MSK

Question 1

1st line Rheumatoid arthritis?

Answer 1

Methotrexate - start within 3 months

Question 2

Scaphoid fracture with <0.5mm displacement treatment ?

Answer 2

Short arm cast for 4-6 weeks.

Question 3

Scaphoid fracture with >1.5mm displacement treatment ?

Answer 3

Surgical fixation

Question 4

What finding in patients with low back pain is 70% sensitive for spinal stenosis?

Answer 4

Poor balance.

Question 5

Spinal stenosis symptoms improved in flexion or extension?

Answer 5

forward flexion e.g. bending over shopping cart

Question 6

1st line for fibromyalgia?

Answer 6

Amitriptyline /Duloxetine

Question 7

Pain + paresthesias on posterior forearm, back of hand (dorsal) and wrist/finger extensors means what nerve is injured?

Answer 7

Radial nerve

Question 8

1st line osteoarthritis? PIP + DIP affected?

Answer 8

NSAIDs - topical or oral

Question 9

Treatment of venous stasis ulcers?

Answer 9

Compression e.g. UNNA boots

Question 10

Curative treatment in DeQuervain Tenosynovitis?

Answer 10

Local corticosteroid injection

Question 11

Venous stasis ulcers but distal pulses absent?

Answer 11

Measure ABI - suspected peripheral arterial disease

Question 12

1st line treatment for locking/popping base of thumb or index finger?

Answer 12

Trigger finger -Local corticosteroid injection

Question 13

Shooting pain down leg, +log roll test, pain worse with external rotation of the hip?

Answer 13

Piriformis syndrome - treat with physical therapy

Question 14

Swelling or tenderness along posterior edge of medial malleolus or medial ankle pain that is worse with weight bearing or activity?

Answer 14

Posterior tibial tendinopathy

Eccentric exercise is recommended treatment posterior tibial tendinopathy (non-inflammatory)

Question 15

Treatment of distal radius buckle fracture?

Answer 15

Cock-up wrist splint

Question 16

Tackle injury/collision sport where ring finger affected and unable to flex DIP joint treatment?

Answer 16

Urgent surgical repair - jersey finger; avulsion FDP tendon

Question 17

First line preventative measure for lower back pain?

Answer 17

Core strengthening exercises

Question 18

Tenderness from lateral heel to mid foot?

Answer 18

Peroneal tendinopathy

Question 19

medial ankle pain with burning, tingling, numbness that radiates to medial mid foot?

Answer 19

Tarsal tunnel syndrome

Question 20

Knee pain with locking, pain with rotation of torso while knee held in 20 degrees of flexion (Thessaly maneuver)

Answer 20

Meniscus tear

Question 21

SLE or RA affects what joint?

Answer 21

MCP & PIP

Question 22

Suspect what disease with elevated ALP and bone pain?

Answer 22

Paget disease of bone, order GGT, XR skull, pelvis, tibia

Question 23

Dupuytren contracture - palpable cord in palm

Question 24

Treatment of osteoarthritis with Stage 3-5 CKD?

Answer 24

Acetaminophen-avoid NSAIDs as nephrotoxic

Question 25

The most common cause of lateral hip pain?

Answer 25

greater trochanteric pain syndrome can be caused by gluteus medius tendinopathy or tearing, or iliotibial band friction.

Question 26

What should be considered in patients with greater trochanteric pain syndrome that does not respond to anti-inflammatory medications and physical therapy?

Answer 26

A gluteus medius tendon tear -> MRI

Question 27

Hip and buttock pain as well as sciatica - shooting pain down leg?

Answer 27

Piriformis syndrome - muscle entrapping the sciatic nerve. Treat with physical therapy if no red flags

Question 28

Plantar bruising is a classic sign and should trigger a high index of suspicion for what condition even with negative plain or weight-bearing x-rays

Answer 28

Lisfranc injury - make non–weight bearing status, plus CT or MRI

Question 29

Hip fractures can present with anterior groin pain and the affected extremity is often visually deformed with external rotation, shortening, and abduction. most appropriate next step?

Answer 29

radiography of the hip and pelvis. CT or MRI would be indicated if x-rays were negative but a high suspicion for fracture persists.

Question 30

The most common cause of foot drop is a compression neuropathy of which nerve?

Answer 30

Peroneal nerve (also known as common fibular) nerve.

Question 31

Osteoarthritis - spares what joint?

Answer 31

MCP joint Topical or oral NSAIDs are the most appropriate pharmacotherapy for osteoarthritis of the hand.

Question 32

Rheumatoid arthritis spares what joint?

Answer 32

DIP joint methotrexate is effective for rheumatoid arthritis.

Question 33

Most patients are diagnosed after an incidental finding of elevated alkaline phosphatase (ALP) on routine laboratory studies or by plain films performed for another reason.

Answer 33

Paget disease of bone gamma-glutamyl transaminase level should be performed to evaluate for hepatobiliary pathology. If negative, this should be followed by plain radiography of the skull and tibia,

Question 34

Treatment

Answer 34

Bisphosphonates are the first-line treatment in active disease, which is signified by bone pain, hearing loss, and lytic lesions.