Musculosckeletal

Question 0

Presentation of hip fracture

Answer 0

Shortened and externally rotated leg

also seen with femoral fracture

Question 1

Treatment of Hip fracture

Answer 1

Open reduction and internal fixation with parallel pinning of the femoral neck

Question 2

how do fat emboli present and what causes them

Answer 2

Caused by femoral fracture

presentation: fever, AMS, dyspnea, hypoxia, PETECHIA, THROMBOCYTOPENIA

Question 3

Presentation of anterior and posterior shoulder dislocation

Answer 3

anterior dislocation= Axillary artery and nerve: ABduction and external rotation of arm

posterior dislocation= Radial artery and nerve: ADDuction and internal rotaion

Question 4

colle’s fracture

Answer 4

Fall on an outstretched hand.
involves the distal radius
Tx: closed reduction + long arm cast

Question 5

Scaphoid fracture

Answer 5

tenderness in the anatomical snuff box

Tx: thumb spica cast/ open reduction

Question 6

Boxers fracture

Answer 6

fifth metacarpal neck injury

closed reduction + ulnar gutter splint

Question 7

humerus fracture

Answer 7

radian nerve injury: wrist drop and loss of thumb abduction

Question 8

achilles tendon rupture presentation and physical exam

Answer 8

sudden “pop” like a rifle shot

exam shows: limited plantar flexion

Question 9

treatment of Achilles tendon rupture

Answer 9

treat surgically followed by long leg cast for six weeks

Question 10

femoral fracture: treament

Answer 10

primary arthroplasty (due to increased risk of AVN)
open reduction and internal fixation

Question 11

bursitis: presentation and treatment

Answer 11

presents with localized tenderness, decreased ROM, edema and erythema

Tx: rest, heat and ice, NSAIDs and steroid injections

Question 12

tendinitis presentation

Answer 12

presents with swelling and impaired function, pain and the site of insertion.

worse with repetitive stress and resisted strength testing of the affected muscle group.

Question 13

tendinitis: most common location

Answer 13

supraspinatus, Biceps, wrist extensors, patella, achilles tendons

Question 14

tendinitis: treatment

Answer 14

rest, NSAIDs, ice

splinting or immobilization

if no improvement: steroid/lidocaine injections

Question 15

Antibiotics that cause tendinitis and tendon rupture

Answer 15

Fluoroquinolones

Question 16

herniated disk diagnosis

Answer 16

positive straight leg test

MRI used for confirmation

Question 17

spinal stenosis presentation

Answer 17

neck and back pain that radiates to the buttocks and legs
+ leg numbness and weakness
worse with sitting, standing and walking uphill

Question 18

spinal stenosis: diagnosis

Answer 18

MRI/ CT of spinal cord

Question 19

spinal stenosis treatment

Answer 19

NSAIDs and abdominal muscle strengthening
Epidural corticosteroid injections
surgical laminectomy

Question 20

most common site of osteosarcoma

Answer 20

distal femur and proximal tibia

Question 21

osteosarcoma is a risk factor for what disease?

Answer 21

Paget’s Disease

Question 22

diagnosis of osteosarcoma

Answer 22

Codman’s triangle

sunburst pattern

Question 23

what is the most common benign bone tumor?

Answer 23

osteochondroma

Question 24

radiographic findings in OA

Answer 24

joint space narrowing osteophytes subchondral sclerosis subchondeal bone cyst

Question 25

duchenne muscular dystrophy: diadnosis

Answer 25

negative dystrophin immunostain and increased CK level EMG: polyphasic potentials most accurate: muscle biopsy (necrotic muscle fibers)

Question 26

duchenne muscular dystrophy: treatment

Answer 26

PT | Tendon release surgery

Question 27

complications of duchenne muscular dystrophy

Answer 27

Pulmonary congestion high output cardiac failure cardiac fibrosis = arrhythmias

Question 28

nursmaids elbow presentation

Answer 28

pain with flexion | radial head subluxation

Question 29

nursemaid's elbow treatment

Answer 29

Manual reduction by supination of the elbow at 90 deg of flexion

Question 30

supracondylar humerus fracture: treatment

Answer 30

cast immobilization and closed reduction

Question 31

Diagnosis of developmental dysplasia of the hip

Answer 31

mostly through PE Ultrasound may be helpful

Question 32

developmental dysplasia of the hip: treament

Answer 32

<6months: splint with a pelvic harness (maintain hip flexed and abducted) 6-15months: Spica cast 15-24months: open reduction followed by spica cast

Question 33

complications of developmental dysplasia of the hip

Answer 33

joint contractures and AVN of the femoral head

Question 34

what is Legg-calve-Perthes Disease

Answer 34

AVN of the femoral head

Question 35

H/P of legg-calve-perthes disease

Answer 35

- painless limp - if pain in present: usually in the grin and anterior thigh - limited abduction and internal rotation

Question 36

treatment of leg-calve-perthes disease

Answer 36

usually self limited (observation) | racing if there is decreased ROM

Question 37

differential diagnosis of pediatric limp (STARTSS HOTT)

Answer 37

``` septic joint tumor Legg-calve-perthes RA/JRA tuberculsis sicke cell disease slipped capital femoral epiphysis Henoch-Schonlein purpura osteomyelitis trauma toxic synovitis ```

Question 38

what is slipped capital femoral epiphysis (SCFE)?

Answer 38

medial and posterior displacement of the femoral head due to imbalance between GH and sex hormones

Question 39

risk factors for SCFE

Answer 39

obesity age 11-13 male ender African american

Question 40

what disorder is SCFE associated with?

Answer 40

Hypothyroidism

Question 41

H/P: SCFE

Answer 41

- acute thigh and knee pain and PAINFUL limp - restricted ROm and inability to bear weight - BILATERAL in 40-50% - limited internal rotation and abduction of the hip

Question 42

diagnosis of SCFE

Answer 42

Radiographs: posterior and medial displacement of the femoral head NEED TO R/O HYPOTHYROIDISM WITH TSH

Question 43

SCFE: treatment

Answer 43

no weight bearing closed reduction

Question 44

scoliosis: treatment

Answer 44

curvature: | 50 degees: surgical correction

Question 45

complication of scoliosis

Answer 45

restrictive lung disease

Question 46

risk factors for baker's cyst

Answer 46

osteoarthritis and RA

Question 47

presentation of Baker's cyst

Answer 47

swollen calf | palpated cyst behind the knee

Question 48

Baker's cyst treatment

Answer 48

NSAIDs and steroid injections

Question 49

4 muscles involved in rotator cuff injury

Answer 49

Suprapinatus (highest risk of being injured) infraspinatus- injury causes loss of external rotation teres minor- injury causes loss of external rotation subscapularis

Question 50

presentation of rotator cuff injury

Answer 50

difficulty abducting arm between 60-120 degrees positive drop test