MSK Formative Review

Question 1

A complex fracture of the proximal fibula is likely to be associated with which clinical signs in the same lower limb?

a. Numbness of the medial calf
b. Numbness of the sole of the foot
c. Numbness of the medial border of the foot
d.
Numbness between the big and second toe on the dorsum of the foot
e. Numbness of the lateral border of the foot

Answer 1

d. Numbness between the big and second toe on the dorsum of the foot

Question 2

Which clinical finding is most consistently seen in patients suffering from carpal tunnel syndrome?

a. Reduced sensation in the palm of the affected hand
b. Numbness of the tip of the little finger on the volar aspect of the affected hand
c. Weakness in the power of finger abduction in the affected hand
d. Weakness in the power of thumb abduction in the affected hand
e. Weakness of power of DIPJ flexion of the little finger of the affected hand

Answer 2

d. Weakness in the power of thumb abduction in the affected hand
* Carpal tunnel syndrome is caused by pressure on the median nerve. = thumb abduction

Question 3

Which radiological feature is not characteristic of the presence of osteoarthritis affecting a joint?

a. Congruent joint surfaces
b. Presence of peripheral osteophytes
c. Joint space narrowing
d. Sub-chondral sclerosis
e. Sub-chondral cysts

Answer 3

a. Congruent joint surfaces

Question 4

Which clinical history is least likely to predispose to osteoarthritis of the knee?

a. A displaced intra-articular fracture of the distal femur on the same side
b. A mal-united tibial fracture of the tibial shaft on the same side
c. Competition in ultra-marathons over a 20 year period
d. A combined ligamentous injury to the knee with instability
e. A body mass index (BMI) of 23

Answer 4

e. A body mass index (BMI) of 23

Question 5

Which findings might you identify on the same side as compression of the lateral femoral cutaneous nerve?

a. Numbness of the lateral calf
b. Absent knee reflex
c. Weakness of power of extension of the knee
d. Diminished skin sensation on the medial aspect of the thigh
e. Reproduction of symptoms pressing medial to the antero-superior iliac spine (ASIS)

Answer 5

e. Reproduction of symptoms pressing medial to the antero-superior iliac spine (ASIS)
* a

Question 6

Where should an intra-muscular covid vaccination be sited in the buttock in order to minimise the risk of damage to the sciatic nerve?

a. Centrally
b. Supero-lateral
c. Infero-medial
d. Supero-medial
e. Infero-lateral

Answer 6

b. Supero-lateral

Question 7

Which of the following scenarios is least likely to be associated with an isolated axillary nerve palsy?

a. A comminuted fracture of the proximal humerus on the same side
b. An anterior dislocation of the humeral head on the same side
c. Inability to abduct the shoulder on the same side
d. Reduced skin sensation on the same side at the level of the deltoid insertion
e. Normal power of elbow flexion on the same side

Answer 7

e. Normal power of elbow flexion on the same side

Question 8

Which individual is least likely to develop septic arthritis?

a. A neonate following a normal vaginal delivery
b. A healthy 30 year old adult on no medications
c. A patient with rheumatoid disease on disease modifying therapy injections
d. A 70 year old who requires regular courses of oral steroids for asthma exacerbations
e. An 8 year old who has recently had chicken pox

Answer 8

b. A healthy 30 year old adult on no medications

Question 9

Which clinical finding makes you suspect osteomyelitis or septic arthritis in a neonate?

a. Sleeping between feeds
b. Maternal difficulty with initiating breast feeding
c. Not moving a limb (pseudo-paralysis) and wincing when it is moved passively
d. Waking during the night crying
e. Frequent loose stools

Answer 9

c. Not moving a limb (pseudo-paralysis) and wincing when it is moved passively

Question 10

Identify which statement about acute osteomyelitis is incorrect.

a. It is more frequently seen in children than adults
b. If diagnosed early, it is usually treated surgically
c. The infection often has spread from a different site (Haematogenous spread)
d. Often it initially presents with localised pain and few clinical signs
e. Staphylococcus aureus is the most frequent causative organism

Answer 10

b. If diagnosed early, it is usually treated surgically

Question 11

Which feature is most common with an osetoid osteoma?

a. Pain made worse during exercise
b. A strong family history of similar problems
c. Relief of symptoms after administration of Ibuprofen
d. A normal MRI scan of the affected area
e. Continued long-term symptoms after resection

Answer 11

c. Relief of symptoms after administration of Ibuprofen

It isn’t cancer (benign). It remains in the same place it starts. It won’t spread to other bones or parts of your body. The center of an osteoid osteoma is the nidus.

> NSAIDs
-> will resolve

Question 12

Which statement about hip joint anatomy is most accurate?

a. Articular cartilage, if damaged, will slowly regenerate
b. Gluteus medius is inserted into the greater trochanter and is a major hip abductor
c. Short external rotators are the main external rotators of the hip
d. Labrum deepens the acetabulum but does not contribute to stability of the hip joint
e. Ligamentum teres has an important role in hip stability

Answer 12

Gluteus medius is inserted into the greater trochanter and is a major hip abductor

Question 13

Which condition does not increase the risk for AVN of the hip?

a. Alcoholism
b. Systemic steroid use
c. Osteoporosis
d. Irradiation
e. Fracture of the femoral neck

Answer 13

c. Osteoporosis

alcohol = fat deposits, disrupts supply to bone

Question 14

If cauda equina syndrome is diagnosed and surgically treated within 48 hours of onset, which residual symptoms are most unlikely?

a. Ongoing urinary continence issues
b. Persistent numbness in parts of the feet
c. Altered sexual function
d. Persistent weakness of foot and ankle muscles
e. Unresolved sciatica

Answer 14

e. Unresolved sciatica

Question 15

Which structures contribute least to the development of lumbar spinal stenosis?

a. The pre-existing shape of the spinal canal
b. Hypertrophy of the facet joints
c. Calcification of the Anterior longitudinal ligament
d. Hypertrophy of the ligamentum flavum
e. Posterior disc bulging

Answer 15

c. Calcification of the Anterior longitudinal ligament

Question 16

For an adult with an open fracture, which statement is most likely to be correct?

a. The presence of intact dermis excludes this injury
b. This is likely to be the result of a low energy injury
c. If systemic antibiotics are given, complications are unlikely
d. The environment the injury occurs in alters the prognosis for the injury
e. Internal fixation of the fracture is contra-indicated

Answer 16

d. The environment the injury occurs in alters the prognosis for the injury

Question 17

Indicate the single answer that is most likely to be correct. After reducing a forearm fracture a cast, curved in the sagittal plane is applied because:

a. It reduces tension on the intact periosteum more than a straight cast
b. It is less likely to crack than a straight cast
c. It is much easier to apply than a straight cast
d. The peripheral circulation to the limb is improved relative to a straight cast
e. The fracture reduction is more likely to be maintained than in a straight cast

Answer 17

e. The fracture reduction is more likely to be maintained than in a straight cast

Question 18

Which of the following statements is most appropriate to the management of open fractures?

a. They require surgical internal fixation immediately
b. Prompt, appropriate, surgical debridement in theatre is strongly advised
c. In young adults these injuries are often caused by a simple trip indoors
d. Knowledge of previous immunization for tetanus is irrelevant
e. IV antibiotics should be avoided because of C. difficile risk

Answer 18

b. Prompt, appropriate, surgical debridement in theatre is strongly advised

Question 19

An otherwise fit 40 year old man has right, posterior lower limb radicular pain and has undergone an MRI confirming a L5/S1 disc proplapse. Which signs are you most likely to find on examination?

a. A positive femoral stretch test
b. Numbness in the L3 dermatome of the right leg
c. A diminished right knee reflex
d. A positive right sciatic stretch test
e. Grade 4/5 weakness of right knee extension

Answer 19

d. A positive right sciatic stretch test

If the patient experiences sciatic pain, and more specifically pain radiating down the leg (radiculopathy), when the straight leg is at an angle of between 30 and 70 degrees, then the test is positive and a herniated disk is a possible cause of the pain. A negative test suggests a likely different cause for back pain.

Question 20

If you were a GP evaluating a patient with symptoms consistent with acute cauda equina compression, which response is least appropriate?

a. A careful focused examination of lower limb neurology
b. Obtaining an accurate history of the timing of symptom onset
c. Question the patient specifically about perineal and bladder function
d. Examining for altered perineal sensation
e. Making a routine referral to the local spinal service

Answer 20

e. Making a routine referral to the local spinal service

Question 21

A 75 year old man presents with acute sudden onset unilateral headache, scalp tenderness and pain in his jaw on eating on a background of 2-month history of pain and stiffness of the shoulder girdle.

Which of the following investigations would be the most likely to help towards a diagnosis?

a. ESR
b. Rheumatoid factor (RF)
c. CT head
d. Temporal artery biopsy
e. Anti-neutrophil cytoplasmic antibodies (ANCA)

Answer 21

d. Temporal artery biopsy

The clinical hallmarks of polymyalgia rheumatica are pain and stiffness in the shoulder and pelvic girdle.

Question 22

A 50 year old man attends his GP complaining of swelling of his toes. He has just returned from a holiday to celebrate his birthday. He has high blood pressure and his BMI is 32. This is a picture of his foot.

a. Serum urate
b. HLA-B27 status
c. CRP
d. Aspirate joint
e. X-ray foot

Answer 22

d. Aspirate joint

Question 23

A 78 year old healthy woman on no medications, presents acutely with a hot, swollen left knee. She was previously well with only mild knee pain on descending stairs. No other joints are involved. She is struggling to weight bear on her knee.

a. Rheumatoid arthritis
b. Psoriatic arthritis
c. Pseudogout
d. Trauma
e. Osteoarthritis

Answer 23

c. Pseudogout

form of arthritis characterized by sudden, painful swelling in one or more of your joints. These episodes can last for days or weeks. The most commonly affected joint is the knee.

Question 24

A 35 year old Asian computer programmer presented to his GP with widespread muscle pain and weakness, and difficulty rising from his chair. His alkaline phosphatase is elevated at 2000 and serum calcium is just below the reference range.

Which of the following tests would be diagnostic for the underlying cause of his problems?

Answer 24

d. Vitamin D status

Question 25

A 50 year old lady attends her GP. She is concerned that she has osteoporosis as her mother has been diagnosed with this. How should her GP proceed initially?

a. Perform a fracture risk assessment
b. Refer for a bone density scan
c. Explain that she is too young for osteoporosis and ask her to return in 5 years
d. Commence therapy with HRT
e. Commence calcium and Vitamin D supplements

Answer 25

a. Perform a fracture risk assessment

Question 26

A 23 year student sees his GP with a several year history back pain and stiffness. The pain is worse at night, first thing in the morning and if he has been sitting for long periods studying. He is otherwise well apart from a previous episode of a red, painful eye for which he received some steroid eye drops. On examination he has a reduced Schober’s test and is tender over his right sacroiliac joint.

Which investigation would be most helpful in reaching a diagnosis?

a. CRP
b. HLA B27
c. MRI whole spine
d. Anti-CCP antibody
e. Trial of non-steroidal anti-inflammatory medication

Answer 26

c. MRI whole spine

Schober’s test is classically used to determine if there is a decrease in lumbar spine range of motion (flexion), most commonly as a result of ankylosing spondylitis

Question 27

The most important muscle providing plantar flexion of the foot is?

a. Plantaris
b. Tibialis anterior
c. Flexor digitorum longus
d. Gastrocnemius
e. Flexor hallucis longus

Answer 27

d. Gastrocnemius

Question 28

A 40 year old woman attends your surgery complaining of shooting pains in the 3rd web space of her foot made worse by wearing high heeled shoes. Which clinical sign is not consistent with the diagnosis of Morton’s neuroma?

a. Reduced sensation in the 3rd web space
b. Reproduction of symptoms by transverse compression of the metatarsal heads
c. A positive Mulder’s click
d. Slight widening of the space between the 3rd and 4th toes
e. Capillary return of 4 seconds in the toes

Answer 28

e. Capillary return of 4 seconds in the toes

Question 29

In a patient with forefoot pain (metatarsalgia) which conservative measure is likely to be least effective?

a. Advice on types of footwear to avoid
b. Advice to regularly flex and extend the toes
c. Advice on weight loss if BMI >40Kg/M2
d. Advice on activity modification
e. Advise on suitable orthotic insoles

Answer 29

b. Advice to regularly flex and extend the toes

Question 30

A 50 year old diabetic woman presents with a painful clicking sensation at the volar aspect of her ring ringer when flexing the digit. There has been no traumatic episode.

What is the most likely diagnosis?

a. Osteoarthritis of the ring finger metacarpophalangeal joint
b. Dupuytren’s disease
c. A trigger finger
d. A ruptured flexor tendon
e. A flexor tendon sheath ganglion

Answer 30

c. A trigger finger

* female, ring finger, clicking, nil trauma