MSK / Orthopaedics

Question 1

What is the most sensitive sign for patient with comparment syndrome?

Answer 1

Pain on passive stretching

Question 2

Commonest site for compartment syndrome

Answer 2

leg

Question 3

What is a key symptom of compartment syndrome?

Answer 3

Pain out of proportion (i.e not controlled by morphine)

Question 4

Patient has MSK pain which is out of proportion with injury and not controlled by strong painkillers including morphine, which diagnosis should you suspect?

Answer 4

Compartment syndrome

Question 5

Compartment syndrome 5 signs (5Ps)?

Answer 5

Pain 
Parasthesia
Pulslessness 
Paralysis 
Painful swelling

Question 6

You suspect that a patient may have comparmtnet syndrome, you order a measurement of the compartment pressure. What pressure reading would indicate compartment syndrome diagnosis?

Answer 6

> /= 40 mmHg

Question 7

What is the operative management of compartment syndrome?

Answer 7

Fasciotomy

Question 8

Give the patient demographics typical of polymyalgia rheumatica?

Answer 8

Caucasian Woman >50

Question 9

Is polymyalgia an inflammatory or non-inflammatory MSK condition?

Answer 9

Inflammatory

Question 10

Patient presents with pain across their shoulders and pelvis, it gets worse with movement and is disturbing their sleep. They are stiff for an hour on a morning, feel fatigued and have a low mood.
Likely diagnosis?
Differentials?

Answer 10

Polymyalgia Rheumatica

OA, RA, myositis,
Fibromyalgia, SLE, osteomalacia

Question 11

What is the management of polymyalgia rheumatica?

Answer 11

15mg prednisolone/day

70% improvement in 3-4wks

Question 12

What other inflammatory condition is polymyalgia rheumatica associated with?

Answer 12

GCA

Question 13

Polymyalgia rheumatica patients take long term corticosteroid treatments. Considering this, what additional management measures should be put in place?

Answer 13

Dont STOP
Dont= don’t stop abruptly, risk of adrenal crisis
S= sick day rules
T= treatment card- steroid tx card to alert others
O= OP prophylaxis e.g bisphosphonates, calcium, vit D
P= PPI (corticosteroids increase acid production)

Question 14

In investigation a potential diagnosis of polymyalgia rheumatica the investigations below are carried out. Which differential are they exploring the possiblilty of...
Calcium (high)=
RF=
Calcium (low)=
ANA=
CK=
Urine bence jones proteins=
Anti-CCP=
Serum plasma electrophoresis=
TSH=

Answer 14

Calcium high= cancer / hyperparathyroid
RF= RA
Calcium low= osteomalacia 
ANA= SLE
CK= myositis
Urine bence jones protein= myeloma 
Anti-CCP= RA 
Serum plasma electrophoresis= myeloma 
TSH= hyper / hypothyroidism

Question 15

What does Anti-CCP stand for? It is found in most patients with what condition?

Answer 15

Anti-cyclic citrillunated peptide

Antibody positive in most patients with RA

Question 16

CPK (creatinine phosphokinaze enzyme) is used as a marker of what?

Answer 16

Muscle tissue damage/inflammation to heart / brain

Question 17

What is an EMG

Answer 17

Electromyograph

Measures muscle response / electrical activity in response to nerve stimulation

Question 18

Does hyper or hypokalaemia cause muscle weakness?

Answer 18

Hypokalaemia may present with muscle weakness

Question 19

A dinner fork deformity is a sign of what kind of fracture

Answer 19

Colle’s fracture (fracture of radius from upward displacement of forearm)

Question 20

A complete fracture of the radius resulting from upwards displacement of forearm describes what kind of fracture?

Answer 20

Colle’s fracture

Question 21

Give a primary cause of large, medium, med/small and small vasculitis?

Answer 21

Large= GCA
Medium= Kawasaki
Med/Sml= wegner's granulomatosis 
Small= heoch-shonlein purpura

Question 22

Methotrexate can cause bone marrow suppression, as a result what should we monitor?

Answer 22

Bloods and LFTs

Question 23

Anti-TNF medications are associated with reactivation of which infectious disease? As a result what should you do?

Answer 23

Reactivation of latent TB
Screen for TB with mantoux / CXR / quantiferon

If (+), tx TB 3mo before anti-TNF

Question 24

Describe the pathophysiology of sjogren’s syndrome?

Answer 24

AI condition effecting exocrine glands leading to dry mucous membranes

Question 25

A patient presents complaining of dry eyes, mouth, +/- vagina, what is the suspected diagnosis and what investigations might you carry out?

Answer 25

Sjogren's syndrome (dry eyes, mouth, vagina) | Ix= schirmers test (filter paper under eye lid <10mm significant). anti-ro, anti-la antibodies.

Question 26

What is the management of sjogren's syndrome?

Answer 26

artificial tears, artificial saliva, PV lubricants | Hydroxychloroquine to halt progression

Question 27

Sjogren's syndrome causing dry mucous membranes at the eyes, mouth and vagina. Give 2 potential complications at each site that may occur?

Answer 27

``` Eyes= conjunctivitis / corneal ulcer Mouth= candida / cavities PV= candidiasis / sexual dysfunction ```

Question 28

Both RF and Anti-CCP are associated with RA, which one is more specific for RA and hence a better investigation to confirm diagnosis of RA?

Answer 28

Anti-CCP | 10% pop= RF positive (1% pop= Anti-CCP)

Question 29

RA Mx

Answer 29

DMARD e.g Methotrexate / sulfasalazine Then add hydroxychloroquine If not working move to biologic e.g adalimumab

Question 30

Azothiprine- indication?

Answer 30

SLE

Question 31

Ptx started on methotrexate 6 weeks ago, presents with dry cough, low grade fever, SOB. What resp complication most likely?

Answer 31

Pneumonitis- acute reaction to methotrexate in lungs, most common in first 6 weeks of treatment

Question 32

What is the management of a patient with suspected GCA?

Answer 32

Prednisolone 60mg daily until reviewed by opthalmology/rheumatology

Question 33

What is the management of polymalgia?

Answer 33

Prednisolone 15mg daily

Question 34

Red flags for back pain?

Answer 34

``` Age <16 or >50 NEW pain Hx CA Wt loss Fever Bladder/bowel sx Neuro sx ```

Question 35

Describe a Galeazzi fracture?

Answer 35

Fracture of distal third of radius and dislocation at distal radioulnar joint

Question 36

Describe a monteggia fracture?

Answer 36

Fracture of ulna | Dislocation at proximal radial

Question 37

Most important sign of compartment syndrome?

Answer 37

pain on passive stretch

Question 38

How many and what are the names of the compartments are there in the leg?

Answer 38

``` 4 Anterior Lateral Superficial posterior Deep posterior ```

Question 39

Splinting a fracture helps in what way?

Answer 39

``` Pain relief (fragments no longer movement) Reduces muscle spasms ```

Question 40

Which fracture within elderly population must be fixed within 36hrs?

Answer 40

Hip