbow and how do you test for it?

Answer 5

Lateral epicondylitis

Pain worse on:
- wrist extension with elbow extended (shoo pigeons)
- supination of forearm with elbow extended

Question 6

What is golfer’s elbow and how do you test for it?

Answer 6

Medial epicondylitis

Pain worse on:
- wrist flexion
- pronation
(elbow extended)

Question 7

What is cubital tunnel syndrome?

Answer 7

Compression of ulnar nerve

Question 8

What is olecranon bursitis?

Answer 8

swelling over posterior aspect of elbow
- hot, red, painful

Question 9

What is radial tunnel syndrome?

Answer 9

Compression of radial nerve
- pain is 4-5cm distal to lateral epicondyle

Question 10

What are the different patterns of systemic sclerosis?

Answer 10

• limited cutaneous systemic sclerosis
• diffuse cutaneous systemic sclerosis

Question 11

What are features of limited cutaneous systemic sclerosis?

Answer 11

CREST syndrome
C – Calcinosis
R – Raynaud’s phenomenon
E – oEsophageal dysmotility
S – Sclerodactyly
T – Telangiectasia

Question 12

What are features of diffuse cutaneous systemic sclerosis?

Answer 12

CREST + CVS/lung/kidney problems

Question 13

Which antibodies would be present in diffuse/limited systemic sclerosis?

Answer 13

diffuse = anti-Scl 70
limited = anti centromere

Question 14

What is pseudogout?

Answer 14

Microcrystal synovitis caused by deposition of calcium pyrophosphate dihydrate crystals in the synovium.

Question 15

Which joints are most commonly affected in pseudogout?

Answer 15

knee, wrist, shoulders

Question 16

What would you find on joint aspiration of someone with pseudogout?

Answer 16

weakly-positive birefringent rhomboid-shaped crystals

Question 17

What would you see on X-ray of someone with pseudogout?

Answer 17

chondrocalcinosis

Question 18

How would you manage someone with pseudogout?

Answer 18

1. aspiration of joint fluid (rule out septic arthritis)
2. NSAIDs or intraarticular steroids

Question 19

What is the most common cause of septic arthritis overall/in young people?

Answer 19

overall = staph aureus
young peeps = neisseria gonorrhoeae

Question 20

How could test whether hip pain is actually just referred lumbar spine pain?

Answer 20

femoral nerve stretch test would be positive (due to femoral nerve compression)

Question 21

Pain over lateral side of thigh in women aged 50-70 might point to which diagnosis?

Answer 21

trochanteric bursitis

Question 22

Burning sensation of antero-lateral aspect of thigh would point to which diagnosis?

Answer 22

meralgia paraesthetica

Question 23

Which antibodies would you find in someone with SLE?

Answer 23

99% are ANA positive
anti-dsDNA more specific

Question 24

What X ray findings would you see in someone with Ankylosing Spondylitis?

Answer 24

• Sacroilitis
• Subchondral erosions
• Sclerosis
• Squaring of lumbar vertebrae

Question 25

What is the management for someone with ankylosing spondylitis?

Answer 25

1. NSAIDs 2. physio 3. DMARD (if peripheral joint involvement)

Question 26

Which organism is most often responsible for osteomyelitis?

Answer 26

Staph aureus

Question 27

What investigation would you carry out on someone with suspected osteomyelitis?

Answer 27

MRI

Question 28

Who should be assessed for osteoporosis?

Answer 28

women over 65 men over 75 younger people with - prev fragility fracture - low BMI - high alcohol intake/smoking - FH of hip fracture - prolonged steroid use

Question 29

What is FRAX?

Answer 29

A scoring system used to estimate probability of fragility fracture in next 10 years

Question 30

What would you do if FRAX score was low/intermediate/high?

Answer 30

low - reassure and lifestyle medium - Order DEXA scan high - bone protection treatment

Question 31

When would you perform a DEXA scan?

Answer 31

1. before starting treatment that may have a rapid adverse effect on BMD 2. people <40 with major risk factor

Question 32

What is osteoporosis?

Answer 32

Condition where bone gradually decreases in bone mineral density, increasing likelihood of fragility fractures.

Question 33

Where is the most common site of fragility fracture?

Answer 33

Spine

Question 34

What is discitis and what is the most common causative organism ?

Answer 34

Infection in the intervertebral disc space - staph aureus

Question 35

What scoring system is used to assess if an ankle injury needs an X-ray?

Answer 35

Ottawa ankle rules

Question 36

When should you order an X-ray for an ankle injury?

Answer 36

Pain in malleolar zone AND 1. inability to weight bear for 4 steps 2. tenderness over distal tibia 3. bone tenderness over distal fibula

Question 37

What blood results would you expect to see in osteoporosis?

Answer 37

- Alk Phos normal - calcium normal

Question 38

What blood results would you expect to see in someone with a secondary bone tumour?

Answer 38

- raised serum calcium - raised Alk Phos