Musculosckeletal

Question 1

Forced Flexion of DIP : Mallet Fracture.

Management?

Answer 1

Splinting the DIP in extension for 8 weeks

Can spare the PIP

Question 2

Polymyalgia Rheumatica
- >50 yrs of age
- Elevated ESR and CRP
TX and diagnosis?

Answer 2

Give prednisone 15 mg

Should be better in 24-48 hrs

Question 3

Non displace Mid shaft clavicular fracture

Tx and alternative with same outcome and patient satisfaction?

Answer 3

• Figure of 8 dressing and Shoulder Sling!

Question 4

Female with worsening hip pain
Pain is exacerbated by FABER and FADIR
Dx?

Answer 4

Hip labral tear

Question 5

Pt with elbow pain, medial in location, doing overhead serve

Dx and cause?

Answer 5

Tennis elbow vs Golfers elbow which is lateral

Ulnar collateral ligament injury

Question 6

Lateral patella dislocation

Mgt?

Answer 6

Medially directed pressure while extension of knee; then immobilize

Question 7

Radial wrist pain
+ for Finkelstein test
- grind test
DX?

Answer 7

• Dequarvain tenosynovitis

- If positive grind test: consider scaphoid fx

Question 8

Chronic Achilles tendinopathy

Tx?

Answer 8

Eccentric strengthening exercises

Question 9

Ankle injury

Ottawa rules? Four

Answer 9

1. Pain in malleolar zone
2. Pain in the mid foot zone
3. Bony tenderness at the base of the 5th metacarpal or Navicular
4. Unable to bear weight

Question 10

32 y/o female, started a running program c/o anterior knee pain. PE is normal except for crepitus and lateral patellar tracking

DX?
TX?

Answer 10

Patellofemoral syndrome

Reduce running distance and PT

Question 11

Evaluation for Meniscal tear?

Answer 11

Thessaly’s maneuver- superior positive and negative predictive value compared to Mc Murray’s

Question 12

What is Female Athlete Triad?

What to order?

Answer 12

1. Amenorrhea
2. Low energy
3. Stress fracture

Get Bone mineral density test

Question 13

Characteristic of Ankylosing Spondylitis

Answer 13

1. Better with exercise and activity
2. Stiffness is worst in AM and may last for hours
3. Symptoms is worse at night

Question 14

82 y/o female coming in for hip fx
She takes ranitidine and Vit d.
What will you give to reduce recurrent fx?

Answer 14

Give Bisphosphonates after hip fx!- Alendronate weekly
PPI increases risk for osteoporosis
Not h2 blockers!

Question 15

65 y/o female with severe low back pain after moving a furniture
Not able to void
Diagnosis?

Answer 15

Large midline disc herniation

• • cauda equina syndrome!
• • cause urinary retention

Question 16

Most effective Tx for Fibromyalgia?

Answer 16

TCA - centralized pain state. Goal is to decrease neurotransmitters or increase activity of inhibitory neurotransmitters like Norepi and Serotonin

Question 17

17 y/o playing football
Pain and tenderness at the flexor crease of DIP
Can fully flex the finger and the PIP
Flexion of the DIP is weak
DX?

Answer 17

Jersey finger: Rupture of Flexor digitorum profundus (in DIP)

Mallet finger is a rupture in the Extensor digitorum tendons

Question 18

PT with CTS

1st line?

Answer 18

Do splint

Order NCV if conservative mgt fails

Question 19

1st line for chronic midsubstance Achilles tendinopathy

Answer 19

Eccentric strengthening of the gastrocnemius and soleus

Tendinopathy vs tendinitis; not inflammatory hence no NSAIDS

Question 20

13 y/o pitcher with pain in upper arm at the shoulder when throwing
Diagnosed with Little league shoulder.
What is it?

Answer 20

Proximal humeral epiphysitis

Question 21

Catcher with paresthesias in the ring and little finger?

Nerve involve?

Answer 21

Ulnar nerve entrapment