MSK/rheumatology

Question 1

Shoulder pain after repetitive activity, point tenderness at anterior humerus or AC joint. + drop arm test or apprehension test

Answer 1

Rotator cuff injury (SITS muscles)

Question 2

FOOSH, radial fracture w/ dorsal displacement, dinner-fork deformity

Answer 2

Colle’s Fx; Tx = volar splint

Question 3

Typing, secretary wrist pain and numb/tingling from wrist to hand. New mothers, pregnant may worsen

Answer 3

Carpal tunnel syndrome

Question 4

Pain at base of thumb, distal radial styloid. Pain reproduced with ulnar deviation of clenched fist.

Answer 4

deQuervain’s tenosynovitis

Question 5

Hand injury after a punch

Answer 5

Boxer’s fracture. Ulnar gutter w/ intrinsic plus positioning. ORIF if angulation > 40 degrees

Question 6

Posterior hip dislocation

Answer 6

Limb will be:
shortened
internally rotated
adducted

Question 7

Female exam, asymmetric posterior chest wall or uneven scapula height with forward bending

Answer 7

Scoliosis (>25 degree Cobb angle = surgery)

Question 8

Hip fracture

Answer 8

Limb will be:
-externally rotated
-shortened

Question 9

Knee injury during football game

Answer 9

ACL (look for description of lachman or drawer test)

Question 10

8-10 year old male with limp, knee pain

Answer 10

Legg-Calve-Perthes disease

Question 11

12-15yo overweight male knee pain, limp, hip pain (knee XR normal)

Answer 11

SCFE

Question 12

Adolescent male with knee pain, tenderness over tibial tuberosity

Answer 12

Osgood-Schlatter disease

Question 13

Retropatellar knee pain esp. in females

Answer 13

Patellofemoral pain syndrome - increased Q angle, strengthen quadriceps

Question 14

Pain on plantar foot @ 2-3rd metatarsal. Associated w/ tight shoes, relieved by removing shoes. Palpable painful mass

Answer 14

Morton’s neuroma; Tx with NSAIDs, wide shoes, then steroid injections

Question 15

Pain after tx of fracture w/ cast

Answer 15

Compartment syndrome

Question 16

HLA-B27

Answer 16

Ankylosing spondylitis, Reiter’s syndrome

Question 17

Acute joint pain. Swollen, warm, erythema

Answer 17

Septic arthritis (synovial fluid = leukocytosis, low glucose)

Question 18

Large joint pain. Knees w/ medial joint space narrowing, osteophytes. No erythema or warmth.

Answer 18

Osteoarthritis. Acetaminophen #1 choice

Question 19

Enlarged PID, DIP

Answer 19

Osteoarthritis (herberden - DIP; bouchard - PIP)

Question 20

Female morning joint pain and stiffness esp. hand/wrists. MCP joint swelling, ulnar deviation

Answer 20

Rheumatoid arthritis. Methotrexate (DMARDs) #1

Question 21

Proximal symmetric muscle pain and stiffness esp. shoulder, neck, pelvic girdle

Answer 21

Polymyalgia rheumatica

Question 22

Male w/ low back pain, stiffness. Pain worse wakening, improve during the day. Decreased ROM at spine. Plain films show sacroiliac abnormality. HLA-B27 positive.

Answer 22

Ankylosing spondylitis; Tx = NSAIDs (Indomethacin)

Question 23

Conjunctivitis, iritis, arthritis, cervicitis, urethritis

Answer 23

Reiter’s syndrome

Question 24

Female with arthralgias, malar rash, +ANA, +anti-double stranded DNA antibodies, +antiphospholipid antibodies

Answer 24

SLE

Question 25

Female, fatigue, general aching, pain at neck, upper shoulders, sleeping problems, tender points

Answer 25

Fibromyalgia (exercise program good management)

Question 26

Cold induced pain at extremities with color change as they warm up

Answer 26

Raynaud's phenomenon

Question 27

Osteomyelitis after stepping on nail wearing sandals or tennis shoes

Answer 27

Pseudomonas aeruginosa (foam padding in shoes)

Question 28

Teenage female with long bone pain without trauma or injury. XR w/ lytic mass, multi-laminated periosteal reaction

Answer 28

Ewing Sarcoma - periosteal "onion skin" reaction

Question 29

Lytic lesions in the back or skull

Answer 29

Multiple myeloma

Question 30

Parts of the rotator cuff

Answer 30

SITS (supraspinatus, infraspinatus, teres minor, subscapularis)

Question 31

Common dislocation directions elbow shoulder Hip

Answer 31

Posterior - FOOSH Anterior Posterior - MVA

Question 32

Nursemaid's elbow

Answer 32

Annular ligament - subluxation of radial head

Question 33

Unable to extend at DIP

Answer 33

Mallet finger

Question 34

Progressive fibroproliferative dz of palmar fascia. Most commonly ring finger

Answer 34

Dupuytren's contracture

Question 35

Pediatric growth plate classification system

Answer 35

Salter Harris "SAL" I=S - separation of growth plate (GP) II=A - above GP III=L - below GP IV= through both V= crush

Question 36

Splint for non-displaced scaphoid fx

Answer 36

Thumb spica spint

Question 37

McMurray test

Answer 37

Meniscal tear

Question 38

Thompson test

Answer 38

Achilles tendon integrity

Question 39

Footdrop

Answer 39

Deep peroneal nerve

Question 40

5 Ps of compartment syndrome

Answer 40

Pain, pallor, pulselessness, paralysis, paresthesia