Musculoskeletal

Question 1

Injury to shoulder, holds arm in abducted, ext rotated: dx, tx, nerve injry

Answer 1

anterior dislocation, risk axillary nerve injury, reduction with sling

Question 2

Post vs ant hip dislocation: nerve injury, tx

Answer 2

Ant: obturator
Post: sciatic nerve, AVN
Tx: closed reduction + abduction pillow
CT after reduction

Question 3

Fall on outstretched hand leads to dorsally placed, dorsally angled fracture: dx, tx

Answer 3

Dx: colles fracture (distal radius
Tx: closed reduction + long arm cast (open if intra-articular fx)

Question 4

Tenderness in anatomical snuff box: dx and tx

Answer 4

Scaphoid fracture

thumb spica cast; if displacement open reduction

Question 5

Injury assoc with humerus fx

Answer 5

radial nerve palsy: wrist drop, loss of thumb extension

Question 6

Tx of ulnar fx

Answer 6

ORIF if significantly displaced

Question 7

Diaphyseal fx of proximal ulna with subluxation ulnar head: type and tx

Answer 7

monteggia’s fx

ORIF of shaft, closed reduction radial head

Question 8

Galeazzi fx: diaphyseal fx of radius with dislocation distal radial-ulnar joint: cause and tx

Answer 8

direct blow to radius

ORIF of radius, casting with supination

Question 9

Tx + complication of femoral fx

Answer 9

Fat emboli

intramedullary nailing, irrigate and debride if open

Question 10

Common complication of tibila fx

Answer 10

compartment syndrome

Question 11

limited plantar flexion and + Thompson test (pressure on gastrocnem absent foot plantar flexion): dx and tx

Answer 11

achilles tendon rupture

surgical + long leg cast for 6 weeks

Question 12

herniate disc: common affected regions, tx

Answer 12

L5-S1

NSAID, PT, local heat, continue normal activity

Question 13

neck pain, back pains that radiates to buttocks and legs, leg numbness/ weakness; leg cramping worsens with standing, improves with felxion at hips/ bending forward: dx and tx

Answer 13

spinal stenosis
NSAIDS/abd muscle strength
epidural corticosteroids (severe)
Laminectomy (refract)

Question 14

“onion-skin” on diaphyseal region of femur

Answer 14

ewing sarcoma

Question 15

soap bubble, on epiphyseal region long bones

Answer 15

giant cell tumor

Question 16

progressive pain, worsen at night, sumburst pattern on xr: dx and common regions

Answer 16

osteosarcoma

distal femur, proximal tibia, proximal humerus

Question 17

Empiric tx of septic arthritis

Answer 17

cetriaxone and vancomycin

Question 18

anti-CCP antibodies

Answer 18

Rheumatoid arthritis

Question 19

Joints affected: OA vs RA

Answer 19

OA: DIP (heberden) /PIP (Bouchard) / hips/ knees
RA: wrist, MCP, ankle, knee, shoulder, hip, elbo

Question 20

Rhomboid vs needle shaped crystals: joint pain

Answer 20

Rhomboid: psudogout, + birefring (calcium pyrophosphate)
Needle: gout, neg biref

Question 21

Acute and long term tx of gout

Answer 21

acute: NSAID > cochicine; steroids
Maintenance: allopurinol (overproducers); probenicid (undersecretors); weight loss + avoid ETOH

Question 22

Back pain with Decr spine flexion, loss lumbar lordosis, worse with morning: dx and other risks

Answer 22

Ankylosing spondylitis; HLA B27

anterior uveitis and heart block

Question 23

arthritis, uveitis, conjunctivits, urethritis in young man: dx and cause

Answer 23

reactive/ reiter arthritis

infx with campy, shigella, slamonella, chlamydia, ureaplasma

Question 24

sausage-shaped digits, DIP joint: dx

Answer 24

psoriatic arthritis

Question 25

asymmetric sacroilitis: dx and common assoc disease

Answer 25

enteropathic spondylitis, IBD

Question 26

Symmetric proximal muscle weakness, heliotrope rash: dx and tx

Answer 26

polymyoisits/ dermatomyositis high dose corticosteroids 4-6 wks azathioprine/ MTX

Question 27

Anticentromere Ab

Answer 27

CREST syndrome

Question 28

Antihistone Ab

Answer 28

Drug-induced SLE

Question 29

Antimitochondrial Ab

Answer 29

PBC

Question 30

Anti-smooth muscle B

Answer 30

Autoimmune hepatitis

Question 31

cANCA vs pANCA

Answer 31

cANCA: Wegener pANCA: microscopic polyangitis

Question 32

U1RNP ab

Answer 32

mixed connective tissue disease

Question 33

RA, splenomegaly, neutropenia

Answer 33

Felty's syndrome

Question 34

RA tx

Answer 34

``` NSAIDs Disease modifying (1st line): MTX, hydroxychloroquine, sulfasalzine ```

Question 35

symmetric thickening of skin of face or distal extr, pulm fibrosis: dx and tx

Answer 35

``` scleroderma Corticosteroids (acute) Penicillamine (skin) Ca Ch block (Raynaud's) ACEI (renal) ```

Question 36

noninfectious vegetations on mitral valve: dx and assoc dis

Answer 36

Libman-sacks endocarditis; SLE and APLAS

Question 37

pain accompanied by loss of function and autonomic dysfunction after trauma: dx and tx

Answer 37

Complex regional pain syndrome NSAIDS, corticosteroids, low-dose TCAs, gabapent Chemical sympathetic block

Question 38

Fibromylagia vs polymyalgia rheumatica: joints involved and tx

Answer 38

Fibromylagia: various joints (>11 of 18, all 4 regions body); NSAIDs, Antidepr, rest, PT Polymyalgia rheumatica: shoulder + pelvic girdle; low-dose prednisone

Question 39

Muscle Bx: necrotic muscle fibers, variation in fiber size with fibrosis: Dx and tx

Answer 39

Neg dystrophin Duchenne PT, use of tendon release to maintain mobility

Question 40

Cause of death: DMD

Answer 40

pulm congestion caused by high output cardiac failure

Question 41

Refusal to bend elbow after being lifted by arm: dx and tx

Answer 41

``` nursemaid elbow (radial head subluxation) manual reduction by gentle supination of elbow at 90deg fexion; no immobilization ```

Question 42

Supracondylar humerus fx: risk + tx

Answer 42

brachial artery entrapment, Volkmann contracture (compartment syndr) cast immobilization

Question 43

hip dysplasia: tx by age

Question 44

Limited abduction and internal rotation, painless limp or groin pain: dx and tx

Answer 44

legg-calve-perthes AVN femoral head observation if nl ROM. pracing

Question 45

pediatric acute groin or knee pain, painful , inability to bare weight, limited internal rotation and abduction: dx and tx

Answer 45

AP and frog leg laterals, TSH Slipped capital femoral epiphysis percutaneous single-screw fixaiton, no weight bearing until surgery

Question 46

Arthritis, high-spiking fevers, maculopapular, evanescent salmon-colored rash (pediatric)

Answer 46

Still's disease