Clin Med I - MSK Questions 1-3

For what condition would you use a Tinel's test? A. Carpal tunnel syndrome B. De Quervain's disease C. Ganglion cyst D. Dupuytren's contracture

A

Thenar atrophy is noted in which of the following conditions? A. Carpal tunnel syndrome B. Dupuytren's contracture C. De Quervain's tenosynovitis D. Ganglion cyst of the wrist

A. Carpal tunnel syndrome

How can pseudogout be distinguished from gout? A. Crystal appearance B. Acute onset C. Involvement of single joints D. Involvement of large joints E. Association with diabetes

A. Crystal appearance [Pseudogout --> rhomboid - similar to diamond; gout = elongated]

A 70-year-old, non-sexually active male complains of fever and pain in his left knee. Several days previously, the patient skinned his knee while working in his garage. The knee is red, warm, and swollen. An arthrocentesis is performed, which shows 200,000 leukocytes/uL and a glucose of 20 mg/dL. No crystals are noted. What is the most important laboratory test to obtain next? Normal values Synovial fluid white blood cells: less than 100/uL Synovial fluid glucose: less than 10 mg/dL lower than blood glucose Synovial fluid crystals: absent Blood glucose: 60 t o 89 mg/dL A. Gram stain and culture of joint fluid B. Urethral culture C. Uric acid level D. Antinuclear antibody levels

A. Gram stain and culture of joint fluid [clearly he has some type of infections and the glucose levels suggested it may be of bacterial origin]

An 80-year-old woman with a significant hunchbacked posture walks into the office. What is this type of deformity called? A. Kyphosis B. Lordosis C. Scoliosis D. Retroscoliosis

A. Kyphosis

A 12-year-old baseball pitcher presents with complaints of elbow pain. You suspect that she has little league elbow. What is the medical term for this? A. Medial epicondylitis B. Lateral epicondylitis C. Olecranon brusitis D. Annular ligament tear

A. Medial epicondylitis [Tendinosis, a chronic tendon injury, of the *flexor/pronator muscles of the wrist*. patient may say "elbow keeps locking. common in baseball and golfers]

An 80-year-old male slips, falls, and lands on his right hip. On presentation at the emergency department, his right lower extremity appears shortened. There is also an open wound at the proximal femur. What is the most appropriate treatment? A. Open reduction-internal fixation of the femur B. Spica hip cast C. Immobilization and non-weight bearing with crutches D. Hip splint

A. Open reduction-internal fixation of the femur

A 28-year-old male presents after a motor vehicle accident in which his knees hit the dashboard. On examination, the left hip is adducted and internally rotated. What is your most likely diagnosis? A. Posterior hip dislocation B. Cruciate ligament injury C. Femoral neck fracture D. Tibial fracture E. Anterior hip dislocation

A. Posterior hip dislocation

In which of the following diagnosis is pain reproduced when placing a vibrating tuning fork over the medial malleolus? A. Tibial stress fracture B. tib. Fib. Fracture C. ITB syndrome D. Osgood Schlatters disease

A. Tibial stress fracture

The treatment for nursemaid's elbow is- A. closed reduction via supination B. closed reduction via pronation C. closed reduction via valgus stress D. open reduction internal fixation (ORIF) E. closed reduction via varus stress

A. closed reduction via supination [no immobilization required, just reduction]

Gamekeeper's thumb involves injury at which joint? A. metacarpal-phalangeal B. proximal interphalangeal C. distal interphalangeal D. interphalangeal

A. metacarpal-phalangeal

Surgical repair of a torn ACL usually involves a graft of which of the following? A. patellar tendon B. quadriceps tendon C. medial collateral ligament D. lateral collateral ligament

A. patellar tendon

Distal humeral fractures often are associated with injury to the ____ nerve A. ulnar B. radial C. median D. axillary E. musculocutaneous

A. ulnar

A 37-year-old tennis player comes to the emergency department complaining of pain in the right shoulder. Physical examination reveals an abducted and externally rotated arm with diminished sensation over the deltoid. The patient is complaining of numbness and tingling over the lateral aspect of the shoulder. An axillary view x-ray reveals an abnormal position of the humeral head. What is the most likely diagnosis? A. Posterior shoulder dislocation B. Anterior shoulder dislocation C. Humeral shaft fracture D. Supercondylar fracture of the humerus

B. Anterior shoulder dislocation [Recall - anterior is most common direction; arm held in external rotation w/ prominence of the acromion giving the shoulder a "squared off" appearance]

What medication is commonly used to treat osteoporosis? A. NSAIDS B. Bisphosphonates C. Barbituates D. Benzoin

B. Bisphosphonates [They INHIBIT osteoclast activity]

A 36 year old male presents with pain in the left neck that radiates into the left lateral upper arm and into the thumb, associated with paresthesias in the thumb. Strength shows that his left wrist extension is 3/5. Which of the following is the nerve root involved? A. C5 B. C6 C. C7 D. C8 E. T1

B. C6

After a severe motor vehicle accident, a 28-year-old male presents with saddle anesthesia, rectal incontinence, bulbocaverosus reflex, urinary incontinence, and decreased anal sphincter tone. What is the most likely diagnosis? A. Spinal stenosis B. Cauda equina syndrome C. Thoracic compression fracture D. Pelvic fracture

B. Cauda equina syndrome

Which of the following is the most likely and concerning complication following a femoral fracture? A. diffuse axonal injury B. Fat embolism C. septic embolism D. systemic thromboembolism E. infection

B. Fat embolism

After watching the Giants game with a group of friends a 50-year-old male presents with a red, hot, and swollen toe. He admits to drinking a "few" beers with his friends and eating two burgers. What is the most likely diagnosis? A. Hallus valgus B. Gout C. Septic arthritis D. Lisfranc fracture

B. Gout

What is the medical term for a rounded back? A. Lordosis B. Kyphosis C. Scoliosis D. Retroscoliosis

B. Kyphosis

What is the normal type of curve that is seen in the upper back? A. Lordotic B. Kyphotic C. Scoliotic D. Spondylotic

B. Kyphotic [Recall - btw 20-40 is normal]

Which of the following would be the treatment of choice for displaced fractures of both malleoli? A. Closed reduction & casting B. ORIF C. observation D. bilateral ankle replacements

B. ORIF [Recall - ORIF = open reduction and internal fixation; open surgery to fix it all maybe w/ plates and screws]

A 52-year-old male presents to the office complaining of right knee swelling. He denies any pain or trauma, but states he just installed a tile floor and was on his knees for about 8 hours. He states that he installs floors daily and that his knee has never swelled like this before. There is ballottable fluid over the patella. What is the most likely diagnosis? A. Infrapatellar bursitis B. Prepatellar bursitis C. Pesanserine bursitis D. Patellar tendonitis E. Suprapatellar bursitis

B. Prepatellar bursitis [aka housemaid's knee; can be caused by extensive kneeling, wrestling, or carpet/floor installation]

A 79-year-old female presents complaining of right knee pain after tripping and falling. Radiographs of the knee reveal no damage, but you notice that her left wrist is swollen. On further exam, her left wrist turns out to be fractured. It is able to be reduced acceptably and can be treated nonoperatively. Once the fracture has healed 6 weeks later, what is your next concern? A. The knee pain that she initially came into your office with B. Prevention of further fractures C. DeQuervain's tenosynovitis D. Carpal tunnel syndrome

B. Prevention of further fractures

A normal variance after a boxer's fracture has healed is which of the following? A. Fingers that over-lap B. a short metacarpal head C. a prominent ulnar stylodi D. tenderness in the TFCC E. DRUJ instability

B. a short metacarpal head [advise patients that even w/ return of function there may be a deformity characterized by lowered metacarpal head]

Any injury to the wrist must include evaluation of the- A. hand B. hand and elbow C. elbow D. hand, elbow, and shoulder E. the opposite wrist only

B. hand and elbow (one above and one below!)

A hip dislocation is most likely to be which of the following? A. anterior B. posterior C. lateral D. medial

B. posterior

Humeral shaft fractures often are associated with injury to the ____ nerve A. ulnar B. radial C. median D. axillary E. musculocutaneous

B. radial

A 65 year old female falls on an outstretched hand and presents to your office with severe right wrist pain and swelling. X-rays reveal a "silver fork deformity" with a fractured distal radius that is displaced dorsally and has severe angulation. Which of the following splints is the most appropriate for this patient during the acute phase in the family doctor's office prior to surgery? A. Ulnar gutter B. short arm cast extending from the proximal forearm to the distal palmar crease C. long arm, sugar tong D. radial gutter

B. short arm cast extending from the proximal forearm to the distal palmar crease [*Colles Fracture* = fx of distal radius in which fragment angulated dorsally. One of the most common fx of elderly population via FOOSH MOI. Tx usually requires surgery, but since she's in the doc's office, casting is best for comfort until further tx]

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

B. torus fracture [Torus fracture aka buckle fracture = incomplete fx of the shaft of a long bone, characterized by *bulging of the cortex*; usually seen in children]

Gamekeeper's thumb involved injury to which ligament? A. medial collateral B. ulnar collateral C. posterior collateral D. anterior collateral E. radial collateral

B. ulnar collateral

A humeral shaft fracture with associated nerve injury might present with weakness with? A. wrist flexion B. wrist extension C. wrist ulnar deviation D. wrist radial deviation E. supination

B. wrist extension [inability to extend the wrist & fingers --> *radial nerve* involvement. Recall, humeral shaft fractures commonly associated w/ radial nerve injury]

A wrist sprain is generally immobilized for ___ days A. 7 B. 5 C. 10-14 D. 14-21 E. 28

C. 10-14 days

Treatment for scoliosis begins with a curvature beyond ____ degrees- A. 5 degrees B. 10 degrees C. 20 degrees D. 30 degrees E. 40 degrees

C. 20 degrees

Incomplete tears of gamekeeper's thumb are treated with a thumb spica cast with the thumb in slight flexion for ____ weeks A. 1-2 B. 2-3 C. 3-4 D. 4-5 E. 5-6

C. 3-4

Kyphosis greater than ___ degrees is considered severe hyperkyphosis- A. 30 degrees B. 40 degrees C. 50 degrees D. 60 degrees

C. 50 degrees

Non-displaced scaphoid fractures are generally casted for how long? A. 4 weeks B. 5 weeks C. 6 weeks D. 8-10 weeks E. 12 weeks

C. 6 weeks

Lachman's test is indicative for injury to which of the following? A. medial meniscus B. lateral meniscus C. ACL D. PCL E. lateral collateral ligament

C. ACL

The best way to check the peripheral vascular blood supply to an extremity is to check which of the following? A. Ausculatory heart sounds B. sharp/dull sensation C. capillary refill D. skin turgor E. 2 point discrimination

C. Capillary refill

A 65-year-old woman calls the answering service while you are on call complaining of low back pain after falling. She reports radiculopathy down the right leg but also states that she has difficulty controlling her urine and controlling her bowels. You call 911 for her and ask that she be transported to the hospital. What condition are you concerned about? A. Bone cancer B. A herniated disc C. Cauda equina syndrome D. Multiple sclerosis E. Guillain-Barre syndrome

C. Cauda equina syndrome [Always the first thing you have to r/o w/ LBP]

What is the etiology of osteoarthritis? A. Infection of the bone B. Degeneration of existing bone and reactive new bone formation C. Degeneration of articular cartilage D. Degeneration of synovium and reactive bone formation E. Inflammation of synovial linings, swelling, and effusions

C. Degeneration of articular cartilage

What is the name for a mass that occurs from a herniation at a joint and that transluminates? A. Bone tumor B. Rheumatoid nodule C. Ganglion cyst D. Gouty tophi

C. Ganglion cyst

Which fracture is most commonly seen in the pediatric population? A. comminuted B. Linear C. greenstick D. compound

C. Greenstick

A 64-year-old man complains of right hip pain that has progressed over the past 5 years. There have been no recent falls or trauma. He was a football halfback during his high school and college days. He is afebrile and has no visible joint deformities on examination. You note poor right hip abduction and slight pain on palpation. You believe he may have osteoarthritis of his right hip. Which of the following statements regarding osteoarthritis is correct? A. Women tend to have fewer joints involved than men. B. Patients typically complain of 1 to 2 hours of morning stiffness. C. It is more likely to be seen if significant trauma has occurred to the effected joint. D. There is usually pain on active range of motion of the involved joint. E. It is always symptomatic with pain, crepitus, and stiffness.

C. It is more likely to be seen if significant trauma has occurred to the effected joint.

A disk herniation with weakness of the extensor hallicus longus, numbness of the dorsal foot and first web space, pain in the posterolateral thigh and calf is associated with a nerve root compression at which level? A. L3 B. L4 C. L5 D. S1 E. S2

C. L5

A 53-year-old female patient presents with radiculopathy and paresthesias down her right leg that she has experienced for 2 weeks. She has difficulty getting into a comfortable position. Physical examination reveals decreased range of motion for all motions of the trunk. There is a positive straight-leg-raise test on the right side, a positive forward flexion test, and positive test for single leg back extensions bilaterally. She denies any history of trauma or injury. What is the most likely diagnosis? A. Lumbar spondylosis B. Lumbar disc herniation C. Lumbar paraspinal muscle spasm D. Piriformis syndrome

C. Lumbar disc herniation [corrected!]

What ligament provides stability to the inside of the knee? A. Lateral collateral ligament B. Medial cruciate ligament C. Medial collateral ligament D. Lateral cruciate ligament

C. Medial collateral ligament

A 39-year-old female presents to the emergency department complaining of right ankle pain after falling and scraping it 2 weeks ago. She states the pain was minimal at the time of the injury but has gotten worse since then. The area is erythematous and fluctuant. She admits to IV drug use. Orthopedic surgery is consulted and the patient is admitted for IV antibiotics. What is the most likely diagnosis? A. Ankle fracture B. Ankle dislocation C. Osteomyelitis D. Osteoid osteoma E. Ewing's sarcoma

C. Osteomyelitis

Ankylosing spondylitis is associated with all of the following EXCEPT- A. HLA-B27 B. bamboo spine on x-ray C. Pain worsened with activity but improved with rest D. involvement of the SI joint

C. Pain worsened with activity but improved with rest

A 36-year-old female is evaluated following a grand mal seizure. Her left arm is adducted against her chest and is internally rotated. What is your most likely diagnosis? A. Proximal humerus avulsion B. Humeral shaft fracture C. Posterior shoulder dislocation D. Anterior shoulder dislocation E. Acromioclavicular joint injury

C. Posterior shoulder dislocation

A 48-year-old construction worker complains of back pain that radiates down his left leg, which is worsened when coughing or sneezing. On examination, when raising his left leg the patient complains of pain in his low back. Also, his left knee reflex is slightly diminished. What type of back pain is the patient experiencing? A. Mechanical back pain B. Referred pain C. Radicular back pain D. Spasm-induced back pain

C. Radicular back pain

The most sensitive physical examination test for a patient with a rotator cuff tear is abducting the arm to 90°, forward flex to 30° with thumb pointed toward the floor. You ask the patient to keep his arm at this position while you actively try to push the arm toward the floor. What muscle does this test? A. Infraspinatus B. Teres minor C. Supraspinatus D. Subscapularis

C. Supraspinatus [This is the empty can test -> RC injury specifically supraspinatus]

Which of the following pharmacological agents used in the treatment of osteoporosis is known to stimulate new bone formation? A. Raloxifene B. Calcitonin C. Teriparatide D. Alendronate

C. Teriparatide

Scaphoid fractures are concerning and risk non-union and osteonecrosis due to- A. the anatomical position of the bone B. the attachment of the SL ligament C. a limited blood supply to the bone D. difficulty in aligning the cast properly E. osteoporosis which is commonly seen in this group

C. a limited blood supply to the bone [Note - scaphoid is the most *commonly fracture carpal bone*; high incidence of non-union and osteonecrosis due to limited blood supply; tx w/ *thumb spica cast splint*]

Uveitis is associated with which of the following? A. cauda equina B. scoliosis C. ankylosing spondylitis D. spinal stenosis

C. ankylosing spondylitis [Uveitis = inflammation of the middle layer of the eye]

Which of the following is associated with a positive crescent sign on x-rays? A. slipped capital femoral epiphysis B. femoral neck fracture C. aseptic necrosis of the femoral head D. dislocation of the hip

C. aseptic necrosis of the femoral head

Humeral shaft fractures are most commonly seen in- A. sports injuries B. direct blows C. automobile accidents D. the elderly E. pediatric patients

C. automobile accidents

Fractures included with gamekeeper's thumb are often ___ in nature A. transverse B. oblique C. avulsive D. spiral E. open

C. avulsive

The most common fracture involving the hand is which of the following? A. Colles' fracture B. 1st mecarpal fracture C. boxer's fracture D. ulnar styloid fracture E. scaphoid fracture

C. boxer's fracture [Tx w/ ulnar gutter split. think - boxers live in the gutter]

The treatment of choice for a simple fracture in the phalanges of the right 3rd toe includes which of the following? A. Closed reduction with casting B. ORIF C. buddy-taping D. full ankle walking cast

C. buddy-taping

Which of the following complications related to orthopedic surgery is the most important to avoid or prevent? A. non-union B. malunion C. deep vein thrombosis, DVT/pulmonary embolism, PE D. arthritis

C. deep vein thrombosis, DVT/pulmonary embolism, PE

NSAID treatment for osteoarthritis may include all of the following side effects EXCEPT- A. Bleeding B. GI effects C. dry mouth D. renal damage

C. dry mouth

Which of the following fratures may most likely result in hemorrhagic shock? A. Tibial fracture B. Fibular fracture C. femoral shaft fracture D. femoral neck fracture

C. femoral shaft fracture [think - femoral shaft has a lot of bone marrow; a fx there will cause a lot of bleeding]

Which of the following is the most likely cause of death associated with pelvic fractures? A. DVT/PE B. infection C. hemorrhage and shock D. nerve damage

C. hemorrhage and shock

Bucks traction with 5 pounds generally reduces pain in which of the following conditions? A. aseptic necrosis of the femoral head B. hip dislocation C. hip fracture D. slipped capital femoral epiphysis

C. hip fracture [Most hip fx treated surgically, but this can be used to stabilize and reduce pain until surgery]

A 65 year old female falls on an outstretched hand and presents to your office with severe right wrist pain and swelling. X-rays reveal a "silver fork deformity" with a fractured distal radius that is displaced dorsally and has severe angulation. Which of the following splints is the most appropriate for this patient after surgery? A. Ulnar gutter B. Thumb spica C. long arm, sugar tong D. radial gutter

C. long arm, sugar tong [Colles fracture; splinting w/ sugar tong]

Once a nursemaid's elbow has been properly treated, which of the following must take place? A. immobilization in a long arm cast for 6 weeks B. immobilization in a short arm cast for 6 weeks C. no immobilization is required D. long term physical therapy must take place E. a corticosteroid must be injected

C. no immobilization is required [Elbow just needs reducing. immobilization or surgery NOT indicated. Recall - this is a common injury in *pediatrics*]

X-ray findings with nursemaid's elbow are generally- A. associated with avulsion fractures B. associated with olecranon fractures C. normal D. associated with greenstick fractures E. associated with a positive fat pad sign

C. normal [nursemaid's elbow = "pulled elbow", usually no fractures involved]

Slipped capital femoral epiphysis is generally seen in which group of patients? A. obese elderly males B. obese elderly females C. obese male pediatric patients D. obese female pediatric patients E. infants

C. obese male pediatric patients

Nursemaid's elbow is often seen in the ___ population: A. elderly B. adult C. pediatric D. neonate E. male

C. pediatric [aka "pulled elbow". MOI = pull on elbow while it is extended w/ forearm pronated. called nursemaid's bc it often results *when child lifted while hold their hand*. child will cry initially but pain subsides quickly, will be reluctant to use arm but in NO distress.]

Nursemaid's elbow involves subluxation of the- A. distal humerus B. olecranon C. radial head D. medial epicondyle E. lateral epicondyle

C. radial head [Subluxation of the *radial head* aka a pulled elbow; common in KIDS!]

A 26 year old male presents with severe left elbow pain following a fall injury during a soccer game. The AP radiograph and lateral films reveal a positive "fat pad sign". Which of the following is the most likely diagnosis? A. Lateral condylar fracture B. olecranon fracture C. radial head fracture D. capitellar fracture

C. radial head fracture [usually present on lateral - pattern of swelling looks like gray/white cotton balls around the radial neck]

A patient presents s/p carpal tunnel release. Which maneuver of the thumb must be checked to rule out any direct injury to the median nerve during surgery? A. thumb flexion B. thumb extension C. thumb opposition D. 2nd digit flexion E. 2nd digit extension

C. thumb opposition

Once femoral head collapse has occurred secondary to aseptic necrosis of the femoral head, the only viable treatment is which of the following? A. physical therapy B. ORIF C. total hip arthroplasty D. NSAIDS E. cortisone injections

C. total hip arthroplasty

A 45 year old female presents with pain in the left hip area (located in a diffuse area inferior to the iliac crest) for the past 3 weeks. The pain radiates down the left anterior thigh. She complains of pain while walking with an extended stride. You examine her and find that you can evert the left hip without inducing aggravation of the pain. Deep tendon reflexes are symmetrical at 2+ in the lower extremities, in both Achilles and the patellar tendons. You find tenderness to fairly firm palpation with two fingers distal to the iliac crest over the prominence of the "hip bone." Which of the following is the most likely diagnosis? A. hip fracture B. aseptic necrosis of the left femur C. trochanteric bursitis D. herniated nucleus pulposus at the L3-L4 level E. colon diverticulitis

C. trochanteric bursitis [inflammation of the bursa at the lateral point of the hip]

In order to properly visualize the scaphoid bone, one must take an x-ray with- A. supination B. radial deviation C. ulnar deviation D. pronation

C. ulnar deviation [Routine AP & Lateral x-rays w/ "scaphoid view" also. hand bent slightly laterally]

The majority of scaphoid fractures are at the- A. proximal pole B. distal pole C. waist D. SL joint E. DRUJ joint

C. waist [60% @ waist; recall that *scaphoid* fx is the *most commonly fx carpal bone*]

While walking through the hospital, you see an elderly female patient lying on a gurney waiting to go into the x-ray department. Her feet and lower legs are exposed and you notice her left leg is shortened and externally rotated. Based on this finding, what is your presumptive diagnosis? A. Dislocated hip B. Fracture of the femoral shaft C. Fracture of the tibia D. Hip fracture

D

What is the optimal daily intake of calcium for the prevention of osteoporosis in postmenopausal women not receiving hormone replacement therapy (HRT)? A. 500 mg B. 1,000 mg C. 1,200 mg D. 1,500 mg E. 2,000 mg

D. 1,500 mg [for those *NOT* on HRT!!!]

A patient with a recent hip replacement would most likely be placed on which medication as prophylaxis for possible infection? A. PCN B. Cipro C. Bactrim D. 1st or 2nd generation cephalosporin, ex: keflex

D. 1st or 2nd generation cephalosporin, ex: keflex [Joint replacements --> cephalosporins]

A boxer's fracture with an angulation greater than ____ degrees is most likely to require ORIF A. 10 B. 20 C. 30 D. 40 E. 50

D. 40

Which of the following is typical in a patient with cauda equina syndrome secondary to a centrally herniated lumbar disc? A. Sciatica involving only one leg B. Normal dorsiflexion and plantar flexion C. Back stiffness D. Bladder dysfunction E. Bamboo-like spine

D. Bladder dysfunction

All of the following may cause aseptic necrosis of the femoral head EXCEPT- A. sickle cell disease B. systemic lupus erythematosus C. Crohn's disease D. HTN E. smoking

D. HTN [May result from traumatic disruption of the vascular supply to the femoral head. Deficient circulation to the femoral head as a result of microvascular thrombosis, corticosteroid use, alcohol abuse, sickle cell disease, rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease, Gaucher's disease, HIV, radiation, smoking, myeloproliferative disorders ]

How does alendronate help to retard bone loss? A. Stimulating osteoblastic activity B. Stimulating osteoclastic activity C. Inhibiting osteoblastic activity D. Inhibiting osteoclastic activity

D. Inhibiting osteoclast activity [Alendronate can be used to tx Paget's and can be used to prevent osteoporosis]

A 61-year-old male presents with pain in his wrist. He states it has been present for "months" but now the pain is getting worse. He states the pain is constant and is temporarily relieved with over-the-counter NSAIDs. He states the pain is worse with activity, but better with rest. He denies fever, chills, or rash. On examination he has tenderness over his left wrist, but not his right wrist. You notice he has a nodule over the left distal interphalangeal joint of his index finger, but no nodules on the metacarpal phalangeal joints. What is the most likely diagnosis? A. Gouty arthritis B. Septic arthritis C. Rheumatoid arthritis D. Osteoarthritis

D. Osteoarthritis

What is the term for a fracture that occurs following a force insufficient to break normal bone? A. Comminuted fracture B. Compound fracture C. Oblique fracture D. Pathological fracture

D. Pathological fracture

What motions does the biceps brachii perform? A. Elbow extension and pronation B. Shoulder extension, elbow flexion, and supination C. Elbow flexion and pronation D. Shoulder flexion, elbow flexion, and supination

D. Shoulder flexion, elbow flexion, and supination

Which type of fracture is most likely associated with twisting? A. Oblique B. Transverse C. Longitudinal D. Spiral

D. Spiral

A 26 year old female presents with radial sided left wrist pain. She has a positive Finklestein's test. The underlying etiology for her condition is which of the following? A. Swelling of the 2nd dorsal compartment tendons B. fracture of the scaphoid C. osteoarthritis of the 1st CMC joint D. Swelling of the 1st dorsal compartment tendons E. posterior interosseous nerve compression

D. Swelling of the 1st dorsal compartment tendons [This is *De Quervain's Tenosynovitis*; first dorsal compartment of the wrist overlong the abductor policies longus and extensor policies bravis tendons. *seen mostly in new mothers who are constantly picking up their children]

A Smith fracture occurs when there is a fracture of the distal radius involving ____ angulation A. lateral B. medial C. dorsal D. volar

D. Volar [smith fx = reverse colles fx; when fragment is angulated *Volarly* aka anterior displacement of the distal fragments. Tx w/ closed reduction (is closed) and *sugar tong splint* pre/post sx for comfort]

Patients with hip fractures generally present with the affected leg- A. adducted, externally rotated and shortened B. adducted, internally rotated and shortened C. abducted, internally rotated and shortened D. abducted, externally rotated and shortened

D. abducted, externally rotated and shortened

Most surgical repairs of gamekeeper's thumb involve use of a- A. pedicle B. prothesis C. bone graft D. anchor with suture E. plate with screws

D. anchor with suture [incomplete tears tx w/ SPICA cat w/ thumb in slight flexion 3-4 weeks. Only complete tears require surgical tx followed by SPICA 3-4 weeks]

Carpal tunnel may be confirmed on physical examination by all of the following EXCEPT- A. positive tinel's test B. positive phalen's test C. thenar atrophy D. atrophy of the dorsal first intraossous web space E. diminished 2-point discrimination

D. atrophy of the dorsal first intraossous web space

A routine work-up for an injured wrist would include examination of all the following EXCEPT- A. musculoskeletal exam B. peripheral vascular examination C. neurologic examination D. cardiac examination

D. cardiac examination

The definitive treatment of spinal stenosis is which of the following? A. Spinal fusion B. epidural pain blocks C. acetaminophen D. laminectomy

D. laminectomy

A bone scan is best used to diagnose all of the following EXCEPT- A. bony metastasis B. stress fractures C. osteomyelitis D. multiple myeloma

D. multiple myeloma [for MM, x-rays will reveal the lytic lesions (punched out lesions)]

A dislocation of the femoral head which is displaced from the acetabulum generally occurs in which direction? A. anterior B. lateral C. medial D. posterior

D. posterior

The most common bone fractured in the wrist is the- A. pisiform B. hamate C. lunate D. scaphoid E. trapezium

D. scaphoid

Which of the following conditions may present with tenderness in the anatomical snuffbox? A. fractures distal radius B. De Quervain's tenosynovitis C. osteoarthritis of the wrist D. scaphoid fracture or SL injury E. fracture of the ulnar styloid

D. scaphoid fracture or SL injury

Scaphoid injuries are always treated with a- A. long arm sugar tong splint B. ulnar gutter splint C. regular short arm splint D. thumb spica splint E. radial gutter splint

D. thumb spica splint [the most commonly fractured carpal bone. Tx w/ thumb SPICA - extended OVER the thumb]

Which of the following types of Salter-Harris classification fractures involves all 3, including the growth plate, the metaphysis, and the epiphysis? A. type I B. type II C. type III D. type IV

D. type IV [Recall - Type IV (SAL*TE*R); TE = through everything]

Which type of splint is used to immobilize a boxer's fracture? A. Sugar tong splint B. short arm splint C. thumb spica splint D. ulnar gutter splint E. radial gutter splint

D. ulnar gutter splint [Boxer's: fx to distal metaphysics of the 5th metacarpal of hand; *most common fx involving the hand*; *ulnar gutter splint* for 3 weeks.]

The standard x-rays ordered for any wrist injury includes: A. AP view B. AP and lateral views C. AP, lateral, and oblique views D. PA, lateral, and oblique views E. AP, lateral, and scaphoid views

E. AP, lateral, and scaphoid views

Conditions pre-disposing a patient to developing carpal tunnel syndrome include all of the following EXCEPT- A. rheumatoid arthritis B. pregnancy C. diabetes D. hypothyroidism E. HTN

E. HTN

A 24 year old male presents with pain in his right wrist that resulted when he fell hard on an outstretched hand. Radiographic studies indicate an anterior dislocation of the proximal row carpal bone that articulates with the most medial proximal row carpal bone (the pisiform). Which of the following bones was dislocated? A. capitate B. lunate C. scaphoid D. trapezoid E. triquetrum

E. Triquetrum

A 4 year old male presents with complaints of right hip pain of 4 days duration and an associated limp. The patient is recovering from an upper respiratory infection that appears to be resolving. The child is currently afebrile. On physical examination there is a notable limitation of movement with internal rotation. Radiographs reveal minor soft tissue swelling around the joint, with no bony findings. CBC and ESR are not elevated. What would be the most appropriate long-term complication to consider for this patient? A. Osteoarthritis of the hip B. septic arthritis C. pyogenic arthritis D. osteomyelitis E. avascular necrosis of the hip

E. avascular necrosis of the hip [S/S: Pain w/ ROM, decreased ROM, limp + gait abnormality; crescent sign on x-ray.]

A 32 year old secretary presents with pain, numbness, and tingling in the right thumb, index, and middle fingers that worsens at night and awakes her from her sleep. EMG/NCU rule out any cervical radiculopathy. Immediate first line therapy for this patient includes all of the following EXCEPT- A. Physical therapy B. cortisone injection C. NSAIDS D. wrist splints E. carpal tunnel release

E. carpal tunnel release

A middle-aged homeless man is brought to the ER because of very severe pain in his right forearm. He had passed out after drinking a bottle of wine, and then slept on a park bench for an unknown amount of time, probably more than 12 hours. Shortly after he woke up and began to walk, the pain began. There are no signs of trauma, but the muscles in his forearm are very firm and tender to palpation. Passive motion of the fingers and wrist elicits severe pain. Pulses at the wrist are normal, radial and ulnar both at 2+. Which of the following is the most appropriate next step in the management of this patient? A. Analgesics and observation B. immobilization in a sling C. immobilization in a plaster cast D. emergent embolectomy E. emergent fasciotomy

E. emergent fasciotomy

Which of the following best describes a ruptured disc in the spine? A. the annulus fibrosus protrudes anteriorly through a weakened nucleus pulposus B. The annulus fibrosis protrudes antermedially through a weakened nucleus pulposus C. the annulus fibrosus protrudes posteriorly through a weakened nucleus pulposus D. the nucleus pulposus protrudes anteriorly through a weakened annulus fibrosus E. the nucleus pulposus protrudes posterolaterally through a weakened annulus fibrosus

E. the nucleus pulposus protrudes posterolaterally through a weakened annulus fibrosus [Recall - most common direction is posterolaterally; L4-5 or L5-S1 most common.]

Initial management for lumbar strain or sprain includes all of the following EXCEPT- A. acetaminophen B. physical therapy C. NSAIDS D. weight reduction E. vicodin

E. vicodin [INITIAL = non opioid]