MSK

Question 1

What would symmetrical small joint swelling suggest?

Answer 1

Rheumatoid arthritis

Question 2

Name the categories of inflammatory arthritis?

Answer 2

Seropositive
Seronegative
Infectious
Crystal induced

Question 3

Name the seropositive arthritis?

Answer 3

RA
Lupus
Sclerodema 
Vasculitis
Sjorgens

Question 4

Name the seronegative arthritis?

Answer 4

Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
Inflammatory bowel disease arthritis

Question 5

What is the ‘S factor’?

Answer 5

Stiffness
Swelling
Squeezing is painful = an inflammatory arthritis

Question 6

How do we diagnose RA?

Answer 6

History and clinical exam
Inflammatory markers (CRP,plasma viscosity)
Autoantibodies
Imaging

Question 7

Which auto-antibody is most specific for RA?

Answer 7

Anti-CCP antibody

Question 8

Treatment for RA?

Answer 8

Early recognition and diagnosis
Early treatment with DMARDS
Tight control with target of remission Patient education

Question 9

What is the description of uric acid crystals as seen under polarised light microscopy?

Answer 9

Negatively birefringent, needle shaped crystals

Question 10

2 main crystal arthropathies?

Answer 10

Gout 
Pseudogout (Calcium pyrophosphate deposition disease)

Question 11

How does gout present?

Answer 11

Intense pain, redness and swelling

Question 12

How do CPPD uric acid crystals appear?

Answer 12

Rhomboid shaped and weakly positive birefringent

Question 13

Name key features of OA on X-ray?

Answer 13

Loss of joint space
Osteophyte formation 
Subchondral sclerosis
Subchondral cysts
- remember LOSS

Question 14

Which type of arthritis has periarticular erosions?

Answer 14

RA

Question 15

In a patient with fibromyalgia, what blood abnormalities would you expect to see?

Answer 15

No abnormality

Question 16

Would morphine sulfate be a suitable treatment for fibromyalgia?

Answer 16

NO

Question 17

Treatment for fibromyalgia?

Answer 17

Use atypical analgesics (amitriptyline, gabapentin)
Graded exercise programmes
CBT
Paracetamol
NOT STEROIDS

Question 18

What can precipitate fibromyalgia?

Answer 18

Emotional or physical trauma

Question 19

Best investigation when you suspect septic arthritis?

Answer 19

Synovial fluid analysis and culture

Question 20

Symptoms of septic arthritis?

Answer 20

Often a normal joint with previous trauma.

Fever, erythema, warm affected joint. Decreased range fo motion, severe pain when bearing weight

Question 21

What is carpal tunnel syndrome caused by?

Answer 21

Compression of the median nerve as it travels under the flexor retinaculum

Question 22

Why does pregnancy predispose to Carpal Tunnel Syndrome?

Answer 22

Increased oedema causes a narrowing of the carpal tunnel, predisposing entrapment of the median nevrve

Question 23

Symptoms of carpal tunnel syndrome?

Answer 23

Numbness, paresthesia in median nerve distribution (thumb, index, middle and radial half of ring finger)

Question 24

Treatment of CTS?

Answer 24

Splint the wrist or local corticosteroids

Question 25

What are the common sites of compartment syndrome?

Answer 25

Calf Forearm/hand Foot Thigh/buttock

Question 26

Signs of compartment syndrome?

Answer 26

``` Disproportionate pain Pain on passive stretch of compartment. Parasethesia Pallor Pulselessness (late sign) ```

Question 27

Treatment for compartment syndrome?

Answer 27

Fasciotomy

Question 28

Which nerve is most likely to be displaced secondary to a Colle's fracture?

Answer 28

Median

Question 29

What is the most suitable treatment for a displaced distal fibular fracture with talar shift?

Answer 29

Open reduction, internal fixation (ORIF)

Question 30

When would external fixation be used?

Answer 30

Temporary fixation of open injuries or severe soft tissue/bone loss

Question 31

What are the goals of fracture management?

Answer 31

Restore joint surfaces | Restore alignment, length and rotation

Question 32

If the bone is displaced ....

Answer 32

Reduce it (open or closed) and stabilise

Question 33

If the bone isn't displaced and is stable...

Answer 33

Use a splint/cast

Question 34

If the bone isn't displaced but also isn't stable...

Answer 34

Stabilise it with wires

Question 35

How does fat embolism syndrome present>

Answer 35

Hypoxia CNS depression Pulmonary oedema Petechial rash

Question 36

What is fat embolism syndrome?

Answer 36

Caused by inflammatory response to embolised fat globules. Fat and marrow are embolised in the blood stream during acute long bone fracture or intramedullary instrumentation

Question 37

What tests are used to test for ACL injury?

Answer 37

Lachman | ACL draw test

Question 38

What tests are used to test for PCL injury?

Answer 38

Posterior draw test

Question 39

When is dynamic hip screw used?

Answer 39

Extra-capsular fractures

Question 40

What do intra-capsular fractures carry a high risk of?

Answer 40

AVN especially if displaced so are often replaced