MSK

Question 1

Which of the following is the most appropriate initial intervention for treatment of Complex Regional Pain Syndrome (CRPS)?

Answer 1

Sympathetic block

Question 2

A patient presents with an injury to his nail bed and a subungual hematoma that covers >50 % of the nail matrix. What is the next step in the management of this patient?

Answer 2

Order an X-ray of his finger

Question 3

In a patient with ankylosing spondylitis, which specialist should you refer the patient to for further evaluation and treatment?

Answer 3

rheumatology and ophthalmologist

Question 5

How long are hip precautions routinely continued after a posterior approach total hip arthroplasty?

Answer 5

12 weeks

Question 6

A 75-year-old patient was treated for local prostate cancer 15 years ago. He has received leuprolide (Lupron) for chemical castration since his diagnosis. He is currently asymptomatic with an undetectable prostate specific antigen and requests guidance in developing a comprehensive exercise program. Which study would be most useful in counseling this patient?

Answer 6

Dual energy x-ray absorptiometry

Question 7

A young female with a history of oligoarticular juvenile idiopathic arthritis (JIA) presents with the following laboratory values: rheumatoid factor (RF) negative, antinuclear antibody (ANA) screen positive, and human leukoctye antigen (HLA) B-27 positive. Which of the following subspecialty referrals is mandatory?

Answer 7

ophtho

Question 8

Which of the following imaging findings is most consistent with congenital cervical stenosis?

Answer 8

Shortened pedicles

Question 9

What percent of rheumatoid arthritis patients are rheumatoid factor positive?

Answer 9

80%

Question 10

In addition to mechanical nerve root compression, which of the following is an alternative explanation for symptomatic spinal stenosis?

Answer 10

venous engorgement

Question 11

Which statement concerning patients with osteoarthritis (OA) is true?

Answer 11

Exercise contributes to OA-related pain reduction.

Question 12

A 27-year-old manual laborer presents with a 6-month history of right shoulder pain. He has a past medical history of a traumatic right shoulder dislocation 3 years ago. On physical exam, he has normal strength and sensation with symmetric reflexes. The shoulder apprehension test is positive. Impingement tests and the O’Brien active compression test are negative. Which diagnosis is most consistent with this presentation?

Answer 12

Anterior-inferior labrum tear

Question 13

A 23-year-old college football player presents to you with a complaint of right knee pain after planting his foot and cutting left in an attempt to avoid a tackle. On exam you note limited weight bearing on ambulation, swelling, decreased range of motion, a positive ballottement test, and a negative Lachman’s test. Which ligament is most likely injured?

Answer 13

ACL

Question 14

Which of the following is commonly associated with sacroiliitis?

Answer 14

inflammatory bowel disease

Question 15

A 40-year-old patient is consulting you for management of her fibromyalgia and has failed to improve in the past with SSRIs, SNRIs, TCAs and Gabapentin. She asks you about other medications that have been developed for treatment of his condition. Which of the following drugs currently has the strongest research backed evidence for treatment of fibromyalgia?

Answer 15

Gabapnetinoids (e.g. Gabapentin), TCAs (e.g. Nortryptiline) and SNRIs (e.g. Duloxetine) also all fall under evidence level 1A.(cannabinoids is answer for this question)

Question 16

Dupuytren contracture is associated with which of the following?

Answer 16

smoking

Question 17

what does Dupuytren contracture cause contracture of

Answer 17

flexion contracture of the MCP and PIP joints.

Question 18

Radiographic evidence of 40% anterolisthesis of L5 on S1 vertebra is consistent with which severity grade in Meyerding’s classification of spondylolisthesis?

Answer 18

grade II

Question 19

An adult patient is referred with a diagnosis of generalized hypermobility syndrome and a Beighton score of 8 points. A true statement about this situation is:

Answer 19

Physical therapy for strength, core stability and endurance training can be helpful.

Question 20

An indicator of a poor outcome for juvenile idiopathic arthritis (JIA) is:

Answer 20

Early radiographic changes

Question 21

What is the most likely cause of knee pain in a 40-year-old female patient reporting spontaneous onset of pain and swelling about the joint three weeks after attending a petting farm with their family?

Answer 21

reactive arthritis

Question 22

The most common organism responsible for septic arthritis in a one-year-old is:

Answer 22

H.flu

Question 23

What percent weight reduction in overweight patients has been shown to result in a moderate to large reduction in self-reported disability related to symptomatic knee arthritis ?

Answer 23

10%

Question 24

Which of the following maneuvers can identify early clinical manifestations of congenital hip dysplasia?

Answer 24

Ortolani test

Question 25

A 20-year-old college recreational athlete presents to your clinic after injuring his right ankle during a flag football game earlier in the day. On exam you note an antalgic gait with significant swelling, bruising, and tenderness to palpation at the anterior aspect of the lateral malleolus. No tenderness along the lateral and posterior aspect of the lateral malleolus, the medial malleolar region, or the foot. Regarding imaging, what should you order?

Answer 25

no imaging at this time

Question 26

An 80-year-old female with osteoporosis and dementia trips and falls onto her hip. The patient was found on the ground with her limb in an externally rotated, abducted, and shortened position. X-rays of the hip most likely shows:

Answer 26

Femoral neck fracture

Question 27

Lumbar spine radiographs demonstrate normal alignment, no fractures, multilevel lumbar disc height loss, and advanced facet hypertrophy. Which of the following terms best summarizes the pathology that presents with these imaging abnormalities?

Answer 27

Spondylosis

Question 28

Iliotibial Band Syndrome (ITBS) is associated with which of the following rotary motions?

Answer 28

Tibial internal rotation

Question 29

The effect of aquatic therapy for patients with osteoporosis is:

Answer 29

Decreased fall risk

Question 30

The American College of Rheumatology's 2010 diagnostic criteria for fibromyalgia includes

Answer 30

Use of a Widespread Pain Index and Symptom Severity Scale to make the diagnosis

Question 31

Which of the following is a poor prognostic indicator for seronegative spondyloarthropathies?

Answer 31

Low response to non-steroidal anti-inflammatory drugs

Question 32

Which is the most common form of juvenile idiopathic arthritis?

Answer 32

oligoarticular

Question 33

Dactylitis is a common finding in which of the following conditions?

Answer 33

psoriatic arthritis

Question 34

The risk of hypertrophic scarring in children after burn injury is increased in a child with:

Answer 34

dark skin, young age, female gender, neck and upper limb burn sites, multiple surgical procedures (including meshed skin graft), as well as deeper wounds and longer healing time (over 3 weeks).

Question 35

what is the initial deformity created in the cervical spine in a whiplash injury?

Answer 35

S-shaped deformation phase in the sagittal plane of the cervical spine, followed by a C-shaped in the sagittal plane phase.

Question 36

Which of the following is optimal initial treatment for congenital hip dysplasia in infants less than 6 months?

Answer 36

pavlick harness

Question 37

What is the minimum recommended rating of pressure garments to reduce hypertrophic scarring in a patient with a burn injury?

Answer 37

25mmHg

Question 38

A 14-year-old quarterback suffers a type V acromioclavicular (AC) joint separation after being sacked. What is the recommended treatment for this athlete?

Answer 38

Referral to orthopaedic surgery for open reduction and internal fixation

Question 39

A 22-year-old female runner presents to your clinic for right hip pain. She has been training hard for an upcoming half marathon. Recent MRI indicates a stress fracture at the superior aspect of the femoral neck. There is no clear cortical break. Based on these findings, what is the best next step in management?

Answer 39

Make her non-weight bearing on crutches and refer her to an orthopedic surgeon

Question 40

how are Stress fractures of the inferior aspect of the femur managed?

Answer 40

non-operatively as this is the side of the femoral neck that is loaded in compression, which is relatively favorable for bone loading (exception: cortical breaks should be referred for evaluation).

Question 41

Which of the following is the most frequent association of nerve injury and fracture?

Answer 41

radial nerve and humeral fracture

Question 42

A 39-year-old male presents to your office after playing basketball with the inability to actively extend the DIP joint of his fourth finger. X-ray was negative for fracture. What would be your next step in the treatment of this patient?

Answer 42

Splint DIP into extension

Question 43

Which of the following is a risk factor for plantar fasciitis?

Answer 43

Factors that increase the tension on the plantar fascia, such as obesity, decreased subtalar motion, pes cavus, pes planus, and a tight Achilles' tendon,

Question 44

Which of the following is true of hypertrophic scars following burns?

Answer 44

It is the most common complication after burn injury

Question 45

In Clay shoveler's fracture, what anatomic region of lower cervical and upper thoracic spine is affected?

Answer 45

spinous process

Question 46

A 40-year-old male presents to your office with reduced grip strength and pain over the ulnar side of his wrist. The patient gives a history of being a professional cyclist with multiple falls in the past. X-rays show sclerosis and fragmentation of the lunate. This patient most likely has which disease?

Answer 46

Kienbock's

Question 47

what is a disease of the elbow seen in children under the age of 10 who are involved in throwing activities and gymnastics. There is lateral elbow pain and the disease is self- limited and thus conservative management is warranted.

Answer 47

Panner's disease

Question 48

Which rheumatic disease has a non-erosive arthritis and may also be caused by certain medications?

Answer 48

SLE

Question 49

A 35-year-old patient presents to your clinic with a 3-month history of groin pain exacerbated by activity. Anteroposterior films of the hip were normal. The magnetic resonance imaging of the hip reported a bony prominence at the femoral head-neck junction. What clinical exam finding is most likely to correlate with these radiographic “abnormalities”?

Answer 49

Pain with hip flexion, internal rotation, and adduction

Question 50

A 27-year-old golfer presents with pain on the volar ulnar aspect of his hand. X-ray shows he has a fracture of the hook of his hamate bone. What is the treatment of choice?

Answer 50

referral to hand surgeon (excision of hook)

Question 51

A patient with lumbar radicular pain with weakness in the gluteus medius muscle and extensor hallucis longus. Which of the following imaging findings would correlate with these findings:

Answer 51

Right paramedian disc herniation at L4-L5

Question 52

Which radiographic findings can be seen in Complex Regional Pain Syndrome?

Answer 52

Juxta-articular osteoporotic changes

Question 53

What percentage of low back pain has a specific identifiable cause?

Answer 53

5-15%

Question 54

A 28-year-old female runner presents to you with increasing right foot pain. She recently read an article about barefoot running and so has transitioned to that over the last month. She runs six days a week, but more recently she has had to stop running due to pain and has pain throughout the day, worsened by any weight bearing. On exam, there is no swelling or redness. She has tenderness directly over the 3rd metatarsal. No tenderness elsewhere within the foot. Normal neurological exam. Pain with attempts to hop. For your initial management, you decide to:

Answer 54

Place her in a walking boot and follow up with her in 3 weeks

Question 55

A 15-year-old high school football player sustains a direct hit to the shoulder. He feels immense shoulder pain and decreased range of motion with associated numbness in his hand. Sideline evaluation confirms a glenohumeral joint dislocation and neurological symptoms resolve after joint reduction. Post-reduction radiographs confirm reduction and reveal a sizeable osseous depression in the posterior-lateral aspect of the humeral head. After providing a sling for comfort, what is the next best step in evaluation?

Answer 55

Referral to orthopaedics for surgical consultation (hills Sachs lesion)

Question 56

In young athletes, the likelihood of a 2nd shoulder dislocation after experiencing a first-time dislocation is:

Answer 56

greater than 60%

Question 57

What is the most common congenital musculoskeletal deformity associated with myelomeningocele?

Answer 57

Equinovarus foot

Question 58

A 65-year-old male presents to clinic with complaints of a chronic stiff neck and dysphagia. He is negative for HLA-B27, rheumatoid factor, and ANA. Which of the following diagnoses best explains the patient's symptoms?

Answer 58

Diffuse idiopathic skeletal hyperostosis

Question 59

A C6/C7 disc herniation into the neural foramen is most likely to produce paresthesias in which of the following areas?

Answer 59

The third digit

Question 60

Along with nonuniform joint space narrowing, which of the following is a characteristic of osteoarthritis ?

Answer 60

bony sclerosis

Question 61

The anterior interosseous nerve innervates which muscle?

Answer 61

Pronator quadratus

Question 62

A factory assembly line worker presents to your office with lateral elbow pain for 3 months. What condition is commonly associated with lateral epicondylitis?

Answer 62

smoking and obesity

Question 63

A 12-year-old baseball player had a twisting valgus deviation of the right knee during play. The MRI showed edema at the inferomedial patella and at the right lateral femoral condyle with ruptured fibers at the medial patellofemoral ligament. What is the most likely diagnosis based on MRI findings?

Answer 63

patellar dislocation

Question 64

How long is an abduction pillow utilized after a posterior approach hip replacement?

Answer 64

6-12 weeks

Question 65

Which stage of complex regional pain syndrome (CRPS 1) is characterized by burning pain, dependent edema, and vasomotor instability?

Answer 65

stage I

Question 66

what stage of CRPS is characterized by severe pain, fixed edema, and cyanosis or pallor.

Answer 66

stage II

Question 67

Which of the following conditions is an absolute contraindication to collision sports?

Answer 67

Odontoid hypoplasia

Question 68

In patients with degenerative disc disease of the lumbar spine, what percentage of weight do the zygapophyseal joints bear?

Answer 68

70%

Question 69

in a normal person, what percentage of weight do the zygapophyseal joints bear?

Answer 69

33%

Question 70

An extraforaminal L4-5 disc protrusion is most likely to affect which nerve root?

Answer 70

L4

Question 71

what are the 4 zones that a disc herniation can occur?

Answer 71

central, subarticular, foraminal, and extraforaminal zones

Question 72

Why do disc herniations in the The extraforaminal zone effect the first nerve (ie: L4 when occurring at L4--L5)

Answer 72

The extraforaminal zone is beyond the parasagittal line of the lateral aspect of the pedicle, and if impacting a nerve root it will be the exiting nerve root at that level.

Question 73

A patient who enjoys playing racquetball presents to your office with a trigger finger. You proceed with a corticosteroid injection. What would be your immediate next step in the treatment of this patient?

Answer 73

modify Raquel handle

Question 74

Which risk factor is most clearly linked with developing subsequent osteoarthritis of the knee?

Answer 74

prior injury

Question 75

When symptomatic Lumbar Spondylolisthesis occurs without a defect in the pars interarticularis, what is the most likely etiologic process?

Answer 75

degenerative

Question 76

A 46-year-old healthy male recreational athlete presents to your clinic with a 3-day-old right Achilles tendon rupture. He asks about his treatment options. What do you tell him?

Answer 76

Re-rupture rates using functional bracing are similar to re-rupture rates after surgery.

Question 77

The American Academy of Orthopedic Surgeons recommends weight loss to patients with symptomatic knee arthritis as a strategy to manage symptoms and improve function when the body mass index is calculated to be greater than or equal to ____ kg/m2:

Answer 77

25

Question 78

Which of the following treatments has the greatest supportive evidence for producing pain relief at a myofascial trigger point?

Answer 78

dry needling

Question 79

What is the normal bladder capacity for a two-year old?

Answer 79

4 (age + 2 ounces)

Question 80

The most common bone for an osteoporotic fracture in women over age 65 is the:

Answer 80

vertebrae

Question 81

A patient with shoulder pain is asked by a clinician to flex the elbow to 90 degrees, pronate the forearm, and keep the arm by their side. The patient is then asked to externally rotate the shoulder and supinate the forearm against the clinician's resistance. If the patient experiences reproduction of their shoulder pain, the most likely diagnosis is:

Answer 81

biceps tendonitis (this is Yergesons test)

Question 82

A patient presents with pain in his ring finger after an opponent tried to slap a basketball out of his hand. On exam flexion and extension of his DIP is intact. X-ray of his finger shows a non-displaced distal phalangeal fracture. What is the next step in his treatment?

Answer 82

splint and immobilize DIP only (allow early motion of uninjured joints)

Question 83

Which of the following is the most common presenting symptom in patients with acquired cervical stenosis?

Answer 83

neck pain

Question 84

Which of the following medications has been shown to decrease mortality and length of stay in patients with hypermetabolism associated with burns?

Answer 84

Oxandrolone (synthetic anabolic steroid)

Question 85

A 12-year-old obese child presents with limp and decreased weight-bearing in the right lower extremity. Hip x-rays reveal abnormal positioning of the femoral head relative to the femoral neck. The most likely diagnosis is:

Answer 85

Slipped capital femoral epiphysis

Question 86

A 19-year-old long-distance runner presents with an insidious onset of left hip pain one month after increasing her mileage from 25 to 50 miles weekly. After obtaining a thorough history and performing a physical examination, you obtain an anteroposterior radiograph of the pelvis to evaluate the hip. The film is unremarkable. What is the next most appropriate step?

Answer 86

Make her non-weight bearing with crutches and order a magnetic resonance image of the hip (concern for femoral neck stress fracture (bone stress injury))

Question 87

A football player presents to your office with pain in his ring finger after trying to tackle his opponent. On exam you notice that he is unable to flex his DIP actively while holding the PIP in extension. The most likely diagnosis is:

Answer 87

jersey finger

Question 88

A 55-year-old patient started yoga 2 months ago and is seeing you for right shoulder pain of 1-month duration. He is unable to lift the dorsum of his hand off his back with his arm fully extended and internally rotated. Based on this test, you suspect he may have a rotator cuff tear involving which of the following muscles:

Answer 88

subscapularis

Question 89

Seat belt use during motor vehicle collisions has not reduced incidence of spinal injuries associated with:

Answer 89

Thoracic and lumbar spine fractures

Question 90

A 55-year-old woman has undergone a right total hip replacement surgery. The physical exam notes the left hip now drops during right stance phase of the gait cycle. Where is the muscle weakness?

Answer 90

right glut med

Question 91

A patient presents with symmetric inflammation of bilateral knee joints. Fluid aspirate microscopy reveals positive birefringent crystals. Which of the following conditions are associated with this synovitis ?

Answer 91

hyperparathyroidism, hypothyroidism, hypomagnesemia, hypophosphatemia, hemochromatosis, and amyloidosis.

Question 92

Which of the following is a risk factor for congenital hip dysplasia (CHD)?

Answer 92

Breech positioning, female gender, and first born are known risk factors for CHD.

Question 93

What percentage of fractures in people older than 45 are related to osteoporosis?

Answer 93

70%

Question 94

What should the serum uric acid level (mg/dl) be lowered to in patients with joint pain symptoms related to gout ?

Answer 94

6

Question 95

22-year-old patient fell on an outstretched right hand 3 weeks ago and complains of continued wrist pain. On examination, she has minimal swelling of the distal limb and is tender to palpation distal to the ulnar styloid between the flexor carpi ulnaris and extensor carpi ulnaris tendons. A plain radiograph was normal except for an ulnar plus variant. She failed conservative treatment with splinting and activity modification. The most appropriate imaging study to obtain would be:

Answer 95

MRI (sustained an injury to her triangular fibrocartilage complex (TFCC)

Question 96

Which stage of Complex Regional Pain Syndrome may be the least painful but the most dysfunctional in terms of progressive vasomotor, motor and trophic changes?

Answer 96

stage 3

Question 97

Which of the following is NOT a risk factor for the development of osteoporosis?

Answer 97

BMI >35

Question 98

A 4-year-old child suffers an ankle inversion. When you examine him the following day, he has mild swelling laterally and is tender to palpation approximately 2-3 cm proximal to the distal aspect of the lateral malleolus and he reacts to pinch. The remainder of the examination is limited due to pain. Radiographs appear normal. What is the management of this patient?

Answer 98

Short leg non-weight bearing cast for 3 weeks (concern for Salter Harris I Fracture of the distal fibular physis)

Question 99

What is a salter Harris fracture I

Answer 99

transverse fracture through the hypertrophic zone of the physis. typically not seen on plain radiograph

Question 100

Which finding would suggest a diagnosis of tendinosis rather than tendonitis?

Answer 100

Histological absence of inflammatory cells

Question 101

A 25-year-old male basketball player presents with right knee pain. On examination, the Lachman test is positive, and you suspect an anterior cruciate ligament tear. What other provocative maneuver supports your diagnosis?

Answer 101

Pivot-shift test, anterior drawer test

Question 102

A football player complains of left neck pain and left shoulder burning and tingling after making a tackle. Sideline examination reveals decreased sensation over the lateral deltoid and weakness with abduction and elbow flexion. Spurling's maneuver is negative. After 15 minutes the symptoms abate. Of note, the player had one previous episode with similar symptoms 2 weeks prior. The next best step in management of this player is:

Answer 102

Obtain imaging work-up prior to return to play

Question 103

Patient is involved in a motor vehicle collision. CT scan shows a fracture at the base of the odontoid process. What is the classification or name of this odontoid fracture?

Answer 103

type 2