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WorksheetsMSK Back & Knee interventions
Total questions: 23
Worksheet time: 12mins
Name
Class
Date
1.
A 45‑year‑old manual labourer with L5/S1 prolapsed disc and persistent severe unilateral sciatica despite 10 weeks of optimal conservative therapy; no red flags. What is the most appropriate next step?
a)
Continue conservative therapy for at least 6 months
b)
Urgent MRI spine and surgical decompression
c)
Refer for consideration of microdiscectomy
d)
Epidural steroid injection contraindicated – avoid intervention
e)
Start long‑term opioid therapy
2.
A 72‑year‑old woman with neurogenic claudication from multilevel lumbar spinal stenosis refractory to conservative measures. Which surgical intervention is most likely to improve symptoms?
a)
Microdiscectomy
b)
Laminectomy
c)
Vertebroplasty
d)
Spinal fusion alone
e)
Disc replacement
3.
A 33‑year‑old with acute cauda equina syndrome due to large central L4/5 disc prolapse. Which surgical option is immediately indicated?
a)
Elective microdiscectomy within 12 weeks
b)
Emergency decompression (within hours)
c)
Trial of high‑dose steroids first
d)
Intensive physiotherapy
e)
Epidural steroid injection
4.
A 60‑year‑old man with chronic mechanical low‑back pain without radiculopathy; MRI shows multilevel degeneration but no compression. Which statement about surgery is MOST accurate?
a)
Spinal fusion is routinely recommended for nonspecific low‑back pain
b)
Disc replacement is first‑line for multilevel disease
c)
Surgery often has limited benefit in isolated mechanical back pain
d)
Microdiscectomy cures degenerative back pain
e)
Discectomy is helpful even without nerve compression
5.
A 68‑year‑old woman with osteoporosis and painful vertebral compression fracture not controlled after 4 weeks of conservative therapy. Which intervention may be considered?
a)
Discectomy
b)
Laminectomy
c)
Kyphoplasty
d)
Spinal fusion
e)
Artificial disc replacement
6.
A 54‑year‑old woman with L4/5 disc prolapse develops progressive weakness of ankle dorsiflexion over 72 hours. What is the most appropriate management?
a)
Continue conservative therapy and review in 6 weeks
b)
Routine orthopaedic referral
c)
Urgent referral for surgical decompression
d)
Epidural steroid injection
e)
Start gabapentin and monitor motor function
7.
A 70‑year‑old man with metastatic spinal cord compression from prostate cancer. What is the most appropriate next step?
a)
Immediate physiotherapy assessment
b)
Start NSAIDs and arrange routine oncology review
c)
Emergency steroids and urgent spinal surgical/oncology referral
d)
Kyphoplasty
e)
Oral opioids and outpatient MRI in 2 weeks
8.
A 41‑year‑old runner with improving S1 radiculopathy after 10 weeks asks for surgery to stop recurrences; neurology intact. What is the BEST advice?
a)
Microdiscectomy guarantees long‑term symptom resolution
b)
Surgery is not indicated because symptoms are improving
c)
Surgery should be performed now to prevent progressive nerve damage
d)
Fusion surgery would stop recurrent symptoms
e)
Disc replacement is the most effective option in radiculopathy
9.
A 65‑year‑old man with degenerative scoliosis, foraminal stenosis, curvature and instability. Which surgical approach is MOST likely?
a)
Microdiscectomy alone
b)
Laminectomy alone
c)
Spinal fusion with deformity correction
d)
Discectomy with disc replacement
e)
Kyphoplasty
10.
A 50‑year‑old woman has persistent pain 9 months after L4/5 microdiscectomy; MRI shows epidural fibrosis without recurrent herniation. What is the most appropriate management?
a)
Repeat microdiscectomy
b)
Spinal fusion
c)
Pain management referral for failed back surgery syndrome
d)
Immediate re‑operation to remove scar tissue
e)
Disc replacement
11.
Which statement BEST summarises (Protien Rich Plasma) PRP’s cost‑effectiveness for early knee OA in routine practice?
a)
Low cost and widely reimbursed with strong guideline support
b)
Provides longer symptom improvement but is costly and evidence quality is variable
c)
Cheaper and more effective than corticosteroid at all OA severities
d)
Guarantees structural modification, offsetting its price
e)
Only injection shown to delay arthroplasty
12.
Which injectable most commonly causes a short post‑injection inflammatory flare (pain ↑ within 48–72 h)?
a)
Corticosteroid
b)
Hyaluronic acid
c)
PRP
d)
Local anaesthetic
e)
Saline
13.
Which therapy has the strongest evidence for short‑term (2–8 weeks) pain relief in knee OA?
a)
PRP
b)
Corticosteroid
c)
Hyaluronic acid
d)
Stem‑cell/BMAC
e)
Saline
14.
Regarding hyaluronic acid (HA) for knee OA, which statement is MOST accurate?
a)
Rapid onset within 48 hours is typical
b)
Best results in end‑stage bone‑on‑bone OA
c)
Onset may take weeks; duration can extend several months in some patients
d)
Universally recommended by NICE and AAOS
e)
Proven disease‑modifying effect on cartilage
15.
Which is a RELATIVE contraindication to a knee corticosteroid injection in primary care?
a)
INR 1.8 on warfarin
b)
Well‑controlled hypertension
c)
Poorly controlled diabetes mellitus
d)
Age >75 years
e)
Presence of non‑tender effusion
16.
Which statement best reflects current evidence and guidance on stem‑cell/MSC injections for knee OA?
a)
Routinely recommended by NICE and AAOS
b)
Reliably regenerates hyaline cartilage
c)
Evidence remains limited/heterogeneous; not standard of care and not widely reimbursed
d)
Works faster than corticosteroid
e)
Mandatory before arthroplasty
17.
Which potential structural risk is most associated with frequent, repeated corticosteroid knee injections?
a)
Accelerated osteophyte formation
b)
Increased cartilage loss on MRI over time
c)
Meniscal hypertrophy
d)
Patellar tendon ossification
e)
Subchondral sclerosis reversal
18.
Rank typical real‑world costs from LEAST to MOST expensive per course: corticosteroid, HA, PRP.
a)
HA → Corticosteroid → PRP
b)
Corticosteroid → HA → PRP
c)
HA → PRP → Corticosteroid
d)
Corticosteroid → PRP → HA
e)
PRP → HA → Corticosteroid
19.
A 52‑year‑old with knee OA had only 2 weeks’ relief from prior steroid. He asks about HA. Which statement is TRUE?
a)
HA typically works within 24 hours
b)
HA may take weeks to act but can last longer than steroid in some patients
c)
HA is contraindicated in OA
d)
HA reverses cartilage loss
e)
HA is clearly superior to PRP in all trials
20.
Which statement about infection risk after intra‑articular knee injections is MOST accurate?
a)
PRP uniquely eliminates infection risk
b)
HA carries double the infection risk of steroid
c)
Risk is low across all injectates and depends primarily on aseptic technique
d)
Only steroid injections can cause septic arthritis
e)
Outpatient injections are contraindicated due to infection risk
21.
For patients with poorly controlled diabetes considering a steroid knee injection, which counselling point is MOST appropriate?
a)
No effect on glucose levels is expected
b)
Transient hyperglycaemia can occur; monitor closely for 1–7 days
c)
PRP causes greater hyperglycaemia than steroid
d)
Metformin should be stopped for 72 h
e)
Only intra‑bursal injections affect glucose
22.
A 45‑year‑old runner with chronic patellar tendinopathy failed eccentric rehab. Which injectable has the best (though mixed) evidence for promoting tendon healing vs short‑term pain relief?
a)
Corticosteroid
b)
PRP
c)
HA
d)
Local anaesthetic
e)
Ozone
23.
Considering 12‑month outcomes in knee OA, which summary is MOST consistent with recent network/meta‑analyses?
a)
Steroid consistently outperforms PRP and HA at 1 year
b)
PRP (often LP‑PRP) shows favourable 12‑month pain/function vs HA and steroid in mild–moderate OA, but high heterogeneity persists
c)
HA is superior to PRP at 12 months in all RCTs
d)
PRP never beats placebo at 12 months
e)
Combining PRP+HA is clearly guideline‑endorsed standard care
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