JOINT/LIMB PAIN

Question 1

Domestic violence DDx:

2

Answer 1

1. Factitious disorder.

2. Substance abuse.

Question 2

Domestic violence workup:

3

Answer 2

1. XR-wrist.
2. CT head.
3. Urine tox.

Question 3

Carpal tunnel syndrome DDx:

3

Answer 3

1. Median nerve compression in the forearm or arm.
2. Radiculopathy of nerve roots C6, C7 in the cervical spine.
3. DeQuervain tenosynovitis.

Question 4

Carpal tunnel syndrome workup:

4

Answer 4

1. Phalen’s maneuver and Tinel’s sign.
2. Finkelstein’s test.
3. Nerve conduction studies.
4. EMG.

Question 5

SLE DDx:

3

Answer 5

1. RA.
2. Psoriatic arthritis.
3. B19 infection.

Question 6

SLE workup:

5

Answer 6

1. ANA, anti-dsDNA, ESR, C3, C4, RF, CCP.
2. CBC.
3. XR-hands.
4. UA.
5. Antibody titers for B19.

Question 7

RA DDx:

3

Answer 7

1. SLE.
2. Disseminated gonorrhea.
3. Arthritis a/w IBD.

Question 8

RA workup:

5

Answer 8

1. XR—hands, left knee.
2. ANA, anti-dsDNA, ESR, RF, CCP.
3. CBC.
4. Cervical culture.
5. Arthrocentesis and synovial fluid analysis.

Question 9

PA DDx:

3

Answer 9

1. RA.
2. SLE.
3. Gout.

Question 10

PA workup:

5

Answer 10

1. ANA, ESR, RF, CCP.
2. CBC.
3. XR-hands.
4. XR-pelvis/sacroiliac joints.
5. Uric acid.

Question 11

Hip fracture DDx:

2

Answer 11

1. Hip dislocation.

2. Pelvic fracture.

Question 12

Hip fracture workup:

5

Answer 12

1. XR-hip/pelvis.
2. CT or MRI —hip.
3. CBC, type and cross.
4. Serum calcium and vitD.
5. Bone density scan (DEXA).

Question 13

Hip dislocation (traumatic) DDx:

1

Answer 13

Hip fracture.

Question 14

Hip dislocation (traumatic) workup:

5

Answer 14

1. XR-hip.
2. CT or MRI-hip.
3. CBC, type and cross.
4. PT/PTT.
5. Urine tox and blood alcohol level.

Question 15

Osteoarthritis DDx:

3

Answer 15

1. Pseudogout.
2. Gout.
3. Meniscal or ligament damage.

Question 16

Osteoarthritis workup:

6

Answer 16

1. XR-knee.
2. CBC.
3. ESR.
4. Knee arthrocentesis and synovial fluid analysis (cell count, Gram stain, culture, crystals).
5. Uric acid.
6. MRI-knee.

Question 17

Septic arthritis DDx:

5

Answer 17

1. Gout.
2. Pseudogout.
3. Lyme arthritis.
4. Trauma.
5. Reiter’s syndrome (reactive arthritis).

Question 18

Septic arthritis workup:

6

Answer 18

1. CBC.
2. Knee arthrocentesis and synovial fluid analysis (cell count, Gram stain, culture, crystals).
3. Blood, urethral cultures.
4. XR-knee.
5. Uric acid.
6. Lyme titers-IgG and IgM.

Question 19

Stress fracture DDx:

2

Answer 19

1. Plantar fasciitis.

2. Foot sprain or strain.

Question 20

Stress fracture workup:

3

Answer 20

1. XR-foot.
2. Bone scan-foot.
3. MRI-foot.

Question 21

Plantar fasciitis DDx:

2

Answer 21

1. Heel fracture.

2. Splinter/foreign body.

Question 22

Plantar fasciitis workup:

2

Answer 22

1. XR-heel.

2. Bone scan-foot.

Question 23

Tennis elbow (lateral epicondylitis) DDx:

1

Answer 23

1. Stress fracture.

Question 24

Tennis elbow (lateral epicondylitis) workup:

3

Answer 24

1. XR-arm.
2. Bone scan.
3. MRI-elbow.

Question 25

Disseminated gonorrhea DDx: | 3

Answer 25

1. RA. 2. SLE. 3. Reiter.

Question 26

Disseminated gonorrhea workup: | 5

Answer 26

1. Knee arthrocentesis and synovial fluid analysis (cell count, Gram stain, culture). 2. ANA, anti-dsDNA, ESR, RF, CCP. 3. CBC. 4. Blood, cervical cultures. 5. XR-knee.

Question 27

Peripheral vascular disease (intermittent claudication): | 3

Answer 27

1. Leriche syndrome (aortoiliac occlusive disease). 2. Lumbar spinal stenosis (pseudoclaudication). 3. Osteoarthritis.

Question 28

Peripheral vascular disease (intermittent claudication) workup: (4)

Answer 28

1. Ankle-branchial index. 2. Doppler US—lower extremity. 3. Angiography. 4. MRI—L-spine.

Question 29

DVT DDx: | 4

Answer 29

1. Baker’s cyst rupture. 2. Myositis. 3. Cellulitis. 4. Superficial venous thrombosis.

Question 30

DVT workup: | 3

Answer 30

1. Doppler US—right leg. 2. CBC. 3. D-dimer.

Question 31

Angina/MI DDx: | 2

Answer 31

1. Tendinitis. | 2. Osteoarthritis.

Question 32

Angina/MI workup: | 6

Answer 32

1. ECG. 2. CBC. 3. XR-shoulder. 4. CXR. 5. Echocardio. 6. Stress test.

Question 33

Shoulder dislocation DDx: | 2

Answer 33

1. Fracture of the humerus. | 2. Rotator cuff injury.

Question 34

Shoulder dislocation workup: | 3

Answer 34

1. XR—shoulder. 2. XR—arm. 3. MRI—shoulder.

Question 35

Rhabdomyolysis due to statins DDx: | 2

Answer 35

1. Polymyositis. | 2. Inclusion body myositis.

Question 36

Rhabdomyolysis due to statins workup: | 6

Answer 36

1. CBC. 2. Phosphate, K, BUN/Cr, glucose, calcium, uric acid. 3. CPK. 4. Aldolase. 5. UA. 6. Urine myoglobin.