MSK random Flashcards
(169 cards)
1
Q
A basketball player suffers a severe tear in his Achilles tendon. What will occur at the site of injury?
A
Fibroblast recruitment for tendon repair
2
Q
Where does hematopoiesis (make new RBC) predominantly occur?
A
Epiphsis
3
Q
The diaphysis is the central shaft of the bone and primarily contains what and for what?
A
yellow bone marrow, serving as a store for fats
4
Q
What method is responsible for the formation of the skull’s flat bones?
A
Intranetbranous ossification
5
Q
What do Volkmann’s canals connect Haversian canals to?
A
Endostenum
6
Q
What is the shaft of a long bone called?
A
Diaphysis
7
Q
What would an increase in calcitonin lead to?
A
Decrease osteoclast activity
8
Q
Growth of long bones originates in what region?
A
Epiphyseal growth plate
9
Q
While crossing the street, Paul is hit by a car and suffers an injury to his knee. Upon screening by a doctor, it is determined that he has torn his anterior cruciate ligament. What two structures does this ligament connect?
A
Femur bone to tibia bone
10
Q
What connective tissue connects bones to bones?
A
ligaments
11
Q
What connects muscles to bone?
A
tendons
12
Q
Loss-of-function mutation in the gene that produces what would lead to an increase in blood calcium levels?
A
Calcitonin
13
Q
What is the cortical bone?
A
periosteum
14
Q
What is bone reabsorbing cells?
A
Osteoclasts
= Break down bone, releasing calcium back into the blood
14
Q
What diseases decrease blood calcium levels?
Parathyroid hormone or calcitonin
A
Calcitonin
15
Q
What is bone forming cells?
A
Osteoblasts
16
Q
Cartilage and synovial fluid decomposition and function deteriorate with age and repeated wear and tear. This describes what?
A
osteoarthritis
17
Q
Synovial fluid proliferation and inflammation. This describes what?
A
RA
18
Q
Deposition of salt crystals eg, uric acid. This describes what?
A
gouty arthritis
19
Q
Where is the infraspinatus located and what is its function?
A
Positioned posteriorly on the superior back
= helps with the external rotation of the shoulder.
19
Q
Where is the subscapularis positioned and what is its function?
A
Positioned anteriorly on the chest
= helps with internal rotation of the shoulder
20
Q
What is the role of the supraspinatus?
A
Located on top of the shoulder
= needed for the first 20° of shoulder abduction
21
Q
What does the teres minor do and where is it located?
A
Located posteriorly on the superior back
= helps with external rotation of the shoulder
22
Q
The process of endochondral ossification is an important means of bone formation
Which term best describes the site at which this process occurs?
A
Metaphysis
23
What are the typical lab values in osteomalacia?
Calcium: Decreased
Phosphate: Decreased
ALP: Increased
PTH: Increased
24
What are the typical lab values in osteoporosis?
Calcium: Normal
Phosphate: Normal
ALP: Normal
PTH: Normal
25
What are the lab values in primary hyperparathyroidism
(leading to osteitis fibrosa cystica)?
Calcium: Increased
Phosphate: Decreased
ALP: Increased
PTH: Increased
26
What are the typical lab values in chronic kidney disease (leading to secondary hyperparathyroidism)?
Calcium: Decreased
Phosphate: Increased
ALP: Increased
PTH: Increased
27
What are the typical lab values in Paget's disease?
Calcium: Normal
Phosphate: Normal
ALP: Increased
PTH: Normal
28
What are the typical lab values in osteopetrosis?
Calcium: Normal
Phosphate: Normal
ALP: Normal
PTH: Normal
29
Which condition is associated with a positive Phalen's sign?
A positive Phalen's sign is associated with carpal tunnel syndrome. This sign is elicited by holding the wrists in full flexion for 60 seconds, which induces numbness or tingling in the fingers
30
What does a positive Froment's sign suggest?
A positive Froment's sign indicates ulnar nerve palsy
= It is tested by asking the patient to grasp a piece of paper between the thumb and index finger. In ulnar nerve palsy, the patient will compensate by flexing the thumb, causing the paper to be pulled out
31
What condition does a positive Finkelstein's sign indicate?
A positive Finkelstein's sign is indicative of De Quervain's tenosynovitis
= It is tested by asking the patient to make a fist with the thumb inside and then deviating the wrist towards the ulnar side. Pain over the radial styloid is considered a positive sign
32
Dactylitis and DIP swelling are characteristic changes of what?
Psoriatic arthritis
33
A 32-year-old man presents to the Emergency Department after sustaining a deep laceration to his right arm from a piece of glass. On examination, there is significant weakness in finger abduction and adduction, as well as sensory loss over the medial aspect of the hand, including the little finger.
He is unable to cross his fingers, and when attempting to flex his wrist, there is a noticeable radial deviation. The patient is also unable to grip objects effectively
What is the most likely location of his injury and the cause?
At the elbow, involving the ulnar nerve
= suggest ulnar nerve palsy
1. Cubital tunnel syndrome
2. Traumatic ulnar nerve injury
3. Ulnar neuropathy
4. medial epicondyle fracture
why?
= (1) Weakness in finger abduction/adduction and inability to cross fingers.
(2) Sensory loss over the little finger and medial hand.
(3) Radial deviation with wrist flexion (due to loss of ulnar flexion)
34
'he has lost the ability to abduct his thumb' suggests what?
Median nerve affected
35
'inability to extend the wrist' suggests what?
Radial nerve affected
36
'weakness of the ring and little fingers' suggests what?
Ulnar nerve affected
37
Lost the ability in - Thumb opposition, flexion, and abduction
What nerve is affected?
median nerve
= mainly via thenar muscles
38
Lost the ability in thumb adduction
What nerve is affected?
ulnar nerve
= adductor pollicis muscle
39
A 52-year-old female presents with weakness and pins and needles in her right hand. On examination, she has wasting of the thenar eminence associated with sensory loss to the palmar aspect of the lateral (radial) three fingers. Which nerve is likely to be affected?
Explain why
Median nerve
= (1) Thenar eminence wasting = median nerve supplies thenar muscles
(2) Sensory loss to the palmar aspect of the lateral three fingers (thumb, index, middle) = classic median nerve distribution
(3) Pins and needles = nerve compression (likely carpal tunnel syndrome)
40
'A 23-year-old man is involved in a fight outside a nightclub and sustains a laceration to his right arm. On examination, he has lost extension of the fingers in his right hand'
What nerve has been affected?
Radial nerve
40
'A 40-year-old lady trips and falls through a glass door and sustains a severe laceration to her left arm. Amongst her injuries, it is noticed that she has lost the ability to adduct the fingers of her left hand'
What nerve has been affected?
Ulnar nerve
41
'A 28-year-old rugby player injures his right humerus and on examination is noted to have a minor sensory deficit overlying the point of deltoid insertion into the humerus'
What nerve has been affected?
Axillary nerve
42
The triceps reflex is mediated by what nerve root?
C7
43
The bicep reflex is mediated by what nerve root?
C6
44
A 42-year-old teacher is admitted with a fall. An x-ray confirms a fracture of the surgical neck of the humerus. Which nerve is at risk?
Axillary
45
'The skin on the palmar aspect of the thumb'
What nerve supplies cutaneous sensation to this region?
Median nerve
46
'The nail bed of the index finger'
What nerve supplies cutaneous sensation to this region?
Median nerve
47
'The skin overlying the medial aspect of the palm'
What nerve supplies cutaneous sensation to this region?
Ulnar nerve
medial side - little finger
lateral side - thumb and median nerve
48
C5 role
Shoulder abduction (deltoid)
Elbow flexion (biceps)
49
C6 role
Elbow flexion (biceps)
Wrist extension (extensor carpi radialis longus)
50
C7 role
Elbow extension (triceps)
Wrist flexion (flexor carpi radialis)
Finger extension (extensor digitorum)
51
C8 role
Finger flexion – flexor digitorum profundus & superficialis
Thumb extension – extensor pollicis longus
51
T1 role
Finger abduction/adduction – interossei muscles
52
Heberden’s nodes are where?
DIPS
53
Bouchard’s nodes are where?
PIPS
54
A 17-year-old boy attends A&E with severe pain in his right elbow following a fall from his bicycle. There is swelling and bruising at the elbow. He also
reports the sensation of pins and needles. Plain radiography shows a fracture of the radius and dislocation of the ulna at the distal radioulnar joint
What is the most likely cause of this presentation?
Galeazzi fracture
55
What tissues in the hand does Dupuytren's contracture primarily affect?
palmar fascia
56
The Simmonds test is used for what?
Achilles tendonitis
57
The Hawkins-Kennedy test is used for what?
assess shoulder impingement
58
The Thomas’ test is used to test what?
fixed flexion deformity of the hip
59
The special test used in clinical examinations for plantar fasciitis is called what?
Windlass test
60
What diseases is this seen in?
= HLA-B27
1. Ankylosing spondylitis
2. Psoriatic arthritis
3. Reactive arthritis
4. IBD-associated arthritis
61
What diseases is this seen in?
= HLA-DR4
1. Rheumatoid arthritis
2. Type 1 diabetes (also DR3)
62
What diseases is this seen in?
= HLA-DR5
1. Pernicious anaemia
2. Hashimoto’s thyroiditis
63
What diseases is this seen in?
= HLA-DR3
1. Type 1 diabetes
2. SLE
3. Addison’s disease
4. Graves’ disease
5. Hashimoto’s thyroiditis (also DR5)
64
What diseases is this seen in?
= HLA-DR2
1. Multiple sclerosis
2. Goodpasture’s syndrome
3. SLE
65
What injury results in a positive Trendelenburg sign?
Superior gluteal nerve
66
An 11-year-old boy is playing football in the park when he falls onto his arm and complains of excruciating pain. An X-ray shows a fracture of the distal third of the radial shaft with dislocation of the radio-ulnar joint.
What is the name given to this type of fracture?
Galeazzi
67
There is a weakness in performing Jobe's test in the right arm.
This suggests damage to where?
Suprascapular nerve
68
The drop arm test is positive in what?
rotator cuff tears
69
A 50-year-old woman presents with heel pain that is worse in the morning and improves with activity. The pain is located at the bottom of the heel, and she has tenderness over the medial calcaneal tuberosity. What is the most likely diagnosis?
Plantar fasciitis
70
What is the most likely cause of "trigger finger"?
Infection of the flexor tendon
71
A 65-year-old man with a history of alcohol abuse presents with severe pain in his big toe, especially at night. His serum urate levels are elevated. What is the most likely diagnosis?
GOUT
72
A 25-year-old woman presents with pain in her knee after playing sports. On examination, there is tenderness over the tibial tuberosity, and she has pain with resisted knee extension. What is the most likely diagnosis?
Osgood-Schlatter disease
73
morning stiffness and elevated ESR/CRP suggest what?
RA
74
An 82-year-old woman falls onto her outstretched hands after not seeing a curb. She immediately cradled her right arm and complained of severe pain. An X-ray in the accident and emergency department has revealed a fracture of the distal end of the radius with dorsal displacement
What is the name of this kind of fracture?
Colles fracture
75
A 62-year-old man presents after his wife commented on the unusual shape of his fingers. On examination, he has a hard swelling adjacent to the distal interphalangeal joint of his right hand with lateral deviation of the finger tip. There is no sensory disturbance, and the swelling is not tender
This suggests what?
Heberden's nodes
76
The patient can plantar flex her foot, which means what?
Achilles tendon is intact
77
A 45-year-old woman presents to the GP with a six-month history of pain in her right heel. She describes the pain as sharp and stabbing, particularly noticeable with the first few steps in the morning or after sitting for a prolonged period. The pain improves somewhat with activity but tends to worsen towards the end of the day, especially after long periods of standing
On examination, there is tenderness over the medial aspect of the heel and along the arch of the foot, but the ankle joint is stable and has a full range of motion
What is the most likely diagnosis?
Plantar fasciitis
78
A 67 year old male patient attends the orthopaedic clinic with a recent neck of femur fracture. He complains that he is unable to extend his left leg backwards. On examination, he leans backwards when the heel of the left foot strikes the ground
What muscle is affected?
Gluteus maximus
79
Injury in the ulnar nerve results in what?
Claw hand
80
A 32-year-old patient presents to the ED after a snowboarding accident with dislocation of the left knee. She has a pale foot.
Which artery is compromised?
Popliteal artery
81
You are in the clinic with your consultant, seeing a 50-year-old man with shoulder pain. The consultant asks the patient to place the back of his hand against the lumbar region of his back.
What muscle of the rotator cuff is needed to bring about this movement?
Subscapularis
82
A 24-year-old man falls and sustains a fracture of his scaphoid bone.
From what area does the scaphoid derive the majority of its blood supply?
From the distal end
83
A middle-aged man presents with pain and numbness in the thumb, index finger and middle finger of his right hand. Which nerve roots are likely to be affected?
C5-T1
84
A 23-year-old woman suffers from recurrent anterior dislocations of her left shoulder. A CT scan reveals a Bankart lesion. This is a lesion of the anterior glenoid labrum. Which rotator cuff muscle tendon is found at the anterior aspect of the shoulder capsule?
Subscapularis tendon
supraspinatus tendon runs superior to the shoulder capsule
85
The scarf test - tests what?
The acromioclavicular joint
86
The empty can test - tests what?
Supraspinatus muscle
87
The lift-off test - tests what?
subscapularis muscle
88
Where on the humerus does the supraspinatus tendon insert?
Greater tubercle of the humerus
89
The scaphoid bone only receives blood supply through what?
The tubercle
90
What are the structures that can pass through the carpal tunnel?
1. Flexor digitorum profundus
2. Flexor digitorum superficialis
3. Flexor pollicis longus
4. Median nerve
91
The axillary nerve supplies the deltoid muscle, as well as what other muscle?
Teres minor
92
All proximal scaphoid pole fractures require what management?
Surgical fixation
93
What treatment is considered if a Dupuytren's contracture occurs and the metacarpophalangeal joints cannot be straightened, and thus the hand cannot be placed flat on the table
surgical
94
A 42-year-old man is reviewed 2 weeks after an injury to his wrist caused by a fall onto outstretched hands. His x-rays reveal a scaphoid fracture.
What sign is most likely found in this diagnosis?
Pain on longitudinal compression of the thumb
95
What innervates the triceps muscle?
Radial nerve C7
96
Explain wrist clawing - ulnar nerve
Worst at the start
97
Explain elbow clawing - ulnar nerve
A bit bad at the start but then worst during recovery the better
98
Hypothenar muscles are controlled by what?
ulnar nerve - little finger
99
What nerve supplies the medial leg and foot?
Saphenous nerve
100
The hamate bone is characterised by what?
hook-like projection at its base and no tenderness at the anatomical snuffbox
101
A 34-year-old male is asked to grasp a piece of paper between his thumb and index finger. He is unable to do this.
Which other action is the patient most likely to struggle with?
Adduction of his fingers
102
In Froment's test, which muscle function is tested?
Adductor pollicis
103
Abductor pollicis longus and Abductor pollicis brevis are responsible for what movements?
abducting the thumb, moving it away from the palm
104
Flexor pollicis longus muscle's main action is to do what?
Flex the thumb
105
A 25-year-old basketball player presents to the Emergency Department after landing awkwardly from a jump. He is complaining of pain and swelling on the lateral side of his foot. The ankle joint is not swollen or painful on palpation. He is unable to bear weight on the affected side.
What is the most likely cause of his symptoms?
Fifth metatarsal fracture
106
Passive movement is preserved in which shoulder injury?
Subacromial Bursitis
107
Ulnar nerve innverates where?
C8–T1
median and radial nerve = C5-T1
108
Damage typically causes abnormal passive abduction of the knee - what stabilises the knee?
medial collateral ligament (MCL)
109
A patient develops loss of knee extension and sensory loss to the anterior and medial aspect of the thigh following a stab injury is a stereotypical history for an injury to which nerve/structure?
Femoral nerve
110
A patient develops tingling and numbness on the outer aspect of the thigh is a stereotypical history for an injury to which nerve/structure?
Lateral cutaneous nerve of the thigh
111
A 45-year-old woman presents to the rheumatology clinic with worsening joint pain. She has a history of longstanding rheumatoid arthritis. Her symptoms have gradually become worse and now stop her from carrying out her activities of daily living.
She has come in today to discuss the option of trying infliximab on the suggestion of her friend, and after having read about it on the internet. She would like to know how it works and how it may help improve her symptoms.
What is the mechanism of action of the drug in question?
Anti-TNF
112
A 35-year-old man with a diagnosis of chronic fatigue syndrome presents to his GP. He has noted a recent exacerbation of his symptoms after he attempted to run a half-marathon. The GP orders routine blood tests.
Assuming that an exacerbation of the patient's current condition is responsible, what results is the GP most likely to find?
Normal ESR, normal haemoglobin
113
A 75-year-old woman presents to the GP with lower back pain. She has a past medical history of rheumatoid arthritis and a previous fragility fracture.
On examination, she is tender on palpation over the L4 and L5 vertebrae.
This is describing what?
OA
114
A 70-year-old retired manual labourer attends his GP practice with the complaint of slowly progressive loss of extension of his 4th and 5th fingers. The doctor also notices nodules between his 4th and 5th fingers.
What is the most likely diagnosis?
Dupuytren's contracture
115
The pathogenesis of osteopetrosis is best explained by which defect?
Osteoclast function
116
What is often the first sign of osteoarthritis?
Reduction in internal rotation
117
What best accounts for the action of PTH in increasing serum calcium levels?
Activation of vitamin D to increase absorption of calcium from the small intestine
118
A 25-year-old male presents to his general practitioner with a 3-month history of polyuria, nocturia, and chronic thirst. He has a past medical history of obsessive-compulsive disorder (OCD), which was diagnosed 3 years ago. A series of investigations were conducted, and the patient was eventually diagnosed with primary polydipsia.
Give the diagnosis. what is this patient's water deprivation test likely to show?
High urine osmolality after both fluid deprivation and desmopressin
119
What is the first-line investigation for a suspected osteoporotic vertebral fracture?
X-ray of the spine
120
A 68-year-old man attends the GP complaining of worsening pain in his right foot. The pain has been getting worse over the past two days, and he now feels generally unwell. He was admitted two weeks ago with an infected arterial ulcer on the base of his right heel and has a history of poorly controlled type 2 diabetes mellitus with a recent HbA1c of 84 mmol/mol. Previously, he was pain-free and had not complained of pain associated with the ulcer.
On examination, there is a deep, circular ulcer on the base of the right heel, and he complains of pain on palpation of the foot, which is swollen compared to the left foot.
What investigation is required for a definitive diagnosis?
Bone bisopy
121
What is the main principles of fracture management if it's displaced?
reduction
122
A 65-year-old woman presents with weakness of the thighs and shoulders leading to difficulty climbing stairs and lifting objects. She has also noticed a purple-coloured rash, most pronounced on her face and affecting the eyelids. On examination, she has itchy and painful papules over the metacarpophalangeal (MCP) joints. She is subsequently diagnosed with dermatomyositis.
What investigation will form part of the next steps in management?
1 in 4 adults with dermatomyositis has an underlying malignancy driving the disease. It is therefore important to fully investigate these patients for malignancy. The easiest and most reliable method of doing this is a
= CT chest/abdomen/pelvis
123
A patient with advanced prostate cancer and bone metastases is offered intravenous zoledronic acid to assist with pain and the presence of bone fractures. Three days after the administration of the drug, the patient presents to the emergency department with body aches, muscle spasms, and tingling around his lips. The patient also mentioned that nausea and vomiting started the day after the infusion, which has since worsened.
What will serum studies likely show in this patient?
hypocaelmia
124
Gottron's papules on the skin mean referral to where?
Rheumatology
125
What electrolyte disturbance is most characteristically caused by bone metastases?
Hypercaelmia
126
What is the next best step in the management of a patient who has ankylosing spondylitis when both ibuprofen and naproxen have failed?
Infliximab
127
A 32-year-old male presents complaining of pain in his buttocks. He explains that this has occurred intermittently for the last few years. He reports that his pain alternates between his buttocks. He is now complaining of new blurred vision and pain in his right eye. There is no evidence of discharge; however, there is evident conjunctival injection
What disease does this suggest?
Ankylosing spondylitis
128
What's better at rest? RA or OA
OA
129
What DMARD drugs are safe in pregnancy?
1. sulfasalazine
2. hydroxychloroquine
130
A 60-year-old woman is diagnosed with rheumatoid arthritis. For the past few months, she has had joint pain, particularly in her hands and feet and worse in the morning. Her past medical history is hypothyroidism, depression and type 2 diabetes. After discussion with the doctor, she is commenced on methotrexate.
What is the most common side effect associated with this drug?
Oral ulceration
131
A 38-year-old woman is reviewed in the rheumatology clinic after suffering from painful swollen fingers for several years. She is found to be positive for the HLA-DR4 serotype.
Which of the following is the most likely diagnosis?
RA
132
Rheumatoid arthritis (RA) usually spares the lumbar and thoracic spine, but can affect what?
Cervical spine - XRAY
133
A 51-year-old female with severe rheumatoid visits the rheumatology clinic. Her disease is severe despite various combinations of DMARDs and a 6-month trial of biologics and claims that her quality of life is very low. Her rheumatologist commences her on long-term prednisolone as a last resort.
Which of the following vaccinations should she not recieve?
MMR - live vaccine shouldn't be given to immunocompromised people. OMG FUCKING GOD THINK BITCH
134
Bilateral means what
symmetrical - RA
135
A 26-year-old male presents to his GP with a one-month history of pain in his left ankle, making it difficult to walk. On further questioning, he also has pain and early morning stiffness lasting 30 minutes in his lower back, which improves with movement and sometimes radiates to his buttocks. He has no other joint pain and no rashes. On examination, his left Achilles tendon is swollen and tender, and pressing on his hips causes pain.
What is this describing, and what is a complication of the likely diagnosis that requires regular screening?
Ankylosing spondylitis
= Osteoporosis
136
Metroxate toxicity causes what side effects?
Mouth sores, fatigue and dyspnoea
137
A 65-year-old male presents to his GP with a 2-month history of muscle weakness affecting his shoulders and hips. He is a current smoker with a 30-pack-year history. On further questioning, he also has shortness of breath on exertion, which has progressively worsened over the past few months.
On examination, he has a purple rash over his eyelids and his muscle power is reduced in his shoulders and hips, though muscle bulk and reflexes are normal. Breath sounds and percussion are normal.
What is the most likely cause of his breathlessness?
ANYTHING MALIGNANT - CANCER
138
A 65-year-old male presents to his GP with a 2-month history of muscle weakness affecting his shoulders and hips. He is a current smoker with a 30-pack-year history. On further questioning, he also has shortness of breath on exertion, which has been getting progressively worse over the past few months.
On examination, he has a purple rash over his eyelids and his muscle power is reduced in his shoulders and hips, though muscle bulk and reflexes are normal. Breath sounds and percussion are normal.
What is the most likely cause of his breathlessness?
Administer 100mg hydrocortisone IV
139
For SS, respiratory involvement suggests what?
Diffuse - SCL-70
140
A raised CRP in a patient with known SLE may indicate what?
Underlying infection
141
Hypertension and renal involvement suggests what antibodies will be positive?
Anti Scl-70 antibodies
142
You have been asked to examine the hands of a 60-year-old lady. On examination, you find that she has a swan neck deformity and ulnar deviation of the fingers with a 'z' deformity of her thumb. She has rheumatoid arthritis.
This condition is an example of which type of hypersensitivity reaction?
3
143
"A boy presents with arm problems after falling from a tree, where he caught a branch to save himself. On examination, he has a claw hand with a hyperextended wrist"
The damage is located where?
Lower trunk of the brachial plexus (C8, T1)
144
"A newborn's arm is noted to be hanging loosely following a difficult forceps delivery. The arm is adducted and internally rotated, with the elbow extended"
The damage is located where?
Upper trunk of the brachial plexus (C5,C6)
145
A 1-year-old child presents with persistent pyrexia and drowsiness. Movement of the right hip causes the child to scream in pain is a stereotypical history of what
Septic arthritis
146
Where is an isolated injury uncommon in?
LCL
147
"Damage may commonly result from skiing and following valgus stress"
What is damaged?
MCL
148
Gout risk factors that would be mentioned in questions that would point to gout rather than pseugout
kidney disease, excess alcohol intake or medications like diuretics
149
First line for diffuse cutaneous systemic sclerosis
ACE inhibitors
150
A patient presents with unexplained thrombosis and recurrent pregnancy loss; given the most likely diagnosis, which of the following clotting tests may be prolonged?
Activated partial thromboplastin time (aPTT)
151
What is Behçet’s disease?
recurrent painful ulcers + eye inflammation + systemic vasculitis
152
AVN risk factors that need to be included in the question
steroids, alcohol, or trauma
NEED TO BE MENTIONED. Also only really affects the hip and wirst
153
Mangement for AVN
Oral NSAIDS
154
Mentions swollen
Septic arthritis
155
"This patient's presentation is suggestive of chronic osteomyelitis. Chronic osteomyelitis develops slowly over months with recurrent pain, which may be subtle, lasting weeks to months"
What is the correct management?
Arrange for surgical removal/ surgery etc
156
A 45-year-old diabetic patient presents to the clinic with a two-week history of significantly increasing pain, redness, and swelling in his left foot. He reports a history of recurrent foot ulcers. Blood tests reveal an elevated white blood cell count and C-reactive protein.
His observations reveal a temperature of 39.8 degrees Celsius. On examination, there is localised redness and tenderness to palpation around a small, punched-out ulcer. There is no discharge or pus visible, and the rest of the leg is not erythematous
What is the most likely cause of his symptoms?
Osteomyelitis
157
Describe staphylococcus aureus
Gram-positive cocci in grape-like clusters
158
A 67-year-old man presents to his GP with pain in his pelvis. During the consultation, he mentions that his friends have been commenting that his head appears larger than before. In addition, he has noticed deterioration in hearing in his left ear.
On neurological examination, a left-sided sensorineural deafness in detected. Closer inspection of the legs reveals bowing of the tibia.
What is the most likely diagnosis?
Pagets u dumb fuck
159
Skin involvement is limited to where in limited cutaneous systemic sclerosis?
face, hands and feet
160
Moth ulcers are present more in which connective tissue disorder?
SLE
161
A 30-year-old Afro-Caribbean woman presents to the accident and emergency department with a 1-week history of progressive shortness of breath and fever. On further questioning, she mentions that her hands have been painful and stiff over the past few months, and she has been having recurrent mouth ulcers. Chest x-ray confirms bilateral pleural effusions and blood tests reveal a raised ESR and a normal CRP.
What is the most likely diagnosis?
SLE
162
Chondrocalcinosis Is seen where?
pseudogout
163
A 23-year-old man presents to the rheumatology clinic with lower back and hip pain. These have been occurring every day for the past two months. Pain and stiffness are worse in the mornings. He also mentions that his right heel has been hurting. He was previously fit and well, but had occasional episodes of lower back pain when he was a teenager.
His symptoms have stopped him from playing tennis. Recent blood tests organised by his GP have shown a raised C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
What is the most appropriate treatment?
NSAID and spinal exercises
164
A 32-year-old man presents to the minor injuries walk-in clinic, complaining of back pain. This had started suddenly that morning after he had lifted a heavy box at home. He mentions that the pain has been shooting down his left leg, and he cannot walk without the support of his friend.
He has not passed urine since the onset of pain. On neurological examination of the lower limbs, tone and power cannot be assessed due to pain, but there are decreased ankle reflexes and a sacral anaesthesia. What is the most appropriate next step?
Arrange urgent MRI
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When DMARDS are not an option, what do you treat RA with?
Tropical NSAIDS
