MSK

Question 1

Pt aged 50 preesents with joint and bone pain, tenderness and evidence of proximal myopathy in the form of a waddling gait. The pt rarely leaves home due to severe mental health issues.
What is the likely diagnosis?

Answer 1

Osteomalacia from vitamin D deficiency

Question 2

Features of S1 nerve root compression?

Answer 2

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

Question 3

Features of L5 nerve root compression?

Answer 3

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

Question 4

Features of L4 nerve root compression?

Answer 4

Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

Question 5

Nerve roots of femoral nerve?

Answer 5

L2,3,4

Question 6

Nerve roots of sciatic nerve?

Answer 6

L4, L5, S1, S2, S3

Question 7

How does adhesive capsulitis present?

Answer 7

Stiffness and pain in the shoulder. Particularly pain on coracoid palpation and impairment of external rotation in active and passive movement

Question 8

Swelling in joints in OA vs psoriatic arthritis?

Answer 8

In OA there are bony swellings in DIP called heberdens nodes
In psoriatic arthritis this swelling is more likely to be boggy

Question 9

What will be grown in a knee joint aspiration in reactive arthritis?

Answer 9

Nothing!!

Question 10

What is Schober test?

Answer 10

A test used to see if there is a decrease in lumbar spine range of motion usually for ankylosing spondylitis
When pt is standing, mark the L5 spinous process and then another mark 10cm above the first. Get pt to flex forward and re assure the distance between the 2 marks.
Positive test is when there is <5cm increase in length with forward flexion.

Question 11

How does Behçet’s disease present?

Answer 11

Oral ulcers, genital ulcers and anterior uveitis

Others:
Thrombophlebitis and DVT
Arthritis
Neurological involvement
GI abdo pain,diarrhoea, colitis
Erythema nodosum

Question 12

How does RA present differently to PA?

Answer 12

Psoriatic arthritis presents with an asymmetrical polyarthritis

Question 13

Antibodies in RA?

Answer 13

Anti-CCP
RF

Question 14

Pharmacological treatment option for Raynaud’s phenomenon?

Answer 14

Nifedipine

Question 15

What is Raynaud’s phenomenon?

Answer 15

An exaggerated vasoconstrictive response of the digital arteries and cutaneous arteriole to the cold or emotional stress.

Question 16

Who is Raynaud’s disease most common in?

Answer 16

Young women
May have CTD, leukaemia, use of vibrating tools. COCP or cervical rib

Question 17

What causes low serum calcium, low phosphate, raised ALP and raised PTH?

Answer 17

Osteomalacis

Question 18

What antibody is associated with limited cutaneous systemic sclerosis?

Answer 18

Anti-centromere antibodies
ANA
Sometimes RF

Question 19

Which antibody is associated with diffuse cutaneous systemic sclerosis?

Answer 19

Anti scl-70
ANA
Sometimes RF

Question 20

Antibodies raised in APS?

Answer 20

Anticardiolipin
Anti-beta2 glycoprotein
Lupus anticoagulant

Question 21

What is the meaning of a DEXA T score of the femoral neck of -2.5?

Answer 21

Bone density is 2.5 standard deviations below that of an average healthy young adult

Question 22

First line Tx for lower back pain?

Answer 22

NSAIDs +/- PPIs

Question 23

XR changes in RA

Answer 23

loss of joint space
juxta-articular osteoporosis
soft tissue swelling
periarticular erosions
subluxation

Question 24

blood supply to the scaphoid bone?

Answer 24

around 80% is from the dorsal carpal branch of the radial artery in retrograde flow

Question 25

symptoms of bakers cyst?

Answer 25

fluctuant swelling in the popliteal fossa
swelling will feel tense when the pts knee is extended and soft when the knee is flexed (Fouchers sign)
may transilluminate

Question 26

what is the ulnar paradox?

Answer 26

The ulnar nerve also innervates the medial half of the FDP muscle. If the ulnar nerve lesion occurs more proximally, the FDP muscle may also be denervated. As a result, flexion of the IP joints is weakened, which reduces the claw-like appearance of the hand. Instead, the fourth and fifth fingers are simply paralyzed in their fully extended position. This is called the “ulnar paradox” because one would normally expect a more proximal and thus debilitating injury to result in a more deformed appearance. As reinnervation occurs along the ulnar nerve after a high lesion, the deformity will first get worse (FDP reinnervated) as the patient recovers - hence the use of the term “paradox”.
A simple way to remember this is: ‘the closer to the Paw, the worse the Claw’.

Question 27

what scoring system is used for hypermobility?

Answer 27

Beighton score

Question 28

antibodies in limited and diffuse cutaneous systemic sclerosis

Answer 28

limited - anticentromere
diffuse - anti scl-70 antibodies

Question 29

what is a Bennett’s fracture?

Answer 29

an intra-articular fracture at the base of the thumb metacarpal
usually caused by fist fights

Question 30

what is a Monteggia’s fracture? what causes it?

Answer 30

dislocation of the proximal radioulnar joint in association with an ulna fracture
caused by FOOSH with forced pronation

Question 31

what is a Galeazzi fracture? what causes it?

Answer 31

dislocation of the distal radioulnar joint in association with an radial shaft fracture
caused by FOOSH with a rotational force superimposed on it

Question 32

what is a Barton’s fracture?

Answer 32

a distal radius fracture with associated radiocarpal dislocation

Question 33

what are the HLAB27 conditions?

Answer 33

ankylosing spondylitis
reactive arthritis
acute anterior uveitis
psoriatic arthritis

Question 34

what scoring tool is used to measure disease activity in RA?

Answer 34

DAS28

Question 35

spinal XR findings in ankylosing spondylitis?

Answer 35

sacroiliitis: subchondral erosions, sclerosis
squaring of lumbar vertebrae
‘bamboo spine’ (late & uncommon)
syndesmophytes: due to ossification of outer fibers of annulus fibrosus

Question 36

what are the “other” features of ankylosing spondylitis?

Answer 36

Apical fibrosis
Anterior uveitis
Aortic regurg
Achilles tendonitis
AV nerve block
Amyloidosis
And cauda equina syndome
arthritis peripherally