POM 2 Exam 3- ortho practice test
A 10 year old boy presents to the emergency room with elbow pain in addition to inability to Abduct and oppose the left thumb as a result of wrestling with the father. Radiological studies were performed. Which of the following statements would be most accurate regarding the patient's diagnosis? A. The most common complication in children is medial nerve injury B. The injury is a result of trapping of the annular ligament C. The injury would likely show posterior displacement of the olecranon D. It involves inflammation of the tendon insertion of the extensor carpi radialis brevis
A
A 13 year-old girl reports two weeks of worsening right knee pain with no history of antecedent injury or recent trauma. She reports frequent episodes of nighttime awakening with knee pain in the past two weeks. Examination of the knee reveals edema and a tender mass over the anterior proximal right tibia. Her knee exam is otherwise within normal limits. Radiographs of the right knee show a lytic mass with a multi-laminated periosteal reaction involving the proximal anterior tibia. What is the most likely diagnosis? A. Ewing sarcoma B. Osteochondroma C. Multiple Myeloma D. Osteoid osteoma
A
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. Galeazis B. Scaphoid C. Colle's D. Smith's
A
A 19-year-old female college student presents to the student health clinic with a 3 day history of fever and chills with swelling and pain in her right hip. She has no PMH. She is sexually active and denies tobacco, etoh, or illicit drug use. He temperature is 100.8F, Physical exam shows her right hip is very painful and erythematous, with decreased ROM. The hip is aspirated and shows a leukocyte count 75,000 cells/mL, the majority of which neutrophils. Gram stain demonstrates gram-negative diplococci. What is the most likely diagnosis? A. Gonococcal Arthritis B. Gout C. Reactive Arthritis D. Calcium pyrophosphate dehydrate crystal deposition disease (CPPD) E. Lyme Disease
A
A 22 year-old male presents with pain along the medial tibia. The pain initially began towards the end of soccer practice but now it is present earlier on. Physical exam reveals pain to palpation over the posterior tibialis muscle body. What is the most likely diagnosis? A. Shin splint B. Stress fracture C. Osgood -schlatter disease D. Patellofemoral pain syndrome
A
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. CCS injection C. Surgical referral D. Darvocet
A
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 CCS injection
A
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
A
A 7-year-old male presents with a knee effusion after being tackled while playing football during recess. No fracture is seen on plain films of the knee. Which of the following is appropriate management step? A. Further evaluation is needed when a pediatric patient has joint effusion that involve joint aspiration and/or MRI B. Immobilize knee and reassess patient in 4 weeks C. Refer to PT D. Begin anti-inflammatories and advise ice E. Order CT of knee with and without contrast
A
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 the scapula D. weakness of rotator cuff
A
A 75 year-old female presents with medial knee pain that worsens with stair climbing. Physical examination reveals swelling and point tenderness inferior and medial to the patella and tenderness overlying the medial tibial plateau. Which of the following is the most likely diagnosis? A. pes anserine bursitis B. prepatellar bursitis C. infrapatellar bursitis D. trochanteric bursitis
A
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. nursemaids elbow (radial head dislocation) B. fractured left wrist C. osteochondritis dissecans D. child abuse
A
ABduction of the shoulder against resistance helps localize pain in which of the following muscles in the shoulder girdle? A. Supraspinatus B. Infraspinatus C. Teres minor D. Subscapularis
A
An 11-year-old boy was tackled while playing football and landed on his shoulder. He immediately complained of upper chest pain and dyspnea. On exam, he has mild neck-vein engorgement and a swollen sternoclavicular joint. What is his most likely diagnosis? A. posterior sternoclavicular joint dislocation B. clavicle fracture C. cervical strain D. rib fracture E. commotion cordis
A
An 80 year-old female presents with pain in her vertebral column. Radiography reveals compression fracture of T12 that is consistent with osteoporotic compression fracture. Which of the following treatment modalities has the potential to cause analgesia of the fracture site with its use? A. Calcitonin nasal spray B. Alendronate (Fosamax) C. Raloxifen (Evista) D. Combined estrogen and progesterone (Prempro) therapy
A
In a trauma patient who has a suspected cervical spine injury, the x-ray view that will identify the majority of significant injuries is A. Lateral B. Oblique C. Anteroposterior D. Odontoid
A
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
What is a frequent cause of exercise-induced patellar pain and swelling at the tibial tubercle in pre-adolescent girls and early adolescent boys? A. Osgood-Schlatter disease B. Chartcot-Marie-Toothe disease C. Bakers Cyst D. Osteochondritis dissecans E. Sever disease
A
Which of the following clinical characteristics is associated with bicipital tendonitis? A. Aggravated by resisted supination of the forearm B. Bulging appearance to the proximal arm C. Weakness of the arm with internal rotation and Adduction D. Pain that awakens the patient at night
A
Which of the following is the most appropriate way to diagnose scoliosis? A. Upright PA, and lateral films B. Supine AP and lateral C. AP, lateral, flexion, and extension D. AP, Lateral, and sunrise E. Upright AP and lateral films
A
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
Which of the following would be a consistent presentation with a C7 nerve root radiculopathy? A. weakness in extension of the arm and flexion of the wrist B. Weakness in flexion of the arm and wrist extension C. Weakness in the deltoid muscle and elbow flexion D. Weakness in finger flexors
A
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. RA B. OA C. Hemochromatosis D. Psuedogout
B
A 21-year-old man presents with worsening right knee pain after a minor twisting injury playing basketball 3 months ago. The patient reports increased swelling along the posterior aspect of his knee and generalized leg edema on the right side. His pain is exacerbated by weight-bearing activities and deep knee flexion. The patient denies night pain, fevers, chills, or recent weight loss. His past medical history is significant for unilateral retinoblastoma, which was treated with minimal residual visual deficit. A technetium bone scan depicts an isolated lesion located in the right distal femur, and magnetic resonance imaging (MRI) shows sparing of the neurovascular bundle. A plain radiograph of the distal femur is shown below. What is the cause of this patient's knee pain? A. Chondromyxoid fibroma B. Chondrosarcoma C. Ewing's sarcoma D. Osteochondroma E. Osteosarcoma
B
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. Colle's fracture D. Smith fracture
B
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 lymphocytes, low glucose level, and no crystals. Which of the following would be the most likely diagnosis? A. RA B. Septic Arthritis C. Gouty Arthritis D. OA
B
A 30 year-old male sustains a blow to his right lateral leg during a soccer game. He complains of pain with weight bearing. Examination reveals tenderness along the lateral aspect of the right lower leg, but no point tenderness over the tibia. There is full active range of motion at the ankle, knee, and hip joints. There is no swelling or tenderness of the ankle or knee joints. Which of the following is the most likely diagnosis? A. anterior cruciate ligament tear B. fracture fibula C. tibial stress fracture D. gastrocnemius contusion
B
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. RICE B. immobilize, antibiotics, orthopedics, referral C. splint for 48 hours, ASA, ice D. surgical referral for amputation of digit
B
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
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 resrorption
B
A 65-year-old man presents with the insidious onset of atraumatic left shoulder pain. He reports recent weight loss but no significant medical history. On physical examination, he has pain with range of motion of the shoulder and a palpable/painful fullness in the left shoulder. An anteroposterior radiograph of the left shoulder is performed (Figure 3). Histologic evaluation of the lesion reveals multiple densely packed hyperchromatic cells per lacunae, and immunohistochemical S-100 protein stain is positive. What is this patient's most likely diagnosis? A. Chondroblastoma B. Multiple myeloma C. Chondrosarcoma D. Osteosarcoma E. Desmoplastic fibroma
B
Intraarticular injection of hyaluronic acid has been approved for treatment of patients with which of the following conditions? A. RA of the knee B. OA of the knee C. Olecranon bursitis D. Gouty Arthritis
B
Which of the following is the correct treatment for a Grade II ankle sprain resulting from an inversion injury? A. CCS injection B. RICE C. Moist heat and a walking cast D. Surgical intervention
B
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. CCS injection followed by splinting
B
Which of the following mechanisms of action is most commonly associated with meniscal tears? A. hyperextension B. axial loading and rotation C. hyperflexion D. valgus force to the lateral knee
B
48 year-old nurse, with a body mass index of 31, presents for an evaluation for back pain. She relates that historically, she had a positive PPD test a year ago and did not follow-up as directed. She has recently been experiencing night sweats and coughing. An x-ray of her lumbar spine reveals osteopenia and cortical breakdown of vertebral bodies L4 and L5. Which of the following diagnosis is most suspect? A. compression fractures secondary to obesity B. degenerative joint disease C. Potts disease D. compression fractures secondary to osteoporosis E. spondylolisthesis
C
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
A 22 year-old female complains of worsening pain, swelling, and tenderness in her left heel for 1 week. She sustained a penetrating injury to the heel two weeks ago when she stepped on a nail while running in tennis shoes. Examination reveals a draining puncture wound with surrounding erythema and exquisite tenderness. X-ray of the left foot demonstrates periosteal reaction associated with the wound. Which organism is classically responsible for this infection? A. E. coli B. S. pyogenes C. Pseudomonas D. S. aureus
C
A 22 year-old male presents to the ED after sustaining a blow to the knee during football practice. The knee exam demonstrates significant forward translation of the tibia when the knee is in 15 degrees of flexion and external rotation at the hip. Which of the following knee maneuvers does this represent? A. ABdution stress test B. Anterior drawer sign C. Lachman test D. McMurray test
C
A 32-year-old male presents with migratory arthralgias and profound malaise and fatigue. He states that one week ago he returned from a hunting trip in Pennsylvania. He is also complaining of a lesion on his left thigh that he noticed about 3 days ago. Physical exam reveals a large annular lesion with a bright red outer border and partial central clearing. Which of the following is the most likely diagnosis? A. RA B. Kawasaki disease C. Lyme disease D. Nongonococcal arthritis
C
A 5-year old boy presents with right hip pain and no history of trauma. What is the most likely cause? A. Femoral neck fracture B. Osteogenesis imperfecta C. Transient synovitis D. Slipped capital femoral epiphysis (SCFE) E. Legg-Calve-Perthese Disease
C
A 65 year-old male presents with back pain two days after he was shoveling snow. The patient complains of pain in his low back that radiates into his buttocks, posterior thigh and calf, and the bottom of his foot. There is associated numbness of his lateral and plantar surface of his foot. Which of the following disc herniations is most likely to be affected? A. L3/4 B. L4/5 C. L5/S1 D. S1/2
C
A female child falls while holding hands with an adult. Afterwards, she holds her arm in a pronated position and refuses to use her hand or elbow. She is taken to the ER, where the injury is reduced manually. What is the most likely diagnosis? A. Osteochondritis dissecans of capitellum B. Apophyseal avulsion fracture of medial humeral epicondyle C. Subluxation of radial head D. Scaphoid fracture E. Injury to distal radial physis
C
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. Gamekeepers thumb
C
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
Which of the following interventions is initially indicated for helping to relieve the symptoms of plantar fasciitis? A. steroid injections B. short leg walking cast C. arch supports D. surgical release
C
A 12 year-old male presents with pain in his left leg that is worse at night. Aspirin relieves the pain and the patient denies injury. On examination, there is point tenderness over the tibia, and the patient has a slight limp that favors the left leg. Radiographs show a 1 cm radiolucent nidus surrounded by osteosclerosis. Which of the following is the most likely diagnosis? A. osteosarcoma B. legg-calve-perthes disease C. osgood-schlatter disease D. osteoid osteoma
D
A 32 year-old male presents with an acute onset of pain and swelling to his left ankle. On physical exam the ankle is warm, swollen and erythematous. Evaluation of the synovial 47 fluid reveals only leukocytosis with a low glucose. Which of the following is the most likely diagnosis? A. Gout B. Psuedogout C. Acute rheumatic fever D. Septic arthritis
D
A 34-old female presents complaining of symmetrical redness and swelling of the small joints of her hands (PIPs and MCPs). She has noted that the symptoms are worst in the morning. Her erythrocyte sedimentation rate is elevated and her rheumatoid factor is negative. Which of the following diagnosis is most likely? progressive systemic sclerosis A. CREST syndrome B. osteoarthritis C. rheumatoid arthritis D. ankylosing spondylitis
D
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
A 57 year-old male presents with acute bilateral lower extremity weakness and urinary incontinence that began after he fell earlier today. His examination is significant for bilateral lower extremity sensory deficits and weakness along with decreased rectal sphincter tone. Which of the following is the most appropriate intervention? A. Epidural steroid injection B. orals NSAID C. PT D. Surgery
D
A 58-year-old female presents complaining of right shoulder pain for the past 2 week that is relieved minimally by an oral NSAID. She cannot recall any traumatic event or specific injury. She describes the pain as dull, deep, and radiating laterally down to her mid-arm, especially with overhead motion. On physical exam, there is no deformity or swelling. She has a full ROM but feels pain starting at 90 degrees of Abduction. She has a positive Neer and Hawkins test but negative Speeds, Yagerson, and drop arm tests. What is the diagnosis? A. Adhesive capsulitis B. Biceps tendonitis C. Rotator cuff full-thickness tear D. Impingement syndrome E. AC arthritis
D
A 6 year-old child falls onto his right arm. An x-ray demonstrates a buckle in the cortices of the distal radius, proximal to the growth plate, without angulation. What is the term used to describe this fracture? A. Salter-Harris Type III B. Salter Harris Type IV C. Salter Harris Type V D. torus/buckle E. greenstick
D
A 6 year-old male is brought into your office for evaluation of his gait. You note that when ambulatory, the medial aspects of his knees are far apart and his feet are unusually close together. Which of the following best describes this condition? A. cubitus valgus B. cubitus varus C. genu valgus D. genu varum E. Legg-Calve-Perthes disease
D
During the stages of fracture healing which of the following is responsible for producing collagen? A. osteoclasts B. chondrocytes C. glycosaminoglycans D. fibroblasts
D
Physical exam findings in a 4 year-old child that include blue sclerae and recurrent fractures indicates which of the following? A. Ehlers-Danlos Syndrome B. Marfans syndrome C. Achondroplasia D. Osteogenesis imperfect
D
A 19-year-old man who is a long-distance runner is referred to the office by his primary care provider because he has had dull, aching pain in his right thigh after running during the past nine months. Six months ago, the patient's primary care provider prescribed ibuprofen, which relieves the pain only temporarily. The patient has no history of specific injury. Physical examination shows no abnormalities of the right lower extremity. X-ray studies of the right femur show cortical thickening of the distal one-third of the shaft with a central nidus measuring approximately 8 mm in diameter. Which of the following is the most likely diagnosis? A. Aneurysmal bone cyst B. Enchondroma C. Osteoblastoma D. Osteochondroma E. Osteoid osteoma
E
A 21-year-old man presents with worsening right knee pain after a minor twisting injury playing basketball 3 months ago. The patient reports increased swelling along the posterior aspect of his knee and generalized leg edema on the right side. His pain is exacerbated by weight-bearing activities and deep knee flexion. The patient denies night pain, fevers, chills, or recent weight loss. His past medical history is significant for unilateral retinoblastoma, which was treated with minimal residual visual deficit. A technetium bone scan depicts an isolated lesion located in the right distal femur, and magnetic resonance imaging (MRI) shows sparing of the neurovascular bundle. A plain radiograph of the distal femur is shown below. What is the cause of this patient's knee pain? A. Chondromyxoid fibroma B. Chondrosarcoma C. Ewing's sarcoma D. Osteochondroma E. Osteosarcoma
E
A patient that you are examining for carpal tunnel syndrome reveals that her paresthesias occur in all five digits. Which digit does NOT experience paresthesias with median nerve neuropathy? A. first (thumb) B. second (index) C. third (long) D. fourth (ring) E. fifth (pinky)
E
