Ortho/Rheum

Question 1

Major risk factors for osteoporosis

Answer 1

Advanced age
Postmenopausal
Low body weight

Question 2

Modifiable risk factors for osteoporosis

Answer 2

Excessive alcohol intake
Sedentary lifestyle
Current smoking

Question 3

Highest risk factor for fragility fracture

Answer 3

Previous fragility fracture

Question 4

Interventions to reduce risk of fragility fracture in osteoporotic patients

Answer 4

Weight-bearing exercise
Non-weight-bearing resistance exercise (weight training)
Adequate intake of calcium & Vitamin D
Bisphosphonates

Question 5

At what level of symptomaticity should a patient be evaluated for surgical intervention of a torn meniscus?

Answer 5

3 - 4 weeks of significant symptoms

If the symptoms don’t last that long, and the patient is asymptomatic on exam, MRI is not your best bet.

Question 6

Breastfeeding and homemade baby food alone are likely to not provide enough

Answer 6

Vitamin D

Kid will get rickets after several months of deficiency

Question 7

White male in first or second decade of life
Pain, swelling for weeks - months
Often misdiagnosed as osteomyelitis
Lytic bone lesion “Onion skin” periosteal reaction

Answer 7

Ewing sarcoma

Highly malignant, metastasizes quickly

Surgery, radiation, multi-drug therapy

Question 8

Papule, pustule, vesicle or nodule
Progresses to expanding ulcer
Purulent base
Ragged violaceous borders

In the context of underlying systemic disorder (IBD, RA, AML)

Answer 8

Pyoderma gangrenosum

Neutrophilic ulcerative skin disease

Diagnose with biopsy
Treat with local or systemic corticosteroids

Question 9

Ecthyma gangrenosum

Answer 9

Hemorrhagic pustules w/ surrounding erythema
Evolve into necrotic ulcers

Due to pseudomonas

Occurs most commonly in setting of profound neutropenia & pseudomonas bacteremia

Question 10

Erythema Nodosum

Answer 10

Multiple tender, erythematous nodules/plaques on lower extremities
Associated with medications, infections or autoimmune disease
Does not usually ulcerate
Resolves in 2 - 8 weeks without scarring

Question 11

Back pain that is worse at night

Answer 11

Malignancy (metastasis)

Question 12

Solitary, lytic longbone lesion

Answer 12

Langerhans Cell Histiocytosis

Question 13

Runner
Numbness or pain between 3rd & 4th toes
Clicking sensation when palpating space between them or squeezing metatarsals

Answer 13

Morton neuroma (interdigital neuroma)
Not a true neuroma
Mechanically induced neuropathic degeneration of interdigital nerves

Causes numbness, aching, burning in distal forefoot
Worsened by walking on hard surfaces

Treatment is metatarsal support w/ a bar or padded shoe inserts to decrease pressure on metatarsal heads

Surgery for those who fail conservative treatment

Question 14

Management of fibromyalgia

Answer 14

Patient education (benign condition, favorable prognosis)
Regular aerobic exercise
Good sleep hygiene
Antidepressants for those who fail conservative treatment

Question 15

Poorly localized anterior knee pain

Positive patellofemoral compression test

Answer 15

Patellofemoral Pain Syndrome

Predominantly affects women

Treatment:
Reduced intensity of exercise (especially running)
Activity modification
NSAIDs
Stretching & strengthening exercises (emphasis on quadriceps, knee extensors, hip abductors)