passmed ortho/rheum

Question 1

Name 3 features of pagets

Answer 1

bone pain

Raised ALP normal Ca / PO4

Bowing of tibia
Bossing of skull

Question 2

Name 2 comps of pagets

Answer 2

deafness (cranial nerve entrapment)

bone sarcoma (1% if affected for > 10 years)

fractures

skull thickening

high-output cardiac failure

Question 3

Main cause of osteomyelitis? what if sickle cell

Answer 3

s aureus

salmonella

Question 4

Pain on radial side of wrist + sore when thumb flexed across palm ?

Name 2 mx options

Answer 4

de quervains

analgesia

steroid injection

immobilisation with a thumb splint

surgical treatment i

Question 5

x-ray: chondrocalcinosis =?

Answer 5

pseudogout

Question 6

Typical age group = 2-10 years
Acute hip pain associated with viral infection
Commonest cause of hip pain in children
=?

Answer 6

Transient synovitis (irritable hip)

Question 7

typically between the ages of 4-8 years. It is due to avascular necrosis of the femoral head

hip pain: develops progressively over a few weeks
limp
stiffness and reduced range of hip movement
x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening

Answer 7

Perthes disease

Question 8

Typical age group = 10-15 years
More common in obese children and boys
Displacement of the femoral head epiphysis postero-inferiorly

Answer 8

Slipped upper femoral epiphysis

Question 9

triad of joint pain, spiking fevers, and a pink bumpy rash

rheumatoid factor and anti-nuclear antibody are negative

Answer 9

Adult onset stills disease

Question 10

Classically, it is described in male patients as a triad of symptoms:

1. Claudication of the buttocks and thighs
2. Atrophy of the musculature of the legs
3. Impotence (due to paralysis of the L1 nerve)

Answer 10

leriche sydrome

Question 11

Basic use of

Subscapularis
Supraspinatus
Infraspinatus
Teres minor

Answer 11

Subscapularis - Internal rotation

Supraspinatus - first 20 degrees of abduction

Infraspinatus - externa rotation
Teres minor - external rotation

Question 12

Hydroxychloroquinine key monitoring

Answer 12

Visual acuity
- may result in a severe and permanent retinopathy

[HEYEdroxychloroquine]

Question 13

Bone pain / muscle weakness

low calcium and phosphate combined with the raised alkaline phosphatase

Answer 13

osteomalacia

Question 14

Basic features of nerves issues

Femoral
lumbosacral
Sciatic
Obturator

Answer 14

Femoral nerve Weakness in knee extension, loss of the patella reflex, numbness of the thigh

Lumbosacral trunk Weakness in ankle dorsiflexion, numbness of the calf and foot

Sciatic nerve Weakness in knee flexion and foot movements, pain and numbness from gluteal region to ankle

Obturator nerve Weakness in hip adduction, numbness over the medial thigh

Question 15

shortened, internally rotated leg

Answer 15

hip dislocation

Question 16

difficulty dorsiflexing her foot when walking. + post knee op

nerve?

Answer 16

common peroneal

[also because most likely to be injured during knee arthroplasty]

Question 17

1st line OA

Answer 17

paracetamol + topical NSAIDs (if knee/hand) first-line

Question 18

Key antibody in limited systemic sclerosis ?

Answer 18

anti-centromere

Question 19

Raised ALP and raised calcium?

Raised ALP and low calcium?

Answer 19

Bone metastases
•Hyperparathyroidism

Osteomalacia
• Renal failure