MSK

A patient has painful shoulder. On examination, the pain occurs on abduction of the shoulder joint in the arc from 45 degree to 120 degree. The pain is felt in the region of the acromion and is MOST LIKELY to arise from which of the following muscles?

A 28 year old woman is 34 weeks pregnant with her first child. She complains of wrist discomfort and increasing pain and numbness in her left hand mainly involving thumb and the lateral two fingers, for the last 2 weeks. The symptoms mostly occur in the morning and sometimes wakes her up during the night. Shaking the hand relieve the symptoms. On examination the symptoms can be reproduced by pressure across her proximal wrist crease.

What is the most likely diagnosis?

This is a plain X-ray of a painful knee in a 55 year old male. The arrow is indicative of:

Screenshot 2023-06-15 144348

A 40 year old woman has a 5 month history of joint pain with associated unintentional weight loss of approximately 3kg. She has had intermittent joint swelling in her fingers, wrists and feet. She complains of tiredness and stiffness that is worst in the mornings and improves after an hour. On examination she looks well and her vital signs are within normal limits. She is tender over the metatarso-phalangeal, metacarpo-phalangeal and proximal inter-phalangeal joints but there is no swelling, redness or rash.

What is the most likely diagnosis?

A patient with elevated antibodies to cyclic citrullinated peptides (anti-CCP antibodies) is also likely to have:

Eroded metacarpophalangeal joints

Increased osteoblast activity

Narrowing of joint spaces on X-rays

Decreased conduction of action potentials in motoneurons

Markedly impaired short term memory

In which of the following does the nerve (first element) innervate the muscle (second element)?

Median nerve -supinator

Median nerve - biceps brachii

Radial nerve - brachioradialis

Ulnar nerve - Lumbrical of the index finger

Radial Nerve - abductor pollicis brevis

Sagging of the left pelvis while walking is ordinarily prevented by which of the following muscles?

T Cells are thought to produce inflammation in rheumatoid synovium by:

Cytotoxic attach on the lining cells of the synovial membranes

Inducing the production of acute phase proteins, such as C-reactive protein

Activation of macrophages, via the production of inflammatory cytokines such as interferon gamma and tumour necrosis factor alpha

Activation of mast cells, via the production of IgE antibodies

Producing rheumatoid factor and the formation of immune complexes in the synovial fluid

Which of the following is correct regarding the foot arches?

Plantar aponeurosis does not provide structural support to the longitudinal arches

Fibularis longus, acting as the sling maintain the medial longitudinal arch

Tibialis anterior, acting as the tie beam maintain the medial longitudinal arch

Spring ligament as an important stabilising factor for the medial longitudinal arch

Calcaneus forming the summit of both the lateral and medial longitudinal arches

Which of the following is LEAST LIKELY to cause avascular necrosis of the head of the femur?

Subtrochanteric fracture of femur

Subcapital fracture of femur

Septic arthritis of hip

Transcervical fracture of femur

Prolonged dislocation of the hip

The BEST surface landmark for locating and appropriate intervertebral space for lumbar puncture at L4-L5 would be a horizontal line drawn between the:

Which treatment class has evidence for us in Psoriatic arthritis (and may be used in Reactive arthritis) but not rheumatoid arthritis ?

A 23 year old male presents to the GP surgery in Monday morning after binge drinking on the weekend. He woke up in his armchair and noticed that he could not extend his right wrist. The most appropriate management of this patient would be:

Referral for electrophysiologic

High dose prednisone therapy

Urgent referral to the ED for suspected stroke

Wrist supporting brace and review in 3 weeks

Use of NSAIDs

Which of these cancers characteristically causes osteoblastic bony metastases?

A 17 year old male presents with a 24 hour history of increasing pain in his knee.

On examination you notice he is febrile, and there are signs of acute inflammation in the knee joint (tenderness, swelling, erythema, warmth) and he is unable to bear weight. Which of the following investigation is the MOST appropriate to make a diagnosis in this patient?

Which of the following bone diseases is characterized by random and haphazard excessive osteoclastic erosion of bone occurring in waves, followed by increased osteoblastic activity attempting to replace the eroded bone?

A 50 year old woman presents with bone ache. Biochemical testing reveals raised total alkaline phosphatase. Renal and hepatic functions are normal, and serum calcium and phosphate are low. There is no evidence of malignancy.

A 54 year old man complains of severe pain and swelling in his toes. An image of his foot can be seen below. Which of the following features is least likely to be associated with the presentation?

Capture

Prominent joint tenderness

History of diet low in meat and seafood

Needle shaped crystals on polarized microscopy of synovial fluid

History of heavy EtOH consumption

Improvement of pain with NSAID therapy

A 52 year old woman presents with a two-month history of hand pain. An image of her hand is shown below. Which of the following additional features would most likely be associated with this case?

Screenshot 2023-06-15 161841

Joint stiffness hours after waking

Lower back pain, most severe at the end of the day

History of recent chlamydia infection

Joint fluid WCC of > 20 000

'rat bites' seen on x-ray of the hand

Which of the following statements is correct?

An adverse effect of ketamine is hypotension

Propofol acts by blocking the action of GABA

Local anaesthetics act primarily on the CNS

An adverse effect of propofol is respiratory depression

Local anaesthetics result in a loss of consciousness

Which of the following statements regarding malignant hyperthermia is true?

Malignant hyperthermia is associated with mutations effecting sodium channels

Bradycardia is a common feature of malignant hyperthermia

Malignant hyperthermia can be caused by dantrolene

Malignant hyperthermia is a common side effect of local anesthetics

Malignant hyperthermia can result in renal failure

A 12 year old boy on the 95^th centile for weight and 50^th centile for height presents with left hip pain. Radiographs of the pelvis and left hip were requested and are shown below. What is the diagnosis?

Screenshot 2023-06-15 162717

A female patient, 62 years old, has vertebral fracture, a BMI of 32, and takes regular Panadol for arthritis. With no other known significant medical history available, she should, in the first instance, be investigated for:

Of the following conditions, valgus deformity of the knee joint is MOST LIKELY associated with:

A 40 year old male presents with sudden onset pain, erythema and swelling of the left knee. His past medical history is significant only for type II diabetes melilotus. Synovial joint fluid aspiration reveals rhomboid-shaped crystals that are positively birefringent under polarized light. Which of the following is the MOST LIKELY diagnosis for the patients knee pain?

Which of the following structures does NOT pass through the tarsal tunnel at the ankle?

With respect to the hormonal regulation of bone metabolism, which of the following statements is FALSE?

Parathyroid hormone increases secretion of osteoprotegerin by osteoblasts

Oestrogen promotes secretion of osteoprotegerin by osteoblasts

Parathyroid hormone increases RANKL expression on osteoblasts

Growth hormone stimulates osteoblast activity in bone

Calcitonin inhibits osteoclast activity in bone

A 70 year old female presents with an atraumatic burst fracture of the T12 vertebra. A diagnosis of osteoporosis is made. Which of the following medications would NOT be beneficial for management of this condition?

A CNC neoplasm that appears well circumscribed on imaging and is characterized by the Dural tail sign is likely to have arisen from which cell type?

With respect to peripheral nerve injuries, which of the following correctly describes "axonotmesis"?

Partial nerve disruption where in repair occurs without Wallerian degeneration

Damage to the axons and their myelin sheath but the endoneurium, perineurium and epineurium remain intact

Focal segment of demyelination without injury or disruption to the axon or its surroundings

Complete division of the nerve with irreversible damage to the axon, myelin sheath and stroma

The mildest type of peripheral nerve injury

A 47 year old man is stabbed in the lateral chest beneath the right arm. The wound does not enter the chest cavity. Physical examination reveals that the vertebral (medial) border of the patients scapula projects posteriorly and is closer to the midline on the injured side. On return visit the patient complains that he cannot reach as far forward (such as to reach for doorknob) as he could before the injury. The nerve injured which caused these symptoms is the:

A 58 year old male presents with sudden pain during functional rehabilitation of the upper extremity. The X-ray film displays which of the features?

Screenshot 2023-06-15 165450

Fracture of shaft of humerus

Anterior dislocation of glenohumeral joint

Osteoarthritic changes on the acromioclavicular joint

Fracture at surgical neck of humerus

Posterior dislocation of the glenohumeral joint

A 27 year old man presented with bilateral weakness in his lower limbs. Which of the following represents the MOST LIKELY location of this lesion?

A lesion caudal to the pyramidal decussation

The right genu of the internal capsule

The anterior limb of the eternal capsule

The left genu of the internal capsule

The right posterior limb of the internal capsule

A 32 year old female presented with pain in the right elbow joint for the past few months.

An x-ray revealed no significant findings. Pain is relieved with steroid injection and heat treatment. The restricted movement gradually increased and the patient presented 2 years later with sever pain during movement. The x-ray is how below. What is the MOST LIKELY diagnosis?

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