1
Q
What is the mechanism of a type I hypersensitivity reaction?
A
Antigen reacts with IgE bound to mast cells
2
Q
Give 2 examples of a type I hypersensitivity reaction
A
- Anaphylaxis
- Atopy
3
Q
What is the mechanism of a type II hypersensitivity reaction?
A
IgG or IgM binds to antigen on cell surface
4
Q
Give 3 examples of a type II hypersensitivity reaction
A
- Autoimmune haemolytic anaemia
- ITP
- Goodpasture’s syndrome
- Pernicious anaemia
- Acute haemolytic transfusion reactions
- Rheumatic fever
- Pemphigus vulgaris / bullous pemphigoid
5
Q
What is the mechanism of a type III hypersensitivity reaction?
A
Free antigen and antibody (IgG, IgA) combine
6
Q
Give 3 examples of a type III hypersensitivity reaction
A
- Serum sickness
- Systemic lupus erythematosus
- Post-streptococcal glomerulonephritis
- Extrinsic allergic alveolitis (especially acute phase)
7
Q
What is the mechanism of a type IV hypersensitivity reaction?
A
T-cell mediated
8
Q
Give 3 examples of a type IV hypersensitivity reaction
A
- Tuberculosis / tuberculin skin reaction
- Graft versus host disease
- Allergic contact dermatitis
- Scabies
- Extrinsic allergic alveolitis (especially chronic phase)
- Multiple sclerosis
- Guillain-Barre syndrome
9
Q
What is the most appropriate management for the following injury:
A 24-year-old man falls sustaining an inversion injury to his ankle. On examination he is tender over the lateral malleolus only. On x-ray there is a fibular fracture that is distal to the syndesmosis.
A
Application of below knee plaster cast to include the midfoot
10
Q
What is the most appropriate management for the following injury:
An 86-year-old lady stumbles and falls whilst opening her front door. On examination her ankle is swollen with both medial and lateral tenderness. X rays demonstrate a fibular fracture at the level of the syndesmosis.
A
Application of below knee plaster cast to include the midfoot
11
Q
What is the most appropriate management for the following injury:
A 25-year-old man suffers an injury whilst playing rugby involving a violent twist to his left lower leg. On examination both malleoli are tender and the ankle joint is very swollen. On x-ray there is a spiral fracture of the fibula and widening of the ankle mortise.
A
Surgical fixation
12
Q
What is the most likely diagnosis:
- Most common primary malignant bone tumour in children
- Commonly affects the metaphyseal region of long bones
- Radiographs classically show Codman triangle (a triangular area of new subperiosteal bone)
A
Osteosarcoma
13
Q
Describe the clinical presentation of psoriatic arthritis
A
- Asymmetrical polyarthritis with >30 minutes of morning stiffness
- Typically affects the hands and feet
- Sacroiliitis
- DIP joint disease and dactylitis
- Psoriatic skin lesions
14
Q
Name the antibody associated with lung fibrosis in myositis
A
Anti-Jo1 antibodies
15
Q
How would you manage a flare of gout in a patient who is already on prophylactic treatment?
A
Continue allopurinol and commence colchicine
(allopurinol should be continued during an acute attack in patients presenting with an acute flare of gout who are already established on treatment)
16
Q
What is the most likely diagnosis in a patient presenting with bone pain, tenderness, and proximal myopathy (→ waddling gait)?
A
Osteomalacia
17
Q
How long must the symptoms of chronic fatigue syndrome be present before making a diagnosis?
A
3 months
18
Q
Name 3 adverse effects of bisphonates
A
- Oesophageal reactions
- Osteonecrosis of the jaw
- Increased risk of atypical stress fractures
19
Q
Which patient group are more at risk of osteonecrosis of the jaw when taking bisphonates?
A
Greater risk for patients receiving IV bisphosphonates in the treatment of cancer
20
Q
What is the first line treatment for SLE?
A
Hydroxychloroquine
21
Q
True/false: creatine kinase levels are elevated in temporal arteritis
A
False
22
Q
A 72-year-old man is brought to the Emergency Department after falling at his nursing home. On arrival he complains of pain in the left hip.
What is the diagnosis?
A
Left subcapital fracture
23
Q
What patient factors are accounted for in a Z-score (DEXA scan)?
A
Age, gender, ethnicity
24
Q
What is the most appropraite management for a non-displaced patella fracture with an entact extensor mechanism (can perform straight leg raise)?
A
Conservative management with knee immobilisation
25
What drug is given to patients with systemic sclerosis following a renal crisis to prevent further renal complications?
ACE inhibitors
26
What is the drug treatment for moderate/severe psoriatic arthropathy?
Methotrexate
27
What are the motor functions of the femoral nerve?
Knee extension, thigh flexion
28
What are the sensory functions of the femoral nerve?
Sensation of the anterior and medial aspect of the thigh and lower leg
29
What are the typical mechanisms of injury to the femoral nerve?
* Hip and pelvic fractures
* Stab/gunshot wounds
30
What is the motor function of the obturator nerve?
Thigh adduction
31
What is the sensory function of the obturator nerve?
Sensation of the medial thigh
32
What is the typical mechanism of injury of the obturator nerve?
Anterior hip dislocation
33
What is the sensory function of the lateral cutaneous nerve of the thigh?
Sensation of the lateral and posterior surfaces of the thigh
34
What is the typical mechanism of injury of the lateral cutaneous nerve of the thigh?
Compression of the nerve near the ASIS → meralgia paraesthetica, a condition characterised by pain, tingling and numbness in the distribution of the lateral cutaneous nerve
35
What are the motor functions of the tibial nerve?
Foot plantarflexion and inversion
36
What is the sensory function of the tibial nerve?
Sensation of the sole of the foot
37
What are the typical mechanisms of injury to the tibial nerve?
* Not commonly injured as deep and well protected
* Popliteral lacerations, posterior knee dislocation
38
What are the motor functions of the common peroneal nerve?
Foot dorsiflexion and eversion, extensor hallucis longus
39
What are the sensory functions of the common peroneal nerve?
Sensation to the dorsum of the foot and the lower lateral part of the leg
40
What are the typical mechanisms of injury to the common peroneal nerve?
* Injury often occurs at the neck of the fibula
* Tightly applied lower limb plaster cast
* Injury causes foot drop
41
What is the motor function of the superior gluteal nerve?
Hip abduction
42
What are the typical mechanisms of injury of the superior gluteal nerve?
* Misplaced intramuscular injection
* Hip surgery
* Pelvic fracture
* Posterior hip dislocation
43
Injury to which nerve results in a positive Trendelenburg sign?
Superior gluteal nerve
44
What is the motor function of the inferior gluteal nerve?
Hip extension and lateral rotation
45
What is the typical mechanism of injury of the inferior gluteal nerve?
* Generally injured in association with the sciatic nerve
* Injury results in difficulty rising from seated position → can't jump, can't climb stairs
46
What is the preferred surgical management for an intertrochanteric (extracapsular) proximal femoral fracture?
Dynamic hip screws
47
When starting treatment with bisphonates, what must be corrected first?
Hypocalcemia/vitamin D deficiency
48
Name 3 causes of dactylitis (inflammation of a digit)
* Spondyloarthritis: e.g. psoriatic and reactive arthritis
* Sickle-cell disease
* Other rare causes include tuberculosis, sarcoidosis and syphilis
49
A 56-year-old man undergoes a low anterior resection with legs in the Lloyd-Davies position. Post operatively he complains of foot drop.
What nerve has likely been injured?
Peroneal nerve
50
A 23-year-old man complains of severe groin pain several weeks after a difficult inguinal hernia repair.
What nerve has likely been injured?
Ilioinguinal nerve
51
A 72-year-old man develops a foot drop after a revision total hip replacement.
What nerve has likely been injured?
Sciatic nerve
52
What are the Ottawa Rules for ankle x-rays?
An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:
* Bony tenderness at the lateral malleolar zone
* Bony tenderness at the medial malleolar zone
* Inability to walk four weight-bearing steps
53
A woman with Crohn's on azathioprine presents with a 3-day history of fever, lethargy, and coryzal symptoms. What is the most important investigation?
FBC - may cause myelosuppression
54
IVDU with infective endocarditis also has back pain. What is the diagnosis?
Discitis
55
6-year-old boy with a limp. His parents report that this has been getting steadily worse over the past few weeks. He complains of pain in the right groin/hip region. An x-ray shows widening of the right hip joint space with flattening of the femoral head.
What is the most likely diagnosis?
Perthes disease
56
A 7-year-old boy is brought in by his mother. For the past day he has felt generally unwell with a headache and nausea. This morning he complained of pain in his right hip and now just able to walk with a limp. On examination flexion, extension and rotation of the hip is painful and limited. Examination of the ears, throat and chest is normal. His temperature is 38.2ºC.
What is the most likely diagnosis?
Septic arthritis
57
4-year-old girl with a three month history of a limp. Her parents report that she has 'not been right' for a few weeks now. She typically complains of pain in her left hip and right knee in the morning which gets better during the day.
What is the most likely diagnosis?
Juvenile idiopathic arthritis
58
What is the management of an extracapsular hip fracture?
Intramedullary device
59
What are the typical features of antiphospolipid syndrome?
Arterial/venous thrombosis, miscarriage, livedo reticularis
60
What is the most useful rule out test for SLE?
ANA - over 99% of patients with SLE are ANA positive
61
What pre-op imaging should you perform on a patient with a medical history of rheumatoid arthritis
Anteroposterior and lateral cervical spine radiographs - to screen for atlantoaxial subluxation
62
What examinations make up the Simmonds' triad (Achilles tendon rupture)?
Palpation, examining the angle of declination at rest and the calf squeeze test
63
What nerve is commonly injured following a posterior hip dislocation?
Sciatic nerve
64
What is the name given to the following fracture pattern:
* Transverse fracture of the radius
* 1 inch proximal to the radio-carpal joint
* Dorsal displacement and angulation
Colles' fracture
65
What is the name given to the following fracture pattern:
* Volar angulation of distal radius fragment (Garden spade deformity)
* Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed
Smith's fracture (reverse Colles' fracture)
66
What is the name given to the following frature pattern:
Intra-articular fracture at the base of the thumb metacarpal
Bennett's fracture
67
What is the name given to the following fracture pattern:
Dislocation of the proximal radioulnar joint in association with an ulna fracture
Monteggia's fracture
68
What is the name given to the following fracture pattern:
Radial shaft fracture with associated dislocation of the distal radioulnar joint
Galeazzi fracture
69
Describe the clinical presentation of osteochondritis dissecans
Knee pain after exercise, locking and 'clunking'
70
What is the next stage in management for a rib fracture not controlled by normal analgesia?
Nerve blocks
71
What are the motor functions of the musculocutaneous nerve (C5-C7)?
Elbow flexion (supplies biceps brachii) and supination
72
What is the sensory function of the musculocutaneous nerve (C5-C7)?
Sensation to the lateral part of the forearm
73
What is the typical mechanism of injury of the musculocutaneous nerve (C5-C7)?
Isolated injury rare - usually injured as part of brachial plexus injury
74
What is the motor function of the axillary nerve (C5,C6)?
Shoulder abduction (deltoid muscle)
75
What is the sensory function of the axillary nerve (C5,C6)?
Sensation to the inferior region of the deltoid muscle
76
What is the typical mechanism of injury of the axillary nerve?
* Humeral neck fracture/dislocation
* Results in flattened deltoid
77
What is the motor function of the radial nerve (C5-C8)?
Extension (forearm, wrist, fingers, thumb)
78
What is the sensory function of the radial nerve (C5-C8)?
Sensation to a small area between the dorsal aspect of the 1st and 2nd metacarpals
79
What is the typical mechanism of injury to the radial nerve (C5-C8)?
* Humeral midshaft fracture
* Palsy results in wrist drop
80
What is the motor function of the median nerve (C6, C8, T1)?
LOAF muscles
81
What is the sensory function of the median nerve (C6, C8, T1)?
Sensation to the palmar aspect of lateral 3½ fingers
82
What is the typical mechanism of injury of the median nerve (C6, C8, T1)?
Wrist lesion → carpal tunnel syndrome
83
What are the motor functions of the ulnar nerve (C8, T1)?
* Intrinsic hand muscles except LOAF
* Wrist flexion
84
What is the sensory function of the ulnar nerve (C8, T1)?
Medial 1½ fingers
85
What is the usual mechanism of injury of the ulnar nerve (C8, T1)?
* Medial epicondyle fracture
* Damage may result in a 'claw hand'
86
What is the motor function of the long thoracic nerve (C5-C7)?
Serratus anterior
87
What is the usual mechanism of injury to the long thoracic nerve (C5-C7)?
* Often during sport e.g. following a blow to the ribs
* Also possible complication of mastectomy
* Damage results in a winged scapula
88
What features would point to a diagnosis of spinal stenosis over peripheral arterial disease?
* Pain improving on sitting down or crouches down
* Weakness of the leg
* Lack of smoking history
* Lack of cardiovascular history
89
Describe the clinical features of a dorsal column lesion
* Loss vibration and proprioception
* Tabes dorsalis, SACD
90
Describe the clinical features of a spinothalamic tract lesion
Loss of pain, sensation and temperature
91
Describe the clinical features of a central cord lesion
Flaccid paralysis of the upper limbs
92
Describe the clinical features of spinal cord infarction
Dorsal column signs (loss of proprioception and fine discrimination
93
Describe the clinical features of cord compression
* UMN signs
* Malignancy
* Haematoma
* Fracture
94
Describe the clinical features of Brown-sequard syndrome
* Hemisection of the spinal cord
* Ipsilateral paralysis
* Ipsilateral loss of proprioception and fine discrimination
* Contralateral loss of pain and temperature
95
Describe the clinical findings of a clubfoot
Inverted + plantar flexed foot which is not passively correctable
96
Describe the clinical features of chondromalacia patellae
* Teenage girls, following an injury to knee e.g. dislocation patella
* Typical history of pain on going downstairs or at rest
* Tenderness, quadriceps wasting
97
What is the management of subluxation of the radial head?
Passive supination of the elbow joint whilst flexed to 90 degrees
98
What lab values are assocaited with osteoporosis?
All values normal
99
What lab values are associated with osteomalacia?
* Calcium: decreased
* Phosphate: decreased
* ALP: increased
* PTH: increased
100
What values are associated with primary hyperparathyroidism?
* Calcium: increased
* Phosphate: decreased
* ALP: increased
* PTH: increased
101
What lab values are associated with chronic kidney disease?
* Calcium: decreased
* Phosphate: increased
* ALP: increased
* PTH: increased
102
What lab values are associated with Paget's disease?
* Calcium: normal
* Phosphate: normal
* ALP: increased
* PTH: normal
103
What lab values are associated with osteopetrosis?
All lab values normal
104
What is the next stage in management of a patient with ankylosing spondylitis who has not responded to NSAIDs?
TNF-alpha blockers such as infliximab and etanercept
105
What clinical findings suggest metastatic tumour to bone?
* Increasing pain at rest
* Increased serum calcium and alkaline phosphatase
106
What investigation is needed in discitis due to Staphylococcus?
Echo - look for endocarditis
107
What are the red flags for back pain?
* Age < 20 years or > 50 years
* History of previous malignancy
* Night pain
* History of trauma
* Systemically unwell e.g. weight loss, fever
108
What advice should be given to patients taking oral bisphonates?
Oral bisphosphonates should be swallowed with plenty of water while sitting or standing on an empty stomach at least 30 minutes before breakfast (or another oral medication); the patient should stand or sit upright for at least 30 minutes after taking
109
What antibodies are associated with SLE?
* ANA
* Anti-dsDNA
* Anti-Smith
110
Describe the clinical features of diffuse systemic sclerosis
* Scleroderma affects trunk and proximal limbs predominately
* Tthe most common cause of death is now respiratory involvement, which is seen in around 80%: interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH)
111
Describe the clinical features of limited cutaneous systemic sclerosis
* Raynaud's may be the first sign
scleroderma affects face and distal limbs predominately
* A subtype of limited systemic sclerosis is CREST syndrome: Calcinosis, Raynaud's phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia
112
What is the most likely diagnosis n a child with an asymptomatic, fluctuant swelling behind the knee?
Baker's cyst
113
List some of the causes of carpal tunnel syndrome
* Idiopathic
* Pregnancy
* Oedema e.g. heart failure
* Lunate fracture
* Rheumatoid arthritis
114
What are the typical findings on joint aspirate seen in septic arthritis?
* High WBC count, predominantly PMNs
* Appearance is typically yellow and cloudy with absence of crystals
115
What is the most appropriate management for an acute flare of rheumatoid arthritis?
Intramuscular steroids such as methylprednisolone (+ referral to rheumatology)
116
A 34-year-old man presents with pain after falling onto his backward stretching right hand. On examination the right shoulder contour is flattened and a small bulge is felt below the right clavicle. You also note that there is a small patch of anaesthesia over the distal attachment of the deltoid muscle.
What injury would explain all the examination findings?
Anterior shoulder dislocation → damage to the axillary nerve
117
Marfan's syndrome is characterised by a mutation in which protein?
Fibrillin-1
118
What does a T score of -2.5 mean?
Bone density 2.5 standard deviations below that of an average healthy young adult
Also the cut off for osteoporosis
119
What HLA is associated with psoriatic arthritis?
HLA B27
120
What is the most common reason total hip replacements need to be revised?
Aseptic loosening
121
This 60-year-old woman who is being treated for heartburn comes for review. She has developed some spots on her lips. What is the most likely diagnosis?
CREST syndrome
122
What is the management of Achilles tendonitis?
Rest, NSAIDs, and physio if symptoms persist beyond 7 days
123
Describe the clinical features of iliotibial band syndrome
* Common cause of lateral knee pain in runners
* Presents with tenderness 2-3cm above the lateral joint line
124
Describe the clinical features of facet joint pain
* May be acute or chronic
* Pain worse in the morning and on standing
* On examination there may be pain over the facets
* The pain is typically worse on extension of the back
125
Describe the x-ray findings seen in AS
* Sacroiliitis
* Squaring of lumbar vertebrae (bamboo spine)
* Syndesmophytes
126
What is Phalen's test?
* Phalen's test is used to asses carpal tunnel syndrome
* The patient's wrist is held in maximum flexion (reverse prayer sign) for 30-60 second
* The test is positive if there is numbness in the median nerve distribution
127
What are the extra-articular features of AS?
* Apical fibrosis
* Anterior uveitis
* Aortic regurgitation
* Achilles tendonitis
* AV node block
* Amyloidosis
128
True/false: back pain in AS usually improves with exercise
True
129
What nerve is commonly injured in a Colles' fracture?
Median nerve - may result in weakness or loss of thumb or index finger flexion
130
What is the initial imaging modality of choice for suspected Achilles tendon rupture?
Ultrasound
131
Describe the management of compartment syndrome
Definitive management involves prompt and extensive fasciotomies
Pre-op:
* Keep limb level with the body
* Intravenous fluids
* Pain control
132
What is the most common site of metatarsal stress fractures?
2nd metatarsal shaft
133
What is the first line drug for lower back pain?
NSAID
134
Describe the management of a prolapsed disc
Analgesia and physiotherapy (MRI unlikely to change management)
135
What is the likely diagnosis?
Severe osteoarthritis
136
What antibody may be positive in UC, but will likely be negative in Crohn's?
pANCA
137
What drugs are associated with drug-induced lupus?
* Procainamide
* Hydralazine
* Isoniazid
* Minocycline
* Phenytoin
138
What imaging should be performed in all patients with rheumatoid arthritis?
X-rays of the hands and feet
139
What investigation can best support a diagnosis of AS?
Pelvic X-ray - sacro-ilitis
140
What treatment should be given to a patient aged over 75 who have sustained a fragility fracture?
Started immediately on oral bisphonate (no need for DEXA scan)
141
Describe the clinical features of adhesive capsulitis
Impairment of external rotation (on both active and passive movement)
142
Patient with rheumatoid arthritis has previously had a reaction to co-trimoxazole. What drug should not be prescribed?
Sulfasalazine
143
Patient with hot swollen joint. X-ray reveals calcification of the fibrocartilage. What is the diagnosis?
Pseudogout
144
How do posterior hip dislocations present?
Shortened and internally rotated leg
145
What is the most common adverse effect of interferon-alpha?
Flu-like symptoms
146
Normal MOI for anterior shoulder dislocation?
FOOSH
147
Normal MOI for posterior shoulder dislocation?
Seizures and electric shock
148
Low serum calcium, low serum phosphate, raised ALP and raised PTH.
What is the diagnosis?
Osteomalacia
149
A 75-year-old man presents with lower back pain that comes on when he walks. After taking a full history and completing a neurological and vascular examination which is normal a diagnosis of spinal stenosis is suspected. After prescribing analgesia, what is the most appropriate next step?
Refer for MRI
150
What is the most specific test for SLE?
Anti-dsDNA
151
What are the Ottowa ankle rules?
Bony tenderness over the malleoli zones OR an inability to walk four weight-bearing step
152
A 40-year-old woman presents to your clinic complaining of a recent onset of mouth and genital ulcers, alongside a reddening of her eyes. You suspect a diagnosis of Behcet's syndrome.
What dermatological finding would most support your diagnosis?
Erythema nodosum
153
A 13-year-old boy presents to his general practitioner with a 3-month history of a growing lump on the posterior aspect of his right arm, which has become extremely painful over the last two weeks. A shoulder radiograph is ordered, which identifies a lytic lesion in the diaphysis of the right humerus with an 'onion skin' appearance.
What is the most likely diagnosis?
Ewing's sarcoma
154
'Plantar spur' and 'pencil and cup' deformity are associated with what condition?
Psoriatic arthritis
155
Carpometacarpal and distal interphalangeal joint involvement is characteristic of what condition?
Hand osteoarthritis
156
Treatment of patients with anti-phospholipid syndrome who haven't had a thrombosis previously?
Low-dose aspirin
157
What investigation is important to perform before starting biologics (e.g. adalimumab)?
CXR - TB
158
How long after precipitating infection can reactive arthritis present?
Up to 4 weeks
159
Name 4 causes of AVN of the hip
* Long-term steroid use
* Chemotherapy
* Alcohol excess
* Trauma
160
What is the mode of inheritence of Marfan's syndrome?
Autosomal dominant
161
A 14-year-old boy jumps off a 10 foot wall and lands on both feet. An x-ray shows a bimalleolar fracture of the right ankle.
What name is given to this fracture?
Pott's
162
A 73-year-old woman presents with pain in her wrist after falling on to an outstretched hand. On examination there is dorsal displacement and angulation.
An x-ray shows a transverse fracture of the radius around 2 cm proximal to the radio-carpal joint.
What is the name given to this fracture?
Colles'
163
What examination findings are associated with lateral epicondylitis?
Pain worse on resisted wrist extension/suppination whilst elbow extended
164
What is the most common cardiac manifestation of SLE?
Pericarditis
165
A patient presents with numbness and tingling along the ulnar border of his wrist and forearm. On examination you also note weak flexion of all the digits including the thumb.
What is the most likely diagnosis?
C8 radiculopathy
166
What is the imaging modality of choice for osteomyelitis?
MRI
167
A 75-year-old female was recently started on alendronate for treatment of osteoporosis following a fragility fracture. She returns to your clinic as she has suffered troubling upper gastrointestinal side effects. What is the most appropriate next step in her management?
Change aldendronate to risedronate or etidronate
168
What is the investigation of choice for psoas abscess?
CT abdomen
169
What is the method of choice for patients with good pre-morbid status with an intracapsular NOF fracture?
Internal fixation
170
Suspected hip fracture, x-rays negative. Next line imaging?
MRI
171
What is iliotibial band syndrome?
Common cause of lateral knee pain in runners, presenting with tenderness 2-3cm above the lateral joint line
172
A 50-year-old man is admitted after falling from scaffolding. He has an open fracture of his tibia with a 15 cm wound. He is neurovascularly intact. What is the best initial course of action?
IV antibiotics, photography, and application of saline soaked gauze with impermeable dressing
173
How would posterior dislocation of a THR present?
'Clunk', leg shortening and internal rotation
174
Ankle fracture, absent pulses. What do you do?
Immediately reduce fracture
175
When should allopurinol prophylaxis be offered to patients with gout?
After first attack
176
Name 2 conditions which are risk factors for pseudogout
Hyperparathyroidism
Haemachromatosis
177
What DEXA scan T score is diagnostic of osteoporosis?
< - 2.5
178
What antibodies are associated with drug-induced lupus?
Anti-histone
179
What is Leriche syndrome?
Atherosclerotic occlusive disease involving the abdominal aorta and/or both of the iliac arteries
* Claudication of the buttocks and thighs
* Atrophy of the musculature of the legs
* Impotence (due to paralysis of the L1 nerve)
180
What is the most specific marker for rheumatoid arthritis?
Anti-CCP
181
What is the management of a grade 1-2 AC joint injury?
Conservative with resting and a sling
182
Systemic vasculitic symptoms in the presence of hepatitis B signs and in the absence of pulmonary symptoms/signs?
Polyarteritis nodosa
183
What fractures are most assocaited with compartment syndrome?
Supracondylar and tibial shaft fractures
184
What autoantibodies are associated with limited systemic sclerosis?
Anti-centromere
185
What drug can cause pancytopenia if prescribed with methotrexate?
Co-trimoxazole
186
Can hydroxychloroquine be used during pregnancy?
Yes
187
What part of the bone is most commonly affected in osteomyelitis in children?
Metaphysis
188
How is osteomalacia managed?
Vitamin D supplementation
189
After a ____ ____ period for oral bisphosphonates (three years for IV zoledronate), treatment should be re-assessed for ongoing treatment, with an updated FRAX score and DEXA scan.
Five year
190
List the poor prognostic features of rheumatoid arthritis
* Rheumatoid factor positive
* Anti-CCP antibodies
* Poor functional status at presentation
* X-ray: early erosions (e.g. after < 2 years)
* Extra articular features e.g. nodules
* HLA DR4
* Insidious onset
191
New diagnosis of RA. What is the most appropriate initial therapy?
Methotrexate plus short oral course of prednisolone
192
How would you manage acute flares of rheumatoid arthritis?
IM steroids
193
What type of hypersensitivity is SLE?
Type III
194
What is the first-line investigation for a suspected osteoporotic vertebral fracture?
X-ray spine
195
Swelling at the DIP joints (Heberden's nodes) is a feature of?
Osteoarthritis
196
What blood test must be carried out before starting azathioprine?
Check thiopurine methyltransferase deficiency (TPMT)
197
Fracture through the physis only (x-ray often normal)
This is Salter-Harris type?
I
198
Fracture through the physis and metaphysis
This is Salter-Harris type?
2
199
Fracture through the physis and epiphysis to include the joint
This is Salter-Harris type?
III
200
Fracture involving the physis, metaphysis and epiphysis
This is Salter-Harris type?
IV
201
Crush injury involving the physis (x-ray may resemble type I, and appear normal)
This is Salter-Harris type?
V
202
What is the diagnosis?
Green stick fracture
A green-stick fracture involves an incomplete fracture usually at the shaft of a long bone (as seen here in the radius and ulna). It is caused by a bending-type mechanism of injury
203
Patient diagnosed with dermatomyositis. What investigation will form part of the next steps in management?
CT chest/abdo/pevis - dermatomyositis is commonly a paraneoplastic phenomenon
204
What should be prescribed when starting allopurinol?
NSAID or colchicine 'cover'
205
What is the most useful rule out test for SLE?
ANA
206
What investigation is indicated in a patient with suspected cauda equina syndrome?
Urgent MRI spine
207
Name 3 causes of bilateral carpal tunnel syndrome
* Pregnancy
* Obesity
* Rheumatoid arthritis
208
What drug should be used to treat acute gout if NSAIDs are contraindicated for example a peptic ulcer?
Colchicine
209
What is the usual presentation of a meniscal tear?
* Twisting injury
* Pain worse on straightenig knee
* Knee may 'give way'
* Knee locking
* Tenderness along joint line
210
What is the most appropriate imaging modality to diagnose meniscal tears?
MRI
211
A 28-year-old man falls onto an outstretched hand. On examination there is tenderness of the anatomical snuffbox. However, forearm and hand x-rays are normal.
Next step in management?
Discharge home with futura splint and fracture clinic appointment
212
Name one condition associated with adhesive capsulitis
Diabetes mellitus
213
What injury is seen?
Clavicular fracture and Salter-Harris type I humeral fracture
214
Inflammatory arthritis involving DIP swelling and dactylitis points to a diagnosis of?
Psoriatic arthritis
215
What are the features of Felty's syndrome?
RA, splenomegaly and low white cell count
216
A 52-year-old man complains of numbness and pain over the lateral skin of the left thigh
What is the most likely diagnosis?
Meralgia paraesthetica
217
A 43-year-old woman complains of right hip pain. During the examination the patient lies on her left side and the right hip is extended with a straight leg. Flexing the knee then recreates the pain
What is the most likely diagnosis?
Referred lumbar spine pain
This is a positive femoral nerve stretch test
218
First line for lower back pain?
NSAIDs
219
What x-ray findings are associated with ank spon?
Subchondral erosions, sclerosis
and squaring of lumbar vertebrae
220
Suspected GCA, biopsy negative. Next step in management?
Continue prednisolone - skip lesions
221
How does trochanteric bursitis present?
Isolated lateral hip/thigh pain with tenderness over the greater trochanter
222
Schober's test <__cm is suggestive of ankylosing spondylitis
5
223
Fundoscopy findings associated with anterior ischaemic optic neuropathy?
Swollen pale disc and blurred margins
224
What is the most common organism found in young adults with septic arthritis?
Neisseria gonorrhoeae
225
Raised serum calcium, low serum phosphate, raised ALP and raised PTH
What is the diagnosis?
Primary hyperparathyroidism
226
What should be corrected before bisphonates?
Hypocalcemia/vitamin D deficiency
227
What feature would indicate primary Raynaud's rather than secondary?
Age of onset under 40 years
228
Osteoporosis in a man, what should be checked?
Testosterone
229
What are the adverse effects of methotrexate?
* Mucositis
* Myolosuppression
* Pneumonitis
* Pulmonary/liver fibrosis
230
What are the blood results associated with polymyalgia rheumatica?
Raised ESR and CRP
Normal CK
231
What is the most commonly affected joint in septic arthritis in adults?
Knee
232
What drug should not be prescribed with allopurinol?
Azathioprine - severe interaction causing bone marrow suppression
233
Patients with suspected visual loss secondary to temporal arteritis are usually given what?
IV methylprednisolone initially
234
Low serum calcium, raised serum phosphate, raised ALP and raised PTH
What is the diagnosis?
Chronic kidney disease leading to secondary hyperparathyroidism
235
Signs of systemic sepsis with changing lower limb neurology
What is the diagnosis?
Possible epidural abscess
236
Describe the presentation of discitis
* Back pain
* Pyrexia, rigors, sepsis
* Neurological features if abscess develops
* Associated with PWIDs
237
An asymmetrical presentation suggests ____ arthritis rather than rheumatoid
Psoriatic
238
Carpal tunnel syndrome causes action potential prolongation in?
Both motor and sensory neurons
239
Drug treatment for moderate/severe psoriatic arthropathy?
Methotrexate
240
Management of discoid lupus erythematous
1. Topical steroids
2. Oral hydroxychloroquine
241
Bone pain, tenderness and proximal myopathy (→ waddling gait)
What is the diagnosis?
Osteomalacia
242
List the causes of Dupuytren's contracture
* Idiopathic (family history)
* Manual labour
* Phenytoin treatment
* Alcoholic liver disease
* Diabetes mellitus
* Trauma to the hand
243
How long should symptoms of chronic fatigue syndome be present before diagnosis?
3 months
244
What pattern of sensory loss is seen in L3 nerve root compression?
Sensory loss to anterior thigh
245
What pattern of motor deficit is seen in L3 nerve root compression?
Weak hip flexion and abduction
Weak knee extension
246
Reduced knee reflex and positive femoral stretch tests indicates a lesion at which level?
L3 or L4
247
What pattern of sensory loss is seen in L4 nerve root compression?
Sensory loss to anterior aspect of knee and medial malleolus
248
What pattern of motor deficit is seen in L4 nerve root compression?
Weak knee extension and hip adduction
249
What pattern of sensory loss is seen in L5 nerve root compression?
Sensory loss over dorsum of foot
250
What pattern of motor deficit is seen in L5 nerve root compression?
Weakness in foot and big toe dorsiflexion
Weakness of hip abduction and foot drop
251
Reflexes intact and positive sciatic nerve stretch tests indicates a lesion at which level?
L5
252
What pattern of sensory loss is seen in S1 nerve root compression?
Sensory loss posterolateral aspect of leg and lateral aspect of foot
253
What pattern of motor deficit is seen in S1 nerve root compression?
Weakness in plantarflexion of foot
254
Reduced knee reflex and positive sciatic nerve stretch tests indicates a lesion at which level?
S1
MBChB Finals
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