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Question 1

Indications for imaging in low back pain ( x-ray, MRI, bone scan/CT) d/t indications for each

Answer 1

X-ray - suspected malignancy, osteoporosis/ compression fracture, ankylosing spondylitis
MRI- sensory/motor deficit, cauda eqina syndrome, suspected epidural abscess/infection
Bone scan/CT- pt not able to have MRI

Question 2

Ankylosing spondylitis

• pain cxs
• associated sxs/manifestations (4)
• laboratory findings
• diagnosis is made by?

Answer 2

Inflammatory, insidious onset back pain, age<40yr, pain relived with exercise but not rest, may b worse at night

• reduces spinal mobility & chest expansion; entheaitis; dactilitis; uveitis
• elevated ESR nCRP; HLA-B27 association
• dx - x-ray of sacroiliac joints, MRI if X-ray is non reveling

Question 3

A 12 yr old boy presented with chronic low back pain. He experienced bed wetting recently. P/E reveals a palpable step-off at the lumbosacral area. Straight leg raise test is negative; no fever or trauma
What’s the dx?

Answer 3

Spondylolisthesis ,, a developmental disorder cxd by a forward slip of vertebrae usually L5 & S1

Question 4

A pt developed posterior knee and calf pain with tenderness and swelling of the calf. An arc of echymosis is visible distal to the medial malleolus
Dx is?

Answer 4

Ruptured popliteal/baker cyst
The cyst first forms due to extrusion of synovial fluid from the knee joint into the gastrocnemius or semimembraneous bursa thru a communication between the joint and the bursa

Question 5

A 35yr old woman presented with recurrent painful oral aphthous ulcer, genital ulcer, anterior uveitis and painful erythematous indurated nodules on her shin
Dx? Epidemiology?major cause of morbidity? Biopsy?

Answer 5

Behçet disease
Turkish, middle Eastern and Asia
Thrombosis is the major cause of morbidity
Biopsy nonspecific vasculitis

Question 6

2major complications of acrolein in cyclophosphamide r?

Answer 6

Hemorrhagic cystitis and bladder Ca

Question 7

Osteoid osteoma
- pain cxs 
- commonest site of involvement 
- pain relieved with the use of ——— ( helps in the dx)
X Ray findings

Answer 7

Worsens at night, without relation to physical activity

• proximal femur
• **NSAIDs relieve the pain
• small round lucency with sclerotic margins

Question 8

A 27 yr old man came with a sharp, non radiating pain over the medial side of the tibia just below the knee. No other problems. P/E revels tenderness but no warmth or swelling; valgus stress test has no effect
Dx?

Answer 8

Pes anserinus pain syndrome

Semitendinosus, sartorius, gracilis conjoined tendons

Question 9

Superficial unilateral hip pain in a middle aged adult that is exacerbated by external pressure to the upper lateral thigh ( as when lying on the affected side in bed) suggests?

Answer 9

Throcanteric bursitis( aka greater trochanteric pain syndrome)

Question 10

The dx of carpal tunnel syndrome can b confirmed by what test?

Mild sxs( no significant weakness) can b treated by?

Significant weakness or refractory sxs r treated with?

Answer 10

Nerve conduction studies
Mild sxs- wrist splinting
Severe- glucocorticoid injection or surgical decompression

Question 11

A 60yr old male came with rt sided chronic neck pain, numbness over the posterior side of the forearm. He has limited neck rotation and lateral bending.
Dx?
The most likely finding on X-ray ?

Answer 11

Cervical spondylosis 
Bone spur(osteophytes)

Question 12

51yr old DM pt came with difficulty walking n foot pain. Significantly deformed feet r seen
X-ray shows large osteophytes, several extra-articular bone fragments.
Dx?
Cause?

Answer 12

Charcot joint
Sensation/nerve damage—> decreased pain, temperature, proprioception, which can occur due to dm, tabes dorsalis, B12 deficiency, syringomyelia…

Question 13

Initial mx of clubfoot?

Answer 13

Manipulation, stretching of the foot followed by serial casts

Question 14

New Mothers who hold their babies with the thumb outstretched- abductor pollicis longus n extensor pollicis brevis r affected
Name of this condition?

Answer 14

De Quervain tenosynovitis

Question 15

A 6 yr old girl with Down syndrome came with behavioral changes, dizziness, urinary incontinence. Limbs r hyperreflexic, babiniski is positive.
Dx?
The condition is due to?

Answer 15

Atlantoaxial instability

Is due to excessive laxity of the posterior transverse ligament

Question 16

Dermatomyositis is most often associated with?

Answer 16

Malignancy

Question 17

Inguinal folds extending beyond the anal orifice r indicative of?
What imaging modalities r used for diagnosing infants at d/t ages? Starting from which age?

Answer 17

DDH(developmental displasia of the hip)
Until 2wks of age, hip laxity can b self resolving so no imaging needed.
2wks -6months, ultrasound is the modality of choice
>4-6months, X-ray

Question 18

A 9yr old boy came with two days of fever, hives, joint pain. He’s bn taking amoxicillin for pharyngitis for the past 9days
Dx?
Pathophysio?

Answer 18

Serum sickness like reaction

A type 3 HSR, after 1-2 wks of betalactam or sulfa administration

Question 19

A 55yr old female presented with stiffness of the shoulder n hip joints, she also has headache, jaw claudication and visual disturbances
Dx?

Answer 19

Polymyalgia rheumatica ( usually occurs in association with giant cell/temporal arteritis, as in this case)

Question 20

A mechanically induced degenerative neuropathy that causes numbness, aching, burning in the distal forefoot. Pain is reproduced by Lateral compression of the metatarsal heads; and palpation of the third metatarsal interspace during compression reveals crepitus.
Dx?

Answer 20

Morton neuroma

Not a true neuroma but is a mechanically induced neuropathic degeneration of the interdigital nerves

Question 21

Dysphagia/esophageal dysmotility In systemic sclerosis is due to?

Answer 21

Atrophy n fibrosis of the smooth mms in the lower esophagus.

Question 22

A 46 yr old sustained an ankle injury. He was walking down a flight of stairs when he missed a step n landed on the lateral aspect of his foot. There’s significant bruising over the lateral left ankle. Limited external rotation due to pain. No tenderness over bony prominences. The pt can walk but has a significant limp
The best next step in the mx?

Answer 22

Ankle sprain- commonly anterior talofibular ligament is injured.
This pt has GRADE 1 sprain- no ligament tear( intact), stable ankle, weight bearing only minimally affected - mx is COMPRESSION BANDAGE or ANKLE BRACE
WITHOUT IMAGING.
Grade ll and lll, partial or complete tear may b associated with anterior or inversion laxity, impaired weight bearing.

Question 23

A rt shoulder pain n weakness after a 2wk hiking trip; p/e- wkness of abduction n external rotation
The most likely cause is?

Answer 23

Suprascapular nerve injury- which innervates Supraspinatus( abduction), infraspinatus( external rotation)
The nerve can b compressed by a heavy backpack as it passes through the suprascapular notch.

Question 24

A 64 yr old known hypertensive n DM pt comes with rt groin pain for the past several months. The pain increases with activity n is relieved with rest. Sometimes radiates to the upper thigh. Lower extremity neurovascular examination is normal.
Most likely Dx?

Answer 24

Osteoarthritis (degenerative joint disease)

Question 25

A 65 yr old female comes with progressively worsening rt knee pain. Pain is worse in the evening. Knee examination shows tenderness over the medial tibial condyle and a small joint effusion. Range of motion elicits bony crepitus
Most likely Dx?

Answer 25

Osteoarthritis
- worse at the end of the day
-particular bony hypertrophy n tenderness
-limited range of motion with crepitus n pain
-baker cyst behind the joint
-varus or valgus angulation
-small joint effusion without erythema or warmth.
Are examination findings of OA