Rafi MSK - Questions & Expert Verified Solutions
An 85-year-old man presents to his GP with low back pain
for 2 days. Over the previous 3 years, he noticed that his
shirts seemed to be getting longer but not looser. He had a
previous rib fracture 1 year ago after falling off his seat. A
blood test is performed and the results are as follows:
Calcium normal
Phosphate normal
ALP normal
Which is the most likely diagnosis?
A. Myeloma.
B. Osteomalacia.
C. Osteoporosis.
D. Paget disease.
E. Tuberculosis." Right Ans - Osteoporosis
"
A 58-year-old woman presents to her physician with hip
pain for 3 weeks. On examination, she has bowing of her tibias. She seems to
have difficulty hearing and the doc-
tor has to keep repeating himself. Her father has similar bowing of tibias.
What is the most appropriate next step in diagnosis?
A. Bone biochemistry.
B. Coeliac serology.
C. Dual-energy X-ray absorptiometry (DEXA) bone scan.
D. Magnetic resonance imaging (MRI) tibia.
E. Test for rheumatoid factor." Right Ans - Bone Biochemistry
"
A 53-year-old man presents to his GP with a headache
for 3 days. The pain is only on the left side of his head
and radiates into his scalp. He has no vision problems
or pain in his jaw when eating but he feels pain when
he combs his hair. The pain is constantly there and is only
,relieved temporarily by paracetamol.
What investigation is most useful in confirming the
diagnosis?
A. Antineutrophil cytoplasmic antibody (ANCA).
B. Erythrocyte sedimentation rate (ESR).
C. Lumbar puncture.
D. MRI of aortic arch.
E. Temporal artery biopsy." Right Ans - Temporal Artery Biopsy
"
A 75-year-old man develops pain in his right wrist and
right third metacarpophalangeal (MCP) joint. The joint
is swollen, red, warm and tender. He is right-handed
and cannot hold his pen properly because of the pain.
Joint aspiration shows rhomboid calcium pyrophosphate crystals. On X-ray,
chondrocalcinosis, subchondral scle-
rosis and osteophytes are seen of his wrist and MCP joint. The patient was
given co-codamol for pain relief.
What is the most effective next step in management for his acute problem?
A. Antibiotics.
B. Disease-modifying antirheumatic drug (DMARD)
therapy.
C. Joint replacement.
D. Physiotherapy.
E. Splinting." Right Ans - Splinting
"
A 22-year-old man develops an acute swelling of his
right knee and ankle with painful heels. There was no
trauma. He had conjunctivitis and fever 1 week ago.
His bloods and urine are taken for culture; results come
back as 'nothing cultured'.
Which of the following is unlikely to be a pathogen?
,A. Chlamydia trachomatis.
B. Escherichia coli.
C. Haemophilus influenzae.
D. Neisseria gonorrhoeae.
E. Salmonella typhi." Right Ans - Haemophilus influenzae
"
A 65-year-old woman with stable rheumatoid arthritis of
8 years notices loss of sensation in her lateral 31⁄2 fingers,
palmar aspect.
What is the most appropriate therapy for her most recent condition?
A. Intramuscular gold injections.
B. Oral methotrexate tablets.
C. Oral steroid tablets.
D. Physiotherapy.
E. Splinting." Right Ans - Splinting
"
A 33-year-old Asian woman comes to her physician com-
plaining of fatigue, myalgia and weight loss. She finds it more painful to weight
bear now as compared to 6 months
ago. She is losing a lot of hair while brushing after a bath,
and there is a non-itchy rash over her nose and cheeks.
What test is most likely to confirm the diagnosis?
A. Anti-double-stranded DNA antibodies.
B. ESR.
C. Lupus anticoagulant.
D. Skin biopsy of the rash.
E. Thyroid function test." Right Ans - Anti-double-stranded DNA antibodies
"
A 58-year-old man presents to Accident and Emergency
(A&E) with breathlessness. It is discovered that his
breathlessness is caused by pulmonary hypertension.
On further examination while in hospital, the man is
, found to have Raynaud phenomenon, calcinosis and sclerodactyly. He also
complains of long-standing heart-
burn, for which he is taking omeprazole.
What is the most likely explanation for these findings?
A. Linear scleroderma.
B. Multiple sclerosis.
C. Paraneoplastic phenomena.
D. Systemic lupus erythematosus (SLE).
E. Systemic sclerosis." Right Ans - Systemic Sclerosis
"
A 47-year-old business woman presents to her GP repeat-
edly with widespread joint pain. Her sleep is disrupted and she complains of
fatigue and poor concentration; this
makes her even more stressed at work. Having already
undergone many different investigations, she finds it
upsetting that doctors cannot find a diagnosis for her.
What is the best treatment strategy for this woman?
A. DMARD therapy.
B. Diet changes.
C. Exercise.
D. Joint injections.
E. Steroids." Right Ans - Exercise
"
A 77-year-old man sees his physician for left knee pain,
gradually getting worse over the past 1 month. He is
finding it more difficult to weight bear on his left side
and notices his knee joint is getting more swollen. Going
for walks has become an arduous process, with his left
knee becoming excruciatingly painful. Sometimes the
pain wakes him up at night.
What would an X-ray of his knee show?
An 85-year-old man presents to his GP with low back pain
for 2 days. Over the previous 3 years, he noticed that his
shirts seemed to be getting longer but not looser. He had a
previous rib fracture 1 year ago after falling off his seat. A
blood test is performed and the results are as follows:
Calcium normal
Phosphate normal
ALP normal
Which is the most likely diagnosis?
A. Myeloma.
B. Osteomalacia.
C. Osteoporosis.
D. Paget disease.
E. Tuberculosis." Right Ans - Osteoporosis
"
A 58-year-old woman presents to her physician with hip
pain for 3 weeks. On examination, she has bowing of her tibias. She seems to
have difficulty hearing and the doc-
tor has to keep repeating himself. Her father has similar bowing of tibias.
What is the most appropriate next step in diagnosis?
A. Bone biochemistry.
B. Coeliac serology.
C. Dual-energy X-ray absorptiometry (DEXA) bone scan.
D. Magnetic resonance imaging (MRI) tibia.
E. Test for rheumatoid factor." Right Ans - Bone Biochemistry
"
A 53-year-old man presents to his GP with a headache
for 3 days. The pain is only on the left side of his head
and radiates into his scalp. He has no vision problems
or pain in his jaw when eating but he feels pain when
he combs his hair. The pain is constantly there and is only
,relieved temporarily by paracetamol.
What investigation is most useful in confirming the
diagnosis?
A. Antineutrophil cytoplasmic antibody (ANCA).
B. Erythrocyte sedimentation rate (ESR).
C. Lumbar puncture.
D. MRI of aortic arch.
E. Temporal artery biopsy." Right Ans - Temporal Artery Biopsy
"
A 75-year-old man develops pain in his right wrist and
right third metacarpophalangeal (MCP) joint. The joint
is swollen, red, warm and tender. He is right-handed
and cannot hold his pen properly because of the pain.
Joint aspiration shows rhomboid calcium pyrophosphate crystals. On X-ray,
chondrocalcinosis, subchondral scle-
rosis and osteophytes are seen of his wrist and MCP joint. The patient was
given co-codamol for pain relief.
What is the most effective next step in management for his acute problem?
A. Antibiotics.
B. Disease-modifying antirheumatic drug (DMARD)
therapy.
C. Joint replacement.
D. Physiotherapy.
E. Splinting." Right Ans - Splinting
"
A 22-year-old man develops an acute swelling of his
right knee and ankle with painful heels. There was no
trauma. He had conjunctivitis and fever 1 week ago.
His bloods and urine are taken for culture; results come
back as 'nothing cultured'.
Which of the following is unlikely to be a pathogen?
,A. Chlamydia trachomatis.
B. Escherichia coli.
C. Haemophilus influenzae.
D. Neisseria gonorrhoeae.
E. Salmonella typhi." Right Ans - Haemophilus influenzae
"
A 65-year-old woman with stable rheumatoid arthritis of
8 years notices loss of sensation in her lateral 31⁄2 fingers,
palmar aspect.
What is the most appropriate therapy for her most recent condition?
A. Intramuscular gold injections.
B. Oral methotrexate tablets.
C. Oral steroid tablets.
D. Physiotherapy.
E. Splinting." Right Ans - Splinting
"
A 33-year-old Asian woman comes to her physician com-
plaining of fatigue, myalgia and weight loss. She finds it more painful to weight
bear now as compared to 6 months
ago. She is losing a lot of hair while brushing after a bath,
and there is a non-itchy rash over her nose and cheeks.
What test is most likely to confirm the diagnosis?
A. Anti-double-stranded DNA antibodies.
B. ESR.
C. Lupus anticoagulant.
D. Skin biopsy of the rash.
E. Thyroid function test." Right Ans - Anti-double-stranded DNA antibodies
"
A 58-year-old man presents to Accident and Emergency
(A&E) with breathlessness. It is discovered that his
breathlessness is caused by pulmonary hypertension.
On further examination while in hospital, the man is
, found to have Raynaud phenomenon, calcinosis and sclerodactyly. He also
complains of long-standing heart-
burn, for which he is taking omeprazole.
What is the most likely explanation for these findings?
A. Linear scleroderma.
B. Multiple sclerosis.
C. Paraneoplastic phenomena.
D. Systemic lupus erythematosus (SLE).
E. Systemic sclerosis." Right Ans - Systemic Sclerosis
"
A 47-year-old business woman presents to her GP repeat-
edly with widespread joint pain. Her sleep is disrupted and she complains of
fatigue and poor concentration; this
makes her even more stressed at work. Having already
undergone many different investigations, she finds it
upsetting that doctors cannot find a diagnosis for her.
What is the best treatment strategy for this woman?
A. DMARD therapy.
B. Diet changes.
C. Exercise.
D. Joint injections.
E. Steroids." Right Ans - Exercise
"
A 77-year-old man sees his physician for left knee pain,
gradually getting worse over the past 1 month. He is
finding it more difficult to weight bear on his left side
and notices his knee joint is getting more swollen. Going
for walks has become an arduous process, with his left
knee becoming excruciatingly painful. Sometimes the
pain wakes him up at night.
What would an X-ray of his knee show?
