-
Question 1
Incorrect
-
A 28-year-old male is complaining about sore feet and lower back pain. He says it feels like walking on gravel. He also mentioned have some urethral discharge that he had not received any treatment for. He had a holiday in Morocco recently. What is the most likely diagnosis?
Your Answer: Gonococcal arthritis
Correct Answer: Sjogren's Syndrome
Explanation:This is a case of Sjogren Syndrome (aka Reiter’s disease). It is characterised by a triad of: seronegative arthritis mostly sacroiliitis (walking on gravel reflects planter fasciitis), urethritis and conjunctivitis. Sjogren Syndrome usually follows gastroenteritis or non specific urethritis. On the other hand gonococcal arthritis usually occurs in patients who are systemically unwell.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 2
Correct
-
A 32-year-old male presents following a car accident. He has a swollen foot, with loss of sensation in the space between the 3rd metatarsal and big toe and foot tenderness. In addition, his dorsalis pedis is not palpable. Which is the most probable diagnosis?
Your Answer: Compartment syndrome
Explanation:Acute compartment syndrome results from severe high pressure in the compartment with concomitant insufficient blood supply to the tissue involved. Acute compartment syndrome is a surgical emergency that can lead to severe impairment of the function of the affected limb, if left untreated.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 3
Correct
-
A 75-year-old woman presented with difficulty in climbing the stairs and difficulty in holding her head up, for the past 6 months. She didn't have any significant joint pain. Her creatinine phosphokinase level was very high and ESR was normal. Which of the following is the most probable diagnosis?
Your Answer: Polymyositis
Explanation:Polymyositis is an idiopathic inflammatory myopathy characterized by symmetrical, proximal muscle weakness, elevated skeletal muscle enzyme levels and characteristic electromyography (EMG) and muscle biopsy findings. Weak neck extensors cause difficulty holding the head up. Pain is not a significant symptom, which differentiates it from arthritic conditions. ESR is elevated in only 50% of patients with polymyositis.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 4
Correct
-
A 67-year-old man reports weight loss. Labs show a raised alkaline phosphatase at 290 U/L (normal range 35-120). Plain radiographs reveal sclerotic lesions of the bone. Which of the following is the most likely cause of these findings?
Your Answer: Prostate cancer
Explanation:Osteoblastic (or sclerotic) bony metastases, characterized by deposition of new bone, present in prostate cancer, carcinoid, small cell lung cancer, Hodgkin lymphoma or medulloblastoma. The other cancers listed in the options are osteolytic.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 5
Correct
-
A 26-year-old male presents with a history of fever and pain in the right lower thigh for one month. On examination the lower one third of the thigh is red, hot and tender. Radiological examination reveals new bone formation. What is the most likely diagnosis?
Your Answer: Osteomyelitis
Explanation:Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children, while the feet, spine, and hips are most commonly involved in adults. Diagnosis of osteomyelitis is often based on radiologic results showing a lytic centre with a ring of sclerosis. Osteomyelitis, a bone infection, may leave the adjacent bone with exostosis formation. An exostosis, also known as bone spur, is the formation of new bone on the surface of a bone.[
Malignant bone tumours can be classified as primary (arising from abnormal bone or cartilage cells) or secondary (bone metastases of other tumours). The most common primary bone tumours are osteosarcomas, Ewing sarcomas, and chondrosarcomas. These tumours differ with regard to primary localization, radiographic characteristics, and the patient age at which they usually develop.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 6
Incorrect
-
A 68-year-old male presents with muscle weakness - he is unable to go up the stairs and has complained of mild breathlessness. He has said that he finds it difficult to swallow food sometimes. Lab tests are conducted and the reports show the following results: alkaline phosphatase 216 U/L; aspartate aminotransferase 49 U/L; alanine transaminase 43 U/L; creatine kinase 417; erythrocyte sedimentation rate 16 mm/h. From the list of options, choose the most likely diagnosis.
Your Answer: Polymyalgia rheumatica
Correct Answer: Polymyositis
Explanation:Muscle weakness and the inability to climb the stairs are consistent with a diagnosis of polymyositis. The condition usually affects those between 30-50 years of age and individuals present with stiffness in the muscles closest to the trunk which gradually worsens over time. Difficulty swallowing may be experienced if the muscle in the oesophagus is affected.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 7
Correct
-
A 70-year-old woman accidentally fell and was brought to the orthopaedics department. Investigations reveal a fracture of the neck of the humerus. Which artery may most likely be injured?
Your Answer: Circumferential artery
Explanation:Circumferential artery provides the blood supply to the neck of the femur. Damage to the artery may lead to avascular necrosis of the femoral neck or head.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 8
Incorrect
-
A 57-year-old diabetic, smoker complains of non-healing ulcers and cramp-like pain in the calves relieved by rest. Examination results are as follows: absent distal pulses, and cold extremities with hair loss around the ankles. What is the most probable diagnosis?
Your Answer: Buerger's disease
Correct Answer: Chronic ischemia of the limbs
Explanation:Chronic Limb Ischaemia presents with calf pain that is relieved by rest.
Intermittent claudication is not a diagnosis but a symptom and is not necessarily associated with diabetes.
Buerger’s disease occurs in younger heavy smokers (usually before age of 50).
DVT causes pain that is consistent, not intermittent as in claudication. -
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 9
Correct
-
A 45-year-old female was diagnosed with a benign ovarian mass on her right side. She complained of inner thigh pain on her right side. Which of the following nerves is responsible for her inner thigh pain?
Your Answer: Obturator nerve
Explanation:The obturator nerve is compressed due to the ovarian mass, this causes pain in the inner thigh because it innervates this area.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 10
Correct
-
A patient who has recently been diagnosed with SLE undergoes serum testing. A rise in which of the following antibodies would indicate severe systemic involvement?
Your Answer: Anti double-stranded DNA antibodies
Explanation:Anti ds-DNA antibodies are very specific for SLE and their presence most often indicates systemic spread of the disease. These antibodies are present in about 30 percent of the total cases of SLE.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 11
Correct
-
A 56-year-old obese female presents due to moderate pain in her finger joints which occurs mostly at the end of the day which gets better with rest. There is also some associated swelling. On examination, there is enlargement of her distal interphalangeal joints and tenderness to palpation. Which of the following is the most likely diagnosis?
Your Answer: Osteoarthritis
Explanation: -
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 12
Incorrect
-
A 42-year-old female presents with a funny bone sensation in her right elbow that is accompanied by numbness and tingling in the 4th and 5th digits. The symptoms are aggravated when the elbow is bent for a prolonged period. Which of the following explains the most likely diagnosis?
Your Answer: Medial epicondylitis
Correct Answer: Cubital tunnel syndrome
Explanation: -
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 13
Correct
-
A 23-year-old student presented with swelling and tenderness near the Lister tubercle of the radius. Passive extension of thumb and index finger further increases the pain. X-ray was normal. What will be the next step in the management of this case?
Your Answer: Immobilization with a cast
Explanation:This patient most likely has distal intersection syndrome, which occurs in the proximal forearm due to the tenosynovitis of extensor pollicis longus muscle tendons.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 14
Correct
-
A 32-year-old woman presents with a painful elbow which she has been feeling for the past two weeks. Which of the following will be consistent with a diagnosis of tennis elbow?
Your Answer: Pain on wrist extension against resistance
Explanation:Lateral epicondylitis (tennis elbow) is an overuse injury of the hand and finger extensor tendons that originate in the lateral humeral epicondyle that occurs following repeated or excessive pronation/supination and extension of the wrist (e.g., in racquet sports). Clinical features include pain and tenderness over the lateral epicondyle and along extensor muscles and thickening of the tendons. The examiner holds the patient’s hand with the thumb placed over the lateral epicondyle – The patient makes a fist, supinates the forearm, deviates radially, and extends the fist against the examiner’s resistance which will result in pain over the lateral epicondyle. Conservative treatment includes rest, physiotherapy and orthotic braces. If this fails corticosteroids and lidocaine injections are employed. Surgery is indicated in patients with persistent symptoms despite 6 months of conservative treatment. Excision of abnormal tendon tissue; longitudinal incisions (tenotomies) in scarred and fibrotic areas to promote healing.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 15
Correct
-
A 68-year-old male presented with right sided hip pain and was found to have a fracture of right hip. On examination he had bilateral pedal oedema and was also found to be deaf. Which of the following is the most probable diagnosis?
Your Answer: Paget's disease
Explanation:Paget disease is a localized disorder of bone remodelling . Hip pain is most common when the acetabulum and proximal femur are involved. The most common neurologic complication is deafness as a result of involvement of the petrous temporal bone. Bilateral pedal oedema is due to associated heart failure.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 16
Correct
-
A 49-year-old female presents to the clinic complaining of pain in her left elbow that is localized to the left lateral epicondyle. She has spent the weekend painting her house. A diagnosis of lateral epicondylitis is suspected. The pain would characteristically worsen on which of the following movements?
Your Answer: Resisted wrist extension with the elbow extended
Explanation:Lateral epicondylitis (tennis elbow) is an overuse injury of the hand and finger extensor tendons that originate in the lateral humeral epicondyle that occurs following repeated or excessive pronation/supination and extension of the wrist (e.g., in racquet sports). Clinical features include pain and tenderness over the lateral epicondyle and along extensor muscles, thickening of the tendons. The examiner holds the patient’s hand with the thumb placed over the lateral epicondyle – The patient makes a fist, supinates the forearm, deviates radially, and extends the fist against the examiner’s resistance which results in pain over the lateral epicondyle. Conservative treatment includes rest, physiotherapy and orthotic braces. If this fails corticosteroids and lidocaine injections are employed. Surgery is indicated in patients with persistent symptoms despite 6 months of conservative treatment. Excision of abnormal tendon tissue; longitudinal incisions (tenotomies) in scarred and fibrotic areas to promote healing.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 17
Correct
-
A 33-year-old female presents with dyspnoea, myalgia, arthralgia and a skin rash. The presence of which of the following antibodies would be the most specific for SLE?
Your Answer: Anti-Sm
Explanation:Anti-Sm antibodies are essential for diagnosis of SLE, especially in anti-dsDNA-negative patients. ANA are also found in 95% of the patients with SLE but they may also occur with other conditions like Juvenile inflammatory arthritis, chronic activity hepatitis, and Sjogren’s syndrome. Anti-Ro, although also found with SLE are more characteristic of Sjogren Syndrome. RF is usually associated with rheumatoid arthritis and cANCA with Wegener’s granulomatosis, Churg Strauss, and microscopic polyangiitis.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 18
Incorrect
-
A 60-year-old male presents with thickened patches of skin over his knuckles and extensor surfaces that are consistent with Gottron's papules. Results reveal an elevated creatine kinase. Diagnosis of dermatomyositis is suspected. Which of the following autoantibody is most specific for this condition?
Your Answer: Anti-Jo-1 antibodies
Correct Answer: Anti-Mi-2 antibodies
Explanation:Anti-Mi-2 antibodies are highly specific for dermatomyositis, but sensitivity is low; only 25% of patients with dermatomyositis demonstrate these antibodies. A positive antinuclear antibody (ANA) finding is common in patients with dermatomyositis, but is not necessary for diagnosis. Anti-Jo-1 antibodies are mostly associated with polymyositis. Anti Scl-70 antibodies and anti centromere antibodies are most commonly found in systemic scleroderma.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 19
Incorrect
-
After examination, a 50-year-old woman was found to have fissuring of the skin of her hands. She has been complaining of fatigue and difficulty in climbing stairs for a couple of months. CXR shows pulmonary fibrosis. Which antibody would you expect to be positive?
Your Answer: Anti Centromere
Correct Answer: Anti Scl 70
Explanation:Anti-Scl-70 antibodies are associated with pulmonary fibrosis and indicate a poor prognosis when positive. Also, they are a specific marker for the diffuse type of systemic sclerosis. Systemic scleroderma, also called diffuse scleroderma or systemic sclerosis, is an autoimmune disease of the connective tissue. It is characterized by thickening of the skin caused by accumulation of collagen, and by injuries to small arteries.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 20
Correct
-
A 35-year-old female complains of headache at the back of her head that has been occurring for several days and pain on neck flexion. She works as a housemaid. Which of the following is the most likely cause of her presentation?
Your Answer: Cervical spondylosis
Explanation:Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs). Cervical spondylosis is very common and worsens with age.
-
This question is part of the following fields:
- Musculoskeletal System
-
SESSION STATS - PERFORMANCE PER SPECIALTY
