Orthopaedics & MSK Practice Questions

Question 1

A 52-year-old diabetic man presents with a non-healing foot ulcer. ABPI is 0.4. What is the most appropriate management?

Accepted Answer

Vascular surgery referral

Answer

Antibiotics alone

Answer

Wound care only

Answer

Amputation

Answer

Hyperbaric oxygen

Question 2

A 29-year-old man presents with acute onset severe lower back pain and bilateral leg weakness after heavy lifting. He has saddle anesthesia and urinary retention. MRI shows central disc herniation at L4-L5. What is the expected outcome with prompt treatment?

Accepted Answer

Variable outcome depending on delay

Answer

Complete recovery in all cases

Answer

Good functional recovery in most cases

Answer

Poor prognosis regardless of treatment

Answer

Recovery limited to bladder function

Question 3

A 45-year-old man presents with acute severe lower back pain and leg weakness. MRI shows large central disc herniation with cauda equina compression. What is the surgical urgency?

Accepted Answer

Emergency (hours)

Answer

Elective (weeks)

Answer

Urgent (days)

Answer

No surgery needed

Answer

Depends on symptoms

Question 4

A 24-year-old man presents with acute onset severe lower back pain and bilateral leg weakness. He has urinary retention and saddle anesthesia. What is the time frame for surgical intervention?

Accepted Answer

Within 24-48 hours

Answer

Within 6 hours

Answer

Within 1 week

Answer

Within 1 month

Answer

No time limit

Question 5

A 72-year-old man presents with confusion and agitation 3 days after hip surgery. He sees people who aren't there and is disoriented to time and place. What is the most likely diagnosis?

Accepted Answer

Postoperative delirium

Answer

Dementia

Answer

Alcohol withdrawal

Answer

Depression

Answer

Anxiety

Question 6

A 25-year-old man presents with acute onset severe lower back pain radiating down his left leg to the foot. He has difficulty walking and reports numbness in his left foot. Straight leg raise test is positive at 30 degrees. What is the most likely diagnosis?

Accepted Answer

Lumbar disc herniation

Answer

Mechanical back pain

Answer

Spinal stenosis

Answer

Cauda equina syndrome

Answer

Ankylosing spondylitis

Question 7

A 33-year-old man presents with acute onset severe lower back pain radiating down both legs. He has bilateral leg weakness and urinary retention. MRI shows large central disc herniation at L4-L5. What is the most appropriate management?

Accepted Answer

Emergency surgical decompression

Answer

Conservative management

Answer

Epidural steroid injection

Answer

Physiotherapy

Answer

Bed rest

Question 8

A 31-year-old man presents with acute severe lower back pain and bilateral leg weakness developing over 6 hours. He has urinary retention and saddle anesthesia. What is the most appropriate immediate management?

Accepted Answer

Emergency surgical decompression

Answer

MRI lumbar spine

Answer

High-dose corticosteroids

Answer

Bed rest and analgesia

Answer

Physiotherapy referral

Question 9

A 23-year-old man presents with acute onset severe lower back pain after lifting heavy weights. He has bilateral leg weakness, saddle anesthesia, and urinary retention. What is the most appropriate immediate management?

Accepted Answer

Emergency surgical decompression

Answer

MRI lumbar spine

Answer

High-dose corticosteroids

Answer

Bed rest and analgesia

Answer

Physiotherapy

Question 10

A 49-year-old woman presents with an 18-month history of lower back pain and bilateral buttock pain. She reports morning stiffness lasting 75 minutes that improves with activity. She has a history of psoriasis and inflammatory bowel disease. HLA-B27 is positive. MRI sacroiliac joints shows bilateral bone marrow oedema and erosions. She has tried NSAIDs with partial relief. What is the most appropriate next step in management according to NICE guidelines?

Accepted Answer

Trial of two different NSAIDs at maximum dose for 4 weeks each with physiotherapy before considering biologics

Answer

Add sulfasalazine to current treatment

Answer

Commence anti-TNF biological therapy (e.g., adalimumab)

Answer

Add methotrexate to current treatment

Answer

Commence oral prednisolone 20mg daily

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