MSK FOR PANCE/PANRE PRACTICE

According to the National Osteoporosis Foundation, all women should have a bone mass measurement by age:

60 - 65

Bone mass measurement should be considered in all women by what age?

60-65

What is not indicated in the evaluation of compartment syndrome?

A bone scan

Test is performed to evaluate medial collateral ligament tears while applying valgus stress.

Abduction stress test

Children with what are below normal standards on growth charts? They have difficulty balancing their large heads when beginning to walk.

Achondroplasia

Which of the following risk factors is the most predictive for the development of osteoarthritis?

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?

Aggravated by resisted supination of the forearm

Would have a positive drawer test and mechanism of injury can be due to a direct blow to the knee or as a result of sudden deceleration and rotation of the knee.

Anterior cruciate ligament injury

This is performed to evaluate the anterior cruciate ligament; however the patient is supine, hips and knees flexed, and feet are flat on the table.

Anterior drawer sign

This shows < 1% of significant injuries.

Anteroposterior view

Second-line therapy in a patient with olecranon bursitis who fails rest and NSAIDs.

Aspiration of the bursa and corticosteroid injection

Which of the following medications inhibits prostaglandin synthesis in a patient with rheumatoid arthritis?

Aspirin

Which of the following mechanisms of action is most commonly associated with meniscal tears?

Axial loading and rotation

May present with a bulging appearance of the proximal arm.

Biceps rupture

This will be aggravated by resisted supination of the forearm.

Bicipital tendonitis

________ of the affected joint in a patient with osteoarthritis may limit joint motion and restrict mobility, which may negatively impact the disease.

Bracing or resting

The most accurate way to determine the exact degree of spinal curvature in a child with scoliosis is by which of the following?

Calculation of the Cobb angle

The treatment of ______ 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.

Carpal tunnel syndrome

This is diagnosed by a positive Tinel's or Phalen's maneuver.

Carpal tunnel syndrome

The presence of calcium-containing salts in articular cartilage and is commonly seen in hyperparathyroidism, diabetes, hypothyroidism, and gout.

Chondrocalcinosis

Make up the articular cartilage

Chondrocytes

The scoliotic curve is measured by the______ using AP and lateral x-ray films of the entire length of the spine.

Cobb method

_____ of the distal radius has a characteristic "silver fork" deformity, but does not involve the elbow joint.

Colles' fracture

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?

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

These are indicated only after a trial of the wrist splint provides no relief.

Corticosteroid injections and surgery

This has no role in the treatment of carpal tunnel syndrome.

Darvocet

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?

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 _______ in the spine and pelvis.

Demineralization

___ 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.

Distal phalanx fracture

This will confirm the presence of a decreased pulse.

Doppler studies

Physical exam findings in what include laxity and hypermobility of joints, mitral valve prolapse, and associated degenerative arthritis?

Ehlers-Danlos

During the stages of fracture healing which of the following is responsible for producing collagen?

Fibroblasts

Produce collagen during the inflammation stage of healing:

Fibroblasts

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?

Fractured fibula

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?

Galeazzi's

Involves a fracture of the mid or distal radial shaft with distal radioulnar joint dislocation.

Galeazzi's fracture/dislocation

This is the most common injury to the metacarpophalangeal collateral ligaments, causing a sprain.

Gamekeeper's thumb

Does not cause pain with weight bearing

Gastrocnemius contusion

Help form the osteon or vascular canal.

Glycosaminoglycans

________ are excluded by the failure to find crystals on synovial fluid analysis.

Gout and pseudogout are excluded by the failure to find crystals on synovial fluid analysis.

Usually result in ACL and PCL injuries

Hyperextension injuries

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?

Idiopathic scoliosis

Asymmetry of the posterior chest wall on forward bending is the most striking and consistent abnormality in patients with:

Idiopathic scoliosis

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?

Immobilize, antibiotics, orthopedics referral

In a patient with olecranon bursitis, ______ is not recommended as it may cause a chronic drainage sinus tract.

Incision and drainage

Neutralizes cytokine tumor necrosing factor.

Infliximab (Remicade)

Can occur with direct or indirect trauma to the fibular shaft. X-ray films of the leg are mandatory for any patient with a history of trauma and pain on ambulation to rule out this potentially overlooked injury.

Isolated fibular fractures

An acute febrile, multisystem disease of children. It is characterized by unresponsiveness to antibiotics, nonsuppurative cervical adenitis, and changes in the skin and mucous membranes such as edema, erythema of the lips and palms, and desquamation of the skin of the fingertips.

Kawasaki disease

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?

Lachman test

Test that is performed to evaluate the anterior cruciate ligament. The knee is placed in 15 degrees of flexion and external rotation of the hip.

Lachman test

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?

Lyme Disease

After an incubation period of 3 to 32 days, erythema migrans develops at the site of the tick bite. Within days or weeks after the onset of erythema migrans the patients develop a severe headache, mild stiffness of the neck, migratory musculoskeletal pain, arthralgias and profound malaise and fatigue.

Lyme Disease

Valgus force to the lateral knee more than likely results in:

MCL = medial collateral ligament injuries

Children with what have hypotonia, arachnodactyly, joint laxity and dislocations?

Marfan syndrome

Test is performed to evaluate medial and lateral meniscal tears while rotating the lower leg internally and externally.

McMurray test

Axial loading and rotation most likely result in:

Meniscal injuries

Inhibits the enzyme dihydrofolate reductase.

Methotrexate

Mild osteogenesis imperfecta presents with blue sclerae, history of recurrent fractures and presenile deafness.

Mild osteogenesis imperfecta

Physical exam findings in a 4 year-old child that include blue sclerae and recurrent fractures indicates which of the following?

Mild osteogenesis imperfecta

Acute rheumatic fever commonly involves:

Multiple joints

Occurs in patients with an underlying predisposition such as rheumatoid arthritis. The common presentation is involvement of a single joint.

Nongonococcal arthritis

This is usually not included in the initial set of x-rays taken. Bilateral supine oblique is a view that may be ordered if all seven cervical vertebrae are not seen on the lateral view.

Oblique view

This reveals 10% of significant injuries.

Odontoid view

An injury occurring at the insertion of the patellar tendon on the tibial tuberosity in a younger age group

Osgood-Schlatter disease

Patients with _____ who exercise are able to maintain range of motion, strengthen periarticular muscles, and improve physical fitness.

Osteoarthritis

Responsible for removing necrotic bone

Osteoclasts

Hyperflexion injuries result in:

PCL injuries

The most common cause of chronic anterior knee pain, more commonly seen in females.

Patellofemoral pain syndrome

Weakness of the arm with internal rotation and adduction is characteristic of:

Pectoralis major rupture or tear

Blocks the tubular reabsorption of filtered urate and is used to reduce serum uric acid.

Probenecid

Which of the following is the correct treatment for a Grade II ankle sprain resulting from an inversion injury?

RICE

The majority of ankle sprains are treated with _______. Corticosteroid injections, moist heat, and a walking cast provide no benefit. Surgical intervention for repair of a ruptured ligament is only necessary in chronically unstable joints.

RICE = rest, ice, compression and elevation

This is demonstrated by simultaneously extending the patient's wrists and fingers while the examiner passively flexes the patient's long finger, which causes pain.

Radial syndrome

Paget's disease of bone presents with bone pain, kyphosis, bowed tibias, large head, and deafness. The initial lesions are destructive and radiolucent. Paget's disease has a normal serum calcium and phosphate, but the serum alkaline phosphatase is elevated.

Radiolucent lesions

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?

Rest and NSAIDS

The most appropriate initial intervention in a patient with olecranon bursitis.

Rest and NSAIDs

In a Distal phalanx fracture, these are not appropriate managements for a pediatric patient...

Rest, ice, and elevation are only palliative measures and not appropriate management. The digit must be immobilized until seen by ortho. Aspirin is not an appropriate analgesic for children.

A symmetrical arthritis that commonly affects the proximal interphalangeal and metacarpophalangeal joints. It is not associated with the rash of erythema migrans.

Rheumatoid arthritis

Night pain is characteristic of:

Rotator cuff tear or tendonitis

Inhibit the enzymatic production of prostaglandins by inhibiting cyclooxygenase.

Salicylates, like aspirin

A fracture of the scaphoid bone and would not cause pain in the elbow joint

Scaphoid fracture

This measures distortions of the torso and is good for screening angle of rotation, but is not exact to determine exact degree of curvature.

Scoliometer or inclinometer

While waist asymmetry and rib hump deformity may be observed on physical examination of the patient with _____, none of them can be used to determine the exact degree of the spinal curvature.

Scoliosis

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?

Septic arthritis

Leukocytosis and a low synovial glucose are indicative of:

Septic arthritis

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?

Shin splint

These cause pain over the posterior tibialis muscle body as opposed to discrete pain over the tibia with a stress fracture.

Shin splints

_____: with volar angulation of the distal radius, but does not involve the elbow joint.

Smith's fracture, which is the reverse of a Colles' fracture

The most important preventive medicine recommendation for patients with osteoarthritis is which of the following?

Start an exercise program

______ into the affected joint may decrease pain but injections are limited to not more than three per year.

Steroid injection

Discrete pain over the tibia:

Stress fracture

Hyperparathyroidism is frequently asymptomatic. Serum parathyroid hormone and serum calcium are elevated. X-ray findings include demineralization, _______ of bone especially in the radial aspects of the fingers.

Subperiosteal resorption

Abduction against resistance tests the:

Supraspinatus

Abduction of the shoulder against resistance helps localize pain in which of the following muscles of the shoulder girdle?

Supraspinatus

This is reserved for chronic bursitis and is not indicated in this acute initial presentation.

Surgical excision

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:

Tenosynovitis

This 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.

Tenosynovitis

In a trauma patient who has a suspected cervical spine injury, the x-ray view that will identify the majority of significant injuries is

The lateral view shows 70-80% of significant injuries. It is important to visualize all seven cervical vertebrae and the upper margin of T1 to avoid missing possible pathology.

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?

Wrist splint for 2-6 weeks: for carpal tunnel syndrome

___ of the lower leg and ankle will only determine bone placement.

X-rays