Regional musculoskeletal problems flashcards
8 high-yield MRCP Part 1 cards from the Intellect Medicos Rheumatology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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What is the gold-standard investigation for carpal tunnel syndrome?
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Nerve conduction studies (slowed conduction velocity, prolonged distal motor latency across the wrist).
Why? Diagnosis is usually clinical (Phalen's and Tinel's tests); NCS confirm it and grade severity before surgery.
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What is the first-line management of mild to moderate carpal tunnel syndrome?
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A wrist splint (worn at night) — or a steroid injection.
Why? Surgical decompression is the definitive treatment for severe or persistent symptoms.
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De Quervain's tenosynovitis affects which two tendons, and which test is positive?
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Abductor pollicis longus and extensor pollicis brevis; Finkelstein's test.
Why? These run in the first dorsal compartment, causing pain over the radial styloid; common in new mothers lifting babies.
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Which tendon origin is mainly involved in lateral epicondylitis (tennis elbow)?
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Extensor carpi radialis brevis (common extensor origin).
Why? Pain is reproduced by resisted wrist extension (Cozen's test) or passive stretch (Mill's test).
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A 35-year-old man who took high-dose prednisolone for months has gradually worsening groin pain on weight-bearing, with reduced internal rotation of the hip. Hip X-ray is normal. Which investigation is most sensitive for the likely diagnosis?
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MRI of the hip (avascular necrosis of the femoral head).
Why? Corticosteroids are the most important non-traumatic cause of AVN; early X-rays are often normal.
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How does movement restriction differ between adhesive capsulitis and a rotator cuff tear?
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Adhesive capsulitis: both active and passive movement restricted. Rotator cuff tear: active reduced, passive preserved.
Why? Frozen shoulder is capsular fibrosis (linked to diabetes), with external rotation typically lost most.
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A 70-year-old man has bilateral leg pain and tingling when walking, relieved by sitting or bending forward (he leans on a shopping trolley). Foot pulses are normal. What is the diagnostic investigation?
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MRI of the lumbar spine (lumbar spinal stenosis).
Why? Neurogenic claudication is eased by spinal flexion, which widens the canal. Management is conservative first, with surgical decompression as the definitive option.
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In ANA-positive oligoarticular juvenile idiopathic arthritis, which complication requires regular screening?
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Chronic anterior uveitis (regular slit-lamp examination).
Why? The uveitis is often asymptomatic and can cause blindness if missed. Methotrexate is the first DMARD in JIA.