Ortho Exam 1 SMARTY pance/Lange practice questions (+ lecture practice questions)

True or false: Anterior fat pad sign may be normal.

True Posterior fat pad sign is ALWAYS abnormal. Anterior --> "Aok" Posterior --> "Problematic"

A Galeazzi fracture consists of a ______________ fracture and ______________ dislocation, while a Monteggia fracture consists of a ______________ fracture and ______________ dislocation.

A Galeazzi fracture consists of a radius fracture and ulna dislocation, while a Monteggia fracture consists of a ulna fracture and radial head dislocation. "GRUsome MURdur"

A 56-year-old diabetic female presents for evaluation of a recurrent catching sensation involving the ring finger of her right hand. When she attempts to make a fist it feels like her ring finger "gets stuck" halfway through the motion, if she keeps trying to flex her ring finger she will feel a pop and will then be able to fully flex the ring finger and make a fist. On examination, there is no obvious erythema involving the ring finger. The skin is not warm to touch. You palpate a nontender nodule just distal to the palmar crease of the ring finger. Which of the following is the most likely diagnosis? (A) Stenosing flexor tenosynovitis (B) Flexor tendon rupture (C) Palmar fascia fibrosis (D) Metacarpophalangeal joint sprain (E) Flexor tendon sheath infection

(A) Stenosing flexor tenosynovitis Trigger finger

Which of the following is most diagnostic of a septic joint? (A) Synovial fluid analysis (B) Plain radiograph (C) Ultrasound of the joint (D) Computed tomography (CT) scan of the joint (E) Magnetic resonance imaging (MRI) of the joint

(A) Synovial fluid analysis

Treatment of scoliosis is usually employed for patients with curvature greater than which of the following curve magnitudes? (A) 20 degrees (B) 30 degrees (C) 40 degrees (D) 50 degrees (E) 60 degree

(A) 20 degrees

Inflammation of a growth plate typically caused by repetitive activity is defined as: (A) Apophysitis (B) Epicondylitis (C) Epicondylosis (D) Osteomyelitis (E) Osteochondriti

(A) Apophysitis

An 18-year-old patient presents to the emergency department after sustaining a contusion to the anterolateral aspect of his lower leg (tib-fib region) 12 hours ago. The contusion occurred when a lacrosse ball hits him. Despite ice, over the counter NSAIDs and elevation of the involved extremity, his pain has been progressively worsening. Examination of the leg reveals a tense skin along the anterolateral aspect of the leg and pain with passive stretch of the ankle dorsiflexors. Radiographs are obtained and there is no evidence of fracture. During the course of your evaluation the patients pedal pulse on the involved extremity has diminished from 2+ to 1+. What would be most appropriate test to confirm your suspected diagnosis? (A) Compartmental pressure testing (B) Ankle-brachial index (ABI) (C) Magnetic resonance imaging (MRI) (D) Lower extremity vascular Doppler ultrasound (US) (E) Serum creatine kinase (CK)

(A) Compartmental pressure testing

A 12-year-old obese boy presents with pain in the right thigh and medial knee. The pain has been over a 6-week period. The pain is described as aching in nature. Over the last month, the patient reports he has been walking with a limp. On physical examination, the right knee is found to be unremarkable. A slight limp noted with gait. Radiographs of the right knee are normal. Which of the following is the most appropriate step in the evaluation of this patient? (A) Examine and x-ray the right hip (B) X-ray the left knee for comparison (C) Obtain a computed tomography (CT) scan of the right knee (D) Obtain a magnetic resonance image of the right knee (E) Reassure the parents and observe the patient for progression

(A) Examine and x-ray the right hip SCFE

A 53-year-old woman presents with pain in her right wrist. The pain is aggravated by movement of the thumb and when she makes a fist. She also notes that when she moves her thumb, there is an occasional locking sensation in the radial aspect of her wrist. Physical examination of the wrist reveals swelling and tenderness over the distal radius. Full flexion of the thumb into the palm combined with ulnar deviation of the wrist, produces pain. Radiographic evaluation of the wrist shows no bone abnormalities. Which of the following would be the treatment of choice in this patient presentation? (A) Immobilization of the wrist with a thumb spica splint (B) Tendon sheath corticosteroid injection (C) Operative treatment to restore functionality (D) Prompt neurological evaluation (E) Proceed to bone scan to evaluate the area of pain

(A) Immobilization of the wrist with a thumb spica splint (A) This patient presentation is most consistent with De Quervain tendinitis or tenosynovitis of the abductor pollicis longus and extensor pollicis brevis. The thickening of the tendon sheath and resultant tendon inflammation causes pain, swelling, and a triggering phenomenon of locking or sticking. This disorder is more common in middle-aged women and in repetitive motion injuries. On physical examination, the finding of a positive Finkelstein test, which is pain with full flexion of the thumb into the palm, with ulnar deviation of the wrist, is diagnostic of De Quervain tendinitis. Initial treatment is aimed at immobilization of the wrist to allow for pain and inflammatory relief. A course of nonsteroidal anti-inflammatory drugs (NSAIDs) is helpful for pain relief as well. Corticosteroid injection is reserved for patients who fail with immobilization and NSAID use. Operative treatment should be considered only if injections are not helpful. Radiographic evaluation is not helpful in the evaluation or treatment of this condition.

Which of the following patterns of stiffness is most characteristic of patients with rheumatoid arthritis? (A) Morning stiffness lasting at least 1 hour (B) Exacerbation of joint stiffness with walking (C) Frequent, brief episodes of stiffness after inactivity (D) Stiffness reflected by a major delay in muscle relaxation (E) Stiffness evidenced by increased resistance to passive movement

(A) Morning stiffness lasting at least 1 hour

A father is concerned because his 5-year-old son is favoring his right elbow and is very reluctant to use his right arm. The child localizes his pain the lateral aspect of the elbow. The child denies a traumatic fall and denies direct trauma to the area. The father reports that the pain began after he lifted his son off the ground by grabbing on his wrists and pulling him upward. What is the most likely diagnosis? (A) Radial head subluxation (B) Lateral epicondylitis (C) Radial head fracture (D) Ulnar nerve injury (E) Olecranon apophysitis

(A) Radial head subluxation

You diagnosis a patient as having adhesive capsulitis and based upon history and physical examination make the determination that the patient is in the inflammatory phase. What would be the most appropriate initial therapeutic intervention for the patient at this time? (A) Subacromial corticosteroid injection (B) Glenohumeral intra-articular corticosteroid injection (C) Orthopedic surgery referral for a manipulation under anesthesia (D) Sling immobilization for 4 to 6 weeks (E) Referral for chiropractic manipulation

(B) Glenohumeral intra-articular corticosteroid injection

A 62-year-old man presents with complaints of an acute onset of pain in his left first metatarsophalangeal joint. The joint is erythematous to inspection. Pain is elicited with active and passive range of motion assessment, and the patient is unable to bear weight on his foot secondary to the pain. Examination of the joint fluid by polarized light reveals needle-like and negatively birefringent crystals. What would be the most appropriate intervention at this time? (A) Parenteral vancomycin for 4 to 6 weeks (B) Indomethacin 50 mg every 8 hours as needed for pain for 10 days (C) Prednisone 50 mg once daily for 5 days (D) Moist heat application (E) Allopurinol 100 mg once daily until symptoms resolve

(B) Indomethacin 50 mg every 8 hours as needed for pain for 10 days

A 65-year-old man presents with complaints of acute onset of pain and swelling of the right great toe. He denies recent alcohol ingestion or trauma to the area. On physical examination, the patient is afebrile, and the first metatarsophalangeal joint is erythematous, swollen, and warm to the touch. Laboratory evaluation reveals a WBC (white blood cells) count of 12,000/mL and a normal differential. Serum uric acid level is found to be 5 mg/dL. Synovial fluid analysis reveals the presence of rhomboid-shaped crystals. Which of the following is the most likely diagnosis? (A) Acute gout (B) Pseudogout (C) Psoriatic arthritis (D) Infectious arthritis (E) Rheumatoid arthritis

(B) Pseudogout

An 8-year-old boy presents with complaint of a painful right wrist of 2 days' duration. The mother of the child reports that the child jumped off a swing landing on his outstretched arms. He immediately complained of pain in the right wrist and now has some mild swelling on the radial aspect of the wrist. Radiographic evaluation of the wrist presents an area of impaction on the distal radius, with a slight bend in the opposing cortex. Which of the following best describes this type of fracture? (A) Greenstick fracture (B) Torus fracture (C) Plastic deformation (D) Radial neck fracture (E) Monteggia fracture

(B) Torus fracture

A 39-year-old woman presents with complaints of left anterior knee pain of 4 weeks' duration. She has noted difficulty with going up and down the staircase. The patient also notes increased pain in the knee upon arising after being seated for a period. The pain may then improve with walking. The patient denies joint crepitus or locking sensation. On physical examination, there is no swelling or obvious joint distortion. The pain is reproduced with placing the knee in slight flexion and gentle pressure placed on the patella as the patient contracts the quadriceps. The knee appears stable, with no signs of crepitus, joint laxity, or internal derangement. Radiographs of the left knee are essentially benign. What course of treatment is best for this patient? (A) Crutches for 6 weeks, keeping the joint non-weight bearing (B) Cortisone injection (C) Physical therapy to strengthen the quadriceps (D) Physical therapy to strengthen the lower back (E) Progress to orthopedic evaluation for consideration of internal derangement of the knee

(C) Physical therapy to strengthen the quadriceps

A 53-year-old obese man presents with a third attack of gout within 1 year. Following the treatment of this acute attack, further laboratory testing is performed and the patient is found to have an elevated serum uric acid level and a 24-hour uric acid secretion of 950 mg (normal 250 to 750 mg per 24 hours). Which of the following medications would be most appropriate to initiate for prevention of further gouty attacks? (A) Colchicine (B) Probenecid (C) Prednisone (D) Allopurinol (E) Indomethacin

(D) Allopurinol

A 67-year-old female is in for follow-up after sustaining a humeral shaft fracture 1 week ago. She is concerned because over the past several days she has developed an inability to extend her wrist. What nerve has she likely injured? (A) Axillary (B) Median (C) Ulnar (D) Radial (E) Musculocutaneous

(D) Radial

A 50-year-old female presents with complaints of left shoulder pain that has been present for 6 months. She denies history of traumatic injury. The pain has been progressively worsening. Shoulder pain and tightness restrict her from being able to reach out the side and perform overhead activities. Physical examination of the left shoulder reveals a significant limitation of both active and passive shoulder external rotation range of motion and a moderate limitation of both active and passive shoulder flexion. Resisted shoulder range of motion testing is pain free and demonstrates no strength loss. What is the most likely diagnosis? (A) Subacromial impingement syndrome (B) Bicipital tendonitis (C) Infraspinatus rotator cuff tear (D) Supraspinatus rotator cuff tear (E) Adhesive capsulitis

(E) Adhesive capsulitis AROM + PROM**

A 7 year old boy is brought to the ED after sustaining a fall onto his outstretched hand. He complains of pain involving the entire arm and refuses to move his arm, which is held in anatomical position with the elbow flexed at 90 degrees. On physical examination, there is notable tenderness over the elbow with associated swelling and pain on attempted rotation. There is no apparent tenderness to palpation involving the wrist or shoulder. The child refuses to participate with range of motion evaluation. Radiographic evaluation of the elbow shows the presence of a positive posterior fat pad sign. What is the most likely diagnosis with this patient's presentation? (A) Nursemaid elbow (B) Lateral epicondylitis (C) Medial epicondylitis (D) Radial head dislocation (E) Occult fracture of the radial head

(E) Occult fracture of the radial head

What makes up Virchow's Triad?

1. Blood stasis 2. Vascular injury 3. Hypercoagulable state Think: dilated distal veins PE: homan's sign Diagnosis: doppler U/S Prevention: compression device/stockings, early immobilization

What are 4 most common risk factors for frozen shoulder?

1. Female 2. 50 years old 3. Diabetes 4. Thyroid disease

Which of the following risk factors is the most predictive for the development of osteoarthritis? A. Age B. Major joint trauma C. Prior inflammatory joint disease D. Repetitive stress

A. Age Age is the most significant risk factor for osteoarthritis. Prevalence and severity increase with age. Ninety percent of people greater than the age of 40 have degenerative changes of the weight bearing joints. Major joint trauma, prior inflammatory joint disease, and repetitive stress are additional risk factors but not as predictive as age.

Which of the following clinical characteristics is associated with bicipital tendonitis? A. Aggravated by resisted supination of the forearm B. Biceps rupture may present with a bulging appearance of the proximal arm C. Weakness of the arm with internal rotation and adduction D. Pain that awakens the patient at night

A. Aggravated by resisted supination of the forearm Bicipital tendonitis will be aggravated by resisted supination of the forearm. Biceps rupture may present with a bulging appearance of the proximal arm

The major complication of slipped capital femoral epiphysis is: A. Avascular necrosis of the hip B. Osteochondritis dissecans C. Leg-length discrepancy D. Transient synovitis of the hip E. Intoeing

A. Avascular necrosis of the hip

The most accurate way to determine the exact degree of spinal curvature in a child with scoliosis is by which of the following? A. Calculation of the Cobb angle B. Measurement of waist asymmetry C. Measurement of rib hump deformity D. Calculation using a scoliometer

A. Calculation of the Cobb angle The scoliotic curve is measured by the Cobb method using AP and lateral x-ray films of the entire length of the spine.

Identification of hip fracture and initiation of treatment is imperative to avoid such complications as avascular necrosis (AVN). Which of the following groups are most at risk for AVN? A. Children and adolescents B. Teenagers C. Adults in middle age D. The elderly

A. Children and adolescents AVN is more common in patients in the pediatric and adolescent age groups. This outcome is due to the precarious nature of the blood supply to the subchondral region of the femoral head, which does not stabilize until years after skeletal maturity, after which collateral flow develops.

A 25-year-old patient presents with a midshaft ulna fracture, often referred to as a "nightstick fracture," following a direct blow to the forearm. What is the most appropriate initial treatment for this type of fracture? A. Closed reduction and casting B. Open reduction and internal fixation (ORIF) C. Immediate surgical exploration D. Observation without intervention

A. Closed reduction and casting Midshaft ulna fractures, commonly known as "nightstick fractures," can often be treated with closed reduction (alignment of the fractured bone without surgical exposure) followed by casting. This approach allows for immobilization and healing of the fracture while avoiding surgery, unless there are specific indications for surgical intervention (ORIF if displaced)

A 55-year-old patient presents to the emergency department with swelling, pain, and redness in their left lower leg. They report they recently flew back from a vacation in Europe. Upon physical exam, there is calf tenderness, a palpable cord, and a positive Homan's sign (pain with passive ankle flexion). Based on their clinical presentation, what is the gold standard diagnostic method for this patient's condition? A. Doppler ultrasound B. D-dimer blood test C. Magnetic resonance imaging (MRI) D. Venography

A. Doppler ultrasound

Which of the following types of hip fracture has the highest risk for avascular necrosis and nonunion? A. Femoral neck B. Intertrochanetric C. Subtrochanteric D. Greater trochanteric

A. Femoral neck Fractures involving the femoral neck typically disrupt the blood supply to the femoral head and may cause avascular necrosis and nonunion.

A 30 year old female presents with localized pain and tenderness over the radial styloid process of the wrist. Upon history, she tells you she recently became a new parent and has noticed that her wrist bothers her when she is picking up her baby. On physical examination, the patient experiences increased pain with resisted thumb extension. Which of the following tests is most likely to be positive in this clinical scenario? A. Finkelstein's Test B. Phalen's Test C. Tinel's Sign D. Adson's Test E. Lachman Test

A. Finkelstein's Test Finkelstein's Test involves grasping the thumb and ulnarly deviating the wrist, which can elicit pain along the course of the inflamed tendons in De Quervain's tenosynovitis.

A 14 year-old patient, who fell on his outstretched hand, complains of pain along his entire arm. There is point tenderness and swelling over the midshaft of the radius. There is significant pain with limited flexion of the elbow joint. An x-ray will most likely show which of the following fractures? A. Galeazzi's B. Scaphoid C. Colles' D. Smith's

A. Galeazzi's Galeazzi's fracture/dislocation involves a fracture of the mid or distal radial shaft with distal radioulnar joint dislocation.

A 75 year-old female falls on her outstretched arm. She sustains a humeral mid-shaft fracture. Nerve impingement occurs due to the fracture. What is the most likely physical examination abnormality that will be encountered? A. Inability to extend the wrist against resistance B. Numbness over the deltoid muscle in the shoulder C. Winging of the scapula D. Weakness of the rotator cuff

A. Inability to extend the wrist against resistance The radial nerve is most likely entrapped by this fracture. Radial nerve damage will cause an inability to extend the wrist against resistance. Radial nerve --> wrist drop or extensor weakness

A baseball pitcher experiences pain on the inner side of the elbow, especially during throwing. Physical examination reveals tenderness and instability on the medial side of the elbow. What is the standard imaging modality for this injury? A. MRI B. CT scan C. X-ray D. Ultrasound

A. MRI MRI standard of diagnosis for UCL tear

What nerve is involved in the most common compression neuropathy of the upper extremity? A. Median nerve B. Ulnar nerve C. Radial nerve D. Axillary nerve

A. Median nerve Carpal tunnel syndrome

Which of the following is a fracture that lacks potential to heal without intervention and is usually diagnosed 3-6 months post fracture? A. Non-union B. Mal-union C. Delayed union D. Heterotopic ossification

A. Non-union

A mother brings her 14 month-old son to your clinic. Earlier today she lifted her son by grabbing him by the wrists and pulling him up off the floor. The child is sitting in his mother's lap with his left forearm is extended and in pronation. He is refusing to move the left arm, forearm or wrist. The arm and joints appear normal with no noted deformities, edema or erythema. Distal pulses and capillary refill are normal and he can move his fingers. Which of the following is the most likely diagnosis? A. Nursemaid's elbow B. Fractured left wrist C. Osteochondritis dissecans D. Child abuse

A. Nursemaid's elbow

Abduction of the flexed hip of a 1-month-old elicits a "clunk." What test is this and what does it assess? A. Ortolani sign; developmental dysplasia of the hip B. Lachman test; slipped capital femoral epiphysis C. Galeazzi test; Legg-Calvé-Perthes disease D. Pavlik's sign; Osgood-Schlatter disease

A. Ortolani sign; developmental dysplasia of the hip In the Ortolani maneuver, abduction of the flexed hip results in the "clunk," which represents the reduction of the dislocated hip back into the acetabulum. Barlow maneuver reproduces slippage (clunk) on adduction. Lachman test evaluates anterior cruciate ligament stability. The Galeazzi test may detect unilateral hip dislocation in an older infant (3 to 6 months) by observing that one knee is lower than the other when the patient is supine with knees and hips flexed and feet flat on the examining table. The Pavlik harness is a soft splint. It is most commonly used for treating infants with developmental dysplasia of the hip (DDH). It helps keep the infant's hips and knees bent and the thighs spread apart.

When treating lateral epicondylitis with a compression strap, which nerve may be compressed? A. Radial nerve B. Ulnar nerve C. Axillary nerve D. Median nerve

A. Radial nerve The compression strap is typically worn around the forearm, and if it is too tight or placed improperly, it can potentially exert pressure on the radial nerve, which runs along the outer aspect of the forearm. This can lead to symptoms such as numbness, tingling, or discomfort in the radial nerve distribution.

A 53 year-old female massage therapist presents with new onset of sudden swelling involving the right elbow. She denies previous episodes similar to this. On physical examination, the patient is afebrile. There is a 4 cm fluid-filled mass that is tender to palpation overlying the tip of the elbow with no evidence of erythema or warmth. Which of the following is the most appropriate intervention? A. Rest and NSAIDs B. Surgical excision C. Incision and drainage D. Aspiration and corticosteroid injection

A. Rest and NSAIDs Rest and NSAID is the most appropriate initial intervention in a patient with olecranon bursitis. Aspiration of the bursa and corticosteroid injection are second-line therapy in a patient with olecranon bursitis who fails rest and NSAIDs

A 60 year-old right hand dominant male presents to your office complaining of right shoulder pain and progressively worsening arm weakness. His symptoms are aggravated when working above the shoulder level. On physical examination, there is no evidence of muscle atrophy. He has strong (5/5) adduction of his right shoulder but considerable weakness (1/5) with abduction when raising his arm above his head. Passive range of motion is intact. Which of the following is the most likely diagnosis? A. Rotator cuff tear B. Subacromial bursitis C. Adhesive capsulitis D. Supraspinatus tendonitis

A. Rotator cuff tear Rotator cuff tears are associated with full passive range of motion but have pain and weakness during active abduction. Of the four rotator cuff muscles, supraspinatus is most likely to strain causing tendonitis. The symptoms cause limited range of motion due to pain but minimal weakness.

An obese 16-year-old boy with a history of hypothyroidism presents with pain in his left groin, hip, and thigh. His mother notices a limp when he walks. The patient denies any recent significant trauma to his left lower extremity. On physical exam, his gait is antalgic. With the patient in the supine position, there is external rotation and abduction of the thigh with passive flexion of the hip. A radiograph of the affected hip is performed, which demonstrates an inferior displacement of the left epiphysis, with the fracture line crossing Klein's line. What is the most likely diagnosis based on this presentation? A. Slipped capital femoral epiphysis (SCFE) B. Femoral shaft fracture C. Hip dislocation D. Stress fracture of the femoral neck E. Osteosarcoma of the proximal femur

A. Slipped capital femoral epiphysis (SCFE) Most common in 7-16 year old obese male during growth spurt, jumping activities

The most important preventive medicine recommendation for patients with osteoarthritis is which of the following? A. Start an exercise program B. Brace the affected joint C. Rest the joint D. Inject steroids monthly

A. Start an exercise program Patients with osteoarthritis who exercise are able to maintain range of motion, strengthen periarticular muscles, and improve physical fitness.

Abduction of the shoulder against resistance helps localize pain in which of the following muscles of the shoulder girdle? A. Supraspinatus B. Infraspinatus C. Teres minor D. Subscapularis

A. Supraspinatus

Which of the following rotator cuff tendons is most likely to sustain injury because of its repeated impingement (impingement syndrome) between the humeral head and the undersurface of the anterior third of the acromion and coracoacromial ligament? A. Supraspinatus B. Infraspinatus C. Teres minor D. Subscapularis

A. Supraspinatus A critical zone exists for the supraspinatus tendon due to its superior insertion site. It is susceptible for injury because it has a reduction in its blood supply that occurs with abduction of the arm. Impingement of the shoulder is most commonly seen with the supraspinatus tendon, the long head of the biceps tendon and/or the subacromial bursa.

What is the preferred recommendation for treatment of a rotator cuff tear? A. Surgical repair B. PT C. Cortisone injections D. Rest

A. Surgical repair Arthroscopic Rotator Cuff Repair is preferred. DOES NOT HEAL ON ITS OWN. Others are options too but aren't preferred.

A 57 year-old male with history of hypertension presents with acute gouty arthritis. Which of the following anti- hypertensive classes should be avoided in this patient? A. Thiazide diuretics B. Beta-blockers C. ACE inhibitors D. CCBs

A. Thiazide diuretics Thiazide diuretics are common causes of increased urate levels causing gout attacks.

A 56-year-old white post-menopausal female had a recent surveillance DEXA bone densitometry. The T-score is -2.7 for her right hip. In counseling this patient, in addition to medications, which of the following would you recommend? A. Weight bearing exercises B. Water aerobics C. Limit sun exposure D. Daily red wine consumption

A. Weight bearing exercises Weight-bearing exercises are an appropriate adjunct to medication in a patient with osteoporosis. Water aerobics are non-weight bearing. Sun exposure and vitamin D supplementation are useful in preventing and treating osteomalacia. DEXA: Normal = 0 to -1 Osteopenia = -1 to -2.5 Osteoporosis = < -2.5

A 32 year-old medical transcriptionist presents with burning and tingling in her right wrist and hand for the past month. On physical exam, Phalen's test is positive; however, there is no atrophy of the thenar eminence. Which of the following is the initial step in management of this patient? A. Wrist splint for 2-6 weeks B. Corticosteroid injection C. Surgical referral D. Darvocet

A. Wrist splint for 2-6 weeks The treatment of carpal tunnel syndrome is aimed at relieving the pressure on the median nerve. This is best accomplished by having the patient wear a wrist splint during the activities that increase the pressure on the median nerve.

Which imaging modality is the best way to distinguish between frozen shoulder and glenohumeral OA? A. X-ray B. MRI C. CT scan D. Ultrasound

A. X-ray

What is the most characteristic symptom of rheumatoid arthritis (RA)? A. early morning joint stiffness B. progressive joint pain C. predilection for the small joints D. joint swelling

A. early morning joint stiffness The most characteristic symptom of RA is early morning stiffness. The total array of rheumatoid arthritic symptoms includes the following: (1) morning stiffness lasting more than 1 hour, (2) pain on motion of joints, (3) tenderness of joints, (4) swelling (soft tissue fluid inflammation rather than bone overgrowth), (5) symmetric joint involvement, and (6) subcutaneous nodules.

An x-ray reveals a break in the cortex of one side of the ulna shaft without a separation or break of the opposite cortex describes what type of fracture? A. greenstick B. transverse C. torus (buckle) D. epiphyseal

A. greenstick A greenstick fracture is a break in the cortex of one side of bone shaft without a break in the opposite cortex.

Which of the following clinical manifestations is commonly seen in a patient with rheumatoid arthritis? A. symmetric joint swelling B. presence of Heberden's nodes C. morning stiffness lasting less than 15 minutes D. cervical spondylosis of C3-C7

A. symmetric joint swelling Symmetric joint swelling associated with stiffness, warmth, tenderness, and pain are characteristic of rheumatoid arthritis.

A 10 year old boy presents with complaints of left posterior heel pain for 3 months. Pain onset was insidious. His parents describe her as a very active child and that currently he his participating in a youth soccer league and a youth basketball league. Pain is increased with weight-bearing activities, especially running and jumping. His parents report that he will limp at times, especially if he has both soccer and basketball practice the same day. Pain will decrease with rest and ice. Pain is the least severe when he first awakes in the morning. He denies night pain. Examination of the left foot and ankle region reveals no erythema, swelling, or obvious deformities. Pain is reproduced with calcaneal compression. Active and passive foot and ankle range of motion is pain free and equal bilaterally. What is the most likely diagnosis? (A) Achilles tendonitis (B) Calcaneal apophysitis (C) Plantar fasciitis (D) Calcaneal osteomyelitis (E) Retrocalcaneal bursiti

B) Calcaneal apophysitis

Which thoracic curvature is an indication for treatment with bracing in an adolescent with scoliosis? A. Less than 20 degrees B. 20 to 40 degrees C. 40 to 60 degrees D. 40 degrees with a lumbar curvature of 30 degrees E. Greater than 70 degrees

B. 20 to 40 degrees Scoliosis is defined by lateral curvature of the spine with rotation of vertebrae and is typically located in the thoracic or lumbar spine in the right or left directions. Idiopathic scoliosis most commonly presents as a right thoracic curve in females from 8 to 10 years of age. Scoliosis is typically asymptomatic unless curvatures are so severe that there is pulmonary dysfunction or there is an underlying disorder (bone or spinal tumor) that is causing the scoliosis. X-rays need to be taken of the entire spine to help determine the degree of curvature. Treatment modalities are based on the degree of curvature: 20 degrees or less does not normally require treatment; 20 to 40 degrees is an indication for bracing in an immature child; and 40 degrees and greater is resistant to bracing and requires surgical fixation with spinal fusion, which is best done at special centers. A greater than 70-degree curvature is associated with poor respiratory function in adulthood.

Idiopathic osteonecrosis of the femoral head is the most likely diagnosis in which of the following patients? A. 5-year-old boy who complains of significant hip and knee pain B. 6-year-old boy who reports a limp and aching in the groin and proximal thigh C. 7-year-old obese girl who manifests a painless limp D. 12-year-old girl who complains of progressively worsening hip pain, fever, and chills E. 18-year-old boy who complains of bilateral hip pain that is worse in the morning and is relieved with activity

B. 6-year-old boy who reports a limp and aching in the groin and proximal thigh Legg-Calvé-Perthes disease is idiopathic osteonecrosis of the femoral head in children. The condition typically affects children between the ages of 4 and 8 years, but the range of onset is 2 to 12 years of age. It is unilateral in 90% of patients and four times more common in male population. Typically, the patient presents with a limp that worsens with activity and is thus more noticeable at the end of the day. If the child reports pain, it is typically an aching in the groin or proximal thigh.

Which of the following is the treatment of choice for a torus (buckle) fracture involving the distal radius? A. Open reduction and internal fixation B. Ace wrap or anterior splinting C. Closed reduction and casting D. Corticosteroid injection followed by splinting

B. Ace wrap or anterior splinting A torus or buckle fracture occurs after a minor fall on the hand. These fractures are very stable and are not as painful as unstable fractures. They heal uneventfully in 3-4 weeks.

A 65-year-old male presents to his primary care physician for stiffness in his arm. He states that he has been having trouble combing his hair and reaching objects that are high on the shelf. The patient has a past medical history of diabetes mellitus type II, obesity, and hypertension. His current medications include metformin, insulin, lisinopril, and hydrochlorothiazide. The patient admits to leading a sedentary life in which he tends to stay home and watch television. He does not engage in any physical or strenuous activity. On physical exam the patient has decreased passive and active range of motion of his shoulder. Strength of the patient's upper extremity is 4/5. Which of the following is the most likely diagnosis? A. Rotator cuff impingement B. Adhesive capsulitis C. Biceps tendinopathy D. Subacromial bursitis

B. Adhesive capsulitis (frozen shoulder) Adhesive capsulitis classically presents in elderly, sedentary patients with a chief complaint of stiffness. On physical exam, the key findings are a loss of active, but more importantly, passive range of motion. It is the loss of passive range of motion that suggests a diagnosis of adhesive capsulitis over rotator cuff injuries, biceps tendinopathy, glenohumeral osteoarthritis, and subacromial bursitis. The diagnosis of adhesive capsulitis is made clinically, however, radiograph, MRI, and ultrasound can be used to rule out other diagnoses. Treatment includes NSAIDs and physical therapy and can include steroids.

During the stages of fracture healing which of the following is responsible for producing collagen? A. Osteoclasts B. Chondrocytes C. Glycosaminoglycans D. Fibroblasts

D. Fibroblasts Fibroblasts produce collagen during the inflammation stage of healing.

Which of the following medications is the treatment of choice for patients with chronic gout to prevent recurrence of symptoms during its quiescent phase? A. Probenecid (Benemid) B. Allopurinol (Zyloprim) C. Colchicine D. Indomethacin (Indocin)

B. Allopurinol (Zyloprim) Allopurinol is the best drug to lower serum urate in overproducers, stone formers, and patients with advanced renal failure. It is a xanthine oxidase inhibitor that is used to prevent the formation of uric acid.

A patient is 12 hours post-closed reduction of a tibial fracture and is in a long leg cast. Despite pain medication the patient complains of unrelieved pain and cannot move his toes. Which of the following is the most appropriate clinical intervention in this patient? A. Elevate the leg B. Bivalve the cast C. Encourage ambulation D. Place on PCA pump

B. Bivalve the cast The cast for this patient is too tight and the pressure needs to be released. Bivalving the cast is the best option for this patient.

A 15 year-old softball player presents after jamming the distal tip of her finger into severe flexion. She is unable to extend the distal phalanx and she has pain on palpation of the distal interphalangeal joint. X-ray of the hand fails to reveal any associated avulsion fracture. Which of the following is the treatment of choice? A. Open reduction and internal fixation B. Continuous extension of the DIP with splinting C. Continuous flexion of the PIP with splinting D. Application of short arm cast

B. Continuous extension of the DIP with splinting The treatment of choice for a tear in the extensor tendon (Mallet finger) of the finger is continuous extension of the DIP via splinting for 6 to 8 weeks

Patient presents to you for ER follow-up for shoulder pain. X-ray report reads amorphous calcification present superior to the greater tuberosity. NSAIDs aren't effective. What is the most effective next line treatment? A. PT B. Cortisone injection C. Surgery D. Opiods

B. Cortisone injection

A 41 year-old female complains of 3 weeks of gradually worsening pain at the base of the thumb and radial aspect of the wrist. She and her husband have been renovating their home for the past 2 months and it has become increasingly difficult for her to hold a hammer. She denies numbness or tingling. She denies any history of previous trauma to the wrist. On examination, there is tenderness over the distal radial styloid and pain reproduced with ulnar deviation of a fist clenched over the abducted thumb. Which of the following is the most likely diagnosis? A. Carpal tunnel syndrome B. De Quervain's tenosynovitis C. Ganglion cyst D. Volar flexor tenosynovitis

B. DeQuervain's tenosynovitis De Quervain's tenosynovitis typically results from repetitive activity involving pinching the thumb while moving the wrist. There is often pain and tenderness over the radial styloid and Finkelstein's is positive in this patient.

A 65 year-old female presents to the office with a six-month history of back pain. The patient states that she is shrinking and thinks she is about an inch shorter than she was a year ago. Serum parathyroid hormone, calcium, phosphorus, and alkaline phosphatase are all normal. Which of the following would you most likely see on the x-ray of her spine? A. Radiolucent lesions B. Demineralization C. Chondrocalcinosis D. Subperiosteal resorption

B. Demineralization Osteoporosis presents with varying degrees of back pain and loss of height is common. The serum calcium, parathyroid hormone, phosphorus, and alkaline phosphatase are normal. X- ray findings demonstrate demineralization in the spine and pelvis.

A 23 year-old male presents to the emergency department with severe right shoulder pain. He is holding his shoulder in internal rotation. Which of the following would increase your suspicion that he has a posterior glenohumeral dislocation? A. History of a direct posterior blow to the humerus B. History of seizure C. Palpable mass in the anterior axilla D. Palpable space beneath the acromion

B. History of seizure Tonic-clonic seizures can create severe contraction of the internal rotator muscles of the shoulder. The other answer choices are specific finding of anterior dislocation. Posterior dislocations are less common and associated with seizures or MVAs

A 52-year-old male presents with a severely painful, swollen right great toe. He denies recent trauma but reports several similar episodes of toe pain and swelling over the past two to three years. He has a history of alcohol abuse and hypertension, for which he "takes medication" of an unknown type. Examination reveals bright erythema and edema associated with the right first MCP joint. Which of the patient's antihypertensive medications is most likely contributing to this condition? A. Diltiazem (Cardizem) B. Hydrochlorothiazide (HCTZ) C. Lisinopril (Prinivil) D. Metoprolol (Lopressor)

B. Hydrochlorothiazide (HCTZ) Thiazide diuretics, such as hydrochlorothiazide, are associated with increased risk of hyperuricemia and gout.

A 4 year-old boy presents to the ED after sustaining a crush injury to his distal third phalanx. Physical exam reveals an associated nail bed injury. Which of the following is the appropriate management? A. Rest, ice, elevation B. Immobilize, antibiotics, orthopedics referral C. Splint for 48 hours, aspirin, ice D. Surgical referral for amputation of digit

B. Immobilize, antibiotics, orthopedics referral Distal phalanx fracture should be immobilized and if there is an associated nailbed injury the fracture is considered "open" and the patient should be given antibiotics and follow-up with ortho in one week.

Which of the following histories is most consistent with rheumatoid arthritis (RA)? A. Acute onset, morning stiffness, monoarticular joint swelling and tenderness B. Insidious onset, morning stiffness, symmetrical joint swelling and tenderness C. Insidious onset, morning stiffness, monoarticular joint swelling and tenderness D. Acute onset, morning stiffness, symmetrical joint swelling and tenderness

B. Insidious onset, morning stiffness, symmetrical joint swelling and tenderness Rheumatoid arthritis has an insidious onset, morning stiffness is typically longer than 30 minutes, and is typically symmetrical in presentation.

A 45-year-old patient with a history of chemotherapy and radiation therapy presents with progressive hip pain. There is a "crescent sign" in the femoral head noted on x-ray. What is the most likely diagnosis? A. Osteoarthritis B. Osteoporosis C. Avascular necrosis (AVN) of the hip D. Hip impingement syndrome

C. Avascular necrosis (AVN) of the hip The presence of the crescent sign on X-ray is a characteristic finding in avascular necrosis of the hip. This condition, also known as osteonecrosis, can be associated with risk factors such as chemotherapy and radiation therapy.

Which nerve should specifically be evaluated following a closed reduction of the GH joint using the milch maneuver? A. Radial nerve B. Ulnar nerve C. Axillary nerve D. Median nerve

C. Axillary nerve

A 68-year-old woman presents to the emergency department with a three-day history of severe progressive pain of the right knee that had begun after an audible painful click upon standing from a sitting position. At presentation, the patient was not able to stand on her right leg. Body temperature was 98.6 The day before it was 100.7 °F. The right knee is swollen and warm, but no redness is seen. Palpation is painful at the lateral joint space. Flexion/extension of the knee is 60-50 degrees. Blood examination shows a C-reactive protein (CRP) level of 169mg/l and leucocytes of 7.3x109/l. X-ray studies of the right knee reveal osteoarthritis of the medial compartment with some loose bodies. What is the next best step in the management of this patient? A. MRI of the Knee B. Joint aspiration C. Blood cultures D. Check serum CRP levels

B. Joint aspiration The definitive diagnostic test is identification of bacteria in the synovial fluid. In the setting of suspected joint infection, synovial fluid aspiration should be performed (prior to administration of antibiotics); fluid should be sent for Gram stain and culture, leukocyte count with differential, and assessment for crystals. If synovial fluid cannot be obtained with closed needle aspiration, the joint should be aspirated under computed tomography (CT) or fluoroscopic or ultrasound guidance. Certain joints, such as the hip or sacroiliac joint, may require surgical arthrotomy for diagnostic aspiration.

What imaging study is most accurate in evaluation of a proximal bicep (long head) rupture? A. X-ray B. MRI C. CT scan D. Ultrasound

B. MRI

Which of the following is the imaging study of choice for soft tissue or occult bony injury? A. X-ray B. MRI C. Ultrasound D. CT scan

B. MRI

A 25 year-old presents with pain in the proximal ulna after falling directly on the forearm. X-ray shows fracture of the proximal 1/3rd of the ulna. There is an associated anterior radial head dislocation. What is the proper name for this condition? A. Galeazzi fracture B. Monteggia fracture C. Colles' fracture D. Smith fracture

B. Monteggia fracture "GRUesome MURder" G: Galeazzi R: Radius fracture U: Ulna dislocation M: Monteggia U: Ulna fracture R: Radial head dislocation

A 14-year old male active in sports, has been complaining of intermittent anterior right knee pain for several months. He denies any specific injuries. On examination, there is no erythema, swelling, deformities, joint laxity, or crepitus. Palpation reveals tenderness over the tibial tubercle and bursa of the right knee. This finding is characteristic of which of the following disorders? A. Discoid meniscus B. Osgood-Schlatter disease C. Chondromalacia patella D. Osteochondritis dissecans

B. Osgood-Schlatter disease Osgood-Schlatter disease causes pain at the tibial tubercle and it is caused by fragmentation of the tip of the proximal tibial physis.

Bony and cartilaginous enlargement of distal interphalangeal joints is commonly seen in which of the following medical conditions? A. Rheumatoid arthritis B. Osteoarthritis C. Psoriatic arthritis D. Gouty arthritis

B. Osteoarthritis Heberden's nodes are commonly seen in primary osteoarthritis.

A 53 year-old patient presents with severe pain at the base of the thumb and no other finger involvement. The pain is worse with activity and lasts a short period of time following rest. There is no specific history of trauma to the thumb but the patient admits working with her hands as a typist. Which of the following is the most likely diagnosis? A. Rheumatoid arthritis B. Osteoarthritis C. Hemochromatosis D. Pseudogout

B. Osteoarthritis The base of the thumb is typically involved with osteoarthritis as are the DIP joints of the other fingers.

In scaphoid fractures, which part of the bone has the highest risk of non-union or avascular necrosis (AVN)? A. Distal pole B. Proximal pole C. Waist D. Tubercle

B. Proximal pole

A 28-year-old female, who has experienced occasional painful migratory arthralgias, complains now of a tender, swollen, and hot left ankle. The joint was aspirated and the synovial fluid showed 55,000 WBCs, 75% polymorphonuclear leukocytes, low glucose level, and no crystals. Which of the following would be the most likely diagnosis? A. Rheumatoid arthritis B. Septic arthritis C. Gouty arthritis D. Osteoarthritis

B. Septic arthritis Septic arthritis presents with a large number of WBCs, predominantly polymorphonuclear, and with glucose levels much lower than serum levels.

A 41-year-old male with a history of intravenous drug abuse presents to your office with acute, nontraumatic right knee pain, chills, and sweats starting 2 days ago. On physical examination, his temperature is 102.9 degrees F. The right knee is erythematous, edematous and tender to palpation and range of motion. Plain knee x-ray reveals soft tissue swelling. Which of the following is most likely the diagnosis? A. Gouty arthritis B. Septic arthritis C. Rheumatoid arthritis D. Psoriatic arthritis

B. Septic arthritis This patient's signs and symptoms are most consistent with septic arthritis. IV drug abuse places this patient at even greater risk.

What is the most common organism responsible for causing both osteomyelitis and septic arthritis? A. Escherichia coli (E. coli) B. Staphylococcus aureus C. Streptococcus pyogenes D. Eikenella corrodens

B. Staphylococcus aureus

An x-ray taken on a patient complaining of wrist pain after being hit by a baseball reveals a non-displaced mid-shaft ulnar fracture. Which of the following splints is most appropriate for treatment? A. Thumb spica B. Sugar tong C. Cock-up wrist D. Short arm gutter

B. Sugar tong Sugar tong splints are best used to immobilize the elbow, wrist and forearm. Ulna shaft fracture = nightstick fracture Diagnosis via x-ray (AP/lateral) Treatment is closed reduction + splint/cast or ORIF if displaced.

A 28-year-old male is rushed to the emergency department after a late-night altercation in a local bar. During the altercation, he was stabbed with a knife in his left upper extremity just proximal to his antecubital fossa. When he arrives at the emergency department, the knife is still embedded in his distal humerus. What is the most appropriate diagnostic step in ruling out vascular injury in this individual? A. Check distal pulses by palpation B. Check distal pulses by auscultation C. Check distal pulses by Doppler ultrasound D. Check distal pulses by magnetic resonance angiography E. Check distal pulses by a combination of palpation and auscultation

C. Check distal pulses by Doppler ultrasound In penetrating wounds to an extremity, the presence of distal pulses does not rule out vascular injury. Perform doppler studies to assess vascular integrity.

A 62-year-old man presents complaining of progressively worse right shoulder pain for 5 weeks. The pain is located anterolaterally and is aggravated by overhead activities. The patient notes significant pain when trying to sleep with his arm in a forward-flexed position and his hand behind his head. The patient notes weakness of the right arm and states that he has noticed that he uses the arm less because of the pain. On physical examination, you elevate the patient's arms to 90 degrees, abduct to 30 degrees, and internally rotate the arms with the thumbs pointing downward. When you apply downward pressure to both arms you note weakness on the right side and the patient reports exacerbation of his shoulder pain. When the patient has his arms at his side and elbows flexed to 90 degrees you ask him to resist inward and outward pressure to the forearms; during this maneuver he has full strength and no complaints of pain. Based on this presentation, what is the most likely injured structure? A. Infraspinatus tendon B. Supraspinatus tendon C. Teres minor tendon D. Subscapularis tendon E. Bicipital tendon

B. Supraspinatus tendon The maneuver described is commonly referred to as the supraspinatus strength test or the "empty the can" test. Weakness in this maneuver is suggestive of injury to supraspinatus tendon. The teres minor and infraspinatus tendons are external rotators and are often tested with the arm at 90 degrees of elbow flexion with the patient attempting to externally rotate against resistance. The subscapularis is also tested at 90 degrees of elbow flexion with resistance applied as the patient attempts to internally rotate against resistance.

Which of the following fractures is associated with the greatest risk of avascular necrosis of the femoral head? A. intertrochanteric B. femoral neck C. subtrochanteric D. pelvic rim

B. femoral neck Femoral neck fractures lead to the greatest disruption of arterial blood supply to the femoral head.

A 62 year-old female presents to the emergency room with significant back pain without radiation after lifting a box weighing approximately 15 pounds. She denies any previous trauma or injuries. Past history includes hysterectomy at age 42 and a 49 pack year smoking history. Her current weight is 107 pounds. Lumbo-sacral spine film indicates a spinal compression fracture at level L4. Which of the following tests would you perform to further assess the patient's findings? A. Computed tomography (CT) of the spine B. Magnetic resonance imaging (MRI) of the spine C. DEXA scan D. Technetium-99m bone scan

C. DEXA scan Low patient weight, smoking, and early estrogen deficiency are all risk factors for osteoporosis. Spontaneous fractures occurring from lifting with above risk factors should be evaluated for bone density.

In the neonate, unequal thigh folds may indicate which of the following? A. Coxa vara B. Legg-Calve-Perthes disease C. Developmental hip dysplasia D. Slipped capital femoral epiphysis

C. Developmental hip dysplasia A dislocated hip displaces proximally in developmental hip dysplasia, causing a shortening of the leg that may present as unequal thigh folds.

What is the gold standard for diagnosing DVT? A. Venography B. D-dimer C. Doppler U/S D. CT scan

C. Doppler U/S

Which of the following diagnostic tests should be ordered initially to evaluate for suspected deep venous thrombosis of the leg? A. Venogram B. Arteriogram C. Duplex ultrasound D. Impedance plethysmography

C. Duplex ultrasound Gold standard

A 55-year-old male patient of northern European descent presents with painless limitation of movement in the ring finger of the right hand. The patient states that over the past 9 months his ring finger has been gradually pulled into a bent position. He has tried to straighten his finger but has been unable to do so. He can bend his finger and make a fist without difficulty. Examination of the palmar aspect of the right hand reveals a taut cord that begins in the palmar region and crosses the metacarpophalangeal joint of the ring finger. There is a palmar skin nodule at the base of the taut band. Palpation of the nodule and taut band does not elicit tenderness. You are able to passively flex the ring finger to its end range of motion but any attempt to extend the ring finger beyond its initial resting position is restricted due to a firm end feel. What is the most likely diagnosis? A. Jersey finger B. Trigger finger C. Dupuytren contracture D. Gamekeeper finger E. Ganglion cyst

C. Dupuytren contracture Dupuytren contracture is a painless nodular thickening and contracture of the palmar fascia that leads to a gradually progressive loss of active and passive finger extension range of motion. Males of northern European descent are the patient population that is most commonly affected. Jersey finger and trigger finger involve tendon ruptures at the distal interphalangeal joint that result in loss of active motion but passive motion is maintained. Patients with trigger finger classically complain of pain and catching when they flex their finger. Gamekeeper injuries typically occur at the first metacarpophalangeal joint and involve injury to the ulnar collateral ligament. Ganglion cysts of flexor tendon sheath can present as a tender mass in the palm but rarely do they limit active or passive range of motion.

What is the most common cause of compartment syndrome? A. Infection B. Nerve compression C. Fracture D. Muscle strain

C. Fracture

A patient presents with pain and instability at the base of the thumb following a skiing accident where they fell while gripping a ski pole tightly. On examination, there is tenderness at the ulnar aspect of the thumb's metacarpophalangeal joint, and there is a noticeable laxity when stress is applied to the thumb in the radial direction. What is the most likely diagnosis? A. De Quervain's Tenosynovitis B. Carpal Tunnel Syndrome C. Gamekeeper's Thumb D. Trigger Finger E. Dupuytren's Contracture

C. Gamekeeper's Thumb U/S or MRI to confirm

What is the most common organism responsible for causing necrotizing fasciitis? A. Escherichia coli (E. coli) B. Staphylococcus aureus C. Group A Streptococcus D. Eikenella corrodens

C. Group A Streptococcus

A 35 year old male presents with persistent wrist pain, especially dorsally, and limited motion. Upon physical exam, there is tenderness to palpation over the lunate bone. Imaging reveals avascular necrosis of the lunate bone. What is the most likely diagnosis? A. Carpal Tunnel Syndrome B. De Quervain's Tenosynovitis C. Kienbock's Disease D. Trigger Finger

C. Kienbock's Disease Most common in males 20-40 years old. Dominent

A positive hook test is found. Which imaging study is most accurate for diagnosis? A. Ultrasound B. X-ray C. MRI D. CT scan

C. MRI MRI is the gold standard diagnostic imaging modality for biceps tear

Which of the following medications is the initial treatment of choice for suppressing the progression of rheumatoid arthritis (RA)? A. Naproxen sodium (Naprosyn) B. Prednisone C. Methotrexate (Rheumatrex) D. Gold salts

C. Methotrexate (Rheumatrex) Methotrexate (DMARD) is the initial treatment choice for RA and aids in suppression of disease.

A 43-year-old female presents with a two-year history of frequent episodes of pain and morning stiffness in both hands and wrists. She experiences some symptomatic relief with ibuprofen but feels that the episodes are becoming more frequent and severe. On examination, you observe joint swelling of several MCP joints on both hands. X-ray of the hands shows joint space narrowing of the MCP joints. In addition to NSAIDs, what is the most appropriate first-line long-term medication to treat this patient? A. Prednisone (Deltasone) B. Infliximab (Enbrel) C. Methotrexate (Rheumatrex) D. Sulfasalazine (Azulfidine)

C. Methotrexate (Rheumatrex) Methotrexate is the standard first-line medication in the treatment of rheumatoid arthritis. This DMARD is generally effective, well-tolerated, and affordable.

Which classification system is commonly used to classify humeral head fractures? A. Smith-Fracture Classification B. Johnson-Humerus Index C. Neer Classification D. AO/OTA Classification

C. Neer Classification

A newborn infant is noted to have a sacral dimple along with an asymmetry of the superior gluteal crease. What is this combination of findings a red flag sign for? A. Gastrointestinal obstruction B. Hip dysplasia C. Neural tube defect D. Skin infection

C. Neural tube defect The presence of a sacral dimple, especially when associated with asymmetry of the superior gluteal crease, can be a red flag sign for underlying spina bifida, which is a neural tube defect. It is important to evaluate and investigate such findings in newborns to rule out spinal cord abnormalities.

A 44 year-old female hairdresser presents to the clinic with a two-month history of pain and numbness of her left hand that awakens her from sleep. Your exam reveals electric tingling sensations with percussion over the volar surface of the wrist just proximal to the palmar crease and paresthesias noted within 15 seconds of passively flexing the wrist. Which of the following would be the best initial treatment in this patient? A. Corticosteroid injection B. Surgical intervention C. Nocturnal splinting D. Gabapentin (Neurontin)

C. Nocturnal splinting Splinting the affected wrist is the initial treatment choice and maintains a neutral position of the wrist.

A 22 year-old male presents several hours after sustaining a hand injury when he punched a wall. X-rays of the hand demonstrate fracture of the fifth metacarpal neck with 65 degrees dorsal angulation and a claw hand. What is the most appropriate intervention? A. Antibiotic treatment and ulnar gutter splint immobilization B. Closed reduction and ulnar gutter splint immobilization C. Open reduction and ulnar gutter splint immobilization D. Ulnar gutter splint immobilization only

C. Open reduction and ulnar gutter splint immobilization Open reduction is indicated with angulation of greater than 40 degrees. Reduction followed by splinting is recommended for fifth metatarsal fractures with angulation of 15-40 degrees.

A 13-year-old boy presents to the clinic for a complaint of right knee pain that he first noticed about a year ago. It started out as mild discomfort in the area just below the kneecap, but has been getting progressively worse. Now, it hurts anytime he uses his leg, even when walking. He does not remember any injury to his knee. On examination of his knee there is swelling and exquisite tenderness over the tibial tubercle. Radiographs are normal. What is the most likely diagnosis? A. Chondromalacia patellae B. Legg-Calvé-Perthes disease C. Osgood-Schlatter disease D. Patellar dislocation

C. Osgood-Schlatter disease Osgood-Schlatter disease is caused by microfractures of the patellar ligament where it inserts into the tibial tubercle. This condition usually occurs in the preteen and adolescent years, and is more common in males than females. The history of injury can be vague and the patient may not remember a specific injury that precipitated the pain. Often, the pain progresses to the point of interference of even routine physical activities. X-rays may or may not show any abnormalities. Upon x-ray, type I disease appears normal, but type II will reveal fragmentation of the tibial tubercle. Often, after healing there will be enlargement of the tibial tubercle. Generally, treatment consists of rest, limitation of activities, and isometric exercises. Chondromalacia patellae can only be diagnosed under an arthroscopic examination, not on the basis of clinical features. Patellofemoral overuse syndrome presents with medial knee pain and subpatellar pain. Additional signs are swelling and crepitus in the knee and it is more common in females than males. It is diagnosed by increased Q-angles (anterosuperior iliac spine through center of patella to tibial tubercle). Subluxation of the patella or dislocation is more common in adolescent girls and the patient presents with acute knee pain. The knee is in flexion with a mass lateral to the knee and with absence of the bony prominence of the patella (flat). X-ray confirms the dislocation. Legg-Calvé-Perthes disease is avascular necrosis of the proximal femur and usually presents between 4 and 8 years of age.

A 60-year-old patient complains of pain and stiffness in their fingers. Physical examination reveals the presence of bony enlargements at the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints. What is the most likely diagnosis based on these findings? A. Rheumatoid arthritis B. Gout C. Osteoarthritis of the hand D. Carpal tunnel syndrome

C. Osteoarthritis of the hand The presence of bony enlargements at the DIP and PIP joints is characteristic of osteoarthritis of the hand. These bony nodules are known as Heberden nodes (at the DIP joints) and Bouchard nodes (at the PIP joints), and they are a hallmark feature of OA in the hand.

Which site is commonly used for bone marrow harvest? A. Femur B. Humerus C. Pelvis D. Radius

C. Pelvis

A 30 year-old diabetic female complains of persistent numbness in her right thumb and forefinger that has been awakening her from sleep for the past week. She is right hand dominant and denies any history of activities involving repetitive motion of the hands. Which of the following is the next step in the evaluation of this patient? A. Electromyogram (EMG) B. Nerve conduction velocity (NCT) C. Phalen maneuver D. Finkelstein test

C. Phalen maneuver The Phalen maneuver is used to reproduce the symptoms of carpal tunnel syndrome by flexion of the wrist.

A 30-year-old patient presents with elbow pain and swelling following a fall on an outstretched hand. On physical examination, you note decreased ROM, swelling, and tenderness to palpation. On X-ray, there is a visible sail sign present. What is the most likely diagnosis? A. Cubital tunnel syndrome B. Lateral epicondylitis C. Radial head fracture D. Ulnar collateral ligament tear

C. Radial head fracture The presence of a fat pad sign, also known as a sail sign, on X-ray imaging is highly indicative of a radial head fracture, which often occurs following trauma to the elbow. This sign represents the displacement of the fat pad due to joint effusion caused by the fracture.

A 34 year-old female construction worker presents with episodic blanching of her fingers when exposed to cold weather. The physical examination of her extremities and digits is normal at this time. Which of the following is the most likely diagnosis? A. Sjogren syndrome B. Scleroderma C. Raynaud phenomenon D. Systemic lupus erythematosus

C. Raynaud phenomenon Raynauds phenomenon is caused by vascular spasm when exposed to cold or stressful situations.

A 12 year-old female presents for a routine sports physical. The physical exam reveals asymmetry of the posterior chest wall on forward bending. This is the most striking and consistent abnormality of which of the following? A. Spondylolysis B. Spondolisthesis C. Scoliosis D. Herniated disc

C. Scoliosis Asymmetry of the posterior chest wall on forward bending is the most striking and consistent abnormality in patients with idiopathic scoliosis.

A 12-year-old active child presents with heel pain that is exacerbated by physical activity, especially running and jumping. On physical examination, there is tenderness and swelling at the posterior aspect of the heel, and pain with passive dorsiflexion of the ankle and when the patient stands on their tiptoes. There are no signs of redness or warmth. What is the most likely diagnosis for this patient's condition? A. Plantar fasciitis B. Achilles tendonitis C. Sever's disease (calcaneal apophysitis) D. Stress fracture of the calcaneus E. Osteomyelitis of the calcaneus

C. Sever's disease (calcaneal apophysitis)

There are 2 specific types of distal radial fractures: Colles' fracture has ______________________ angulation, while Smith's has ______________________ angulation. (dorsal/volar)

Colles' fracture has dorsal angulation, while Smith's has volar angulation.

An obese 12 year-old male presents with a 1 month history of right thigh pain worsened with weight bearing.Examination is normal, however, radiographs reveal a posterior and medial displacement of the femoral head. Which of the following is the most likely diagnosis? A. Legg Calvé Perthes disease B. Developmental dysplasia of the hip C. Slipped capital femoral epiphysis D. Osgood-Schlatter disease

C. Slipped capital femoral epiphysis Slipped capital femoral epiphysis is the posterior and usually medially displacement of the femoral head in overweight adolescents during puberty. The growth plate is susceptible to slippage due to the rapidly thickened cartilage physis secondary to growth hormone, the lack of sex hormone secretion for physis stability, mechanic stress secondary to obesity, and the anatomy and hip mechanics.

A 30 year-old female presents with left wrist pain after slipping on the ice while walking to her car. On examination, pain is noted on palpation over the anatomical snuff box. X-ray of her wrist shows no identifiable fracture. Which of the following is the most appropriate treatment in this patient? A. No treatment necessary B. ACE wrap application C. Splint application D. Immediate orthopedic referral

C. Splint application Tenderness in the snuff box should be treated as a suspected scaphoid fracture. The patient should be treated as if it is fractured and placed in a splint with a referral to an orthopedic specialist for further evaluation and repeat imaging.

An 18 year-old male presents with pain in his wrist after he fell off of a moving motor cycle. Physical examination reveals tenderness in the anatomic snuffbox. No fracture is noted on plain radiography of the wrist. Which of the following is the recommended treatment for this patient? A. Ace wrap of the wrist B. Closed reduction of the fracture site C. Thumb spica cast application D. Open reduction of the fracture site

C. Thumb spica cast application Even with normal initial radiographs, patients with a consistent history and tenderness in the anatomical snuffbox are treated as a stable fracture with immobilization in a thumb spica cast. Casting is recommended for all presumed nondisplaced scaphoid fractures.

A baseball pitcher experiences pain on the inner side of the elbow, especially during throwing. Physical examination reveals tenderness and instability on the medial side of the elbow. What is the most likely diagnosis? A. Tennis Elbow B. Golf Elbow C. Ulnar Collateral Ligament (UCL) Tear D. Radial Collateral Ligament Sprain

C. Ulnar Collateral Ligament (UCL) Tear

A 22 year-old male presents to the emergency department complaining of right hand pain after punching a brick wall. His pain is noted at the ulnar aspect of his hand and worsens with touch and movement. On examination, you notice obvious swelling and tenderness over the dorsum of the right hand proximal to the metacarpal phalangeal (MCP) joint of the fifth digit. Skin is intact. X-ray reveals a fracture of the proximal fifth metacarpal with good alignment. Which of the following is the treatment of choice? A. Immediate orthopedic consult for surgical fixation B. Long finger splint extending beyond the MCP C. Ulnar gutter splint to immobilize fracture site D. Referral for casting

C. Ulnar gutter splint to immobilize fracture site An ulnar gutter splint is the most appropriate care in the emergency room.

In adults and intravenous drug abusers, which of the following bones is most commonly affected with acute osteomyelitis? A. Femur B. Humerus C. Vertebral spine D. Tibia

C. Vertebral spine The bones of the vertebral spine are most commonly affected in a patient with osteomyelitis. Organisms reach the well-perfused vertebral body of adults via spinal arteries and quickly spread from the end plate into the disk space and then to the adjacent vertebral body. The infection may originate in the urinary tract and intravenous drug use carries an increased risk of spinal infection. Gold standard diagnosis of osteomyelitis = needle aspiration and bone biopsy.

An 18 year-old patient has a tibia/fibula fracture following a motorcycle crash. Twelve hours later the patient presents with increased pain despite adequate doses of analgesics and immobilization. Which of the following is the most likely diagnosis? A. avascular necrosis B. myositis ossificans C. compartment syndrome D. reflex sympathetic dystrophy

C. compartment syndrome Compartment syndrome is characterized by a pathological increase of pressure within a closed space and results from edema or bleeding within the compartment. It may occur as an early local complication of fracture.

Which of the following would demonstrate rotational misalignment in a patient with a fracture of the fourth metacarpal? A. base of the ring fingernail and index fingernail line up in the partially closed hand B. fingernails of the open hand form an asymmetric arc C. ring finger of the closed hand overlaps the little finger D. ring finger of the open hand is shortened

C. ring finger of the closed hand overlaps the little finger All fingernails should point to the same spot when the hand is closed. Overlapping of one finger over the other indicates rotational misalignment.

A patient who demonstrates pain on the radial aspect of the wrist with abrupt ulnar movements while the thumb is flexed into the closed palm most likely has: A. carpal tunnel syndrome B. radial tunnel syndrome C. tenosynovitis D. gamekeeper's thumb

C. tenosynovitis Tenosynovitis is diagnosed using Finkelstein maneuver. The patient's thumb is placed in the palm of the hand and the wrist is abruptly deviated to the ulnar aspect of the wrist, causing pain on the radial aspect.

Which of the following is an established risk factor for osteoporosis? A. Parity status B. Carbohydrate intake C. Lactation history D. Low body weight

D. Low body weight Established risk factors for osteoporosis include low body weight, female sex, advanced age, Caucasian race, and bilateral oophorectomy before menopause without estrogen replacement.

What is the definitive diagnostic test for compartment syndrome? A. Clinical examination B. X-ray imaging C. Magnetic resonance imaging (MRI) D. Measurement of compartment pressures

D. Measurement of compartment pressures > 30 mmHg

A 57 year-old male recently on a high protein diet presents with an exquisitely tender, erythematous, warm right great toe. Which of the following is the treatment of choice for this patient? A. Corticosteroids B. Colchicine C. Allopurinol D. Non-steroidal antiinflammatory agents

D. Non-steroidal antiinflammatory agents NSAID medications are the treatment of choice for acute gouty attacks.

Bone mass measurement should be considered in all women by what age? A. 30 - 35 B. 40 - 45 C. 50 - 55 D. 60 - 65

D. 60 - 65 According to the National Osteoporosis Foundation, all women should have a bone mass measurement by age 60 - 65.

A 42-year-old male presents with pain and tenderness on the outer aspect of their elbow, exacerbated by gripping objects and wrist extension. There is no history of trauma. Upon physical exam, there is a positive Cozens. What is the affected muscle group in this condition? A. Common flexors B. Middle extensors C. Biceps brachii D. Common extensors

D. Common extensors Lateral epicondylitis, commonly referred to as tennis elbow, primarily affects the common extensor forearm muscles, leading to pain and tenderness on the outer (lateral) aspect of the elbow. It is often associated with activities that involve repetitive gripping or wrist extension and is not typically caused by trauma. Remember: "Miniature golf is fun" = Golfers, medial epicondylitis, flexors"

A 38 year-old male sustained a fracture of the left distal tibia following a 25-foot fall and is taken to the operating room for an open reduction internal fixation of the distal tibia. Sixteen hours post-op, the patient develops sustained pain, which is not relieved with narcotics. On passive range of motion of the toes the patient "yells" in agony. The patient also states that the top of his foot has decreased sensation. On physical examination the physician assistant notes that the leg is swollen and the foot is cool to touch. Based upon this information what diagnostic testing should be done? A. X-ray of the lower leg and ankle B. Doppler studies C. Bone scan D. Compartment pressure

D. Compartment pressure Compartmental pressures should be obtained as soon as possible. If they are elevated this is a surgical emergency.

An examination of the hips of a newborn, a "clunk" is noted with abduction of the right hip to almost 90 degrees while lifting the greater trochanter. Which of the following is the most likely diagnosis? A. Ligamentum teres rupture B. Legg-Calve-Perthes disease C. Slipped capital femoral epiphysis D. Developemental dysplasia of the hip

D. Developemental dysplasia of the hip The Ortolani test is positive in the newborn patient with developmental dysplasia of the hip. The test is performed by lifting the greater trochanter while abducting the hip to 90 degrees.

A 32-year-old male presents to the ED with a bite wound after an altercation with another man at a bar. The wound is red, swollen, and showing signs of infection. What is the most likely microorganism involved in this infection? A. Escherichia coli (E. coli) B. Staphylococcus aureus C. Streptococcus pyogenes D. Eikenella corrodens

D. Eikenella corrodens Human bites are often associated with infections caused by a variety of bacteria, but one of the notable organisms is Eikenella corrodens. It is known for causing infections following human bites, particularly in the hand or finger area. Staphylococcus aureus and Streptococcus pyogenes are also possible pathogens, but Eikenella corrodens is a common culprit in these cases.

A 40-year-old patient presents with elbow pain and swelling following a direct blow to the elbow. On physical exam, the patient is unable to straighten the elbow. What is the most likely diagnosis? A. Cubital tunnel syndrome B. Lateral epicondylitis C. Radial head fracture D. Olecranon process fracture

D. Olecranon process fracture Inability straighten the elbow is highly indicative of an olecranon process fracture.

A 28-year-old female presents to the ED with a dog bite wound after defending her dog from an off-leash dog in the Boston Common. The wound is red, swollen, and has signs of infection. What is the most likely microorganism involved in this infection? A. Escherichia coli (E. coli) B. Staphylococcus aureus C. Streptococcus pyogenes D. Pasteurella multocida

D. Pasteurella multocida Dog bites are commonly associated with infections caused by Pasteurella multocida, a bacteria commonly found in the mouths of dogs and cats. It is a common pathogen responsible for skin and soft tissue infections following animal bites.

You are evaluating a 13-year-old male for progressively worsening thoracic pain that has been present for the past 6 months. The patient characterizes the pain as a dull ache that is present all of the time. If he tries to lean backward and extend his upper back, the pain will become sharp. His parents have noticed that his upper back has been becoming progressively more rounded over the past several years. Radiographs (x-rays) of the thoracic spine reveal anterior wedging of four adjacent thoracic vertebrae, the degree of wedging ranges from 7 to 10 degrees. What is the most likely cause of his pain? A. Ankylosing spondylitis B. Postural kyphosis C. Thoracic scoliosis D. Scheuermann kyphosis E. Thoracolumbar scoliosis

D. Scheuermann kyphosis Scheuermann kyphosis is most common in boys and is diagnosed radiographically a kyphotic curve with anterior wedging of more than 5 degrees in a minimum of three successive vertebrae. Postural kyphosis is more common in girls and the patient is able to correct the curvature voluntarily. Ankylosing spondylitis results in straightening and fusion of the involved spinal segment. Scoliosis is the term used to describe a lateral curvature of the spine.

A 32-year-old male presents with an acute onset of pain and swelling in his left ankle. On physical exam, the ankle is warm, swollen and erythematous. Evaluation of the synovial fluid reveals only leukocytosis with a low glucose. Which of the following is the most likely diagnosis? A. Gout B. Pseudogout C. Acute rheumatic fever D. Septic arthritis

D. Septic arthritis Gout and pseudogout are excluded by the failure to find crystals on synovial fluid analysis. Acute rheumatic fever commonly involves multiple joints. Leukocytosis and a low synovial glucose are indicative of septic arthritis.

A patient presents with a soft, painless lump on their wrist that has been changing in size. The lump is smooth and moves freely beneath the skin when pressed. What is the definitive treatment for this presentation? A. Aspirin for pain relief B. Immobilization with a splint C. Physical therapy D. Surgical excision

D. Surgical excision Need to close joint capsule and remove the stalk

A 22-year-old female was playing basketball when she tripped and landed on the pavement with her hands outstretched. She presents complaining of abrasions on the right thenar eminence and "wrist pain." Physical examination reveals tenderness to palpation between the extensor pollicis longus and extensor pollicis brevis. Assessment of the median, ulnar, and radial nerves reveals no sensor or motor changes when compared with the left hand. Radial and ulnar pulses are 2+ bilaterally with capillary refill less than 2 seconds on all five digits of the right hand. Posterior- anterior view radiographs of the wrist and posterior-anterior wrist radiographs with the wrist in ulnar deviation reveal no fractures or dislocations. What is the appropriate management for this patient at this time? A. Immediate orthopedic referral B. Cock-up splint until symptoms resolve C. Physical therapy referral for assessment and treatment D. Thumb spica splint and repeat radiographs in 2 weeks E. No further treatment is necessary because the radiographs were negative and no vascular or neurological abnormalities were noted on examination

D. Thumb spica splint and repeat radiographs in 2 weeks The scaphoid bone is based on the proximal row of carpal bones but extends into the distal row, making it more vulnerable to injury when a patient falls on an outstretched hand. The scaphoid bone is the most frequently injured carpal bone, accounting for 60% to 70% of all carpal fractures. At the time of initial injury, 10% to 15% of scaphoid fractures may not be visible on plain radiographs. Patients with pain in the anatomical snuffbox to palpation or axial loading, even with normal radiographs, should be treated as though they have a scaphoid fracture and placed in a thumb spica splint. Repeat radiographs should be taken after 1 to 2 weeks. If radiographs are still normal but tenderness over the scaphoid bone persists, an MRI should be ordered. Fractures of the scaphoid have a high incidence of nonunion and osteonecrosis because the major blood supply enters in the distal segment of the bone and can be disrupted with injury/fracture and thus conservative management is warranted

Which imaging study is best for rotator cuff tearing if MRI is not plausible? A. X-ray B. MRI C. CT scan D. Ultrasound

D. Ultrasound

A 55 year-old secretary presents with ongoing pain and numbness in her hand. These symptoms are worse at night and she must shake her hand to regain feeling in it. Which of the following physical examination signs will be present? A. Hypothenar atrophy B. Weakness of finger abduction C. Inability to maintain wrist extension against resistance D. Weakness of thumb abduction

D. Weakness of thumb abduction Median nerve injury causes weakness of thumb abduction (measured by thumb opposition strength) along with thenar atrophy. Tinel's and Phalen's signs will also be positive with carpal tunnel syndrome.

Spina bifida occulta is usually detected by which initial diagnostic evaluation? A. Electroencephalogram B. Alpha-fetoprotein levels C. Folic acid levels D. X-ray of the spine

D. X-ray of the spine X-ray or MRI is the definitive test to diagnose spina bifida occulta, showing the vertebral bony defect.

A 58 year-old male presents complaining of anterior right shoulder pain the day after performing extensive yard work. The pain is localized over the anterior proximal humerus with distinct point tenderness. There are no visible abnormalities. The patient has full range of motion and strength with all shoulder movements. The pain is reproduced by asking the patient to resist the examiner during supination of the right elbow. Which of the following is the most likely diagnosis? A. supraspinatus tendonitis B. subacromial bursitis C. rotator cuff tear D. bicipital tendonitis

D. bicipital tendonitis Bicipital tendonitis presents with anterior shoulder pain that is reproduced by palpating the tendon in the humeral bicipital groove and through resisted motion of the biceps muscle (elbow flexion or supination).

The most reliable site from which to identify the causative organism in cases of osteomyelitis is the: A. base of ulcer B. blood C. sinus tract D. bone

D. bone Samples from needle aspiration of pus in the bone, or from a bone biopsy, are essential to determine the exact causative agent.

A 14 year-old male who is overweight presents with complaints of left knee and anteromedial thigh pain for the past month. He states the pain gets better with rest and denies any known trauma. On examination of the gait, a slight limp is noted. X-ray films of the left knee are normal. The most likely diagnosis is: A. genu valgum B. Legg-Calve-Perthes disease C. Osgood-Schlatter disease D. slipped capital femoral epiphysis

D. slipped capital femoral epiphysis Slipped capital femoral epiphysis is most common in overweight adolescent males who present with complaints of pain that is referred to the thigh or medial side of the knee associated with a limp. X-ray films of the knee are normal since the condition involves the hip.

A 45-year-old woman with recent diagnosis of rheumatoid arthritis has begun treatment with celecoxib. She has been on this medication for 3 months and notes that her pain continues. Early signs of joint involvement are present in the patient's hands. Which of the following medications is the most appropriate to add to her treatment? (A) Aspirin (B) Rituximab (C) Etanercept (D) Leflunomide (E) Methotrexate

E) Methotrexate

A 33-year-old man complains of left anterior shoulder pain for 4 weeks. The pain is made worse with overhead activities. On examination, you note maximal pain in the shoulder with palpation between the greater and lesser tubercle. Pain in the shoulder is exacerbated when the arm is held at the side, elbow flexed to 90 degrees, and the patient is asked to supinate and flex the forearm against your resistance. Based on this presentation, what is the most likely diagnosis? A. Rotator cuff tendonitis B. Acromioclavicular sprain C. Anterior shoulder dislocation D. Rotator cuff tear E. Bicipital tendonitis

E. Bicipital tendonitis Bicipital tendonitis is an inflammation of the long head of the biceps tendon and tendon sheath, which causes anterior shoulder pain that, resembles and often accompanies coexisting rotator cuff tendonitis. Tenderness with bicipital tendonitis is reproduced with Yergason test. During Yergason test, the shoulder pain is exacerbated when the arm is held at the side, elbow flexed to 90 degrees, and the patient is asked to supinate and flex the forearm against your resistance. Rotator cuff injuries often accompany bicipital tendonitis, and bicipital tendonitis can occur secondary to compensation for rotator cuff disorders or labral tears. In this case, the pain is clearly reproduced in a pattern suggestive of bicipital tendonitis. Acromioclavicular sprains can result in pain with overhead activities but the area of palpable tenderness will be over the acromioclavicular joint, not the biceps tendon. The cross arm test is the provocative test that would reproduce the shoulder pain associated with an acromioclavicular joint sprain. There is no historical component that would suggest a recent shoulder dislocation and there is no mention of positive apprehension test, which would be indicative of anterior shoulder instability.

A 70 year old male presents complaining of gradual onset of a palpable nodule and thickened cord in the palm of his ring finger. On physical examination, the patient is unable to lay their palm completely flat against the table and the ring finger exhibits contracture greater than 30 degrees. What is the most appropriate treatment option for this hand condition based on the presentation? A. No treatment is required; it will resolve on its own B. Oral corticosteroid medication C. Physical therapy and hand exercises E. Surgical intervention

E. Surgical intervention Surgical repair of Dupuytren's contracture is indicated when there is > 30 degrees of deformity present.

On what is the pathophysiologic process of rheumatoid arthritis (RA) based? A. bone destruction B. bone spur formation C. bone sclerosis D. symmetric joint involvement E. synovial inflammation

E. synovial inflammation Synovial inflammation is the pathophysiologic basis for this disease

Most commonly shoulder dislocations are ___________________, while elbow dislocations are ___________________. (anterior/posterior)

Most commonly shoulder dislocations are anterior, while elbow dislocations are posterior. Posterior shoulder dislocations --> seizure, electrical shock, or MVA

What is the most common fracture in individuals under the age of 65? a. Scaphoid fracture b. Ulna styloid fracture c. Distal radius fracture d. Metacarpal fracture

c. Distal radius fracture