High-Yield UKMLA Topics: Musculoskeletal and Trauma & Orthopaedics

Presenter: Her Lacey

Covering 10 high-yield SBA questions related to musculoskeletal and trauma & orthopaedics for UKMLA
Questions formatted in MLA exam style, based on NICE or society guidelines

Case Study: 61-year-old woman with knee pain, stiffness, inability to weight bear, rheumatoid arthritis
Management: Intravenous antibiotic therapy (Answer: B)
Etiology: Staphylococcus aureus, Streptococci, Neisseria gonorrhoeae
Risk Factors: Prosthesis, intra-articular interventions, pre-existing joint diseases, immunosuppression, increasing age, IV drug use
Symptoms: Acute monoarticular pain, reduced range of motion, heat, erythema, swelling, systemic illness
Diagnosis: Arthrocentesis, synovial fluid analysis, gram stain, blood cultures, x-ray, CT/MRI for chronic infections
Management: Therapeutic arthrocentesis, intravenous antibiotics for 6 weeks, surgical debridement for prosthetic joints, supportive measures
Complications: Chronic osteoarthritis, osteomyelitis, osteonecrosis, bony/cartilaginous destruction, fractures, sepsis, death

Case Study: 31-year-old pregnant woman with hand pain, tingling, numbness, weakness
Management: Carpal tunnel syndrome (Answer: A)
Symptoms: Paresthesia, numbness, burning pain, compromised motor function, thumb weakness, reduced grip strength
Diagnosis: Clinical, tests (thumb abduction, Phalen's maneuver, Tinel's sign)
Management: Conservative initially (avoid repetitive movements, wrist splints), corticosteroid injections, nerve conduction studies, surgical release if needed

Case Study: 71-year-old man with pain, inability to weight bear after fall, shortened/external rotated leg
Management: Total hip replacement (Answer: E)
Etiology: Fragility fracture in older adults, high impact trauma in younger adults
Risk Factors: Osteoporosis, age, smoking, malnutrition, vitamin deficiencies, fall risks
Symptoms: Shortened/external rotated leg, groin pain, minor symptoms in undisplaced fractures
Diagnosis: X-ray, MRI if needed
Classification: Garden classification (Type 1-4)
Management: Immediate resuscitation, surgical intervention (total hip replacement, hemiarthroplasty, dynamic hip screw, intramedullary nail), correction of comorbidities

Case Study: 32-year-old woman with bilateral hand pain, stiffness, morning worsening
Management: Rheumatoid arthritis (Answer: D)
Symptoms: Pain at rest, swelling, stiffness, symmetrical presentation
Diagnosis: Clinical, rheumatoid factor, anti-CCP antibodies, CRP/ESR, imaging
Management: DMARDs (methotrexate, leflunomide, sulfasalazine, hydroxychloroquine), glucocorticoids, combination therapy, biological DMARDs
Complications: Joint destruction, deformities (ulnar deviation, boutonniere, z-thumb, swan neck), cardiovascular disease, osteoporosis, anemia, infection risk, systemic involvement

Case Study: 76-year-old woman with back pain, past breast cancer, neurological symptoms
Management: MR whole spine (Answer: C)
Symptoms: Progressive back pain, worsened by movement, localised tenderness, neurological deficits
Diagnosis: MRI, clinical
Management: Spinal immobilisation, dexamethasone, pain management, bisphosphonates, surgery, radiotherapy

Case Study: 20-year-old man with knee pain after football, popping sound
Management: Medial meniscal tear (Answer: C)
Symptoms: Knee pain, slow swelling, joint line tenderness, locking, restricted movement
Diagnosis: MRI
Management: Conservative (rest, ice, elevation, analgesia, physiotherapy), surgery if symptoms persist

Case Study: 48-year-old woman with groin pain, SLE, steroid use
Management: Osteonecrosis (Answer: B)
Etiology: Ischemia of bone, trauma, steroids, alcohol, chemoradiotherapy, smoking
Symptoms: Gradual pain onset, risk factors history, restricted range of motion
Diagnosis: X-ray, MRI
Management: Reduce weight bearing, pain management, physiotherapy, surgical intervention

Case Study: 22-year-old man with shoulder pain after fall, previous injury
Management: Closed reduction (Answer: B)
Etiology: Trauma, risk factors include previous injury, rotator cuff instability
Symptoms: Pain, reduced ROM, palpable humeral head
Diagnosis: X-ray
Management: Analgesia, reduction, sling immobilisation, physiotherapy, neurovascular assessment

Case Study: 23-year-old man with ankle pain after fall
Management: Trimalleolar fracture (Answer: B)
Etiology: Twisting injuries
Symptoms: Pain, swelling, reduced ROM
Classification: Weber classification (A-C)
Management: ED referral, neurovascular assessment, Ottawa rules for x-ray, splint immobilisation for stable fractures, ORIF for unstable

Covered high-yield topics: septic arthritis, radiculopathy, upper limb soft tissue injury, lower limb fractures, rheumatoid arthritis, spinal cord compression, lower limb soft tissue injury, compartment syndrome
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