Step 2 MSK

Question 1

Back pain exacerbated by standing and walking and relieved with sitting and hyperflexion of hips

Answer 1

Spinal stenosis

Question 2

Joints in the hand affected by RA

Answer 2

MCP and PIPs

Question 3

Joint pain and stiffness that worsens over course of day and is relieved by rest

Answer 3

OA

Question 4

Genetic disorder characterized by multiple fractures & blue sclera

Answer 4

OI

Question 5

Hip & back pain + stiffness that improves w activity and worsens w rest. Diagnostic test?

Answer 5

Ankylosing spondylitis. check HLA-B27

Question 6

Arthritis, conjunctivits, and urethritis in young men. Assc’d bugs?

Answer 6

Reactive arthridis. Most commonly assc’d w Chlamydia, Campylobacter, Shigella, Salmonella, and Ureaplasma

Question 7

55 yo w sudden, excruciating first MTP joint pain after a night of drinking wine. Dx, w/up and acute/chronic tx?

Answer 7

Gout. Needle-shaped negatively birefringent crystals are seen on joint fluid aspirate. Acute tx: NSAIDS #1, colchicine or steroids. Chronic treatment w allopurinol or prebenecid.

Question 8

Elder w stiff shoulders and hips a dn pain. Cannot lift her arms above her head. Labs show anemia and elevated ESR.

Answer 8

Polymyalgia rheumatica

Question 9

Bone fractured due to fall on outstreched hand. What bone?

Answer 9

Distal radius/Colles fx.

Question 10

Complication of scaphoid fx

Answer 10

AVN

Question 11

Signs suggesting radial nerve dmg w humerus fx

Answer 11

Wrist drop. Loss of thumb ABduction.

Question 12

Most common primary malignant tumor or bone?

Answer 12

Multiple myeloma

Question 13

HA, soreness in jaw, pain on scalp, transient monocular blindness?

Answer 13

Giant cell arteritis

Question 14

Anterior shoulder dislocation. Presentation and treatment?

Answer 14

Most common type of shoulder dislocation. Patients hold arm in slight abduction and external rotation. Risk of axillary nerve injury. Tx: reduction followed by sling and swath. Recurrent dislocations may need surg.

Question 15

Posterior shoulder dislocation. Presentation and treatment?

Answer 15

Rare. Assc’d w seizure and electrocution. Patients hold arm in adduction and internal rotation. Tx: reduction followed by sling and swath.

Question 16

Humerus fx. Presentation and treatment?

Answer 16

Direct trauma. Risk of radial nerve palsy which may lead to wrist drop and loss of thumb extension/abduction. Tx: hanging-arm cast vs. coaptation splint and sling. Functional bracing.

Question 17

“Nightstick fracture” / Ulnar fracture. Presentation and treatment?

Answer 17

P: Direct trauma often self defense. T: ORIF if significantly displaced

Question 18

Monteggia fracture. Presentation and treatment?

Answer 18

Diaphyseal fracture of proximal ulna with subluxation of the radial head. Results from fall on pronated and outstretched arm. T: ORIF of the shaft and closed reduction of the radial head

Question 19

Galeazzi fracture. Presentation and treatment?

Answer 19

Diaphyseal fx of the radius with dislocation of the distal radioulnar joint. Results from direct blow to radius. T: ORIF of the radius and casting of the fractured forearm in supination to reduce the distal radioulnar joint

Question 20

Colles fracture involves distal ??? Presentation and treatment?

Answer 20

Distal radius. Dorsally displaced, dorsally angulated fracture. Commonly seen in kids and old folx. Tx: Closed reduction followed by long arm cast. ORIF if intra-articular fx.

Question 21

Most commonly fractured carpal bone?

Answer 21

Scaphoid. Results from fall on outstretched hand . May take 2 weeks for XR to show FX. Assume fx if tenderness in anatomic snuffbox w axial loading. Tx: Thumb spica cast. If displacement or scaphoid nonunion is present, treat with open reduction. With proximal-third fx, AVN is a risk.

Question 22

Boxers Fx? Presentation and treatment?

Answer 22

Fx of fifth metacarpal neck. Closed reduction and ulnar gutter splint. Percutaenous pins if fx is excessively angulated

Question 23

What is the unhappy triad knee injury?

Answer 23

MCL, ACL, and medial meniscus.

Question 24

Median nerve injury results from what classic sign? what can the patient not do?

Answer 24

Median nerve injury leads to “benediction sign” where patient cannot close the first-third digits.

Question 25

Ulnar nerve injury causes inability to do what with fingers?

Answer 25

Ulnar nerve injury prevents patient from opening the 4th and 5th digits "claw hand"

Question 26

RED flags for LBP

Answer 26

age >50, >=6 weeks of pain, previous cancer history, severe pain, consititutional sx, neurologic deficits, loss of anal sphincter tone.

Question 27

L4 nerve root motor sensory and reflex innervation

Answer 27

Motor: foot dorsiflexion reflex: patellar sensory: : medial aspect of lower leg

Question 28

L5 nerve root motor sensory and reflex innervation

Answer 28

Motor: big toe dorsiflexion (extensor hallucis longus), foot eversion (peroneus muscles) Reflex: nonte Sensory: dorsum of foot and lateral aspect of lower leg

Question 29

S1 nerve root motor sensory and reflex innervation

Answer 29

Motor: plantar flexion (gastrocnemus and soleus), hip extension (gluteus max) Reflex: achilles Sensory: plantar and lateral aspects of the foot

Question 30

Joint aspirate with WBC 500: inflammatory or noninflammatory?

Answer 30

inflammatory starts @ WBC of 1000.

Question 31

30 yo woman w knee pain and mass, with "soap bubble" appearance along eipphyseal/metaphyseal region of long bone. Dx?

Answer 31

giant cell tumor

Question 32

labs for RA?

Answer 32

RF & anti-CCP

Question 33

Causes of hyperuricemia?

Answer 33

``` Increased cell turnover (as in hemolysis, blast crisis, tumor lysis, myelodysplasia, psoriais) cyclosporine dehydration DI increased meat and alchol Diuretics lead poisoning lesch-Nyhan Salicyalates starvation ```

Question 34

Gout: acute tx and chronic maintenance?

Answer 34

Acute: high-dose NSAIDS (indomethacin) Colchicine (which inhibits neutrophil chemcotaxis and is most effective when used early in flare, can also cause diarrhea and neutropenia) Cx:Allopurinol for overproducers or those with contraindications to probenecid (tophi, renal stones, CKD). Probenecid for under-secreters

Question 35

Compare polymyositis and dermatomyositis

Answer 35

Polymyositis: symmetric, progressive proximal muscle weakness and/or pain. Difficulty breathing or swallowing in severe disease. Anti-Jo Ab. Increased serum CK Dermatomyositis: Sx as above + rash. Heliotrope, shawl rash or gottron papules. Anti-Jo Ab. Increased serum CK

Question 36

Anti-centromere Ab +. Dx?

Answer 36

CREST: Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly, Telanciectasias

Question 37

Anti-dsDNA Ab +. Dx?

Answer 37

SLE

Question 38

Anti-histone Ab +. Dx?

Answer 38

Drug-induced SLE

Question 39

Antimitochondrial Ab +. Dx?

Answer 39

primary biliary cirrhosis

Question 40

Anti-Scl-70 Ab +. Dx?

Answer 40

Systemic sclerosis

Question 41

Anti-Sm Ab +. Dx?

Answer 41

SLE

Question 42

Anti-smooth muscle Ab +. Dx?

Answer 42

Autoimmune hepatitis

Question 43

Antitopoisomerase I Ab +. Dx?

Answer 43

Systemic sclerosis

Question 44

Anti-TSH-R Ab +. Dx?

Answer 44

Graves Dz

Question 45

c-ANCA Ab +. Dx?

Answer 45

vasculitis, esp. granulomatosis w polyangitis

Question 46

p-ANCA Ab +. Dx?

Answer 46

vasculitis, esp. microscopic polyangitis

Question 47

U1RNP Ab +. Dx?

Answer 47

Mixed connective tissue dz

Question 48

Criteria for SLE: DOPAMINE RASH

Answer 48

``` Discoid rash Oral ulcers Photosensitivity Arthritis Malar rash Immunologic criteria: anti-dsDNA, anti-Sm, anti-phospholipids Neurologic sx (lupus cerebritis ESR (elevated) Renal dz ANA Serositis: pleural or pericardial effusions Hematologic abnormalities ```

Question 49

numbness in pinky and 1/2 ring finger. Dx?

Answer 49

Numbness of the pinkie and half of the ring finger is ulnar entrapment (cubital tunnel syndrome, which happens at the elbow)