CME/JAAPA

Question 1

In which patient age group does degenerative lumbar
spinal stenosis most commonly occur?
a. under 20 years
b. 20 to 34 years
c. 35 to 50 years
d. over 50 years

Answer 1

D

Question 2

Symptomatic relief with which of the following maneuvers
is known as the shopping cart sign?
a. flexion at the waist
b. extension at the waist
c. flexion at the neck
d. extension at the neck

Answer 2

A

Question 3

Which statement is true about the diagnosis of lumbar
spinal stenosis?
a. Fever and weight loss are common symptoms.
b. Focal weakness or sensory loss typically follow one
dermatome or myotome.
c. Neurogenic intermittent claudication is the most specific
clinical feature.
d. Neuropathy typically presents in a stocking-glove
distribution.

Answer 3

C

Question 4

Considering nonsurgical management recommendations
for lumbar spinal stenosis, which of the following is least
appropriate?
a. abdominal and leg strengthening exercises
b. lumbar extension stretching exercises
c. NSAID therapy
d. weight loss for obese patients

Answer 4

B

Question 5

What is the most appropriate next step for a patient
with lumbar spinal stenosis who develops cauda equina
syndrome?
a. elective laminectomy
b. emergent surgical evaluation
c. epidural steroid injection
d. NSAID therapy

Answer 5

B

Question 6

Which statement is correct about the evaluation of knee
pain caused by osteoarthritis?
a. Cartilage loss is reversible.
b. Patients with osteoarthritic knees often have concomitant
meniscal tears.
c. Hip examination is unnecessary for evaluating knee pain.
d. Symptoms due to osteoarthritis of the knee generally improve
with increased activity.

Answer 6

B

Question 7

Which diagnostic test is essential for evaluating knee
osteoarthritis?
a. CT scan
b. joint fluid analysis
c. MRI
d. weight-bearing radiographs

Answer 7

D

Question 8

Which medications are the cornerstone of pharmacologic
treatment for symptomatic knee osteoarthritis?
a. corticosteroid injections
b. glucosamine and chondroitin
c. NSAIDs
d. opioid receptor agonists

Answer 8

C

Question 9

What is the best treatment approach for a patient with
knee osteoarthritis who develops loss of flexion to less
than 110 degrees?
a. hyaluronic acid injections
b. NSAIDs
c. tramadol
d. orthopedic referral

Answer 9

D

Question 10

Ten years after total knee arthroplasty what percentage of
implants are still in place?
a. less than 5%
b. 25% to 50%
c. 51% to 75%
d. more than 95%

Answer 10

D

Question 11

Which of the following is a characteristic of a
Lisfranc fracture?
a. dorsal bruising
b. subtle injury on radiograph of the middle cuneiform and
second metatarsal base
c. ability to bear weight on the affected limb
d. minimal swelling of the affected limb

Answer 11

B

Question 12

Which statement is correct about managing
Lisfranc injuries?
a. A fracture boot or short cast is indicated for ligament-only
injuries.
b. All Lisfranc injuries should be treated with the same
modalities.
c. A custom orthotic or support shoe is the recommended
fi rst-line treatment.
d. Weight-bearing within 1 week is recommended for rapid
healing.

Answer 12

A

Question 13

The treatment of anterior process fractures should
include which of the following?
a. immediate surgical repair
b. full weight-bearing
c. early mobilization
d. immobilization

Answer 13

D

Question 14

Patients who injure the anterior calcaneal process will
present with which of the following symptoms?
a. signifi cant loss of range of motion compared with patients
with a sprained ankle
b. point tenderness of the anterior talofi bular ligament
c. isolated point tenderness in the calcaneocuboid joint
d. marked swelling, beyond that expected of ankle sprains

Answer 14

C

Question 15

Which statement is correct about calcaneal fractures?
a. The common fracture line runs in a superior-to-inferior
direction.
b. Fractures through the posterior facet are associated with
comminuted fracture patterns.
c. Patients have a marked increase in the Bohler angle and
crucial angle of Gissane.
d. A radiograph is most effective in assessing the displacement
of the surface of the posterior calcaneal facet.

Answer 15

B

Question 16

Which statement is correct about the genetics of gout?
a. Gout is a monogenic trait.

b. Genetics account for less than 10% of serum uric acid varia-
tions.

c. A positive genetic test is required for definitive diagnosis of
gout.
d. HPRT enzyme deficiencies are X-linked disorders that are
common causes of hyperuricemia.

Answer 16

B

Question 17

Consuming which of the following foods has been shown
to reduce serum uric acid levels?
a. asparagus
b. beer
c. lamb
d. low-fat yogurt

Answer 17

D

Question 18

Persistent arthralgia or repeated episodes of acute gout,

usually complicated by tophi formation, is most consis-
tent with which of the following?

a. asymptomatic hyperuricemia
b. acute gout
c. intercritical gout
d. chronic gout

Answer 18

D

Question 19

Which of the following is the diagnostic gold standard for
gout?
a. joint aspiration and fluid analysis
b. genetic testing
c. serum uric acid level
d. plain film radiographs

Answer 19

A

Question 20

A 56-year-old man presents with abrupt onset of six
erythematous, warm, swollen, and exquisitely sensitive metatarsophalangeal joints. He is known to have medication intolerance to NSAIDs and colchicine from previous gout flares. Which of the following is the best choice in
the acute management of this patient?
a. indomethacin
b. intra-articular injections of triamcinolone acetonide
c. IM injection of triamcinolone acetonide
d. allopurinol

Answer 20

C

Question 21

Which of the following is a risk factor associated with the higher prevalence of cuff tear
arthropathy?
a. Male sex
b. Working in a sedentary occupation
c. Younger age group
d. Having an unrepaired rotator cuff tear

Answer 21

D

Question 22

Which statement is correct about the physical examination of a patient with shoulder
pain?
a. Clinicians do not need to examine the patient’s neck and cervical spine.
b. A patient with rotator cuff arthropathy will, be definition, always have abnormal
range of motion of the joint.
c. The empty can test and external rotation lag test are useful in determining
shoulder strength.
d. The Hornblower test is an assessment for anterosuperior escape of the humeral
head from the glenoid fossa.

Answer 22

C

Question 23

Which radiographic finding likely indicates the presence of cuff tear arthropathy?

a. Increased glenohumeral distance
b. Osteopenia at the proximal humerus and glenoid sites
c. Joint space widening at the glenohumeral and humeral-acromial junctions
d. Thickening of the coracoacromial arch

Answer 23

B

Question 24

Which statement is correct about recommended management for patients with rotator
cuff pathology?
a. Patient under age 65 years with symptomatic full-thickness tears benefit most
by receiving 6 to 12 months of physical therapy before undergoing surgery.
b. In patients with partial rotator cuff tears, using injections of sodium hyaluronate
with hydrocortisone has no benefit over hydrocortisone alone.
c. Surgical treatment of rotator cuff pathology is contraindicated in patients over
age 70 years.
d. Patients in group 1 should be advised to undergo a 3- to 6-month trial of
conservative therapy.
***Just FYI, group 1 is intact rotator cuff with tendinitis, low risk for developing
short-term irreversible changes.

Answer 24

D

Question 25

Which statement is correct about reverse shoulder arthroplasty?
a. The procedure enables the center of rotation of the glenohumeral joint to move
more medially.
b. Humeral lengthening of 2 to 4 cm reduces the risk of postoperative neurologic
impairment.
c. This procedure is desirable in patients who have poor deltoid integrity.
d. Postoperative acromial fractures occur in 10% to 15% of patients.

Answer 25

A