ortho

Question 1

is RA or OA pain worse in the morning?

Answer 1

RA

Question 2

joints in the hand affected by OA

Answer 2

DIP (Heberden) and PIP (Bouchard)

Question 3

the MCP joints of the hand are usually spared, except one…

Answer 3

the thumb

Question 4

mild and non inflammatory OA, first line therapy?

Answer 4

Acetaminophen, if it fails move to NSAIDS

Question 5

what joint is usually spared in RA?

Answer 5

DIP

Question 6

name two labs that are not specific but usually positive in RA?

Answer 6

Rheumatoid factor (RF) and anti-CCP antibodies
CPR and ESR will most likely be elevated

Question 7

what is seen on X-ray of RA joints

Answer 7

juxta-articular demineralization

Question 8

two classes of medical treatment for RA?

Answer 8

NSAIDS and DMARDs (methotrexate, steroids, antimalarials, etanercept, rituximab, infliximab

Question 9

Explain a Lisfranc fx

Answer 9

Junction of the 2nd metatarsal and cuneiforms leading to unstable arch of foot

Question 10

Dancers Fx

Answer 10

allusion of 5th MT

Question 11

do heel spurs develop b/c of Plantar Fascitis

Answer 11

no-separate process

Question 12

what type of injuries cause achielle’s ruptures?

Answer 12

jumping/explosion, fluoroquinalone and steroids

Question 13

how remember tennis elbow

Answer 13

Lively Exciting Tennis= Lateral epicondylitis w/ extensors

Question 14

how to remember gofers elbow

Answer 14

Mundane Foul Golf=Medial epicondylitis w/flexors

Question 15

what would you see on X-ray of a supracondylar humerus fracture.

Answer 15

The most common elbow fracture in pediatric trauma is supracondylar humerus fracture. Occult supracondylar fracture may present with a posterior fat pad and/or positive sail sign (distended anterior fat pad) on the lateral x-ray study of the elbow

Question 16

A 45 year old carpenter presents to your clinic complaining of right shoulder pain that is worse in the evenings. On physical exam he has pain on range of motion, a positive Neer’s and Hawkins tests, but strength appears to be normal bilaterally. What is the initial diagnostic test that should be ordered in this patient?

Answer 16

x-ray for suspected subacromial impingement, then move on to MRI

Question 17

A 23 year old male was admitted to the hospital following a motor vehicle accident. He sustained a crush injury to his left leg and was kept as a precaution since otherwise he seemed to be stable. You are rounding on him on day three, and he is complaining of severe pain in his left leg. Which of the following findings would suggest the absence of compartment syndrome in this patient?

Answer 17

Compartment syndrome is often described using the ‘5 P’s’: pulselessness, paralysis, paresthesias, poikilothermia, and pallor - and one could add pain out of proportion to visible injury. A finding of intact pulses decreases one’s suspicion for compartment syndrome.

Question 18

A patient who has recently begun treatment for systemic lupus erythematosus with hydroxychloroquine, what is the most likely side effect?

Answer 18

Night vision, macular degeneration

Question 19

What is the most common side effect associated with Colchicine?

Answer 19

GI side effects

Question 20

Jefferson’s fracture involves which of the following bones?

Answer 20

Jefferson’s fracture is a fracture of C1

Question 21

Which of the following is the most common side effect of methotrexate?

Answer 21

Stomatitis

Question 22

What anatomic abnormality may predispose a person to develop impingement syndrome or rotator cuff tendonitis?

Answer 22

type 2 or type 3 acromion processes however, the underside of the acromion is not flat, but curved or hooked respectively and thus may predispose a patient to those conditions.

Question 23

Joint fluid analysis revealing negatively birefringent crystals, is a finding of?

Answer 23

Gout

Question 24

joint abnormality that follows an viral upper respiratory infection?

Answer 24

Transient synovitis

Question 25

name the fracture of the distal radius with dislocation of distal radioulnar joint and an intact ulna.

Answer 25

Galeazzi fracture-dislocation

Question 26

Which of the following is the most common site affected by osteoarthritis?

Answer 26

the knee

Question 27

This joint fluid analysis is most consistent with RA.

Answer 27

Turbid yellow fluid with low viscosity WBC 2500 52% Neutrophils Crystals - absent Glucose low Culture - negative

Question 28

Sensation in which of the following places would indicate that sensory function is intact for median, radial, and ulnar nerve distributions?

Answer 28

First dorsal web space, the thenar eminence, and the 5th digit

Question 29

The radiographic finding of a ‘Collar on the Scottie Dog’ on oblique view of a lumbar spine xray indicates which condition?

Answer 29

Spondylolysis reveals the ‘Scottie dog’ sign (representing pars interarticularis defect) on oblique views of the spine.

Question 30

A 14 year old boy presents to your clinic complaining of ‘bumps’ on his legs. Physical exam reveals non-tender bony protuberances on the distal femur and proximal tibia. Which of the following is the most likely diagnosis?

Answer 30

. | Osteochondroma

Question 31

Which blood pressure medications can increase gout attacks

Answer 31

HTCZ ends to increase serum uric acid levels, and may therefore precipitate a gouty

Question 32

Microfractures along the tibia due to repetitive stressors

Answer 32

shin splints

Question 33

what is the most specific test used for diagnosing Sj green’s syndrome.

Answer 33

Anti-La is the most specific test used for diagnosing Sj gren’s syndrome.

Question 34

In a patient with a separated acromioclavicular joint, which of the following treatment modalities is most important for restoring normal functioning?

Answer 34

Gentle range of motion exercises

Question 35

What degree of rotational deformity is acceptable (meaning not requiring surgical correction) in a fracture of the fifth metacarpal?

Answer 35

none. ps this is a boxer's fracture

Question 36

Which nerve root is likely to have been damaged if on physical exam you observe an inability to maintain plantar flexion of the foot, and an asymmetric ankle jerk reflex?

Answer 36

S1

Question 37

What is the hallmark sign or symptom of herniated disc disease?

Answer 37

Lumbosacral radiculopathy

Question 38

Which is the most common bone cancer?

Answer 38

Metastasize to bone from distant cancer

Question 39

A tibial plateau fracture needs surgical repair in the vast majority of patients

Answer 39

TRUE

Question 40

Which of the following is the most commonly affected site by osteomyelitis?

Answer 40

hip

Question 41

Which of the following physical exam tests, if positive, is most suggestive of inferior instability of the glenohumeral joint?

Answer 41

The sulcus sign is performed by applying inferior traction to the arm and observing the shoulder for the formation of a sulcus at the lateral edge of the acromion process. This test is indicative of inferior instability.

Question 42

Duchenne’s muscular dystrophy

Answer 42

exam shows hip girdle weakness, enlargement of the distal muscles of the leg, and atrophy of the proximal thigh muscles. Lab studies reveal an elevated serum creatinine kinase.