FARR MSK

Question 1

Back pain that is exacerbated by standing and walking and relieved with sitting and hyperflexion of the hips.

Answer 1

Spinal stenosis.

Question 2

Joints in the hand affected in rheumatoid arthritis.

Answer 2

MCP and PIP joints; DIP joints are spared.

Question 3

Joint pain and stiffness that worsen over the course of the day and are relieved by rest.

Answer 3

Osteoarthritis.

Question 4

Genetic disorder associated with multiple fractures and commonly mistaken for child abuse.

Answer 4

Osteogenesis imperfecta.

Question 5

Hip and back pain along with stiffness that improves with activity over the course of the day and worsens at rest. Diagnostic test?

Answer 5

Suspect ankylosing spondylitis. Check HLA-B27.

Question 6

Arthritis, conjunctivitis, and urethritis in young men. Associated organisms?

Answer 6

Reactive (Reiter’s) arthritis. Associated with Campylobacter, Shigella, Salmonella, Chlamydia, and Ureaplasma.

Question 7

A 55-year-old man has sudden, excruciating first MTP joint pain after a night of drinking red wine. Diagnosis, workup, and chronic treatment?

Answer 7

Gout. Needle-shaped, negatively birefringent crystals are seen on joint fluid aspirate. Chronic treatment with allopurinol or probenecid.

Question 8

Rhomboid-shaped, positively birefringent crystals on joint fluid aspirate.

Answer 8

Pseudogout.

Question 9

An elderly woman presents with pain and stiffness of the shoulders and hips; she cannot lift her arms above her head. Labs show anemia and ↑ ESR.

Answer 9

Polymyalgia rheumatica.

Question 10

An active 13-year-old boy has anterior knee pain. Diagnosis?

Answer 10

Osgood-Schlatter disease.

Question 11

Bone is fractured in a fall on an outstretched hand.

Answer 11

Distal radius (Colles’ fracture).

Question 12

Complication of scaphoid fracture.

Answer 12

Avascular necrosis.

Question 13

Signs suggesting radial nerve damage with humeral fracture

Answer 13

Wrist drop, loss of thumb abduction.

Question 14

A young child presents with proximal muscle weakness, waddling gait, and pronounced calf muscles.

Answer 14

Duchenne muscular dystrophy.

Question 15

A first-born female who was born in breech position is found to have asymmetric skin folds on her newborn exam. Diagnosis? Treatment?

Answer 15

Developmental dysplasia of the hip. If severe, consider a Pavlik harness to maintain abduction.

Question 16

An 11-year-old obese African-American boy presents with sudden onset of limp. Diagnosis? Workup?

Answer 16

Slipped capital femoral epiphysis. AP and frog-leg lateral view.

Question 17

The most common 1° malignant tumor of bone.

Answer 17

Multiple myeloma.

Question 18

Herniated disc Symptoms improve with

Answer 18

flexion at the hips and bending forward.

Question 19

The most common benign bone tumor is

Answer 19

osteochondroma.

Question 20

Codman’s triangle

Answer 20

(periosteal new bone formation at the diaphyseal end of the lesion)

Question 21

“onion skinning,” which is classic for

Answer 21

Ewing’s sarcoma.

Question 22

Polymyositis is

Answer 22

a progressive, systemic connective tissue disease characterized by immune-mediated striated muscle inflammation. Dermatomyositis presents with symptoms of polymyositis plus cutaneous involvement, although the pathogenesis is different. Most often affect patients 50–70 years of age; the male-to-female ratio is 1:2. African-Americans are affected more often than Caucasians.

Question 23

CREST syndrome:

Answer 23

Calcinosis

Raynaud’s phenomenon Esophageal dysmotility Sclerodactyly Telangiectasias

Question 24

Criteria for SLE—

Answer 24

DOPAMINE RASH
Discoid rash Oral ulcers Photosensitivity Arthritis
Malar rash Immunologic criteria Neurologic symptoms
(lupus cerebritis,
seizures) Elevated ESR Renal disease
ANA

Question 25

SLE TREATMENT

Answer 25

I NSAIDs for mild joint symptoms.
I Corticosteroids for acute exacerbations.
I Corticosteroids, hydroxychloroquine, cyclophosphamide, and azathioprine
for progressive or refractory cases.

Question 26

Duchenne Muscular Dystrophy (DMD)

Answer 26

An X-linked recessive disorder resulting from a deficiency of dystrophin, a cytoskeletal protein. Onset is usually at 3–5 years of age.

Question 27

Differential diagnosis of pediatric limp—

STARTSS HOTT

Answer 27

Septic joint Tumor
Avascular necrosis
(Legg-Calvé-Perthes) Rheumatoid arthritis/JIA Tuberculosis
Sickle cell disease
SCFE Henoch-Schönlein
purpura Osteomyelitis Trauma
Toxic synovitis