Master CPS - Musculoskeletal
for MSRA
Access 50+ high-yield questions tailored for the 2026 syllabus. Includes AI-powered explanations and performance tracking.
Core Concepts
Key musculoskeletal pathologies for MSRA:
- Degenerative: Osteoarthritis (OA) – "wear and tear."
- Inflammatory:
- Rheumatoid Arthritis (RA) – autoimmune, symmetrical polyarthritis.
- Gout/Pseudogout – crystal deposition.
- Septic Arthritis – joint infection (MEDICAL EMERGENCY).
- Traumatic: Fractures, sprains/strains.
- Spinal: Non-specific back pain, sciatica, Cauda Equina Syndrome (SURGICAL EMERGENCY).
- Metabolic: Osteoporosis – fragile bones.
Clinical Presentation
- Osteoarthritis (OA):
- Gradual, activity-related pain.
- Morning stiffness <30 min, crepitus.
- Asymmetrical, weight-bearing joints (knees, hips, spine, hands).
- Rheumatoid Arthritis (RA):
- Symmetrical polyarthritis (small joints: MCPs, PIPs).
- Morning stiffness >30 min, fatigue, systemic symptoms.
- Swelling, warmth, tenderness, rheumatoid nodules.
- Gout:
- Acute, severe monoarthritis (often big toe).
- Rapid onset of pain, redness, swelling, warmth.
- Septic Arthritis:
- Acute, hot, swollen, exquisitely painful monoarthritis.
- Fever, chills, inability to move joint (passive or active).
- Fractures:
- Trauma, sudden pain, swelling, deformity, loss of function.
- Hip fracture: shortened, externally rotated leg.
- Back Pain:
- Non-specific: Mechanical, no red flags.
- Sciatica: Radicular leg pain, neurological deficit (dermatome/myotome).
- Cauda Equina Syndrome: Saddle anaesthesia, bilateral leg weakness, new bladder/bowel dysfunction.
Diagnosis (Gold Standard)
- OA: Clinical + X-ray (joint space narrowing, osteophytes).
- RA: Clinical (ACR/EULAR) + Bloods (RF, anti-CCP, ESR, CRP) + X-ray (erosions).
- Gout/Pseudogout: Joint aspiration for synovial fluid microscopy (Gout: neg. birefringent urate; Pseudogout: pos. birefringent CPPD).
- Septic Arthritis: Joint aspiration for Gram stain, MCS. Bloods (FBC, CRP, ESR).
- Fractures: Plain X-ray. CT for complex/occult.
- Back Pain:
- Non-specific/Sciatica: Clinical. MRI for red flags or persistent symptoms.
- Cauda Equina: Urgent MRI spine.
Management (First Line)
- OA: Physiotherapy, weight loss. Paracetamol, NSAIDs (oral/topical). Intra-articular steroids for flares.
- RA: Prompt DMARDs (e.g., Methotrexate). NSAIDs for symptoms, oral steroids for flares.
- Gout: Acute: NSAIDs, Colchicine, oral steroids. Prophylaxis: Allopurinol (after acute resolves).
- Septic Arthritis: Urgent IV antibiotics + surgical washout/drainage.
- Fractures: Analgesia, immobilisation, reduction (closed/open), fixation (internal/external). Urgent surgery for open, neurovascular compromise, or unstable fractures (e.g., hip).
- Back Pain:
- Non-specific/Sciatica: Analgesia, stay active, physiotherapy.
- Cauda Equina: Immediate neurosurgical referral + urgent decompression surgery.
Exam Red Flags
- Septic Arthritis: Hot, swollen, very painful monoarthritis + fever + inability to move joint.
- Cauda Equina Syndrome: New/worsening bilateral leg weakness, saddle anaesthesia, new bladder/bowel dysfunction, reduced anal tone.
- Neurovascular Compromise: Pallor, pulselessness, paraesthesia, paralysis, pain distal to injury. Compartment syndrome.
- Open Fracture: Skin breach over fracture.
- Back Pain Malignancy/Infection: Unexplained weight loss, night pain, fever, history of cancer, IVDU, new onset >50 or <20, unremitting pain.
- Non-Accidental Injury (NAI) in Children: Inconsistent history, multiple fractures, spiral fractures in non-ambulatory.
Sample Practice Questions
A 48-year-old carpenter presents with a 3-month history of right shoulder pain. The pain is worse with overhead activities, especially when reaching up or lifting objects. He describes a 'painful arc' when abducting his arm between 60 and 120 degrees. There is no history of specific trauma, and his range of movement is largely preserved, although painful. What is the most likely diagnosis?
A 55-year-old female complains of dull, aching pain in her right shoulder for the past 3 months. The pain worsens with overhead activities and reaching behind her back. She denies any acute injury. On examination, she has a painful arc of movement between 60-120 degrees of abduction and pain on external rotation against resistance. Passive range of motion is full but painful.
A 70-year-old woman presents with bilateral knee pain, worse in her right knee, that has been gradually worsening over the past few years. The pain is worse with activity and relieved by rest. She reports morning stiffness lasting about 15 minutes. On examination, there is crepitus on movement, mild effusions, and some tenderness along the joint lines of both knees. Which of the following is the most likely diagnosis?
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