MSK

Question 1

What is tenosynovitis

Answer 1

• Inflammation of the fluid-filled sheath that surrounds a tendon
• Typically leading to joint pain, swelling, and stiffness

Question 2

In osteomyelitis for how long does an X-ray remain normal looking

Answer 2

The first 10-14 days

Question 3

Regarding osteomyelitis:

• Good disc = ?
• Bad disc = ?

Answer 3

• Good disc = Bad news (tumour)

- Bad disc = Good news (infection)

Question 4

Define ankylosis

Answer 4

Joint stiffness due to abnormal adhesion and rigidity of the bones of the joint

Question 5

Describe the antibiotic part of ortho TB treatment

Answer 5

• Initially = Rifampicin, Isoniazid, Ethambutol for 8 weeks

- Then = Rifampicin + isoniazid for 6-12 months

Question 6

what disease activity score = clinical remission and what score = eligibility for biologic therapy

Answer 6

• DAS <2.4 = clinical remission

- DAS >5.1 = eligibility for biologic therapy

Question 7

Outcome of RA

Answer 7

• Life expectancy shortened by ~7 years

- 50% out of workplace within 2 years of diagnosis

Question 8

Describe the function of the normal synovium

Answer 8

• Maintenance of intact tissue surface
• Lubrication of cartilage
• Control of synovial fluid volume + composition
• Nutrition of chondrocytes within joints

Question 9

4 types of OI

Answer 9

• Type 1 = Milder form, presents when child starts walking (can be present in adults)
• Type 4 = Similar to type 1 but more severe
• Type 11 = Lethal by age 1
• Type 111 = Progressive deforming with severe bone dysplasia + poor growth

Question 10

Treatment of osteoporosis

Answer 10

• Bisphosphonates (oral) (first line)
• Parathyroid Hormone Analog (teriparatide)
• Monoclonal antibody against RANK ligand (Denosumab)
• HRT
• Selective oEstrogen Receptor Modulator (SERM)

Question 11

Why use denosumab and how is it taken

Answer 11

• Subcutaneous injection every 6 months

- Safer in patients with significant renal impairment than bisphosphonates

Question 12

What is enthesitis

Answer 12

Inflammation of the entheses, the sites where tendons or ligaments insert into the bone.

Question 13

What is sacroiliitis

Answer 13

• Inflammation within one, or both, of the sacroiliac joints

- Causes prolonged, inflammatory pain in the lower back region, hips or buttocks

Question 14

What does DMARDs stand for

Answer 14

Disease-modifying antirheumatic drugs

Question 15

What is dactylitis

Answer 15

Inflammation of an entire digit (AKA sausage digit)

Question 16

What is monoarthritis

Answer 16

• Monoarthritis is inflammation of one joint at a time

- Usually caused by trauma, infection, or crystalline arthritis

Question 17

What is oligoarthritis

Answer 17

• Oligoarthritis isthe most common type of juvenile idiopathic arthritis (JIA)
• Often mild and is the most likely to go away and leave little or no damage to your joints.

Question 18

What drugs can cause under excretion of uric acid leading to hyperuricaemia + gout

Answer 18

• Alcohol
• Low dose aspirin
• Diuretics
• Cyclosporin

Question 19

What is tophaceous gout

Answer 19

• A chronic form of gout

- Nodular masses of uric acid crystals (tophi) are deposited in different soft tissues

Question 20

3 rules of lowering uric acid levels

Answer 20

• Wait until the acute attack has settled before attempting to reduced the urate level
• Use prophylactic NSAIDs or low dose colchicine/steroids until urate level normal
• Adjust allopurinol dose according to renal function

Question 21

What is Arthralgia

Answer 21

Joint pain

Question 22

What is Fibromyalgia

Answer 22

-Fibromyalgia is a disorder characterized by widespread MSK pain +fatigue, sleep, memory and mood issues.

Question 23

Commonest form of joint problem

Answer 23

Osteoarthritis

Question 24

What is not recommended by NICE for Rx of OA

Answer 24

• Acupuncture

- Natraceuticals (glucosamine, chondroitin)

Question 25

What are bony swellings on the DIP + PIP called

Answer 25

- DIP = Herberden's nodes (sign of OA) | - PIP = Bouchard's nodes (sign of OA + RA)

Question 26

Contraindication for NSAIDs

Answer 26

- Patients in aspirin | - Active GI ulceration

Question 27

Define a myotome + dermatome

Answer 27

``` -Myotome = A group of muscles that is innervated by a single spinal nerve Dermatome = Area of skin innervated by a single spinal nerve ```

Question 28

Incomplete vs complete spinal injuries

Answer 28

- Complete - no function below injury | - Incomplete - variable function

Question 29

What are the Ottawa rules

Answer 29

For ankle -There is any pain in the malleolar zone AND 1 of the following: -Bone tenderness along the distal 6 cm of the posterior edge of the tibia/fibula or tip of the medial/lateral malleolus, -Inability to bear weight both immediately and in the ED for four steps

Question 30

Cause of Osgood-schlatter's and sever's disease

Answer 30

- Osgood-schlatter's disease = Inflammation of the patellar ligament at the tibial tuberosity - Sever's disease = Growth plate inflammation of the calcaneus

Question 31

How to assess wasting

Answer 31

- Hip problem = Look at gluteal muscles - Knee problem = Look at thigh - Foot/Ankle problem = look at calf

Question 32

Define polyserositis

Answer 32

Inflammation of several serous membranes at the same time

Question 33

Define haemarthrosis

Answer 33

Bleeding into joint spaces

Question 34

What is Mulder's Click

Answer 34

- Mulder’s Sign is a physical exam finding associated with Morton's neuroma, - May be elicited by squeezing the 2metatarsal heads together with 1 hand, while concomitantly putting pressure on the interdigital space with the other hand - Causes pain + audible click

Question 35

What is AVN

Answer 35

Avascular necrosis (e.g. AVN of femoral head seen in untreated SUFE)

Question 36

If a child has symptoms similar to SUFE but is <10yrs/>16yrs what should be considered

Answer 36

-Endocrinopathy e.g. hypothyroidism or growth hormone imbalance

Question 37

Describe the difference of Barlow's and Ortolani's test use in DDH

Answer 37

-Barlow = bad Ortolani = good With baby lying on their back on a bed: -Barlow's = Adduct hip while applying a post. force on the knee (pull leg towards midline + push towards bed) resulting in a dislocation Ortolani's = Abduct hip while applying an ant. force on the femur (pull leg away from midline and pull away from bed) which will reduce the hip joint

Question 38

Describe Galeazzi's sign in DDH

Answer 38

- With knees flexed and heels carefully aligned, the knees are seen at different heights - Implying the femoral (or tibial) segment is short - In an infant this suggests DDH - The shorter one has DDH