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Question 1 CORRECT A 40-year-old man presents to the office complaining of right knee pain for the past three days after a weekend football game in his neighborhood. He fell with his knee in extension after being tackled and felt a sudden sharp pain as he hit the ground. Afterwards, he could not stand on the knee and has been taking acetaminophen and using ice packs to help reduce the swelling. He is in moderate pain and cannot walk up and down stairs in his house. On examination, the right knee is red and swollen with a mild effusion anteriorly. The left knee appears normal. There is mild tenderness to palpation diffusely. There are no sites of penetration or fluctuance. A Lachman's test is positive. Which of the following is the most likely diagnosis for this patient? A Anterior cruciate ligament injury B Lateral collateral ligament injury C Medial collateral ligament injury D Medial meniscus injury E Posterior cruciate ligament injury

A Anterior cruciate ligament injury

Which of the following histories best describes spinal stenosis? A Gradual onset of back and thigh pain exacerbated by walking and alleviated by sitting B Acute onset of low back pain with radiation of pain to right foot, aggravated by sitting C Aching in bilateral buttocks with associated pain felt in shoulder or neck D Thigh pain aggravated by walking and absence of pedal pulses

A. Gradual onset of back and thigh pain exacerbated by walking and alleviated by sitting pinal stenosis typically presents as back pain and thigh pain aggravated by ambulation and relieved by sitting.

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 this is the classic presentation for nursemaid's elbow

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 this patient is presenting w/ olecranon bursitis. rest and NSAIDs are the most appropriate initial intervention in a patient w/ olecranon bursitis

Which of the following is the most specific antibody for SLE? A Anti-Ro antibodies B Anti-Smith antibodies C Anti-dsDNA antibodies D Anti-histone antibodies

B. anti-smith antibodies aunti smith is pathognomonic for SLE

Which of the following physical exam tests, if positive, is most suggestive of inferior instability of the glenohumeral joint? a. apprehension test b. drop arm test c. sulcus sign d. speeds test e. hawkin's test

C. Sulcus sign The sulcus sign is performed by applying inferior traction to the arm and observing the shoulder for the formation of a sulcus at the lateral edge of the acromion process. This test is indicative of inferior instability.

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

What spinal nerve root is most likely affected in a patient with weak wrist extension, thumb and index finger paresthesias and diminished triceps reflex? A Cervical 4 B Cervical 5 c Cervical 6 D Cervical 7

Cervical 6 (thumbi -c-6)

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 leukocytosis and low synovial glucose are indicative of septic arthritis

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 dexa scans are recommended at starting at 65

Which of the following is not generally considered a routine and common finding upon physical examination of hip fracture? A Limited range of motion (especially internal rotation) B Pain upon passive hip motion C Tenderness to palpation over the femoral neck D Ecchymosis overlying the affected area

D. ecchymosis overlying the affected area

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 seen here. Which of the following is the most likely diagnosis? a. osteoscarcoma b. legg-calve-perthes dz c. osgood schlatter dz d. osteoid osteoma

Osteoid osteoma is a benign tumor in children age 5 to 20, presents with increasing pain, worse at night and relieved by aspirin.

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? Escherichia coli Streptococcus pyogenes Pseudomonas aeruginosa Staphylococcus aureus

Pseudomonas aeruginosa is frequently associated with osteomyelitis involving puncture wounds of the foot. This is believed to result from direct inoculation with P. aeruginosa via the foam padding found in tennis shoes.

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 b. scaphoid c. colles d.smith

a. galeazzi

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. shin splint shin splints cause pain over the posterior tibialis muscle body as opposed to discrete pain over the tibia w/ a stress fracture

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

b. OA this is a description of heberden's nodes which is a buzzword for OA.

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 greatest disruption of arterial blood supply to the femoral head

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 Rheumatoid arthritis B Kawasaki disease C Lyme disease D Nongonococcal arthritis

c. lyme disease migratory arthralgias, malaise, and fatigue post hunting trip/exposure to outdoors that increases risk of tick bites. fPLUS large erythema migrans

A 7-year-old boy is brought into your urgent care clinic because of a red and swollen ankle for 4 days. Upon eliciting the history, you discover that about one week prior he sustained a minor injury to the right ankle, breaking the skin. Over the past couple of days, his parents have noticed him walking with a limp that has gradually worsened until this morning when he refused to bear weight on that leg. Physical examination reveals a temperature of 103.2 F (39.6 C), and an erythematous and edematous right ankle. Range of motion is decreased when compared to the left, and it is exquisitely tender to palpation and with motion. Ultrasound reveals effusion around the joint. Other laboratory results are pending. Which of the following is the most likely diagnosis? a. superficial cellulitis b. osetomyelitis c. septic arthritis d. gout e. erysipelas

c. septic arthritis based on infection presentation plus history of break in skin integrity

Which of the following conditions is caused by rupture of the extensor tendon as it inserts into the base of the distal phalanx? a. bouchard nodes b. boutonniere deformity c. heberden nodes d. mallet finger e. swan neck deformity

d. mallet finger

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 Marfan syndrome C Achondroplasia D Osteogenesis imperfecta

d. osteogenesis imperfecta triad of OI: brittle bones, blue sclera, and deafness

a 47-year-old female with a complaint of feeling unusually tired and weak. She works as a hairstylist and in the past few weeks has experienced difficulty performing her job. She finds it difficult to work while she has her arms raised. She denies any fevers, weight gain or loss, or any other motor deficits. Physical exam reveals decreased strength in her shoulders. No rash is appreciated. Laboratory evaluation reveals increased creatinine phosphokinase, positive antinuclear antibody, and positive anti-JO 1 antibodies. She is started on high-dose corticosteroids. based on the PE ALONE, how are you able to r/o polymyalgia rheumatica

decreased msucle strength on PE is not consistent w/ polymyalgia rheumatica also elevations of in CK is not consistent w/ polymyalgia rheumatica

Which nerve abnormality may be associated with medial epicondylitis? a. brachial plexus injury b. median nerve palsy c. musculocutaneous nerve paresthesias d. radial nerve entrapment e. ulnar nerve paresthesia

e. ulnar nerve paresthesia medi-ulnar or maybe media ulnar epicondylitis later-radial epicondylitis la-tennis-ral epicondylitis for tennis elbow

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

early morning joint stiffness

a 35-year-old woman comes to your office with a 1-year history of "aching and hurting all over." She also complains of a chronic headache, difficulty sleeping, and generalized fatigue. When questioned carefully, she describes "muscle areas tender to touch." Although the pain is worse in the back, there really is no place free of pain. She also describes headaches, generalized abdomen pains, and some constipation. what is your most likely diagnosis

fibromylagia based on chronic pain and difficulty sleeping and trigger points.

a 40-year-old carpet installer who spends his working day on his knees, fitting carpets. In the past few months, he had been aware of a dull ache over his right knee, which had seemed to be aggravated by pressure and on flexion of the knee. He had been wearing kneepads, using a soft mat and trying to avoid kneeling on that knee. However, he was alarmed to wake one morning with a large, tender, fluctuant swelling over the kneecap. what would be initial management for this patient?

this patient has housemaid's knee or prepatellar bursitis based on his hx and symptoms. compression of the area and NSAIDs would be a good way to start management.

a 14-year-old boy with left knee pain. He denies any trauma to the knee. The patient runs cross country for his high school team and attends practice regularly. On physical exam, the tibial tubercle is pronounced and there is tenderness to palpation over the affected area. The patient reports pain upon resisted knee extension what is the most likely diagnosis?

we have a 14 YO patient who runs a lot w/ tender and pronounced tibial tubercle. the most likely diagnosis here is osgood schlatter disease

Which thoracic curvature is an indication for treatment with bracing in an adolescent with scoliosis? Less than 20 degrees 20 to 40 degrees 40 to 60 degrees 40 degrees with lumbar curvature of 30 degrees Greater than 70 degrees

20 to 40 degrees

Septic arthritis in adults younger than 30 years is usually caused by A Neisseria gonorrhea B Staphylococcus aureus C Pseudomonas aeruginosa D Salmonella species

A Neisseria gonorrhea

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

Which of the following is an indication for pharmacologic therapy in postmenopausal women and men aged 50 years or older? A A T score of -2.5 or less at the femoral neck or spine after evaluation for secondary causes of osteoporosis B A fracture in a wrist C A 10-year probability of a hip fracture of at least 2% D A 10-year probability of a major osteoporosis-related fracture of at least 10%

A T score of -2.5 or less at the femoral neck or spine after evaluation for secondary causes of osteoporosis

A 21-year-old white man comes to your clinic complaining of hip and back pain and stiffness for the past several months that is worse in the morning, but gradually improves throughout the day. You order x-rays of the hips and back which reveal progressive fusion of the lumbar vertebrae and fusion of the sacroiliac joints. Which of the following is the most likely diagnosis in this patient? A. Ankylosing spondylitis B. Lumbar disk disease C. Rheumatoid arthritis D. Spondylolisthesis E. Lumbar stenosis

A. Ankylosing spondylitis . Ankylosing spondylitis This patient's presentation and radiographic findings are most consistent with ankylosing spondylitis, an inflammatory spine disease. It is characterized by sacroiliitis and spinal fusion. It is more common in white males, and is usually diagnosed before the age of 40 years. Imaging will show a 'bamboo spine' and fused sacroiliac joints. It is also associated with a positive HLA-B27. Extraarticular manifestations may be present, including uveitis and inflammatory bowel disease. 91% choose this answer

A 26-year-old woman with a history of fatigue, intermittent fever, joint pain, and facial rash for the past two months, comes to the office for follow-up visit. At her initial visit, she stated that her normal exercise is martial arts, and she has noticed that her exercise tolerance has diminished. Additionally, she has had increasing pain and swelling of the joints in her hands, and mild diffuse muscle weakness. Temperature is 37.6°C (99.7°F), pulse rate is 86/min, respirations are 18/min, blood pressure is 116/68 mmHg. Physical examination shows a mild erythematous maculopapular rash overlying the cheeks and nasal bridge. Mild tenderness and edema is noted over the proximal interphalageal and metacarpophalangeal joints of both hands. Initial laboratory testing showed a positive anti-nuclear antibody test. Which of the following additional laboratory tests is most likely to confirm this patient's diagnosis? a. anti double stranded DNA antibody b. c-reactive protein c. cryoglobuin d. ESR e. HLA b27

A. Anti-double stranded DNA antibody Anti-double stranded DNA (anti-dsDNA) antibody testing is used to help make a diagnosis of systemic lupus erythematosus in a person who has a positive result on a test for antinuclear antibody (ANA), and has clinical signs and symptoms that suggest lupus. While anti-dsDNA testing is highly specific for lupus, only 50-70% of patients have a positive test.

Endotracheal intubation should be performed with caution in patients with which of the following underlying conditions due to the propensity to cause subluxation of C1 on C2? A Rheumatoid arthritis B Osteoarthritis C Gout D Pseudogout

A. RA Patients with advanced rheumatoid arthritis will have synovitis of the atlantoaxial joint (C1-C2) which may damage the transverse ligament of the atlas, producing forward displacement of the atlas on the axis (atlantoaxial subluxation).

A 72-year-old man comes to the clinic complaining of low back and leg pain that is exacerbated during his morning walks for the past few months. He admits that the pain tends to come on about mile 2, but if he leans forward somewhat he is able to finish his walk. The pain only goes away when he either sits or lies down. On physical examination, straight leg raise is negative, and no paraspinal muscle spasms are noted. Which of the following is the most likely diagnosis? a. spinal stenosis b. peripheral arterial disease c. herniated disc pulposis d. sciatica e. lumbar strain

A. Spinal stenosis Spinal stenosis is a major source of back pain in the elderly, due to narrowing of the central spinal canal and neural foramen. Patients may describe neurogenic claudication: pain that is worse with walking and relieved by leaning forward or sitting down. Patients may also have numbness, tingling, and weakness.

A 42 year-old male sustained a closed left tibial fracture in a fall two days ago. He was treated with a cast for immobilization. Acutely, he developed severe pain in his left leg. Examination reveals the anterolateral aspect of the leg to be exquisitely tender to palpation. The patient has extreme pain with plantar flexion. What is the most likely diagnosis? A Compartment syndrome B Deep venous thrombosis C Osteomyelitis D Complex regional pain syndrome

A. compartment syndrome One of the earliest signs of compartment syndrome is severe pain that occurs with extension of the involved muscles.

Which of the following are among the most common symptoms in new cases or recurrent active SLE flares? A Fatigue and arthralgia B Cranial neuropathy C Pleuritis D Peptic ulcer disease

A. fatigue and arthralgia

A 55 year-old female presents with complaints of stiffness, aching, and pain in the muscles of her neck, shoulders, lower back, hips, and thighs. There is no associated weakness associated with the stiffness and achiness. Laboratory evaluation shows an elevated C reactive protein and erythrocyte sedimentation rate. Which of the following medications is used to treat this condition immediately and will also serve to prevent a known complication from this disorder? A. Glucocorticoids B Cyclophosphamide (Cytoxan) C Methotrexate (Rheumatrex) D Azathioprine (Imuran)

A. glucocorticosteroids this patient is presenting w/ polymyalgia rheumatica. TOC for polymyalgia rheumatica is PO prednisone

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 cuf

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.

A 27 year-old male presents with gradually worsening low back pain and stiffness for the past two years. His symptoms are worse upon awakening and gradually improve throughout the day. Lumbosacral flexion is less than 50%. Lumbosacral spine films show erosions in the joint line of both sacroiliac joints. HLA-B27 test is positive. Which of the following is the most appropriate first-line medication for this patient? A Indomethacin (Indocin) B Methotrexate (Rheumatrex) C Prednisone (Medrol dose pack) D Sulfasalazine (Azulfidine)

A. indomethacin NSAIDS, such as indomethacin, are the mainstay of therapy in ankylosing spondylitis NSAID-losing spondylitis

Inflammation and necrosis of the muscular tissue supplied by small- and medium-size arteries is known as A. Polyarteritis nodosa B Pyoderma gangrenosum C Polymyositis D Giant cell arteritis E Dermatomyositis

A. polyarteritis nodosa

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 Abduction against resistance tests the supraspinatus

a 34-year-old male who brought into the ER by EMS after a high impact MVA. He is experiencing severe ankle pain, edema, deformity and inability to bear weight. On exam, there is exposed bone and skin. An x-ray of the affected extremity is seen here. what is the most likely diagnosis?

Ankle dislocation

Which of the following studies is indicated to identify potential celiac disease in a patient with secondary osteoporosis? A Thyrotropin level B Antigliadin and antiendomysial antibodies C Urinary free cortisol level D Serum tryptase

Antigliadin and antiendomysial antibodies

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

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

Intraarticular injection of hyaluronic acid has been approved for treatment of patients with which of the following conditions? A Rheumatoid arthritis of the knee B Osteoarthritis of the knee C Olecranon bursitis D Gouty arthritis

B Osteoarthritis of the knee

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

Management of SLE depends on disease severity and manifestations. However, which of the following medications is considered the cornerstone of SLE management? A Nonsteroidal anti-inflammatory drugs (NSAIDs) B Hydroxychloroquine C Methotrexate D Belimumab

B hydroxychloroquine Hydroxychloroquine has a central role for long-term treatment in all patients with SLE. The LUMINA (Lupus in Minorities: Nature versus Nurture) study and other trials have offered evidence of a decrease in flares and prolonged life in patients given hydroxychloroquine, making it the cornerstone of SLE management.

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.

A 55-year-old man is being evaluated in the office for nodular thickening on the palmar surface of the hand for the past six months. Physical examination shows flexion contractures of approximately 30 degrees at the metacarpal-phalangeal joints of the fourth and fifth fingers. Which of the following is the most likely diagnosis? a. boutonniere deformity b. dupuytren contracture c. felon d. swan neck deformity e. volkmann contracture

B. Dupuytren contracture Dupuytren disease is a condition that affects the palmar fascia, which lies underneath the skin in the palm and fingers. It is usually first detected when nodules form under the skin, often times followed by pitting on the surface of the palm as the diseased tissue pulls on the overlying skin. As the disease progresses, bands of fascia in the palm develop into thick cords that can tether one or more fingers, and the thumb into a flexed position. The most common finger to be affected is the ring finger; the thumb and index finger are much less often affected. The disease begins in the palm and moves towards the fingers, with the metacarpophalangeal joints affected before the proximal interphalageal joints. In Dupuytren contracture, the palmar fascia within the hand becomes abnormally thick, which can cause the fingers to curl, and can impair finger function.

A 29-year-old male presents to his primary care physician with complaints of pain with urination, eye dryness, and left ankle and knee pain that has developed over the last several weeks. He reports an illness 3 weeks ago that involved frequent diarrhea as well as nausea and vomiting. This episode resolved without treatment within 2 days. Physical exam shows moderate conjunctivitis; the knee and ankle joints show mild crepitus but no overlying redness or warmth. Which of the following is the best next step in the management of this patient? A Prescribe azithromycin and doxycycline B Initiate ibuprofen C Aspiration of the left knee and ankle joints D Initiate PO prednisone E Obtain MRI of the left knee and anklE

B. Initiate Ibuprofen This patient's presentation is consistent with Reiter's syndrome, also known as reactive arthritis. Nonsteroidal anti-inflammatory medications, such as ibuprofen, are the recommended first-line treatment to reduce the pain and inflammation associated with this disease. Reiter's syndrome or reactive arthritis is an autoimmune response to infection that classically involves a triad of noninfectious urethritis, arthritis, and conjunctivitis. This classic triad is actually only seen in approximately one-third of patients with reactive arthritis. The disease is associated with preceding gastrointestinal infection with organisms such as Salmonella, Shigella, Yersinia, or Campylobacter as well as preceding genitourinary infection, with the most common causative organism being Chlamydia. Diagnosis is primarily based on history and clinical presentation

A 45-year-old man who was recently started on hydrochlorothiazide for hypertension comes to your clinic first thing in the morning, because he woke up with exquisite left great toe pain. Physical examination shows an erythematous and swollen left first metatarsophalangeal (MTP) joint, with greatly decreased range of motion secondary to pain. Which of the following results from diagnostic testing would best confirm the suspected diagnosis? a. increased ESR b. joint fluid analysis revealing negatively birefringent crystals c. joint fluid analysis revealing positively birefringent crystals d. radiographs showing rat bite appearance e. serum uric acid of 8 mg/dL

B. Joint fluid analysis revealing negatively birefringent crystals Joint fluid analysis showing negatively birefringent crystals is the diagnostic test of choice for gout as it is both sensitive and specific for gout. These crystals are needle shaped and composed of monosodium urate. The high serum uric acid, elevated ESR, and radiographic findings would certainly increase your suspicion of gout, but these are not the best tests. 79% choose this answer PEARL: HCTZ can cause GOUT.

Which of the following is a comorbidity that is recognized to increase the risk for morbidity and mortality in patients with SLE? A Inflammatory bowel disease B Osteoporosis C Atrial fibrillation D Pregnancy

B. Osteoporosis Question 1 Explanation: The European League Against Rheumatism (EULAR) task force also identified the following comorbidities as increasing the risk for morbidity and mortality in patients with SLE: Infections Hypertension, Lipid disorders (dyslipidemia), atherosclerosis, and coronary heart disease, Diabetes mellitus, Bone-related conditions: osteoporosis, avascular bone necrosis, and Malignancies, such as non-Hodgkin lymphoma, lung cancer, and hepatobiliary cancer

Patients diagnosed with Sjögren syndrome should be counseled to avoid which of the following class of medications? A penicillins B decongestants C antihistamines D corticosteroids E fluoroquinolones

B. decongestants

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. demineralizaton 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 44-year-old woman is seen in the office for evaluation of right foot pain that she has had for the past five days. She denies any trauma, but states that she practices martial arts for exercise. The pain is located at the bottom of the foot, and is most intense when she gets out of bed in the morning and begins to walk. Physical examination of the foot shows moderate tenderness on the plantar surface overlying the calcaneus. The remainder of the examination shows no abnormalities. In addition to recommending oral nonsteroidal antiinflammatory medication, which of the following is the most appropriate additional next step in management? a. application of short leg walking cast b. initiation of plantar fascia stretching program c. injection of corticosteroid into the plantar fascia d. referral to an orthopedic surgeon for plantar fascia release e. referral to a podiatrist for extracorporeal shock wave therapy

B. initiation of plantar fascia stretching program stretching is the best treatment for plantar fasciitis. home exercisise to stretch the achilles tendon and plantar fascia are the mainstay of treament and reduce the chance of recurrence

Which of the following signs and symptoms are associated with Sjögren's syndrome? A Hepatomegaly, chronic rhinitis, and palmar erythema B Keratoconjunctivitis, parotid gland enlargement, and xerostomia C Confusion, tremors, and peripheral neuropathies D Polycythemia, leukocytosis, and negative rheumatoid factor E Hyperextensibility of joints, iritis, and glossitis

B. keratoconjunctivitis sicca, parotid gland enlargement, and xerostomia

Which of the following medications used to treat rheumatoid arthritis is contraindicated in patients with chronic hepatitis? A Sulfasalazine B Methotrexate C Minocycline D Infliximab

B. methotrexate

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 Galeazzi is DIZTALLY the fracture is radially so if you know that the fracture is on the radius then the dislocation is at the ulna. just flip these when you get to monteggia meaning the fracture is proximal at the ulna and the dislocation is radial head

Which of the following x-ray views will show the presence of a "Scotty dog" deformity seen with spondylolysis? A Lateral B Oblique C Anteroposterior D Open-mouth odontoid

B. oblique

which of the following is the correct treatment for grade II ankle sprain resulting from an inversion injury? a. corticosteroid injection b. rest, ice, compression, elevation c. moist heat and a walking cast d. surgical intervention

B. rest, ice, compression, elevation The majority of ankle sprains are treated with RICE (rest, ice, compression and elevation). 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.

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 splint are best used to immobilize the elbow, wrist, and forearm

A football player complains of burning pain, numbness, and tingling extending from the left shoulder down into the hand after he tackled a player. These symptoms resolved spontaneously in minutes. Following resolution of the symptoms, he has full strength and normal sensation in the left arm. What is the most likely etiology of his symptoms? A Acute muscle strain B Mild concussion C Stretching of nerve roots and brachial plexus y D Thoracic outlet obstruction

C Stretching of nerve roots and brachial plexus y

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-L4 B L4-L5 C L5-S1 D S1-S2

C L5-S1 radiation of numbness to the dorsal (s1) and lateral (L5) aspect of leg and foot are consistent w/ L5-S1 radiculopathy

A 45-year-old man comes to the emergency department with severe back and posterior leg pain after lifting something heavy at work yesterday. While eliciting the history you discover that he is experiencing paresthesias on the medial aspect of both legs, and he did have an episode of fecal incontinence. What is the next step in the management of this patient? A. Prescribe NSAIDs and muscle relaxers, and observe for the next 24 hours B. observe for 24 hrs and if not improved order an MRI c. emergency neurosurgical consult for decompression d. refer to an orthopedist for corticosteroid injections e. order PA and lateral radiographs

C emergency neurosurgical consult for decompression B is wrong because you don't delay getting an MRI and getting a consult when a patient presents w/ cauda equina syndrome

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 this patient is presenting w symptoms of carpal tunnel and the best initial treatment for carpal tunnel is overnight bracing

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 Tibi

C vertebral spine

A 7-year-old boy is brought into your urgent care clinic because of a red and swollen ankle for 4 days. Upon eliciting the history, you discover that about one week prior he sustained a minor injury to the right ankle, breaking the skin. Over the past couple of days, his parents have noticed him walking with a limp that has gradually worsened until this morning when he refused to bear weight on that leg. Physical examination reveals a temperature of 103.2 F (39.6 C), and an erythematous and edematous right ankle. Range of motion is decreased when compared to the left, and it is exquisitely tender to palpation and with motion. Ultrasound reveals effusion around the joint. Other laboratory results are pending. Which of the following is the most likely diagnosis? a. distal radial buckle fracture in an 8 yo boy who fell riding his bicycle b. a green stick tibial fracture in a 3 yo girl that had a mattress fall on top of her c. posterior rib fracture in a 13 month old girl that fell from the first step D. A spiral tibial fracture in a 3 year old that happened after jumping off the couch E. A supracondylar fracture in a 6 year old boy after a fall from the swing onto an outstretched hand

C. A posterior rib fracture in a 13 month old girl that fell from the first step a posterior rib fracture = very specific for shaken baby syndrome AKA ABUSE

A 36-year-old man has just undergone surgical debridement for acute osteomyelitis. You review the post-op note and the surgeon requested you initiate antibiotic treatment. The patient will be discharged tomorrow and asks you how long he will be on antibiotics. You reply: A. He only needs one more IV dose before being discharged B. He will receive IV antibiotic therapy for two weeks C. He will receive 6 weeks of IV antibiotics followed by 1-2 weeks of oral antibiotics D. He will be on oral antibiotic for 10 days E. He will be on oral antibiotic for 8 weeks

C. He will receive 6 weeks of IV antibiotics followed by 1-2 weeks of oral antibiotics Antibiotic regimens vary, but patients can expect to be on IV antibiotics for 4-6 weeks followed by oral antibiotics for an additional 1-2 weeks. S. aureus is the most common organism implicated. Empiric IV antibiotics include Vancomycin OR Linezolid OR Daptomycin plus Ceftriaxone OR ciprofloxacin OR Cefepime. Effective oral antibiotics include clindamycin, rifampin, trimethoprim-sulfamethoxazole, and fluoroquinolones. A wound or bone culture should be obtained to assist with appropriate antibiotic choice. 60% choose this answer

A 42-year-old man presents to your clinic complaining of shoulder pain and weakness that began after a heavy workout at the gym two days ago. At that time he felt a tearing sensation in the left shoulder and has had severe pain ever since, especially if he brings his arm up over his head. Along with tenderness to palpation in the affected shoulder, and restricted range of motion, what additional physical examination finding would you expect in this patient to help confirm your suspected diagnosis? A. A step-off at the acromioclavicular joint B. Radiculopathy in the left arm C. Positive drop arm test D. A bulging and irregularly distributed biceps muscle just proximal to the antecubital fossa E. Localized edema and ecchymosis overlying the proximal humerus

C. Positive drop arm test

A patient presents with chronic back pain. On physical examination testing, the patient is found to have abnormalities of proprioception and vibration discrimination. Which of the following portions of the spinal column are most likely affected? A Lateral spinothalamic tract B Ventral spinothalamic tract C Posterior column D Transection of the cord

C. Posterior Column posterior/dorsal column affects proprioception and vibration sense

A 40-year-old female presents to her primary care physician with complaints of worsening muscle aches and diffuse weakness over the past several months. She states that she now has difficulty climbing stairs and extending her neck. Ultimately, she became more concerned when she began having trouble swallowing and experienced shortness of breath. Physical examination confirms symmetric proximal muscle weakness and is also significant for bilateral atrophy of the shoulder and hip girdle musculature. An EMG is conducted and shows fibrillations. A muscle biopsy is ordered; however, results are pending. Which of the following is the first-line treatment for this patient's condition? A Naproxen B Intravenous immunoglobulin C Prednisone D Cyclophosphamide E Neostigmine

C. prednisone This patient's presentation is consistent with polymyositis. The first-line treatment of inflammatory myositis is high-dose glucocorticoids. Polymyositis is a systemic, autoinflammatory connective tissue disease that is characterized by proximal muscle pain and weakness. More advanced disease is associated with shortness of breath and difficulty swallowing with involvement of the pharyngeal and/or esophageal musculature. EMG is abnormal in almost all patients with polymyositis. Muscle biopsy provides more definitive diagnosis and shows inflammation as well as muscle cell necrosis and regeneration. Management is first with corticosteroids followed by immunosuppressants and other agents (IVIG, monocolonal antibodies) as second-line agents as appropriate.

Which of the following bone mineral density (BMD) scores (as compared with the mean in young women) indicates osteopenia? A BMD within 2 standard deviations (SDs) and a T score ≥-1 B BMD 1 SD below the mean and a T score of 1 C BMD 1-2.5 SDs below the mean and a T score between -1 and -2.5 D. BMD ≥2.5 SDs below the mean and T score ≤-2.5

C.BMD 1-2.5 SDs below the mean and a T score between -1 and -2.5 osteoporosis T score is less than -2.5

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

Calculation of the Cobb angle

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? Children and adolescents Teenagers Adults in middle age The elderly

Children and adolescents

Reactive arthritis most commonly presents with a tetrad of urethritis, conjunctivitis, mucocutaneous lesions, and oligoarthritis. Which of the following joints are most commonly involved with this condition? A Sacroiliac joints B Metatarsophalangeal joints C Large weight-bearing joints D Metacarpophalangeal joints E Distal interphalangeal joints

Correct answer: Large WB joints Question 2 Explanation: The most common joints involved in reactive arthritis are the large weight-bearing joints of the knees and ankles. The sacroiliac joints are involved in only 20% of patients with reactive arthritis. The small joints of the feet, such as metatarsophalangeal joints, are not likely joints involved in reactive arthritis. Metacarpophalangeal joints are primarily involved in rheumatoid arthritis or systemic lupus erythematosus. Distal interphalangeal joints are commonly involved in osteoarthritis and psoriatic arthritis.

A 33-year-old male presents to your office with a complaint of right knee injury associated with pain and swelling. He states he was running after his loose dog and suddenly stopped, hyperextended his knee, heard a pop and noticed immediate swelling. On physical examination, the Lachman test and anterior drawer test demonstrates joint laxity. Which of the following ligaments is most likely injured? A Medial collateral B Lateral collateral C Posterior cruciate D Anterior cruciate

D Anterior cruciate

Which of the following is included in the American College of Rheumatology's alternative criteria for the diagnosis of fibromyalgia? A A pain location score (number of areas in which the patient has had persistent pain over the past week) ≥ 20 B The presence of another pain disorder rules out a diagnosis of fibromyalgia C Symptoms and pain locations must be persistent for at least 6 months D Symptom Impact Questionnaire score (which measures pain, energy; stiffness; sleep; depression; memory issues; anxiety; tenderness; balance; and noise, light, odor, and cold sensitivity) ≥ 21

D Symptom Impact Questionnaire score (which measures pain, energy; stiffness; sleep; depression; memory issues; anxiety; tenderness; balance; and noise, light, odor, and cold sensitivity) ≥ 21

65-year-old man with pain in his right knee. He says he fell and "banged it up fairly bad" approximately 6 months ago but that it had since recovered spontaneously and provided no further trouble until now. He further said the pain does not get worse during the day, and if anything, it hurts more on awakening. His past history showed no hypertension, and he never had any other joint pain of significance. On examination, his temperature is 37.5 °C and his blood pressure is 125/70 mm Hg. He has an inflamed, tender, swollen right knee. No other joints are affected. No other abnormalities are found on physical examination. A plain radiographic examination of the right knee reveals streaking of the surrounding soft tissue with calcium deposits (chondrocalcinosis). You remove accumulated synovial fluid for polarized light microscopic analysis and also obtain a serum sample. In the clinical scenario in the patient presentation above which of the following possible results from these laboratory studies is most consistent with the symptoms described and will confirm a diagnosis? A needle-like crystals with negative birefringence and a normal serum uric acid level B needle-like crystals with negative birefringence and a high serum uric acid level C rhomboidal crystals with weak positive birefringence and a high serum uric acid level D rhomboidal crystals with weak positive birefringence and a normal serum uric acid level

D rhomboidal crystals with weak positive birefringence and a normal serum uric acid level Question 1 Explanation: The condition described is undoubtedly pseudogout, also known as calcium pyrophosphate deposition disease (CPDD). The symptoms are caused by calcium pyrophosphate deposition in nonosseous tissues in joints, most commonly in a knee. The differential diagnosis includes the many things that can cause swelling and pain in a knee. Considering the patient's age and history, the more likely conditions are osteoarthritis, gout, and pseudogout. The fact that the pain does not become worse during the day points away from but certainly does not exclude osteoarthritis. Similarly, the presence of the condition in the knee rather than in an MTP joint points away from but does not exclude gout. The chondrocalcinosis found on radiographic examination is almost pathognomonic for CPDD, and the presence of rhomboidal crystals with weak positive birefringence in the synovial fluid confirms this diagnosis. The serum uric acid level is not elevated.

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 this patient is exhibiting the 6 Ps of compartment syndrome pain out of proportion pulseless pallor paralysis paresthesia poikolothermia

Which of the following medications inhibits prostaglandin synthesis in a patient with rheumatoid arthritis? A Methotrexate B Infliximab (Remicade) C Probenecid (Benemid) D Aspirin

D. ASA ASA MOA is cycoloxygenase inhibition resulting in inhibition of prostaglandin production

A 32-year-old professional pianist comes to your clinic because of numbness in her hands for the last month. Her symptoms are worse at night, and have progressively become worse. On physical examination you note decreased grip strength bilaterally, and a positive Phalen test. This patient should be screened for which of the following endocrine abnormalities? a. addison dz b. hyperparathyroidism c. hypertriglyceridemia d. hypothyroidism e. prolactinoma

D. Hypothyroidism Carpal tunnel syndrome affects patients with comorbid hypothyroidism at a higher rate than the general population, and may be correlated with poorly controlled hypothyroidism. Other risk factors for carpal tunnel syndrome include obesity, female gender, connective tissue disease, rheumatoid arthritis, diabetes, and pregnancy. Patients will have pain and numbness in the median nerve distribution: digits 1-3 and half of the fourth digit. Treatment can involve splinting, steroid injections, and surgical decompression. 69% choose this answer

The patient develops a local flare-up in her right knee. Her left knee is affected to a small degree but not nearly as severely as the right knee. Up until this time, remission had been maintained, and she was taking oral antiinflammatory agents for suppression of inflammation What is the drug of choice for the suppression of inflammation in a patient with this disease? A auranofin B methotrexate C oral prednisone D naproxen

D. Naproxen NSAIDs are the drug of choice for suppression of inflammation in RA.

A 14-year-old boy presents to your clinic complaining of a 'bump' on his leg. Physical examination reveals a non-tender bony protuberance on the distal femur. The patient states, "I think it's been there for awhile" and otherwise has no complaints regrading it. His mother is very concerned so you obtain, and xray of the femur which reveals a stalk-like bony growth near the growth plate of the distal femur. Which of the following is the most likely diagnosis? a. erythema nodosum b. ewings sacroma c. gouty tophi d. osteochondroma e. osteosacroma

D. Osteochondroma Osteochondroma is an overgrowth of cartilage most often affecting the long bones of the leg, the pelvis, or the shoulder blade. They are non-tender bony protuberances common in ages 10-30. They are the most common, benign bony tumor. 67% choose this answer

A 28-year-old man is being evaluated in the emergency department for a knee dislocation he sustained in a motor vehicle accident 30 minutes ago. Following closed reduction, which of the following blood vessels must be evaluated for injury? a. femoral artery b. femoral vein c. greater saphenous vein d. popliteal artery e. superior genicular arteries

D. Popliteal artery Because of its ligamentous fixation and anatomic relationships to the femur, tibial plateau, and knee joint apparatus, the popliteal artery is uniquely susceptible to injury with blunt extremity trauma. Injury to the popliteal artery is frequently associated with knee dislocation, and delay in its diagnosis is the leading cause of amputation in this limb-threatening injury.

Which of the following statements is a common feature of fibromyalgia? A Men are more commonly affected than women. B Alcohol abuse is commonly associated. C Joint inflammation and erythema D Aggravation of the condition due to lack of sleep, trauma, or cold exposure E Normal autonomic and neuroendocrine regulation

D. aggravation of the condition due to lack of sleep, trauma, or cold exposure treating sleep disturbances in fibromyalgia is very important step in managing this condition

33 year-old male presents to your office with a complaint of right knee injury associated with pain and swelling. He states he was running after his loose dog and suddenly stopped, hyperextended his knee, heard a pop and noticed immediate swelling. On physical examination, the Lachman test and anterior drawer test demonstrates joint laxity. Which of the following ligaments is most likely injured? A Medial collateral B Lateral collateral C Posterior cruciate D Anterior cruciate

D. anterior cruciate sudden change in direction or sudden stop in the middle of running is the classic presentation of an ACL injury. plus other buzzwords here are the lachman test and anterior drawer

A 23 year-old female presents with ongoing arthralgias with intermittent flares of arthritis. She is found to have a malar rash and an abnormal urinalysis. Serum ANA and anti-double-stranded DNA antibodies are present. Which of the following tests should be ordered to assess her risk for thrombotic events and future risk of spontaneous abortion? A complete blood count B PT/INR C bleeding time D anti-phospholipid antibodies

D. anti-phopholipid antibodies this patient has SLE. need to check for anti phospholipid ABs and anticardiolipin ABs in order to start anticoagulation

Which of the following cutaneous manifestations of SLE are included in the American College of Rheumatology (ACR) lupus diagnostic criteria? A Alopecia B Livedo reticularis C Raynaud phenomenon D Malar rash

D. malar rash need 4 out 11 of the ff to make a lupus diagnosis malar rash discoid rash photosensitivity oral lesions/ulcers arthritis serositis renal issues neurological disorders hematologic disorders immunologic disorders ANA

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 anti inflammatory agents

D. non-steroidal anti-inflammatory agents Question 5 Explanation: Nonsteroidal antiinflammatory drugs (NSAIDs) are the drugs of first choice in most settings. There is no evidence that one NSAID is superior to another in the treatment of gout. Systemic corticosteroid therapy can be used for patients with acute polyarticular gout who have not responded to other therapies as well as for patients in whom other therapies are contraindicated. Intra articular injections of corticosteroid medication are usually effective in patients with acute monoarticular gout.

What is the definitive diagnostic test of choice for this patient's disease? A a plasma level B a random urine test C a 24-hour urine test D a synovial fluid analysis E Gram stain plus culture and sensitivity

D. synovial fluid analysis

Which of the following groups is most likely to present with Duchenne's muscular dystrophy? A Adolescent females B Middle-aged males C Infant females D. Toddler-aged males

D. toddler-aged males

Which extraarticular condition is sometimes associated with ankylosing spondylitis? A. Amaurosis fugax B. Hepatitis C. Baker's cysts D. Uveitis E. Hypertension

D. uveitis

which of the following statements about scoliosis is true? A The most common form is congenital B The patient has a normal Adam's test C Patients with abnormalities > 5 degrees should be referred to an orthopaedist D.Most curvature is to the right in the thoracic spine, causing the right shoulder to be higher than the left E Syringomyelia is not associated with scoliosis

D.Most curvature is to the right in the thoracic spine, causing the right shoulder to be higher than the left

A 30-year-old woman comes to the urgent care clinic because of persistent right wrist pain and swelling since accidently falling onto her outstretched right hand two days ago. Physical examination of the wrist shows decreased range of motion, increased pain with wrist extension and radial deviation. There is point tenderness over the anatomical snuffbox. X-ray study of the right wrist shows no fracture or dislocation. Which of the following is the most appropriate initial step in management? A. Application of an elastic wrist wrap B. Application of a thumb spica splint C. Application of a ulnar gutter splint D. Corticosteroid injection of the wrist E. Refer the patient to physical therapy for range of motion exercises and muscle strengthening

E. Refer the patient to physical therapy for range of motion exercises and muscle strengthening

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

E. synovial inflammation

Although patients with fibromyalgia do not have characteristic or consistent abnormalities on laboratory tests, some routine studies help rule out other conditions. Which of the following is often recommended as a routine test in patients with suspected fibromyalgia? A Immunohistochemical staining B Erythrocyte sedimentation rate (ESR) C Antinuclear antibody (ANA) testing D Rheumatoid factor testing

ESR is often recommended as a routine laboratory test in patients with fibromyalgia to rule out the presence of inflammatory disorders that may mimic symptoms. Although the ESR is usually normal in patients with fibromyalgia, it is a nonspecific measure of inflammation and mild elevations may not be meaningful. The upper limit of normal for the ESR in women is one half their age (eg, a rate of 40 mm/hr in an 80-year-old women is normal), and in men it is one half their age minus 10. The ESR can also be mildly elevated in obese patients. However, a high ESR may be indicative of an inflammatory disorder or occult cancer that should be thoroughly evaluated. Routine ANA or rheumatoid factor testing in not recommended unless patients have signs or symptoms that may indicate systemic lupus erythematosus or rheumatoid arthritis. A low-titer positive ANA or rheumatoid factor level is common in the general population, so these findings may be of no clinical significance in a patient with fibromyalgia. No histologic abnormalities are seen in fibromyalgia syndrome. The earlier belief that fibromyalgia was associated with inflammation in muscle fascia has been disproven.

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 Fractured fibula C Tibial stress fracture D Gastrocnemius contusion

Fractured fibula Isolated fibular fractures 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.

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

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

Question 1 Which of the following statements about lumbar disc disease is true? A It usually involves the L5-S1 interspace B It typically involves anterior herniation of the nucleus pulposus C It usually requires surgical intervention D Treatment involves strict bed rest for 1 to 2 weeks E Forward flexion of the trunk often helps relieve symptoms

It usually involves the L5-S1 interspace

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 20 degrees of flexion and the tibia is forced forward while the femur is stabilized. Which of the following knee maneuvers does this represent? A abduction stress test B anterior drawer sign C Lachman test D McMurray test

Lachman test

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. CT of the spine b. MRI of the spine c. DEXA scan d. technetium-99m bone 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. correct answer is c. dexa scan

A 26-year-old male was lifting a heavy object two weeks ago when he felt a sudden onset of low back pain. He describes pain in the low mid back at the belt line aggravated with movement. Radicular symptoms are noted in the left buttock down the leg to the dorsal aspect of the foot. He denies any urine or bowel complaints His examination demonstrates an inability to stand on his toes and a positive straight leg raise. Which of the following is most appropriate diagnostic study in this patient? A Computed tomography (CT) B Magnetic resonance imaging (MRI) C Discography D Electromyogram

MRI is the diagnostic study of choice in a patient with suspected disc herniation.

Which of the following is the most sensitive to determine whether there is a small effusion in the knee? a Compress the patella and move it against the femur, noting any crepitus b Flex the knee to about 90 degrees and palpate for tenderness over the joint line c Milk the medial aspect of the knee, press lateral margin of the patella, and note a bulge of returning fluid medial to the patella d Force fluid into space between the patella and the femur, tap the patella over the femur to detect a click

Milk the medial aspect of the knee, press lateral margin of the patella, and note a bulge of returning fluid medial to the patella

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

NSAID medications are the treatment of choice for acute gouty attacks.

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

Open reduction and ulnar gutter splint immobilization Open reduction is indicated with angulation of greater than 40 degrees.

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. trochanteris bursitis

Pes anserine bursitis The pes anserine bursa underlies the semimembranosus tendon and may become inflamed or painful owing to trauma, overuse, or inflammation. It is a common cause of knee pain and it is often misdiagnosed in adults.

A 76-year-old white woman presents with the acute onset of disabling diffuse pain and stiffness involving both the pelvic girdle and the shoulder girdle. The pain is worst when she arises in the morning, improves as the day progresses, and worsens toward evening. She reports feeling feverish but has not checked her temperature. Her activity has been limited by pain. The patient was previously healthy except for Heberden nodes, for which she takes acetaminophen as needed. She has no joint swelling or rash. There is mild weakness of her shoulder girdle. There is no tenderness. Neurologic examination is normal. The CBC shows only a mild normocytic anemia. The ESR is 52 mm/hr. Which of the following is the most likely diagnosis? A Rheumatoid arthritis B Osteoarthritis C Polymyositis D Polymyalgia rheumatica E Fibromyalgia

Question 4 Explanation: Polymyalgia rheumatica is characterized by the acute onset of disabling pain and morning/rest stiffness involving both the upper half and the lower half of the body, along with an ESR higher than 50 mm/hr, which suggests that the pain has an inflammatory origin. Patients are almost always older than 50 years. Shoulder-girdle weakness is often found, arising from disuse as a result of the pain. In view of the absence of tenderness and small-joint swelling, rheumatoid arthritis is unlikely. The symptoms suggestive of inflammatory pain and the ESR higher than 50 mm/hr are atypical for both fibromyalgia and osteoarthritis, rendering those diagnoses less likely as well.

A 76-year-old white woman presents with a 3-month history of diffuse pain involving both the upper half and the lower half of the body. She has a past history of trigeminal neuralgia, recurrent neck pain, and headaches. Her pain is mostly over soft tissue; it worsens throughout the day and is more severe after activity. On examination, the patient has no joint swelling or crepitus, but there is tenderness over multiple joints and bursae. No rash is visible. Neurologic examination yields normal results. Radiographs of the hands are normal; radiographs of the cervical spine show bone spurs. Magnetic resonance imaging (MRI) of the skull and brain shows normal findings, and MRI of the cervical spine shows bone spurs without spinal-cord compression. On laboratory evaluation, the patient has an ESR of 32 mm/hr and a low-titer positive test result for rheumatoid factor (RF). Which of the following is the most likely diagnosis? A New-onset rheumatoid arthritis B Polymyalgia rheumatica C Cervical spinal stenosis D Fibromyalgia E Osteoarthritis

Question 5 Explanation: D. fibromyalgia The finding of diffuse pain and tenderness that persists throughout the day without joint swelling is consistent with fibromyalgia. Given that the ESR is lower than 50 mm/hr and the pain is typically worse in the morning, polymyalgia rheumatica is unlikely. Bone spurs in the cervical spine are frequently asymptomatic and are unlikely to be causing her symptoms in the absence of any evidence of spinal-cord or nerve-root compression. Osteoarthritis is also an unlikely cause in the absence of supportive findings on physical examination. New-onset rheumatoid arthritis should present with joint swelling in addition to pain. Whereas a low-titer positive RF test result is often found in patients with new-onset rheumatoid arthritis, it is also found in about 15% of elderly patients without rheumatoid arthritis.

A 56-year-old white woman presents with diffuse muscle pain and progressive weakness of 3 months' duration. Her past history is negative for illnesses except for mild osteoarthritis in her knees, which she has had for several years. Examination reveals diffuse tenderness of proximal muscles in the shoulder girdle and pelvic girdle with muscle weakness that is worse in proximal muscles. Crepitus is palpated over both knees. No rash or joint swelling is observed, and neurologic examination yields normal results. Which of the following is the most likely diagnosis? A Rheumatoid arthritis B Fibromyalgia C Osteoarthritis D Polymyositis E Polymyalgia rheumatica

Question 6 Explanation: Polymyositis The finding of progressive proximal-muscle weakness suggests polymyositis. (The light micrograph in the slide shows a section of human muscle affected by polymyositis.) Although the diffuse pain and tenderness are consistent with fibromyalgia, the presence of progressive proximal-muscle weakness militates against that diagnosis. The absence of joint swelling and the presence of tenderness over muscles rather than over joints make both rheumatoid arthritis and osteoarthritis unlikely. Polymyalgia rheumatica is not typically associated with muscle tenderness or progressive muscle weakness. You

patient will present as → a 36-year-old woman who comes to your office with a 6-month history of malaise, paresthesia in both hands, and vague pain in both hands and wrists. She also has felt extremely fatigued. She tells you that the pains in her joints are much worse in the morning and improves throughout the day. She is also beginning to notice pain and swelling in both knees. The patient has a normal family history, with no significant diseases noted. She is taking no drugs and has no allergies. On examination, vital signs are normal. There is a sensation of bogginess and slight swelling in both wrists and multiple metacarpophalangeal joints. Both knees also feel somewhat swollen and boggy. There are no other joint abnormalities, and the rest of the physical examination is normal. Rheumatoid Factor and Anti-citrullinated peptide antibodies are positive. what is your most likely diagnosis

RF is not very sensitive for RA; however it is usually first line screening test. Anti-CCP however, more sensitive than RF and when you have a patient who tests positive for Anti-CCP, this means that they are in the advanced stages for RA. This patient has RA.

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

Raynaud phenomenon

a 65-year-old woman with left knee pain. The pain has been present in both knees for approximately 5 years and has been steadily getting worse. She describes stiffness, sticking and grinding of the right knee. Over the last 2 weeks, she has been taking ibuprofen almost every day, requiring an increasing frequency of doses for adequate pain control. On physical exam, there is swelling of the right knee and tenderness to palpation. There is palpable crepitus. A weight-bearing radiograph of the left knee is shown in here. what is your most likely diagnosis?

She most likely has OA that is in the late stages based on the grinding and sticking of the knee. the WB x-ray also shows loss of joint space in the knee. she doesn't complain of any systemic symptoms so we can rule out RA.

A 26 year-old male who is an avid swimmer has been experiencing right shoulder pain for the past month. On examination, pain is elicited with palpation below the anterior acromion. Anterior shoulder pain is also reported when the patient flexes and extends his arm. Which of the following diagnostic tests is most appropriate at this time? A. SHOULDER XRAY B. SHOULDER ARTHROSCOPY C. SHOULDER MRI D. SUBACROMIAL LIDOCAINE INJECTION

Subacromial injection of lidocaine leading to a transient but dramatic improvement in pain with shoulder extension makes the diagnosis of impingement highly likely.

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? Supraspinatus Infraspinatus Teres minor Subscapularis

Supraspinatus

Patient will present as → a 35-year-old male presents with a three-month history of low back pain and right leg pain that has failed to improve with nonoperative modalities including selective nerve root corticosteroid injections. Leg pain and paresthesias are localized to his buttock, lateral and posterior calf, and the dorsal aspect of his foot. On strength testing, he is graded a 4/5 for plantar-flexion and 4+/5 to ankle dorsiflexion. On flexion and extension radiographs there is no evidence of spondylolisthesis. Sagittal and axial T2-weighted MRI images are obtained. this clinical presentation is most consistent with?

The clinical presentation is consistent with a lumbar disc herniation with symptoms of a combined L5 and S1 radiculopathy L5 = leg pain and paresthesia lateral leg/ reduced ankle dorsiflexion S1 = leg pain and paresthesia posteriorly (leg and foot)/ reduced ankle plantar flexion

A 60 year-old female injured her right wrist when she slipped and fell onto her outstretched hand. Radiographs show a fracture through the metaphysis of the distal radius with dorsal displacement and angulation. Which of the following splints is the best method of temporary immobilization? A Dorsal forearm B Ulnar gutter C Volar forearm D Volar with thumb spic

The volar forearm splint is best for temporary immobilization of forearm, wrist and hand fractures and is the splint of choice for Colles' fracture. my notes for colles says sugar tong

A 21 year old who is training for his first half marathon progressively develops worsening pain in his right foot. At first it was relieved with rest but now it persis. Examination reveals pain with pressure applied to the fifth metatarsal. Which of the following is the best test to confirm the suspected diagnosis? A CT B MRI C bone scan D x-ray

This is a stress fracture from the history of over use and pain improvement w/ rest. the best way to diagnose a stress fracture is c. Bone scan.

a 62-year-old female complaining of headaches, muscle pain, and weakness. She has no history of headaches but has now started experiencing them every morning for the past two weeks. She reports feeling very weak and tired in the mornings and cannot even raise her arms to brush her hair. She also mentions that she has occasional headaches and blurry vision Physical exam shows that she has normal strength and normal range of movement. Passive range of motion is limited in all directions and she has difficulty rising out of the exam room chair. You also note that she has some scalp tenderness. her Erythrocyte sedimentation rate is elevated. what is your most immediate concern regarding this patient's condition and how would you address it

This patient has a combination of polymyalgia rheumatica and giant cell arteritis. the most immediate concern here is the ocular symptoms. if this is not addressed immediately, then permanent blindness can occur. her condition would be treated w/ PO corticosteroids

This patient is exhibiting signs and symptoms of polymyositis. the confirmatory diagnosis for this condition is a muscle biopsy

45-year-old male with generalized symptoms such as malaise, fever, sore throat, and joint and muscle aches and pains. He also complains of numbness, tingling, sensory disturbances, and weakness. On physical examination, you notice the presence of tender lumps under the skin, especially on the thighs and lower legs. Laboratory testing is notable for a newly elevated creatinine of 2.6 mg/dL, erythrocyte sedimentation rate, and C-reactive protein. He is also seropositive for hepatitis B virus, ANCA-negative, and guaiac positive. what is the main stay of treatment for this condition

This patient is presenting w/ symptoms consistent w/ polyarteritis nodosa. treatment here would be high dose steroids

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

Ulnar gutter splint to immobilize fracture site this patient has a boxer fracture. an ulnar gutter splint is the most appropriate care in the ER.

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

X-ray of the spine

antinuclear antigen (ANA) is most commonly associated w/ and monitors progress of which of the ff disorders a. SLE b. RA c. OA d. ankylosing spondylitis

a. SLE ANA is for SLE RF is better for RA

which of the ff risk factors is the most predictive for the development of OA? a. age b. major joint trauma c. prior inflammatory joint diseas 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

A 21-year-old woman is brought to the student health center by her coach following an injury to her right knee while playing soccer one hour ago. She states that while positioning herself for a kick, she suddenly felt a pop in her knee. Since the incident, her knee has become increasingly swollen, and she has had difficulty ambulating. Physical examination shows a swollen knee with decreased range of motion. While positioning the knee in 30 degrees of flexion, an anteriorly directed force is applied behind the tibia with one hand while maintaining stabilization of the femur with the other hand. This maneuver produces anterior translation of the tibia. Which of the following structures of the knee is most likely injured? a. ACL b. LCL c. lateral meniscus d. MCL e. PCL

a. anterior cruciate ligament Anterior cruciate ligament (ACL) injuries most often result from low-velocity, noncontact, deceleration injuries, or contact injuries with a rotational component, twisting, valgus stress, or hyperextension. Symptoms of an acute ACL injury may include: feeling or hearing a "pop" sound in the knee, pain and inability to continue activity, swelling and instability of the knee, and development of a large hemarthrosis. The Lachman test, which is described here, is the most sensitive test for acute ACL rupture. Another tradtional test is observing for the presence of an anterior drawer sign.

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

a. axial loading and rotation

A 7-year-old boy is brought to the office by his legal guardian because of persistent right wrist pain for the past two weeks. The child states that he tripped and fell onto his right hand during a domestic dispute involving his biologic parents. He came under the care of his guardian only two days ago. Physical examination of the right forearm shows mild to moderate tenderness of the distal radius. Neurovascular examination shows no abnormalities. X-ray study of the wrist is shown. Which of the following types of injury is shown by the arrow in the x-ray? a. buckle fracture b. galeazzi fracture c. salter harris type I d. salter harris type III e. subluxation of the radial head

a. buckle fracture

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 pray b. alendronate c. raloxifene d. combined estrogen and progesterone therapy

a. calcitonin Calcitonin has the ability to cause analgesia when used for acute compression fracture of the vertebral body

A 76-year-old man is being evaluated in the office for gradually worsening lower back, pelvic and thigh pain over the past two years. He resides in a skilled nursing facility, and is confined to a wheechair. Physical examination shows generalized muscle weakness. X-ray study of the pelvis shows osteopenia, and pseudofractures. Which of the following laboratory findings in serum is most likely to be present with this patient's clinical condition? a. decreased 25 hydroxy vitamin D b. decrease alkaline phosphatase c. decreased cortisol d. increased calcium e. increased phosphate

a. decreased 25 hydroxy vitamin D this patient has osteomalacia and not osteoporosis. osteoporosis does not present w/ proximal muscle weakness. the most common cause of osteomalacia is decreased 25 hydroxy vitamin d

An obese 15 year-old male presents with complaint of a limp and right knee pain for two weeks. He denies recent trauma or history of previous injury. Physical examination of the right knee is unremarkable. Examination of the right hip reveals pain with passive range of motion and limited internal rotation and abduction. Flexion of the hip results in external rotation of the thigh. Gait is antalgic with the right hip externally rotated. Which of the following radiographic findings supports the most likely diagnosis? a, displacement of the femoral epiphysis b. irregularity and fragmentation of the joint space c. capsular swelling of the joint d. dislocation of the hip

a. displacement of the femoral epiphysis buzzwords male obese knee pain w/ no findings antalgic gait

A 13 year-old girl reports two weeks of worsening right knee pain with no history of antecendent 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. osteod osteoma

a. ewing sarcoma The distinctive feature of Ewing sarcoma is the radiographic appearance of a periosteal "onion skin" reaction. MM also produces LYTIC lesions but is a condition that is seen in a much older population and is more likely to present w/ back pain

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 patient who has recently begun treatment for systemic lupus erythematosus with hydroxychloroquine returns to your clinic because she is experiencing side effects from the medication. Which of the following is the most likely her complaint? a. impaired night vision b. jaundice c. achille tendon rupture d. easy bruising e. shortness of breath

a. impaired night vision A patient who has recently begun treatment for systemic lupus erythematosus with hydroxychloroquine returns to your clinic because she is experiencing side effects from the medication. Which of the following is the most likely her complaint?

which of the ff leads to retropatellar pain a. increased Q angle b. increased quadriceps tone and strenght c. osgood-schlatter dz d. hamstring stretching

a. increased Q angle Patients with an increased Q angle have more force directed laterally during knee flexion and are at greater risk of patellofemoral pain syndrome.

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. lateral

which of the ff describes a positive thompson test a. no motion of the foot is observed when squeezing the gastrocnemius B. Pain in the right lower quadrant with deep palpation in the left lower quadrant C. Anteroposterior mobility of the patella when fluid is moved from suprapatellar area D. Pain when arm and forearm are held at 90 and internally rotated E. Laxity with anterior motion of the ankle

a. no motion of the foot is observed when squeezing the gastrocnemius

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 active ABDUCTION weakness but intact passive motion of ABDUCTION = supraspinatus muscle is indicated adhesive capsulitis will havve both active and passive motion deficits.

A 20 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 during practice. Physical exam reveals pain to palpation over the posterior tibialis muscle body. What is the most likely diagnosis? shin splint stress fracture osgood schlatter dz patellofemoral pain syndrome

a. shin splint

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 w/ osteoarthritis who exercise are able to maintain range of motion, strengthen periarticular muscles, and improve physical fitness

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 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. calcium channel blockers.

a. thiazide diuretiics

which of the ff is an extra articular manifestation of RA? a. vasculitis b. malar rash c. coronary artery aneurysms d. periorbital xanthelasma

a. vasculitis Vasculitis affecting any organ system is seen in patients with severe rheumatoid arthritis.

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 exercise Weight bearing exercises are an appropriate adjunct to medication in a patient with osteoporosis. Water aerobics are non-weight bearing. Sun exposure adn vitamin D supplementation are useful in preventing and treating osteomalacia.

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. mainstay is brace/splint for treatment of carpal tunnel esp. when thenar eminence atrophy is not yet present.

Which of the following is the first-line imaging study for suspected fracture of the hip or pelvis? A X-ray scanning B MRI C Bone scanning D Linear tomography

a. x-ray X-ray films are always indicated to determine which type of fracture, if any, is present. Anteroposterior views of the pelvis and hip, as well as cross-table lateral x-ray films, are usually sufficient to evaluate potential fractures. Rotating the affected leg internally or externally can increase the sensitivity of these radiographs. If the clinical picture is highly suggestive of a fracture or stress fracture, and the x-ray findings fail to demonstrate a fracture, then MRI, linear tomography, or bone scanning can be useful in defining otherwise imperceptible fractures

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

aggravated by resisted supination of the forearm biceps are responsible for pronation and suppination of forearm

an 80-year-old woman arrives at the emergency room with severe right shoulder pain and immobility. She fell down the steps outside her house and landed on her right side two hours prior to presentation. On exam, her right arm is abducted and externally rotated. She has decreased sensation to touch over the lateral aspect of her right shoulder. the radiographs show a bankhart lesion and a hill-sachs lesion. what is your diagnosis of this woman's condition

anterior shoulder dislocation

a 44-year-old female with intermittent joint pain. The joint pain began about 13 months ago affecting primarily the joints in her hands, wrists, and feet. She expresses concern regarding worsening fatigue, muscle aches, and feelings of depression. The physical exam reveals tender, edematous bilateral wrists; painless oral ulcers; and erythematous maculopapular lesions on her face. what tests would you order to evaluate for risk of thrombotic events for this patient

anti cardiolipin antibodies and antiphospholipid antibodies

a 44-year-old female with intermittent joint pain. The joint pain began about 13 months ago affecting primarily the joints in her hands, wrists, and feet. She expresses concern regarding worsening fatigue, muscle aches, and feelings of depression. The physical exam reveals tender, edematous bilateral wrists; painless oral ulcers; and erythematous maculopapular lesions on her face. what test would be pathognomic for this condition if it resulted positive

auntie smith is pathognomic for SLE anti-smith antibodies

an 80-year-old woman arrives at the emergency room with severe right shoulder pain and immobility. She fell down the steps outside her house and landed on her right side two hours prior to presentation. On exam, her right arm is abducted and externally rotated. She has decreased sensation to touch over the lateral aspect of her right shoulder. what is the most common nerve injury associated w/ this condition?

axillary nerve injury shoulder-anterior-axillary

A 26 year-old male was lifting a heavy object two weeks ago when he felt a sudden onset of low back pain. He describes pain in the low mid back at the belt line aggravated with movement. Radicular symptoms are noted in the left buttock down the leg to the dorsal aspect of the foot. He denies any urine or bowel complaints His examination demonstrates an inability to stand on his toes and a positive straight leg raise. Which of the following is most appropriate diagnostic study in this patient? a. CT B. MRI c. Discography d. electromyelogram

b. MRI this patient is potentially exhibiting signs and symptoms of radiculopathy which is commonly caused by disc herniation and the best way to diagnose this is w/ MRI

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. pseudogout

b. OA RA classically spares the thumb

which of the following is the treatment of choice for a torus (buckle) fracture involving the distal radius a. ORIF b. ace warp or anterior splinting c. closed reduction and casting d. corticosteroid injection followed by splinting

b. ace wrap or anterior splinting

Which of the following osteoporosis therapies is so poorly absorbed that it must be taken alone and on an empty stomach? A raloxifene (Evista) b. alendronate (Fosamax) C calcitonin (Miacalcin) D teriparatide (Forteo

b. alendronate

which of the ff meds is the TOC for patients w/ chronic gout to prevent recurrence of symptoms during its quiescent phase a. probenecid b. allopurinol c. colchicine d. indomethacin

b. allopurinol 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.

which of the ff is the TOC for stage one lyme dz in a patient less than 12 YO? a. doxycycline b. amoxicillin c. chloramphenicol d. azithromycin

b. amoxicillin Amoxicillin is first line therapy in a patient less than 12 years of age due to the harmful effects of doxycycline on teeth and bones in children.

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 deQuervain's tenosynovitis C Ganglion cyst D Volar flexor tenosynovitis

b. deQuervain's tenosynovitis

What is the most common metabolic abnormality found in patients with gout? A increased production of uric acid B decreased renal excretion of uric acid C increased production of uric acid metabolites D decreased renal excretion of uric acid metabolites

b. decreased renal excretion of uric acid Question 4 Explanation: Decreased renal excretion of uric acid is the cause of primary gout in 75% to 90% of patients, whereas uric acid overproduction accounts for the other 10% to 25% of cases. Secondary causes of gout include chronic renal disease, acute ethanol ingestion, low-dose salicylates (they are uricosuric at high doses), and diuretics, especially the thiazide type. The most common cause of overproduction of uric acid is a myeloproliferative or lymphoproliferative disorder. In addition, when a patient is undergoing cancer chemotherapy, there is a significant liberation of uric acid from dying cells. The greater the responsiveness of the tumor to chemotherapy or radiotherapy, the quicker the tumor breakdown and the more extensive the breakdown of uric acid. Colchicine has many gastrointestinal side effects, particularly diarrhea, that limit its usefulness.

What is the treatment of choice for both PMR and GCA? A IV pulsed steroids B oral prednisone: 20 mg/day for PMR and 60 mg/day for GCA C oral methotrexate D cyclosporine IV every third day for 4 weeks E IV dihydroergotamine

b. oral prednisone: 20 mg/day for PMR and 60 mg/day for GCA

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

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 history of IVDU plus symptoms of infection lead to the conclusion that he is suffering from septic arthritis

A 34 year-old female, with a past medical history of irritable bowel syndrome and migraines, presents with fatigue, generalized aching and stiffness of the trunk, hip, and shoulder girdles. She complains of pain and tightness in the neck and across the upper posterior shoulders. She complains of poor sleep, but denies depression. Physical examination is unremarkable except for numerous tender points on palpation. Laboratory evaluation was unremarkable. Which of the following is the best intervention for this patient? A corticosteroids B supervised exercise program C hydrocodone (Vicodin) D refer to endocrinologist

b. supervised exercise program this patient has fibromyalgia. before starting any form of pharmacologic treatment, conservative measures should be tried first. a carefully planned and individualized exercise program has been proven to be effective for fibromyalgia management.

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 unknown type. Examination reveals bright erythema and edema associated with the right first MCP joint. Which of the patient's antihypertensive medications may be contributing to this condition? A Diltiazem (Cardizem) B Hydrochlorothiazide (HCTZ) C Lisinopril (Prinivil) D Metoprolol (Lopressor)

b.HCTZ this patient has gout based on the classi presentation of swollen and painful great toe plus history of alcohol abuse and HTN. HCTZ is a diuretic that can cause gout b/c it tends to increase absorption of urate and lead to hyperuricemia.

The presence of a "bamboo spine" on spine radiographs, elevated ESR, and a positive test for HLA-B27 support the diagnosis of A Multiple myeloma B Reiter's syndrome C Ankylosing spondylitis D Rheumatoid arthritis E Pott's disease

bamboo spine plus HLA b27 is consistent w/ ankylosing spondylitis

Patient presents as → a 35-year-old male presents with new-onset lower back pain. His symptoms began approximately 3 weeks ago and have not subsided. The patient was playing tennis when he set up for a service and immediately while tossing the ball began to have pain. The pain in pain does not radiate. He denies night sweats, unexpected weight loss, bowel, or bladder symptoms. He does not use illicit drugs and does not smoke. On physical exam, no saddle anesthesia, muscle weakness, or sensory changes are noted. There is tenderness over the iliolumbar ligament. what is the most likely diagnosis

based on symptoms of pure back pain and absence of radiculopathy plus history of strenuous activity, this is most likely back strain/lumbar strain.

A 5-year-old boy is brought to your office because his mother has noticed him walking with a limp that didn't resolve after a few days. He has now been limping for the past week, but does not complain of pain. Physical examination is unremarkable, other than mildly restricted internal rotation of the hips bilaterally. Which of the following diagnostic studies is the most appropriate initial step in the evaluation of this patient? a. joint fluid aspiration w/ culture and sensitivity b. MRI of the hips c. bilateral hip radiographs d. complete blood count and ESR e. serum uric acid levels

best INITIAL evaluation would be c. bilateral hip radiographs C. Bilateral hip radiographs This clinical presentation most likely represents a patient with Legg-Calve-Perthes disease (LCPD), an idiopathic avascular necrosis of the femoral head commonly affecting males ages 4-8 years. LCPD is bilateral in 10-20% of cases. Bilateral hip radiography including AP, lateral, and frog leg views is indicated as the initial diagnostic evaluation. However, radiographs may initially be normal, so if clinical suspicion is high, a bone scan or hip MRI would be indicated down the line. Treatment can involve splints and surgery.

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 ° and the patient is asked to supinate and flex the forearm against your resistance. On the basis of this presentation, what is the most likely diagnosis? rotator cuff tendonitis myocardial infarction anterior shoulder dislocation rotator cuff tear bicipital tendonitis

bicipital tendonitis

What is the most characteristic sign of RA? A joint swelling B bilateral (symmetric) joint involvement C erythema surrounding the affected joints D joint bogginess E involvement of the glenohumeral joint in all cases

bilateral (symmetric) joint involvement

a 49-year-old woman that works as an attorney has a 3-year history of bilateral painful forefeet that is exacerbated by the dress shoes she wears for work. Physical examination reveals bursal inflammation and calluses at the medial eminence of the first metatarsal with a 1st metatarsophalangeal (MTP) joint deformity that passively corrects. A radiograph is performed with results shown here. The hallux valgus angle (HVA) is measured at 25 degrees and the intermetatarsal angle(IMA) is measured at 12 degrees. what is your diagnosis and what is your initial form of treatment

bunion/hallus valgus b/c of the deformity of the first metatarsal bilaterally. initial form of treatment would be shoe modification (wide toe comfortable shoes)

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

buzzword here is pain/swelling/tenderness over the tibial tubercle (even though radiographs are normal, maybe it hasn't progressed enough for bone fragmentation to occur. perhaps at this point its only inflammation) correct answer is C. osgood schlatter disease.

A 44 year-old female presents with ongoing arthralgias and myalgias with intermittent flares of arthritis. She is found to have a malar rash that worsens with sun exposure. She is known to have progressive renal damage and has recurrent infections that are slow to respond to therapy. She takes ibuprofen (Motrin) as needed for her joint pain and takes no other medication. Which of the following tests would be the initial test recommended to screen for this diagnosis? A Rheumatoid factor B Antihistone antibodies C Anti-Smith (Anti-Sm) antibodies D Anti-nuclear antibodies (ANA)

c. ANA this patient is exhibiting symptoms of SLE. best initial test is ANA.

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-L4 B L4-L5 C L5-S1 D S1-S2

c. L5-S1

A 67 year-old female presents with progressive pain in her left knee that is worse with activity and relieved with rest. She notes stiffness of the knee that last about 20 minutes after activity is resumed. She exercises regularly. No known drug allergies. On physical exam she is 5' 5", 225 pounds. Her left knee exam reveals mild effusion without erythema or warmth. Radiographs of the left knee reveal medial joint space narrowing and subchondral bone sclerosis. Her sodium is 138 mEq/L, potassium 4.3 mEq/L, bicarbonate 24 mEq/L, chloride 104 mEq/L, BUN 23 mg/dl and creatinine 1.8 mg/dl. Which of the following medications is most appropriate for this patient's worsening pain? a. naprosyn b. prednisone c. acetaminophen d. methotrexate

c. acetaminophen

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. arch supports

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

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 dypslasia

Which of the following is true about the treatment of fibromyalgia? A Physical therapy modalities are strongly encouraged after minor trauma B First-line treatment in children suspected of having fibromyalgia is pharmacotherapy C Dietary changes are essential to improving symptoms D Screen all patients with fibromyalgia for Chiari malformation, and treat with skull surgery

c. dietary changes are essential to improving symptoms

Which of the following is recognized as a risk factor for osteoporosis? A Obesity B African-American race C Estrogen deficiency D Male sex

c. estrogen deficiency

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 Abduction stress test B Anterior drawer sign C Lachman test D McMurray tes

c. lachman The Lachman test is performed to evaluate the anterior cruciate ligament. The knee is placed in 15 degrees of flexion and external rotation of the hip.

Which of the following is generally considered the most widely acknowledged biochemical abnormality associated with fibromyalgia? A Decreased substance P levels B Increased adenosine triphosphate levels C Low serotonin levels D Higher levels of insulinlike growth factor 1

c. low serotonin levels

which of the ff treatment strategies is the most likely to promote optimal health and limit morbidity and mortality associated w/ RA? a. meningococcal vaccination b. NSAIDs c. methotrexate d. corticosteroids

c. methotrexate first line DMARD for RA is methotrexate

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 this patient has RA based on MCP joint involvement (OA tends to like the DIP and PIP and the base of the thumb while RA classically spares the thumb) treatment of RA w/ methotrexate (DMARDS) is first line

Which of the following views on plain films is preferred to identify spondylolysis? A Anterior B Posterior C Oblique D Lateral

c. oblique scotty dog w/ collar can only been via oblique view of x-ray

A 74 year-old male presents with one month history of right shoulder pain without any known precipitant. His pain involves an area from the right paraspinous musculature to the right deltoid with occasional radiation down the arm. Pain is worse with movement of the shoulder and is not relieved by acetaminophen. He reports numbness of the right index finger and thumb. Physical examination of the shoulder is limited by pain. There is decreased grip strength and absent pinprick sensation in the index finger and thumb. Relexes are normal. What is the most appropriate initial study to obtain? A EMG with nerve conduction B MRI of the right shoulder C Radiographs of the neck D Radiographs of the right shoulder

c. radiographs of the neck this patien is presenting w symptoms consistent w/ cervical radiculopathy b/c he has shoulder pain w/ associated paresthesia in the fingers.

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 finger nail line up in the partially closed hand b. fingernails of the open hand form an asymmetric arc c. ring finger of the closed hand overlap w/ the little finger d. ring finger of the open hand is shortened.

c. ring finger of the closed hand overlap w/ the little finger all fingernails should point to the same spot when the hand is closed. overlapping of one finger over the other indicated 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 the test being described here is finklestein's which is the test for DeQuervain's tenosynovitis

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 tenderness in the anatomic snuffbox is classic presentation for a scaphoid fracture. scaphoid fractures are managed w/ thumb spica

Patient will present as → a 33-year-old man who has undergone ORIF of the left tibia. Fifteen hours postoperatively, the patient complains of increased pain and swelling of his left leg. His pain is unrelieved by medication, he is experiencing numbness, tingling, and loss of function in the extremity. Physical examination demonstrates decreased sensation and painful paralysis of his toes along with diminished pedal pulses on the affected side and coolness with a loss of color in the area. what is the most likely ddx here?

compartment syndrome. b/c... tibia = most commonly where compartment syndrome occurs positive history for trauma/fracture/recent surgery positive for Pain, paresthesia, pallor, pulselessness (diminished pulses), poikolothermia (coolness), paralysis

A 36 year-old male has a history of recurrent low back pain. When lifting a stack of books yesterday, he experienced sudden, severe pain in the lumbar area. He denies radicular pain. His lower extremity examination is unremarkable, and his back examination is remarkable for paraspinal muscle tenderness and increased pain with flexion at the waist. Which of the following management options should be instituted at this time? A refer the patient to orthopedic surgery B continue ordinary activities as tolerated C confine the patient to bed with traction D recommend sleeping on a softer mattress

continue ordinary activities as tolerated

Which of the following is the investigation of choice in PMR? A muscle CK B erythrocyte sedimentation rate (ESR) C antinuclear antibody titer D rheumatoid factor titer E computed tomography scan of the shoulders and hip girdle

correct answer is B. ESR either ESR and CRP are initial tests for PMR. CRP is more favored.

What is (are) the major difference(s) between PMR and polymyositis? A marked proximal muscle weakness in polymyositis B marked proximal muscle tenderness in polymyositis C elevated muscle enzymes such as creatine kinase (CK) in polymyositis D a, b, and c

correct answer is D all of the above Question 1 Explanation: The differences between PMR and polymyositis on clinical examination are as follows: (1) there is marked weakness associated with proximal muscle pain in polymyositis, (2) there is often marked muscle tenderness (versus joint pain in PMR) associated with the proximal muscle pain in polymyositis, and (3) laboratory examination reveals elevated muscle enzymes only in polymyositis.

An 80-year-old woman presents with a 6-month history of stiffness in both hands. It is maximal on awakening in the morning and subsides soon thereafter. She has also noticed mild pain in her lower back, hips, and knees. On examination, the patient is obese. She has significant swelling of both the proximal interphalangeal (PIP) joints and the distal interphalangeal (DIP) joints. There is also deformity of both knees on examination. The rest of her physical examination is normal Which of the following statements regarding the condition described is false? A pain is the chief symptom B stiffness of the involved joint is common but of relatively brief duration C the pain is characteristically dull and aching D a major physical finding is bone crepitus E the presence of osteophytes is sufficient to make the diagnosis

correct answer is E. the presence of osteophytes is sufficient to make the diagnosis other conditions can produce osteophytes such as hypercalcemia. this finding alone is not enough to make the diagnosis of OA.

Which of the following should not be included in the initial management of a patient with fibromyalgia? Cognitive therapy Instruction on normalizing sleep patterns Amitriptyline 25 mg/day A graded exercise program Patient education about fibromyalgia

correct answer is: amytriptyline 25 mg/day Question 6 Explanation: initial management of fibromyalgia should focus on nonpharmacologic therapy, including patient education, sleep management, cognitive therapy, and a graded education program. Analgesics and anti-inflammatory drugs (eg, naproxen) are generally ineffective. Concomitant depression should be treated, but such treatment alone will not improve fibromyalgia. If initial nonpharmacologic management does not improve the patient's symptoms, a medication that is effective against fibromyalgia should be added.

The patient develops a local flare-up in her right knee. Her left knee is affected to a small degree but not nearly as severely as the right knee. Up until this time, remission had been maintained, and she was taking oral antiinflammatory agents for suppression of inflammation. What is the treatment of choice for this local flare-up? A methotrexate B hydroxychloroquine C intraarticular corticosteroid injection D oral prednisone

correct answer: intraarticular corticosteroid injection Because the flare-up is limited to one joint, it is reasonable to treat with a localized approach. An intraarticular corticosteroid injection may temporarily help control local synovitis.

A 43 year-old male with a history of a right medial meniscectomy and a strong family history of osteoarthritis presents to the clinic for a routine physical exam. He states he is very active and runs 20-25 miles a week and competes routinely in 5 km races. He is 5' 10" and 160 lbs, BP is 128/76 and P 72. His physical examination is unremarkable. Which of the following would you recommend to this patient to delay the onset of osteoarthritis? A weight loss B corticosteroid injections C 1500 mg of calcium daily d. consider swimming or biking instead of running

d consider swimming or biking instead of running Swimming and biking would promote excellent joint motion and muscle strength and void the high-impact of competitive short-distance running.

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. SCFE the patient is obese w/ a limp complaining of knee pain but w/o radiological findings on the knee. findings are consistent w/ SCFE

A 53 year-old male is seen in the emergency department following a motor vehicle collision in which his knee impacted against the dashboard. The patient has a posterior knee dislocation that is promptly reduced in the emergency department. The patient currently has a palpable pulse in the dorsalis pedis and posterior tibial areas. Which of the following studies is mandatory? a. anterior plain film of knee b. sunrise view of the knee c. measurement of compartment pressures d. angiography

d. angiography the popliteal artery is at risk for injury whenever a patient sustains a posterior dislocation of the knee and should be evaluated w/ an ateriogram despite the presence of pedal pulses

A 35 year-old female presents with a long standing complaint of dry, scratchy eyes and dry mouth. She also reports dyspareunia. Labs demonstrate a positive anti-nuclear antibody and Anti-La antibodies. The patient has a prolonged Schirmer test. Which of the following classes of medicines should be avoided in treating this condition? A Antimalarials B NSAIDs C Glucocorticoids D Anticholinergics

d. anticholinergics this patient has sjogren's as characterized by keratoconjunctivitis sicca and xerostomia plus positive ABs. def need to avoid anticholinergics or decongestants bc they will make the dryness worse.

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

The most reliable site from which to identify the causative organism in cases of osteomyelitis is the a. base of ulcer d. blood c. sinus tract d. bone

d. bone samples from needle aspiration of pus int he bone, of from a bone biopsy are essential to determine the exact causative agent

When injecting a corticosteroid into a joint to help relieve pain, which of the following would most commonly be mixed in the syringe? A Hyaluronic acid B Ketorolac C Chondroitin sulfate d. Lidocaine

d. lidocaine

A 32-year-old man who is otherwise healthy comes to the urgent care clinic because of sudden onset back pain that occurred three hours ago during his routine morning calisthenics. The pain is localized to the lower back, and is aggravated by sudden movements. Intermittently, he has pain that radiates down the posterior right thigh. Physical examination shows a positive straight leg raise test on the right lower extremity. The remainder of the examination shows no abnormalities. In addition to recommending analgesics for pain relief and early return to activity as tolerated, which of the following is the most appropriate next step in management? a. CT scan of the lumbar spine b. lumboscaral plain x-rays c. MRI of the lumbar spine d. observation e. referral to ortho surgeon

d. observation this guy doesn't need an MRI b/c he doesn't have any of the "red flag" symptoms for back pain such as bowel/bladder dysfunction Sciatica is a condition characterized by pain radiating down the lower limb from the lower back. Typically, symptoms are unilateral, and may go down the posterior, lateral, or anterior areas of the extremity. Lower back pain is sometimes, but not always present. Weakness or numbness may occur in various parts of the affected leg and foot. Approximately 90% of the time, sciatica is due to a spinal disc herniation pressing on one of the lumbar or sacral nerve roots. The straight-leg-raising test is often helpful in diagnosis. In most cases, imaging studies are not needed. Exceptions to this are when bowel or bladder function is affected, there is significant loss of feeling or weakness, symptoms are long standing, or there is a concern of a tumor or infection. Initial treatment typically includes analgesic pain medication, and a recommendation to continue with activities to the best of their abilities. Observation is usually all that is required as in about 90% of patients, the problem resolves in less than six weeks. If problems persist beyond this time period, additional imaging may be warranted such as x-rays followed by MRI.

which of the ff preventative strategies against osteoporosis associated vertebral fractures has a known side effect of increasing the incidence of hot flashes when used in a perimenopausal female a. calcitonin b. alendronate c. estrogen d. raloxifene

d. raloxifene Raloxifene has effects on bone turnover and bone mass and has been shown to decease vertebral fractures. It has anti-estrogen effects on the non-skeletal portions of the body and increases hot flashes in perimenopausal females.

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 steroids B Oral NSAIDs C Physical therapy D surgery

d. surgery this patient has cauda equina which is a surgical emergency immediate decompression of the affected nerve is necessary Cauda equina syndrome is a rare but serious surgical emergency because the duration of nerve compression is inversely correlated with the likelihood of full neurologic recovery.

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.

A 56-year-old woman comes to the office because of right-sided back pain for the past two days. Physical examination of the right lower extremity shows positive straight leg raise, decreased sensation over the dorsal foot and great toe, and inability to extend the great toe. Deep tendon reflexes are symmetric bilaterally. Lumbar disc herniation is suspected. Which of the following nerve roots is most likely affected? a. L1 b. L2 c. L3 d. L4 e. L5

e. L5 L5 lesions cause sensory loss over the leg, lateral and dorsal foot and great toe, and does not contribute typical reflex assessment. It provides major motor contributions to gluteus medius and minimus, semitendinosus, extensor hallicis longus, peronei, and posterior tibialis S1 is responsible for ankle reflex

Which of the following conditions predispose(s) individuals toward pseudogout? A hemochromatosis B hyperparathyroidism C trauma D surgery E all of the above

e. all of the above!

Which of the following is (are) a manifestation(s) of giant cell arteritis (GCA), also known as temporal arteritis? A jaw claudication B headaches C amaurosis fugax D scalp tenderness E all of the above

e. all of the above.

A 6-year-old boy is brought to the emergency room after he fell from a swing early today and landed awkwardly, hyperextending his right arm. Now he is complaining of severe pain around the elbow. On physical examination you note tenderness around the elbow joint and moderate edema. Radiographs reveal a positive posterior fat pad. Which of the following is the most likely diagnosis? a. adhesive capsulitis b. rotator cuff tear c. anterior instability of the glenohumeral joint d. humeral shaft fracture e. bicipital tendonitis

e. bicipital tendonitis The Yergason test is done to evaluate for bicipital tendonitis. The test is done by having the patient flex their elbow to 90 degrees, the examiner then applies downward pressure on the patients forearm. The patient is then instructed to attempt to supinate against resistance. Eliciting pain with this movement is indicative of bicipital tendonitis. no idea what this test is. but the only reason i got this right was b/c i knew that supination and pronation of the forearm is done by the biceps.

A patient who has recently begun treatment for systemic lupus erythematosus with hydroxychloroquine returns to your clinic because she is experiencing side effects from the medication. Which of the following is the most likely her complaint? a. elevated white blood cell count b. gram staining shows no organisms c. normal glucose level d. normal protein level e. positively birefringent rhomboid shaped crystals

e. positvely birefringent rhomboid shaped crystals This patient most likely has pseudogout, calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, which involves intra-articular and/or extra-articular deposition of CPPD crystals. Acute, subacute, or chronic arthritis can occur, usually in the knee or other large peripheral joints. Acute attacks can be similar to gout, but usually not as severe. Patients may be asymptomatic between attacks, or have continuous low-grade symptoms in multiple joints, similar to rheumatoid arthritis or osteoarthritis. Diagnosis of CPPD crystal deposition disease is established by identifying rhomboid- ('classic') or rod-shaped crystals in synovial fluid. These crystals are usually weakly or strongly positively birefringent, using compensated polarized light microscopy.

a 39-year-old female who reports that her fingers often feel very swollen and stiff and sometimes feel "stuck" in a bent position. She reports that for several months she has been getting a really cold, numb feeling in her fingers throughout the day, especially when she is sitting in the air conditioning at her office. Overall, she has just not felt well for the past few months either. When she eats, she has trouble fully opening her mouth to put food in. Then, when she lies down at night after dinner, she gets a feeling of heartburn and sometimes feels she has to vomit. However, she says she has been eating poorly lately, so it's probably her fault she hasn't felt well. Additionally, she reports losing 20 pounds in the past month without any lifestyle changes. Physical exam reveals tightened, shiny skin with induration over her face and arms, sclerodactyly, and dry rales in the lungs. There are also telangiectasias on her left cheek. Explain what is causing her heartburn sensation and difficulty eating

esophageal dysmotility part of CREST C for calcinosis R for raynaud's E for esophageal dysmotility S for sclerodactyly T for talengiectasia

A 40-year-old female presents to her primary care physician with complaints of worsening muscle aches and diffuse weakness over the past several months. She states that she now has difficulty climbing stairs and extending her neck. Ultimately, she became more concerned when she began having trouble swallowing and experienced shortness of breath. Physical examination confirms symmetric proximal muscle weakness and is also significant for bilateral atrophy of the shoulder and hip girdle musculature. An EMG is conducted and shows fibrillations. A muscle biopsy is ordered; however, results are pending. What specific labs would you order for this patient? a. CK and anti-jo 1 AB b. ANA c. RF d. anti-CCP

her symptoms are consistent w/ polymyositis. the best labs to order for this patient are CK and anti-jo 1 AB

her symptoms of raynaud's, esophageal issues causing difficulty eating, shiny and tightened skin on the face and arms, sclerodactily, and rales in the lungs (could be interstitial lung dz), and talengiectasia = consisten w/ CREST syndrome also known as limited systemic sclerosis or limited scleroderma

Patient will present as → a 35-year-old woman presents with severe left hip pain. She was sitting in the passenger seat of a car when the car was hit head-on by another vehicle. On physical exam, she has significant pain and deformity in her left hip. She is unable to move her hip or bear weight. She is neurovascularly intact distally. Her left hip is adducted, flexed, and internally rotated. this is a classic presentation of what condition?

hip pain followed by trauma and affected hip characterized by internal rotation, flexion, and adduction. this is the classic presentation for a posterior hip dislocation.

Patient will present as → a 23-year-old male with redness of the eye as well as discharge. He reports that he experiences pain with urination and stiffness and pain of the knee and ankle. With further questioning, he reports a history of gonorrhea infection that was diagnosed and treated approximately 5 weeks ago. He is otherwise healthy. On physical exam, there is conjunctivitis, asymmetric oligoarthritis, and discharge from the urethral meatus. what is the most likely diagnosis

his history of an STI (gonorrhoea) and his symptoms of arthritis, eye findings, and urethral findings are consistent w/ can't see, can't pee, can't climb a tree = Reiter's syndrome also known as reactive arthritis.

A 35 year-old patient with lupus is being treated for mild arthralgias and rash with hydroxychloroquine. Which of the following clinical manifestations is the most common side effect of this medication? A impaired night vision B jaundice C proteinuria mouth sores

impaired night vision

Which of the following is most suggestive of cauda equina syndrome? Low back pain without a clear precipitating event Presence of other systemic symptoms (eg, fever, weight loss, dysuria) New-onset bowel or bladder dysfunction Straight-leg test results indicating pain radiating to below the knee, not merely in the back or hamstrings

new-onset bowel or bladder dysfunction

a 37-year-old flight attendant complaining of worsening foot pain for 3 weeks. The pain is located on the plantar surface of her forefoot and is described as severe, "burning" pain. The pain also radiates into her third and fourth toes. The patient states that, at first, she thought she had a pebble in her shoe, but when she removed her shoe, she could not find any obvious offending agent in her shoe. On physical examination, you are able to reproduce the pain by grasping the medial and lateral aspect of the foot in your hand and squeezing the metatarsal heads together. There is no tenderness with palpation of the metatarsal shafts. An MRI is performed with results seen here. what is the most likely diagnosis

pain is on the plantar surface of the forefoot and radiates to the 3rd and 4th toes. the patient also feels a palpable mass associated with it. there is also reproducible pain when the metatarsal heads are squeezed together. this is most likely morton's neuroma.

Patient presents as → a 39-year-old woman presents with complaints of pain in her left foot of 4 weeks' duration. The patient works as a cashier in a department store, which requires her to be on her feet for long periods. She notes that the pain is most severe on the bottom of her foot and is worse upon arising in the morning and then it subsides with ambulation. On examination, there is no pain with medial and lateral compression of the calcaneus. Active and passive foot and ankle range of motion is pain-free and equal bilaterally. Resisted foot and ankle range of motion is 5/5 and pain-free. The patient has a benign medical history and no other complaints. what is the most likely diagnosis

pain on the plantar surface of foot that is worse in the morning and worse at the initiation of walking (gets better w/ prolonged ambulation). this is plantar fasciitis.

a 62-year-old female complaining of headaches, muscle pain, and weakness. She has no history of headaches but has now started experiencing them every morning for the past two weeks. She reports feeling very weak and tired in the mornings and cannot even raise her arms to brush her hair. Physical exam shows that she has normal strength and normal range of movement. Passive range of motion is limited in all directions and she has difficulty rising out of the exam room chair. Erythrocyte sedimentation rate is elevated. what is your most likely diagnosis?

polymyalgia rheumatica consistent w/ elevated ESR, age over 50, muscle pain and weakness (too tiiired to raise her arms to brush her chair and has difficulty getting up off a chair), PE = NORMAL strength in the muscle strength test!

polymyalgia rheumatica and giant cell arteritis/temporal arteritis

Patient will present as → a 24-year-old male with severe pain in the right knee. He is a professional football player and a few hours prior to presentation, an opposing player hit his leg from his left side. Afterward, he felt a "popping" sound that was followed by severe knee pain and a sensation of knee instability. On physical exam, there is an anterior translation of the proximal tibia when pulled as the patient has the knee flexed at 90° and supine. Ice is applied to the knee and ibuprofen is prescribed. An MRI is ordered. Orthopedic surgery is consulted to evaluate if ligament reconstruction is needed. what ligament is most likely to have been injured?

popping sound followed after direct contact injury w/ severe knee pain and instability. Also the special test done here is the anterior drawer test which was positive. this leads to a diagnosis of a torn ACL

a 48-year-old male with calf and heel pain with weakness and difficulty walking. The patient sustained an injury yesterday while he was playing tennis. He was attempting to change direction when he felt a "pop" in Achilles tendon region and he felt like he was kicked in the back part of his leg. Since the injury, he has been unable to put any weight on the involved extremity. He provides an additional history that for the past 6 months his primary care provider has been treating him for Achilles tendonitis with corticosteroid injections. On physical exam, you note a palpable gap along with increased resting ankle dorsiflexion in the prone position with knees bent. The Thompson test reveals lack of plantar flexion when the calf is squeezed. what is the most likely diagnosis

positive history of achilles tendonitis and "pop" followed by pain and inability to bear weight Plus positive thompson test = this is an Achilles Tendon rupture

A 6-year-old boy is brought to the emergency room after he fell from a swing early today and landed awkwardly, hyperextending his right arm. Now he is complaining of severe pain around the elbow. On physical examination you note tenderness around the elbow joint and moderate edema. Radiographs reveal a positive posterior fat pad. Which of the following is the most likely diagnosis? a. lateral epicondylitis b. elbow strain or sprain c. nursemaid's elbow d. supracondylar humeral fracture e. humeral shaft fracture

posterior fat pad sign is a buzzword for elbow fractures, particulary supracondylar humeral fractures

The neuromuscular hallmark of polymyalgia rheumatica is A asymmetric muscle pain and stiffness. B distal paresthesias. C muscle weakness. D proximal muscle pain and stiffness

proximal muscle pain and stiffness Proximal symmetric muscle pain and stiffness, particularly involving the shoulder, neck and pelvic girdle, is the musculoskeletal hallmark of polymyalgia rheumatica.

Patient will present as → a 49-year-old female with progressive left hip pain and limp which has become progressively worse over 13 months. Her past medical history is significant for heterozygous sickle cell anemia and she is has been under hydroxyurea treatment for about 20+ years. She is on no other medication and denies alcohol or tobacco use. The pain is localized to the groin, lateral hip, and buttocks and she reports a sudden increase in pain about two months ago after her last sickle cell crisis. Physical exam reveals a left hip with painful restriction of ROM and a limp. Right hip has mild symptoms. what is the most accurate diagnosis

risk factor = SCD symptoms: progressive worsening hip pain (insidious onset), pain localized to groin, lateral hip and buttocks area, plus sudden increase in pain after recent SCD crisis. PE: painful hip with limp this patient is suffering from avascular necrosis of the hip.

a 23-year-old elite dancer falls and sustains an injury to her left foot. She has pain and inability to bear weight on her injured foot. She has no plantar ecchymosis but does have tenderness over her lateral foot. A radiograph of her foot is seen here. what is the most likely diagnosis?

she has a fracture on the 5th metatarsal so she has jones fracture. her symptom of pain on lateral aspect of her foot is also consistent w/ a jones fracture

she is positive for joint pain w/ tenderness and edema and muscle aches, she also has nueropsych symptoms w/ the depression. she has PAINLESS oral ulcers plus the malar rash on her face. these findings are consistent w/ SLE

a 39-year-old female who reports that her fingers often feel very swollen and stiff and sometimes feel "stuck" in a bent position. She reports that for several months she has been getting a really cold, numb feeling in her fingers throughout the day, especially when she is sitting in the air conditioning at her office. Overall, she has just not felt well for the past few months either. When she eats, she has trouble fully opening her mouth to put food in. Then, when she lies down at night after dinner, she gets a feeling of heartburn and sometimes feels she has to vomit. However, she says she has been eating poorly lately, so it's probably her fault she hasn't felt well. Additionally, she reports losing 20 pounds in the past month without any lifestyle changes. Physical exam reveals tightened, shiny skin with induration over her face and arms, sclerodactyly, and dry rales in the lungs. There are also telangiectasias on her left cheek. what test would you order to confirm your diagnosis of this condition ?

she is presenting w/ symptoms of Limited systemic sclerosis or limited scleroderma or CREST. the best test to check for this condition is anti-centromere AB. anti-crestocentromere AB

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 °, abduct to 30 °, and internally rotate the arms with the thumbs pointing downward. You note weakness and drooping of the right arm with this maneuver that is exacerbated when you apply downward pressure to the right arm. On the basis of this presentation, what is the most likely injured structure? infraspinatus tendon supraspinatus tendon teres minor tendon subscapularis tendon

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 ° of elbow flexion with the patient attempting to externally rotate against resistance. The subscapularis is also tested at 90 ° of elbow flexion with resistance applied as the patient attempts to internally rotate against resistance.

the patient is male w/ generalized symptoms. he also has some neuropathy and he has subcutaneous nodules on his legs. His creatinine is elevated suggesting kidney involvement a positive stool guaiac is a concern for mesenteric ischemia he is also seropositive for hep B and he is ANCA negative the most likely diagnosis here is polyarteritis nodosa

the patient's right arm is abducted and externally rotated. this is classic presentation for an anterior shoulder dislocation. so I would see an anterior shoulder dislocation on the x-ray

An 80-year-old woman presents with a 6-month history of stiffness in both hands. It is maximal on awakening in the morning and subsides soon thereafter. She has also noticed mild pain in her lower back, hips, and knees. On examination, the patient is obese. She has significant swelling of both the proximal interphalangeal (PIP) joints and the distal interphalangeal (DIP) joints. There is also deformity of both knees on examination. The rest of her physical examination is normal Which of the following statements concerning the condition described is false? A this condition is the most common form of joint disease in the United States B 70% to 90% of people older than 75 years have at least one affected joint C this condition has both primary and secondary forms D narrowing of the joint space is unusual E pathologically, the articular cartilage is first roughened and then finally worn away

the statement D. the narrowing of joint space is unusual in OA is false b/c narrowing of joint space is almost always a finding in OA.

Patient presents as → a 20-year-old male with complaints of left lateral ankle pain following an injury that occurred when he was landing from a jump while playing basketball. On examination, there is tenderness over the anterior talofibular ligament. He has an antalgic gait and requires rest after walking 15 steps. The calcaneofibular and posterior talofibular ligaments are nontender to palpation. Anterior drawer testing is positive for pain and loss of endpoint. Inversion subtalar tilt test does not cause any pain and there is a firm endpoint. what is most likely diagnosis

there is tenderness over the talofibular ligament and for anterior drawer test but he is still able to walk. This patient has an ATFL sprain

this an ankle sprain of the Anterior talofibular ligament and this d/t inversion injuries.

this is an achilles tendon rupture. the best way to diagnose this by imaging is via MRI.

this is compartment syndrome. treatment is fasciotomy and decompression of pressure.

a 39-year-old female who reports that her fingers often feel very swollen and stiff and sometimes feel "stuck" in a bent position. She reports that for several months she has been getting a really cold, numb feeling in her fingers throughout the day, especially when she is sitting in the air conditioning at her office. Overall, she has just not felt well for the past few months either. When she eats, she has trouble fully opening her mouth to put food in. Then, when she lies down at night after dinner, she gets a feeling of heartburn and sometimes feels she has to vomit. However, she says she has been eating poorly lately, so it's probably her fault she hasn't felt well. Additionally, she reports losing 20 pounds in the past month without any lifestyle changes. Physical exam reveals tightened, shiny skin with induration over her face and arms, sclerodactyly, and dry rales in the lungs. There are also telangiectasias on her left cheek. what test would you prescribe for this patient to help the numb feeling in her fingers that is worsened by her AC in the office

this patient has CREST/limited scleroderma/limited systemic sclerosis and she is suffering from Raynaud's as a result. the best treatment for raynaud's is CCB or prostacycline

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

this patient has a mallet finger deformity d/t the avulsion of the extensor tendons. the TOC for mallet finger is splint the DIP in hyperextension for 6-12 wks

this patient has an ACL tear. He is also a professional football player. His profession essentially tells you that conservative management is not going to work for this high demand patient. the most likely mode of treatment for him would be surgical repair.

An 80-year-old woman presents with a 6-month history of stiffness in both hands. It is maximal on awakening in the morning and subsides soon thereafter. She has also noticed mild pain in her lower back, hips, and knees. On examination, the patient is obese. She has significant swelling of both the proximal interphalangeal (PIP) joints and the distal interphalangeal (DIP) joints. There is also deformity of both knees on examination. The rest of her physical examination is normal.Which of the following statements regarding this patient's condition is true? A this patient will most likely have a normal erythrocyte sedimentation rate B the swelling present at the DIP joints may represent Bouchard nodes C the swelling present at the PIP joints may represent Heberden nodes D this patient will most likely have a positive rheumatoid factor E synovial fluid analysis will probably demonstrate a low viscosity

this patient has classic presentation of OA: - affected joints are lower lumbar, distal and proximal IP, hips, and knee. she even has bouchard (PIP) and haberdeen's nodes (distal) - stiffness is worse int he morning and is relieved immediately (less than 30 mins). the correct answer would be "the patient will most likley have a normal erythrocyte sed rate" b/c OA is not associated with systemic inflammation and therefore ESR will not be elevated.

this patient has lumbar strain. first line treatment would be NSAIDS. also would be beneficial to tell the patient to avoid strain, apply heat or ice as well.

45-year-old male with generalized symptoms such as malaise, fever, sore throat, and joint and muscle aches and pains. He also complains of numbness, tingling, sensory disturbances, and weakness. On physical examination, you notice the presence of tender lumps under the skin, especially on the thighs and lower legs. Laboratory testing is notable for a newly elevated creatinine of 2.6 mg/dL, erythrocyte sedimentation rate, and C-reactive protein. He is also seropositive for hepatitis B virus, ANCA-negative, and guaiac positive. if this patient had an active hepatitis B infection, what is your treatment

this patient has polyarteritis nodosa based on symptomatology. if he had active Hep B infection treatment would be plasmpapheresis.

a 62-year-old female complaining of headaches, muscle pain, and weakness. She has no history of headaches but has now started experiencing them every morning for the past two weeks. She reports feeling very weak and tired in the mornings and cannot even raise her arms to brush her hair. Physical exam shows that she has normal strength and normal range of movement. Passive range of motion is limited in all directions and she has difficulty rising out of the exam room chair. Erythrocyte sedimentation rate is elevated. what is the best treatment for her?

this patient has polymyalgia rheumatica. the treatment of choice for polymyalgia rheumatica is PO corticosteroids

a 62-year-old female complaining of headaches, muscle pain, and weakness. She has no history of headaches but has now started experiencing them every morning for the past two weeks. She reports feeling very weak and tired in the mornings and cannot even raise her arms to brush her hair. Physical exam shows that she has normal strength and normal range of movement. Passive range of motion is limited in all directions and she has difficulty rising out of the exam room chair. Erythrocyte sedimentation rate is elevated. what condition is usually coexists w/ with this patient's condition?

this patient has polymyalgia rheumatica. giant cell arthritis or temporal arteritis is usually concurrent w/ PMR.

this patient has polymyositis. confirmatory test for this condition is a muscle biopsy

this patient has reactive arthritis. the synovial fluid would most likely be ASEPTIC = meaning we would not be able to isolate an organism in the culture.

this patient is exhibiting symptoms of lupus. the best INITIAL test to order on her is ANA

this patient works on his knees all day and is now experiencing pain over the knee w/ knee flexion. Also he is positive for swollen, tender, fluctuant mass over the patella. This man has housemaid's knee or pre-patellar bursitis

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